Abstract
PurposeVacuum-assisted deliveries (VAD) are complex procedures that require training and experience to be performed proficiently. We aimed to evaluate if a more resource intensive practice-based training program for conducting VAD is more efficient compared to a purely theory-based training program, with respect to immediate training effects and persistence of skills 4–8 weeks after the initial training.MethodsIn this randomized-controlled study conducted in maternity staff, participants performed a simulated low-cavity non-rotational vacuum delivery before (baseline test) and immediately after the training (first post-training test) as well as 4–8 weeks thereafter (second post-training test). The study’s primary endpoint was to compare training effectiveness between the two study groups using a validated objective structured assessment of technical skills (OSATS) rating scale.ResultsSixty-two participants were randomized to either the theory-based group (n = 31) or the practice-based group (n = 31). Total global and specific OSATS scores, as well as distance of cup application to the flexion point improved significantly from baseline test to the first post-training test in both groups (pall < 0.007). Skill deterioration after 4–8 weeks was only found in the theory-based group, whereas skills remained stable in the practice-based group.ConclusionA practice-based training program for conducting VAD results in comparable immediate improvement of skills compared to a theory-based training program, but the retention of skills 4–8 weeks after training is superior in a practice-based program. Future studies need to evaluate, whether VAD simulation training improves maternal and neonatal outcome after VAD.
Highlights
Operative vaginal delivery (OVD) with the aim to expedite delivery and thereby reduce maternal and fetal morbidity is an essential skill for obstetricians
OVD decreased in countries like the United States and Sweden, whereas it increased in countries like Austria or Norway
We do not know whether this is true in maternity staff with previous exposure to vacuumassisted deliveries (VAD) or already skilled in VAD; a key question in efforts aiming to improve the quality of care in obstetric clinical routine. In this randomized-controlled study conducted in maternity staff, we aimed to evaluate if a practice-based training program for conducting VAD is more efficient compared to a purely theory-based training program, using a validated procedure-specific skill rating scale [25]
Summary
Operative vaginal delivery (OVD) with the aim to expedite delivery and thereby reduce maternal and fetal morbidity is an essential skill for obstetricians. The rates of OVD vary worldwide and lie between 3 and 15% [1, 2]. OVD decreased in countries like the United States and Sweden, whereas it increased in countries like Austria or Norway. OVDs are complex procedures that require a combination of fine motor skills, understanding of the maternal and fetal anatomy and the mechanics of vaginal birth and need training and experience to be performed proficiently. Failed OVD has been directly linked to increased fetal and maternal morbidity and is often attributed to the skill level of the operator [6, 8,9,10]. The reported rate of failed vacuumassisted deliveries (VAD) varies throughout the literature and lies between 1 and 34% [3, 11,12,13,14]
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