Resident Education in Complex Obstetric Procedures: Are We Adequately Preparing Tomorrow's Obstetricians?

Abstract

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 4th year 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 year (PGY) 3&4. 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. DISCUSSION: 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.