title: Learning from experience: development of a cognitive task-list to assess the second stage of labour for operative delivery.
abstract: OBJECTIVE
  Ensuring the availability of operative vaginal delivery is one strategy for reducing the rising Caesarean section rate. However, current training programs appear inadequate. We sought to systematically identify the core steps in assessing women in the second stage of labour for safe operative delivery, and to produce an expert task-list to assist residents and obstetricians in deciding on the safest mode of delivery for their patients.
  
  
  METHODS
  Labour and delivery nursing staff of three large university-associated hospitals identified clinicians they considered to be skilled in operative vaginal deliveries. Obstetricians who were identified consistently were invited to participate in the study. Participants were filmed performing their normal assessment of the second stage of labour on a model. Two clinicians reviewed all videos and documented all verbal and non-verbal components of the assessment; these components were grouped into overarching themes and combined into an integrated expert task-list. The task-list was then circulated to all participants for additional comments, checked against SOGC guidelines, and redrafted, allowing production of a final expert task-list.
  
  
  RESULTS
  Thirty clinicians were identified by this process and 20 agreed to participate. Themes identified were assessment of suitability, focused history, physical examination including importance of an abdominal examination, strategies to accurately assess fetal position, station, and the likelihood of success, cautionary signs to prompt reassessment in the operating room, and warning signs to abandon operative delivery for Caesarean section. Communication strategies were emphasized.
  
  
  CONCLUSIONS
  Having expert clinicians teach assessment in the second stage of labour is an important step in the education of residents and junior obstetricians to improve confidence in managing the second stage of labour.
authors.affiliation: Division of Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto ON; The Ritchie Centre, Monash Institute of Medical Research, Department of Obstetrics and Gynaecology, Monash University, Victoria, Australia.
authors.forename: Ryan
authors.initials: R
authors.lastname: Hodges
authors.affiliation: Department of Obstetrics and Gynaecology, University of Toronto, Toronto ON.
authors.forename: Andrea
authors.initials: A
authors.lastname: Simpson
authors.affiliation: Department of Obstetrics and Gynaecology, University of Toronto, Toronto ON.
authors.forename: David
authors.initials: D
authors.lastname: Gurau
authors.affiliation: Department of Obstetrics and Gynaecology, University of Toronto, Toronto ON.
authors.forename: Michael
authors.initials: M
authors.lastname: Secter
authors.affiliation: Department of Obstetrics and Gynaecology, University of Toronto, Toronto ON; Department of Obstetrics and Gynaecology, St Michael's Hospital, Toronto ON.
authors.forename: Eva
authors.initials: E
authors.lastname: Mocarski
authors.affiliation: Department of Obstetrics and Gynaecology, University of Toronto, Toronto ON; Department of Obstetrics and Gynaecology, Sunnybrook Hospital, Toronto ON.
authors.forename: Richard
authors.initials: R
authors.lastname: Pittini
authors.affiliation: Department of Obstetrics and Gynaecology, University of Toronto, Toronto ON.
authors.forename: John
authors.initials: J
authors.lastname: Snelgrove
authors.affiliation: Division of Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto ON; Department of Obstetrics and Gynaecology, University of Toronto, Toronto ON.
authors.forename: Rory
authors.initials: R
authors.lastname: Windrim
authors.affiliation: Division of Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto ON; Department of Obstetrics and Gynaecology, University College Dublin, National Maternity Hospital, Dublin, Ireland.
authors.forename: Mary
authors.initials: M
authors.lastname: Higgins
mesh_terms: D002170:Canada; D002983:Clinical Competence / Q000592:standards; D036861:Delivery, Obstetric / Q000379:methods / Q000592:standards; D004521:Educational Measurement / Q000379:methods*; D005260:Female; D006801:Humans; D007748:Labor Stage, Second; D009774:Obstetrics / Q000193:education*; D011247:Pregnancy; D018794:Problem-Based Learning / Q000379:methods*
keywords: assessment; experience; operative delivery; second stage