Learning From Experience: Qualitative Analysis to Develop a Cognitive Task List for Kielland Forceps Deliveries

Area of Science:

• Obstetrics and Gynecology
• Surgical Education
• Maternal-Fetal Medicine

Background:

• Fetal malposition frequently necessitates Caesarean sections during labor's second stage.
• Rotational (Kielland) forceps offer a method for vaginal delivery in specific cases, but training opportunities are limited.

Purpose of the Study:

• To identify key verbal and non-verbal elements of safe Kielland forceps delivery.
• To create a training task list for obstetric residents based on expert demonstrations.

Main Methods:

• Expert clinicians filmed performing Kielland forceps deliveries on models.
• Verbal and non-verbal components were analyzed through thematic analysis.
• A consensus-based algorithm and task list were developed.

Main Results:

• Identified themes included malposition prevention, patient assessment, team communication, forceps technique, and recognizing safety "red flags".
• Eight expert clinicians contributed insights.
• A comprehensive task list was created from their collective experience.

Conclusions:

• A cognitive task list derived from expert experience can standardize training for rotational forceps.
• This algorithm aims to enhance resident education in performing safe Kielland forceps deliveries.