Abstract
IntroductionObstetrical emergencies are a high-risk yet infrequent occurrence in the emergency department. While U.S. emergency medicine (EM) residency graduates are required to perform 10 low-risk normal spontaneous vaginal deliveries, little is known about how residencies prepare residents to manage obstetrical emergencies. We sought to profile the current obstetrical training curricula through a survey of U.S. training programs.MethodsWe sent a web-based survey covering the four most common obstetrical emergencies (pre-eclampsia/eclampsia, postpartum hemorrhage (PPH), shoulder dystocia, and breech presentation) through email invitations to all program directors (PD) of U.S. EM residency programs. The survey focused on curricular details as well as the comfort level of the PDs in the preparation of their graduating residents to treat obstetrical emergencies and normal vaginal deliveries.ResultsOur survey had a 55% return rate (n=105/191). Of the residencies responding, 75% were in the academic setting, 20.2% community, 65% urban, and 29.8% suburban, and the obstetrical curricula were 2–4 weeks long occurring in post-graduate year one. The most common teaching method was didactics (84.1–98.1%), followed by oral cases for pre-eclampsia (48%) and PPH (37.2%), and homemade simulation for shoulder dystocia (37.5%) and breech delivery (33.3%). The PDs’ comfort about residency graduate skills was highest for normal spontaneous vaginal delivery, pre-eclampsia, and PPH. PDs were not as comfortable about their graduates’ skill in handling shoulder dystocia or breech delivery.ConclusionOur survey found that PDs are less comfortable in their graduates’ ability to perform non-routine emergency obstetrical procedures.
Highlights
Obstetrical emergencies are a high-risk yet infrequent occurrence in the emergency department
75% were in the academic setting, 20.2% community, 65% urban, and 29.8% suburban, and the obstetrical curricula were 2-4 weeks long occurring in post-graduate year one
The most common teaching method was didactics (84.1-98.1%), followed by oral cases for pre-eclampsia (48%) and postpartum hemorrhage (PPH) (37.2%), and homemade simulation for shoulder dystocia (37.5%) and breech delivery (33.3%)
Summary
While U.S emergency medicine (EM) residency graduates are required to perform 10 low-risk normal spontaneous vaginal deliveries, little is known about how residencies prepare residents to manage obstetrical emergencies. Pregnancy-related conditions are the sixth most common reason for admission to the emergency department (ED) and the fourth most common final diagnosis from the ED for women of childbearing age.[1] Pregnant women often present to the ED because they feel they are having an emergency.[2] Being able to manage both emergent and non-emergent pregnancies is a hallmark of an emergency physician (EP).[2] Currently there are no formal standardized teaching requirements beyond the minimum mandatory requirement of 10 low-risk, normal spontaneous vaginal deliveries[3] (NSVD) and the assumption that obstetrical knowledge is a core principle of emergency medicine (EM), which means that EPs must achieve this knowledge in order to practice after residency.[3,4]. The few published studies are old and may not be representative of the current landscape.[8,9] Recently it has been shown that current EM residents feel unprepared for management of these emergencies once they leave residency.[10]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
