title: Learning From Experience: Development of a Cognitive Task List to Perform a Safe and Successful Non-Rotational Forceps Delivery.
abstract: OBJECTIVE
  Increased rates of delivery by Caesarean section have resulted in a reduction in rates of instrumental deliveries. This has led to a new educational challenge for teaching and development of skills. In teaching trainees, there are subconscious tasks that the supervising staff may not review because they are automatic. This study aimed to create a new tool to meet this challenge: to identify the core steps required to perform a non-rotational forceps delivery safely and successfully.
  
  
  METHODS
  Labour and delivery nursing staff of three large teaching hospitals were asked to identify clinicians they considered to be particularly skilled in non-rotational forceps deliveries. Obstetricians who were identified consistently in this way were invited to participate in the study. After providing written consent, participants were then filmed performing a non-rotational forceps delivery on a model. Two clinicians reviewed all videos and documented verbal and non-verbal components of the assessment. Thematic analysis combined findings into an integrated summary. The initial summary was then circulated to all participants for their approval.
  
  
  RESULTS
  Seventeen clinicians were identified and consented. Themes identified included the need for careful assessment of suitability for operative delivery, the role of the multidisciplinary team, the need for careful and appropriate communication with the parents, the technique of delivery itself, and postpartum care and documentation.
  
  
  CONCLUSIONS
  In the core steps identified, the clinicians balanced respect for the "elegant technique" of non-rotational forceps deliveries with careful assessment and knowing when to stop if safety criteria were not met.
authors.affiliation: Department of Obstetrics and Gynaecology, University of Toronto, Toronto ON.
authors.forename: Andrea N
authors.initials: AN
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: Department of Obstetrics and Gynaecology, 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; Department of Maternal Fetal Medicine, Mount Sinai Hospital, Toronto ON.
authors.forename: Rory
authors.initials: R
authors.lastname: Windrim
authors.affiliation: Department of Maternal Fetal Medicine, Mount Sinai Hospital, 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: D003142:Communication; D036861:Delivery, Obstetric / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D007258:Informed Consent; D009772:Obstetrical Forceps; D010347:Patient Care Planning; D010348:Patient Care Team; D011181:Postnatal Care
keywords: education; non-rotational forceps; operative delivery