title: An international assessment of trainee experience, confidence, and comfort in operative vaginal delivery.
abstract: OBJECTIVE
  The aim of this study was to assess Irish and Canadian obstetricians in training ("trainees") experience, confidence, and comfort in performing operative vaginal delivery (OVD).
  
  
  METHODS
  Trainees in Obstetrics and Gynaecology in the University of Toronto and the Royal College of Physicians of Ireland (RCPI) were invited to participate in an anonymous online survey reviewing experience as primary operator of OVD. Trainee confidence and comfort was self-assessed based upon their last few OVDs.
  
  
  RESULTS
  The response rate was 55% amongst Canadian trainees (31/56) and 44% amongst Irish trainees (21/48). When comparing Irish with Canadian trainee experience, the median numbers of vacuum and forceps deliveries performed by Irish trainees as primary operator were reported to be higher [125 (range 10-150) vs 20 (range 5-40); p < 0.0001 (ventouse), 45 (range 10-150) vs 6 (range 1-12); p = 0.0001 (forceps)]. Despite this, trainee confidence between the groups did not differ [confidence score: 18.7 (SD 3.2) vs 17.8 (SD 3.5), p = 0.3]. There were some differences regarding comfort in certain aspects of OVD, most notably increased comfort in Irish trainees in pre-procedure assessment skills of OVD.
  
  
  CONCLUSIONS
  With falling OVD rates worldwide, training experience is declining. Despite higher numbers of OVD within the Irish trainee group, there was no difference in trainee confidence between the two groups. These results suggest that a high number of cases as primary operator may not be required to establish operator confidence in performing a procedure. Irish trainees self-reported more comfort in non-technical skills of OVD, suggesting a step-wise effect of experience on first technical and then non-technical skills.
authors.affiliation: UCD Perinatal Research Center, Obstetrics and Gynaecology, School of Medicine, National Maternity Hospital, University College Dublin, Dublin, Ireland.
authors.forename: D A
authors.initials: DA
authors.lastname: Crosby
authors.affiliation: University of Toronto, Toronto, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Sarangapani
authors.affiliation: University of Toronto, Toronto, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Simpson
authors.affiliation: University of Toronto, Toronto, Canada.|Maternal Fetal Medicine, Mount Sinai Hospital, Toronto, Canada.
authors.forename: R
authors.initials: R
authors.lastname: Windrim
authors.affiliation: University of Toronto, Toronto, Canada.|Obstetrics and Gynaecology, St Michaels Hospital, Toronto, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Satkunaratnam
authors.affiliation: UCD Perinatal Research Center, Obstetrics and Gynaecology, School of Medicine, National Maternity Hospital, University College Dublin, Dublin, Ireland. mary.higgins@ucd.ie.
authors.forename: M F
authors.initials: MF
authors.lastname: Higgins
mesh_terms: D002170:Canada; D002983:Clinical Competence / Q000592:standards*; D036861:Delivery, Obstetric / Q000379:methods*; D005260:Female; D006801:Humans; D007494:Ireland; D008297:Male; D010820:Physicians / Q000592:standards*; D011247:Pregnancy; D011795:Surveys and Questionnaires
keywords: Forceps; Operative vaginal delivery; Training; Ventouse