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Resident Education in Complex Obstetric Procedures: Are We Adequately Preparing Tomorrow’s Obstetricians?
Purpose: Describe resident experience with surgical obstetrics and
comfort in performing those procedures after graduation.
Background: ACGME milestones and CREOG objectives for OB/GYN
residents include obstetrical technical skills. Data is limited on how often
graduating residents meet these.
Methods: Anonymous 27-question e-survey sent to all US OB/GYN
residents in 3/2018 via CREOG coordinator-listserv. Complex obstetric
procedures included: forceps(FAVD), vacuum(VAVD), cerclage, breech second
twin(B2T), breech delivery(BVD), perineal repairs, and cesarean hysterectomy.
Technical skills questions included experience as primary surgeon(PS), comfort
performing procedures independently(CPI), and for 4thyear residents
only-comfort performing procedures post-residency(CPPR). Descriptive statistics
used to analyze responses.
Results: 417 residents completed the survey. Respondents were
88% female, 75% from academic programs, and nearly 50% were post-graduate
Among residents of all levels, many had been
primary surgeon in operative vaginal deliveries(51%-FAVD,72%-VAVD) and
cerclage(62%), fewer for BVD(21%) and B2T(34%), cesarean hysterectomy(21%), and
4th degree repairs(37%). For PGY 3&4, 85% were CPI VAVD, while only 34%
were CPI FAVD. 14% and 37% were CPI BVD and 4th degree repairs respectively. Of
the 95 PGY4 respondents, all felt CPPR either VAVD or FAVD. Nearly all felt
CPPR a 3rd degree repair(97%), but almost 20% did not feel CPPR a 4th degree
repair. 33% did not feel CPPR a cesarean hysterectomy, 28% and 74% did not feel
CPPR with B2T and BVD respectively.
Discussions: Though ACGME and CREOG recommend that graduating
residents are able to perform complex obstetric procedures, data suggest that
for many graduating chief residents, this is not the case.
CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Residency Director, Patient Care, Medical Knowledge, GME, Assessment, Maternal-Fetal Medicine, General Ob-Gyn,