title: Does the number of forceps deliveries performed in residency predict use in practice?
abstract: OBJECTIVE
  We aimed to determine whether a threshold number of forceps deliveries in residency predicts use of forceps in independent practice.
  
  
  METHODS
  We surveyed obstetrics and gynecology residency graduates of 2 academic programs from 2008 through 2012 regarding the use of operative vaginal delivery in practice. At these programs, residents are trained in both forceps and vacuums. Individual case log data were obtained with the number of forceps deliveries performed by each respondent during residency. Respondents were grouped as currently using any forceps or vacuums alone. A logistic regression model estimated the probability of forceps use, predicted by the number of residency forceps deliveries. From the resulting receiver-operating characteristic curve, we assessed sensitivity, specificity, positive predictive value, and area under the curve.
  
  
  RESULTS
  The response rate was 85% (n = 58) and 90% (n = 52) practice obstetrics. Seventy-nine percent (n = 41) use forceps in practice. The mean number of forceps performed during residency was 22.3 ± 1.3 (mean ± SE) in the any-forceps group and 18.5 ± 2.1 in the vacuums-only group (P = .14). Although the model performed only moderately (area under the curve, 0.61, 95% confidence interval [CI], 0.42-0.81), more than 13 residency forceps deliveries corresponded to a 95% sensitivity (95% CI, 84-99) and a positive predictive value of 83% (95% CI, 69-92) for using forceps in practice. The specificity of this threshold is 27% (95% CI, 6-61).
  
  
  CONCLUSIONS
  Although exceeding 13 forceps deliveries made it highly likely that obstetricians would use them in practice, further study is necessary to set goals for a number of resident forceps deliveries that translate into use in practice.
authors: Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO.
authors: Sasha E
authors: SE
authors: Andrews
authors: Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO; Department of Obstetrics and Gynecology, Denver Health Medical Center, Denver, CO.
authors: Meredith J
authors: MJ
authors: Alston
authors: Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Denver, Denver, CO.
authors: Amanda A
authors: AA
authors: Allshouse
authors: Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO.
authors: Gaea S
authors: GS
authors: Moore
authors: Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO; Department of Obstetrics and Gynecology, Denver Health Medical Center, Denver, CO. Electronic address: Torri.Metz@dhha.org.
authors: Torri D
authors: TD
authors: Metz
mesh_terms: D000328:Adult; D005113:Extraction, Obstetrical / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007396:Internship and Residency; D016015:Logistic Models; D008297:Male; D009772:Obstetrical Forceps; D009774:Obstetrics / Q000193:education*; D011247:Pregnancy; D012680:Sensitivity and Specificity
keywords: forceps; operative vaginal delivery; residency training