Forceps delivery volumes in teaching and nonteaching hospitals: are volumes sufficient for physicians to acquire and maintain competence?

Kathy L. Kyser; Xin Lu; Donna Santillan; Mark Santillan; Aaron B Caughey; Mark C Wilson; Peter Cram

doi:10.1097/ACM.0000000000000048

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Forceps delivery volumes in teaching and nonteaching hospitals: are volumes sufficient for physicians to acquire and maintain competence?

Journal article

Open access

Peer reviewed

Forceps delivery volumes in teaching and nonteaching hospitals: are volumes sufficient for physicians to acquire and maintain competence?

Kathy L. Kyser, Xin Lu, Donna Santillan, Mark Santillan, Aaron B Caughey, Mark C Wilson and Peter Cram

Academic medicine, Vol.89(1), pp.71-76

01/2014

DOI: 10.1097/ACM.0000000000000048

PMCID: PMC4317267

PMID: 24280847

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Abstract

The decline in the use of forceps in operative deliveries over the last two decades raises questions about teaching hospitals' ability to provide trainees with adequate experience in the use of forceps. The authors examined (1) the number of operative deliveries performed in teaching and nonteaching hospitals, and (2) whether teaching hospitals performed a sufficient number of forceps deliveries for physicians to acquire and maintain competence. The authors used State Inpatient Data from nine states to identify all women hospitalized for childbirth in 2008. They divided hospitals into three categories: major teaching, minor teaching, and nonteaching. They calculated delivery volumes (total operative, cesarean, vacuum, forceps, two or more methods) for each hospital and compared data across hospital categories. The sample included 1,344,305 childbirths in 835 hospitals. The mean cesarean volumes for major teaching, minor teaching, and nonteaching hospitals were 969.8, 757.8, and 406.9. The mean vacuum volumes were 301.0, 304.2, and 190.4, and the mean forceps volumes were 25.2, 15.3, and 8.9. In 2008, 31 hospitals (3.7% of all hospitals) performed no vacuum extractions, and 320 (38.3%) performed no forceps deliveries. In 2008, 13 (23%) major teaching and 44 (44%) minor teaching hospitals performed five or fewer forceps deliveries. Low forceps delivery volumes may preclude many trainees from acquiring adequate experience and proficiency. These findings highlighted broader challenges, faced by many specialties, in ensuring that trainees and practicing physicians acquire and maintain competence in infrequently performed, highly technical procedures.

Pregnancy

United States

Delivery, Obstetric - instrumentation

Hospitals, Teaching - statistics & numerical data

Clinical Competence

Practice Patterns, Physicians' - statistics & numerical data

Hospitals - statistics & numerical data

Humans

Cesarean Section - statistics & numerical data

Female

Delivery, Obstetric - statistics & numerical data

Obstetrical Forceps - utilization

Details

Title: Subtitle: Forceps delivery volumes in teaching and nonteaching hospitals: are volumes sufficient for physicians to acquire and maintain competence?
Creators: Kathy L. Kyser - Walter Reed National Military Medical Center
Xin Lu
Donna Santillan
Mark Santillan
Aaron B Caughey
Mark C Wilson
Peter Cram
Resource Type: Journal article
Publication Details: Academic medicine, Vol.89(1), pp.71-76
DOI: 10.1097/ACM.0000000000000048
PMID: 24280847
PMCID: PMC4317267
NLM abbreviation: Acad Med
ISSN: 1938-808X
eISSN: 1938-808X
Publisher: United States
Grant note: AR062133 / NIAMS NIH HHS K24 AR062133 / NIAMS NIH HHS R01 GM090148 / NIGMS NIH HHS
Language: English
Date published: 01/2014
Academic Unit: Obstetrics and Gynecology; Medicine Administration; Internal Medicine
Record Identifier: 9983931739202771

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