title: Obstetric training in Emergency Medicine: a needs assessment.
abstract: BACKGROUND
  Identification and management of obstetric emergencies is essential in emergency medicine (EM), but exposure to pregnant patients during EM residency training is frequently limited. To date, there is little data describing effective ways to teach residents this material. Current guidelines require completion of 2 weeks of obstetrics or 10 vaginal deliveries, but it is unclear whether this instills competency.
  
  
  METHODS
  We created a 15-item survey evaluating resident confidence and knowledge related to obstetric emergencies. To assess confidence, we asked residents about their exposure and comfort level regarding obstetric emergencies and eight common presentations and procedures. We assessed knowledge via multiple-choice questions addressing common obstetric presentations, pelvic ultrasound image, and cardiotocography interpretation. The survey was distributed to residency programs utilizing the Council of Emergency Medicine Residency Directors (CORD) listserv.
  
  
  RESULTS
  The survey was completed by 212 residents, representing 55 of 204 (27%) programs belonging to CORD and 11.2% of 1,896 eligible residents. Fifty-six percent felt they had adequate exposure to obstetric emergencies. The overall comfort level was 2.99 (1-5 scale) and comfort levels of specific presentations and procedures ranged from 2.58 to 3.97; all increased moderately with postgraduate year (PGY) level. Mean overall percentage of items answered correctly on the multiple-choice questions was 58% with no statistical difference by PGY level. Performance on individual questions did not differ by PGY level.
  
  
  CONCLUSIONS
  The identification and management of obstetric emergencies is the cornerstone of EM. We found preliminary evidence of a concerning lack of resident comfort regarding obstetric conditions and knowledge deficits on core obstetrics topics. EM residents may benefit from educational interventions to increase exposure to these topics.
authors.affiliation: Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, USA; adam_janicki@brown.edu.
authors.forename: Adam James
authors.initials: AJ
authors.lastname: Janicki
authors.affiliation: Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, USA.
authors.forename: Courteney
authors.initials: C
authors.lastname: MacKuen
authors.affiliation: Department of Obstetrics and Gynecology, Alpert Medical School of Brown University, Women & Infants Hospital, Providence, RI, USA.
authors.forename: Alisse
authors.initials: A
authors.lastname: Hauspurg
authors.affiliation: Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, USA.
authors.forename: Jamieson
authors.initials: J
authors.lastname: Cohn
mesh_terms: D015148:Cardiotocography / Q000379:methods; D002983:Clinical Competence; D003479:Curriculum; D004635:Emergency Medicine / Q000193:education*; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000458:organization & administration*; D007744:Obstetric Labor Complications / Q000628:therapy; D009774:Obstetrics / Q000193:education*; D011247:Pregnancy; D016216:Ultrasonography, Prenatal / Q000379:methods
keywords: Emergency Medicine; curriculum development; graduate medical education; obstetrics