Influence of Residency Training on Operative Vaginal Delivery in Independent Practice

To determine if residency training in the use of forceps and vacuums in vaginal deliveries is associated with their use in postgraduate practice.

We surveyed all Ob/Gyn residency graduates of 4 academic programs from 2004-2012. The average number of vacuums and forceps performed per graduating resident was linked to respondents, who were then grouped by self-report as using forceps alone, vacuums alone, or both in practice. Multivariable logistic regression determined predictors of use of forceps and vacuums in practice

The response rate was 61.2% (n=200). Those practicing obstetrics (n=171) were classified as forceps only (24%), vacuums only (22%), or both (54%). Use of forceps in practice was greater for those who graduated within the last 5 years (OR 7.55, 95% CI 2.37-24.07), felt inadequately trained in vacuums (OR 4.58, 95% CI 1.23-17.00), cared for a patient population <50% privately insured (OR 4.08, 95% CI 1.58-10.52), and performed more forceps in residency (OR 1.69, 95% CI 1.31-2.18 per 5 forceps performed on average). The only significant predictor of vacuum use was the number of vacuum deliveries performed in residency (OR 3.71, 95% CI 2.28-6.01 per 5 vacuums performed on average).

Independent practice pattern for operative vaginal delivery reflects residency training for both vacuums and forceps.