title: Learning From Experience: Qualitative Analysis to Develop a Cognitive Task List for Kielland Forceps Deliveries.
abstract: OBJECTIVE
  Fetal malposition is a common indication for Caesarean section in the second stage of labour. Rotational (Kielland) forceps are a valuable tool in select situations for successful vaginal delivery; however, learning opportunities are scarce. Our aim was to identify the verbal and non-verbal components of performing a safe Kielland forceps delivery through filmed demonstrations by expert practitioners on models to develop a task list for training purposes.
  
  
  METHODS
  Labour and delivery nurses at three university-affiliated hospitals identified clinicians whom they considered skilled in Kielland forceps deliveries. These physicians gave consent and were filmed performing Kielland forceps deliveries on a model, describing their assessment and technique and sharing clinical pearls based on their experience. Two clinicians reviewed the videos independently and recorded verbal and non-verbal components of the assessment; thematic analysis was performed and a core task list was developed. The algorithm was circulated to participants to ensure consensus.
  
  
  RESULTS
  Eleven clinicians were identified; eight participated. Common themes were prevention of persistent malposition where possible, a thorough assessment to determine suitability for forceps delivery, roles of the multidisciplinary team, description of the Kielland forceps and technical aspects related to their use, the importance of communication with the parents and the team (including consent, debriefing, and documentation), and "red flags" that indicate the need to stop when safety criteria cannot be met.
  
  
  CONCLUSIONS
  Development of a cognitive task list, derived from years of experience with Kielland forceps deliveries by expert clinicians, provides an inclusive algorithm that may facilitate standardized resident training to enhance education in rotational forceps deliveries.
authors.affiliation: Department of Obstetrics and Gynaecology, University of Toronto, Toronto ON.
authors.forename: Andrea N
authors.initials: AN
authors.lastname: Simpson
authors.affiliation: The Ritchie Centre, Monash Institute of Medical Research, Department of Obstetrics and Gynaecology, Monash University, Victoria, Australia; Department of Maternal Fetal Medicine, Mount Sinai Hospital, University of Toronto, Toronto ON.
authors.forename: Ryan
authors.initials: R
authors.lastname: Hodges
authors.affiliation: Department of Obstetrics and Gynaecology, University of Toronto, Toronto ON.
authors.forename: John
authors.initials: J
authors.lastname: Snelgrove
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 Health Sciences Centre, Toronto ON.
authors.forename: Richard
authors.initials: R
authors.lastname: Pittini
authors.affiliation: Department of Obstetrics and Gynaecology, University of Toronto, Toronto ON; Department of Maternal Fetal Medicine, Mount Sinai Hospital, University of Toronto, Toronto ON.
authors.forename: Rory
authors.initials: R
authors.lastname: Windrim
authors.affiliation: Department of Maternal Fetal Medicine, 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: D002983:Clinical Competence; D036861:Delivery, Obstetric / Q000379:methods*; D005260:Female; D006801:Humans; D007396:Internship and Residency; D007746:Labor Presentation; D009772:Obstetrical Forceps; D010347:Patient Care Planning; D011247:Pregnancy; D013663:Teaching / Q000379:methods*
keywords: Kielland forceps; obstetrics; persistent occiput posterior; resident training; vaginal operative delivery