[Instrumental extractions using Thierry's spatulas: evaluation of the learning curve]

To determine the learning curve of fetal extractions with Thierry's spatulas.

Single-center prospective study following the progress of six residents in obstetrics and gynecology in learning fetal extractions by Thierry's spatulas. The instrumental extractions procedures performed by the residents were evaluated by the senior obstetrician on call according to a validated scoring rubric. In parallel, the residents would fill out a questionnaire on their own perception of their abilities at the time of the procedure.

The six residents participated in 160 extractions using Thierry's spatulas between November and May 2011. Sixty-three (39.6%) were evaluated, i.e. an average number of 12±6 extractions per resident. After validating respectively 0, 1, 2 or 3 semesters, the mean global assessment scores (graded out of 5) obtained by the residents were 3.54, 3.18, 4.43 and 4.61. The overall average score was significantly higher when the resident participated in more than 20 extractions before the studied extraction (4.0 vs. 3.7, P<0.001). After attending more than 20 extractions, no resident had obtained the maximum evaluation score of 5/5 nor was deemed capable of performing extractions without supervision.

Learning extractions with Thierry's spatulas, including an objective assessment by senior doctors and a self-assessment by the residents, is a constant process over the first six months of training. Specific training simulator should be developed to enable students to achieve a threshold number of extractions, ensuring the safety of the procedure in the birthing rooms.