title: Learning From Experience: Qualitative Analysis to Develop a Cognitive Task List for Vaginal Breech Deliveries.
abstract: OBJECTIVE
  Achieving clinical competence in managing safe vaginal breech delivery (VBD) is challenging in contemporary obstetrics. Novel educational strategies are required, as exposure of obstetric trainees to VBD remains limited. The aim of this study was to identify the verbal and non-verbal skills required to manage VBD through filmed demonstration by experts.
  
  
  METHODS
  Labour and delivery nursing staff at three large university-affiliated hospitals identified clinicians whom they considered skilled in VBD. Obstetricians consistently identified were invited to participate in the study. Participants were filmed performing a VBD on a birth simulator while discussing their assessment, technique, and providing clinical pearls based on their experience. Two study members reviewed all videos and documented verbal and non-verbal components of the assessment, grouped them into common themes, and produced an integrated summary. This was circulated to all participants and reviewed by senior obstetricians from outside Canada.
  
  
  RESULTS
  Seventeen clinicians were identified; 12 (70%) consented to participation. Themes identified were meticulous assessment and pre-pregnancy counselling; roles of the multidisciplinary team; need for careful and appropriate communication with parents; specific techniques of the delivery; and postpartum care and documentation. A clinical task list was generated based on this analysis.
  
  
  CONCLUSIONS
  Derived from clinicians with extensive experience, we have developed a comprehensive task list outlining the important features involved in safe VBD. Common themes in the experts' teaching for safe VBD included rigorous antepartum selection and counselling, appreciation for when to convert to Caesarean section, and a "hands off" delivery technique.
authors.affiliation: Department of Obstetrics and Gynaecology, University of Toronto, Toronto ON.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Secter
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: John W
authors.initials: JW
authors.lastname: Snelgrove
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; 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: D000328:Adult; D001946:Breech Presentation; D002170:Canada; D002983:Clinical Competence; D036861:Delivery, Obstetric / Q000193:education* / Q000379:methods; D005260:Female; D006801:Humans; D007396:Internship and Residency; D011247:Pregnancy; D013663:Teaching / Q000379:methods*
keywords: experience; obstetrics; resident training; vaginal breech delivery