Improvement of Operative Vaginal Delivery Training in Residency: A Single Institution Experience [17G

Abstract

INTRODUCTION: Operative vaginal delivery (OVD) rates are decreasing in the US, creating fewer opportunities for trainee participation. Residents, not adequately trained in OVD, are less likely to use this skill after training, contributing to a growing cesarean rate. We aimed to improve resident participation in OVD. METHODS: Retrospective analysis from July 2017 to December 2018 of an intervention bundle applied prospectively on all OVDs performed at Yale New Haven Hospital. Staff and clinicians were interviewed to assess barriers to resident participation. Interventions applied: 1) training of residents in didactics and simulations on OVD, 2) outreach to providers to create awareness and comfort with resident participation, and 3) change of workflow on the Labor & Birth unit to improve notification to the resident team about OVD events through a mobile texting tool. Our goal was to achieve >90%; resident participation in OVD, calculated to meet the ACGME minimum. Process control and run charts were used for analysis. RESULTS: There were 214 OVDs. Overall mean resident coverage was 83.6%. Prior to intervention, the median attendance rate of residents at OVD was 76%. After intervention, the median monthly coverage rate was 100%. Prior to intervention, process control chart analysis shows multiple points outside control limits (outside 3 standard deviations). After intervention, there were no points outside of control limits, and >8 points were above the median consecutively, showing achievement of process control. Mean attendance rate after intervention was 98.7%. CONCLUSION: Resident participation in OVD increased to the target rate with implementation of low cost, low technology solutions.