Doulaveris Georgios, George Karen E, Gressel Gregory M, Banks Erika
From the Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (Drs Doulaveris, Gressel, and Banks).
Department of Obstetrics and Gynecology, George Washington University School of Medicine and Health Sciences, Washington, DC (Dr George).
Am J Obstet Gynecol MFM. 2022 Jan;4(1):100505. doi: 10.1016/j.ajogmf.2021.100505. Epub 2021 Oct 14.
Operative vaginal delivery is used to expedite a safe vaginal delivery in the second stage of labor and is considered an essential part of residency training in obstetrics and gynecology.
To assess the self-reported readiness of obstetrics and gynecology residents in the United States to perform vacuum-assisted vaginal delivery and forceps-assisted vaginal delivery compared with the perceptions of program directors.
The Council on Resident Education in Obstetrics and Gynecology surveyed the residents in all US training programs about their readiness to perform forceps-assisted and vacuum-assisted deliveries. The program directors were simultaneously surveyed about the readiness of their cohort to perform operative deliveries with and without attending oversight. The primary outcome of the survey was the residents' self-reported confidence in their ability to autonomously and independently perform operative deliveries.
Α total of 5084 out of 5514 (92.9%) resident physicians and 241 out of the 292 (83%) residency program directors completed the survey. Eighty-seven percent (95% confidence interval, 84.9-88.9) of the graduating residents reported feeling that they could autonomously perform a vacuum-assisted vaginal delivery, compared with 49.5% (95% confidence interval, 46.6-52.4) for forceps-assisted vaginal delivery (P<.01). Similarly, whereas 95.9% (95% confidence interval, 94.6-97.0) of the residents felt that they could confidently perform an emergency vacuum-assisted vaginal delivery, only 42.3% (95% confidence interval, 39.4-45.2) felt confident performing an emergency forceps-assisted vaginal delivery (P<.01). The residency program directors significantly overestimated their residents' confidence in independently performing an emergency forceps-assisted vaginal delivery or vacuum-assisted vaginal delivery than the residents themselves (54% [95% confidence interval, 47.1-60.5] vs 24% [95% confidence interval, 22.5-24.9] and 98.6% [95% confidence interval, 97.0-100] vs 71.9 [95% confidence interval, 70.6-73.2] respectively P<.01). Trainees in military-based residency programs and those interested in pursuing a career as generalists or maternal-fetal medicine specialists reported significantly higher preparedness to perform a forceps-assisted vaginal delivery.
Graduating obstetrics and gynecology residents report feeling less prepared to independently perform a forceps-assisted vaginal delivery than a vacuum-assisted vaginal delivery. The program directors had more confidence in the ability of their residents to perform an operative vaginal delivery than the residents themselves.
手术助产用于加快第二产程安全的阴道分娩，被认为是妇产科住院医师培训的重要组成部分。
评估美国妇产科住院医师自我报告的进行真空辅助阴道分娩和产钳辅助阴道分娩的准备情况，并与项目主任的看法进行比较。
妇产科住院医师教育委员会对美国所有培训项目中的住院医师进行调查，了解他们进行产钳辅助和真空辅助分娩的准备情况。同时，对项目主任进行调查，了解他们的学员在有无上级监督的情况下进行手术助产的准备情况。调查的主要结果是住院医师自我报告对自主独立进行手术助产能力的信心。
5514名住院医师中有5084名（92.9%）、292名住院医师培训项目主任中有241名（83%）完成了调查。87%（95%置信区间为84.9 - 88.9）的即将毕业的住院医师表示他们能够自主进行真空辅助阴道分娩相比之下，产钳辅助阴道分娩的这一比例为49.5%（95%置信区间为46.6 - 52.4）（P <.01）。同样，95.9%（95%置信区间为94.6 - 97.0）的住院医师认为他们能够自信地进行紧急真空辅助阴道分娩，而只有42.3%（95%置信区间为39.4 - 45.2）的住院医师对进行紧急产钳辅助阴道分娩有信心（P <.01）。住院医师培训项目主任显著高估了他们的学员独立进行紧急产钳辅助阴道分娩或真空辅助阴道分娩的信心，高于学员自身（分别为54%[95%置信区间为47.1 - 60.5]对24%[95%置信区间为22.5 - 24.9]以及98.6%[95%置信区间为97.0 - 100]对71.9[95%置信区间为70.6 - 73.2]，P <.01）。军事住院医师培训项目中的学员以及那些有志于成为全科医生或母胎医学专家的学员报告称进行产钳辅助阴道分娩的准备程度显著更高。
即将毕业的妇产科住院医师报告称，他们感觉独立进行产钳辅助阴道分娩的准备程度低于真空辅助阴道分娩。项目主任对其学员进行手术助产能力的信心高于学员自身。
