Forceps-Assisted Vaginal Delivery

Abstract

BACKGROUND: Residents demonstrate deficiencies of knowledge and skills performing forceps-assisted vaginal delivery (FAVD) that varies by year. OBJECTIVE: To assess resident performance of FAVD and evaluate if FAVD performance can be improved with didactic instruction and simulation training. METHODS: Resident knowledge, skills and attitudes of FAVD was assessed with a written test, objective standardized assessment of technical skills (OSATS) in a simulation environment and survey. After participation in a FAVD curriculum that included lecture, PowerPoint materials, suggested readings, and simulation sessions, these measures were repeated. Data were analyzed with χ2, analysis of variance, and Wilcoxon signed-rank tests. RESULTS: Thirty-four residents participated. In the pretest phase, marked deficiencies of FAVD knowledge and skills were evident. Written test performance was fair and improved modestly (49.9±13.9% to 59.5±5.5% [P=.018]). Postgraduate year (PGY) did not predict performance on the written test (P=.29), however performance on OSATS varied by PGY (OSATS range PGY-1=36.7%–PGY-4=70.2%, P=.001). Residents exhibited fair baseline knowledge, but poor skills especially in the application of forceps and checking placement. Across all PGY groups, knowledge and skills on the OSATS (P=.001), overall performance (P=.005), and economy of time and motion (P<.001) improved after participation. The difference in performance in OSATS precurriculum and postcurriculum was 24.0% (P=.12). Residents reported improved understanding of indications (0.014), steps (P=.007), application (P=.007) and confidence (P=.010) of FAVD. CONCLUSION: Participating in a structured multimodal curriculum significantly improves performance. This curriculum offers an OSATS that can be used in simulation and clinical scenarios.