Factors associated with adverse clinical outcomes among obstetric trainees
Brockelsby, Jeremy C
Department of Obstetrics and Gynaecology
MetadataShow full item record
Aiken, C., Aiken, A., Park, H., Brockelsby, J. C., & Prentice, A. (2015). Factors associated with adverse clinical outcomes among obstetric trainees. Medical Education, 49 (7), 674-683. https://doi.org/10.1111/medu.12741
Objective: To determine whether UK obstetric trainees transitioning from directly to indirectly-supervised practice have a higher likelihood of adverse patient outcomes from operative deliveries compared to other indirectly supervised trainees and to examine whether performing more procedures under direct supervision is associated with fewer adverse outcomes in initial indirect practice. Methods: We examined all deliveries (13,861) conducted by obstetricians at a single centre over 5 years (2008-2013). Mixed-effects logistic regression models were used to compare estimated blood loss, maternal trauma, umbilical arterial pH, delayed neonatal respiration, failed instrumental delivery, and critical incidents for trainees in their first indirectly-supervised year with trainees in all other years of indirect practice. Outcomes for trainees in their first indirectly-supervised 3 months were compared to their outcomes for the remainder of the year. Linear regression was used to examine the relationship between number of procedures performed under direct supervision and initial outcomes under indirect supervision. Results: Trainees in their first indirectly-supervised year had a higher likelihood of >2 litres estimated blood loss at any delivery (OR 1.32;CI(1.01-1.64) p<0.05) and of failed instrumental delivery (OR 2.33;CI(1.37-3.29) p<0.05) compared with other indirectly-supervised trainees. Other measured outcomes showed no significant differences. Within the first three months of indirect supervision, the likelihood of operative vaginal deliveries with >1litre estimated blood loss (OR 2.54;CI(1.88-3.20) p<0.05) was higher compared to the remainder of the first year. Performing more deliveries under direct supervision prior to beginning indirectly-supervised training was associated with decreased risk of >1litre estimated blood loss (p<0.05). Conclusions: Obstetric trainees in their first year of indirectly-supervised practice have a higher likelihood of immediate adverse delivery outcomes, which are primarily maternal rather than neonatal. Undertaking more directly supervised procedures prior to transitioning to indirectly-supervised practice may reduce adverse outcomes, suggesting that experience is a key consideration in obstetric training programme design.
obstetrics, training, supervision, delivery outcomes, education
ARA is supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) grant for Infrastructure for Population Research at Princeton University (Grant R24HD047879). During the initial preparation of this manuscript she was also supported by an NICHD Individual Predoctoral Fellowship (Grant F31HD079182) and an NICHD infrastructure grant awarded to the Population Research Center at The University of Texas at Austin (Grant R24HD042849).
External DOI: https://doi.org/10.1111/medu.12741
This record's URL: https://www.repository.cam.ac.uk/handle/1810/247702