Current practices in caesarean section training: A cross-sectional study comparing high- and low-middle-income...

This study identifies and describes global caesarean section (CS) training practices, comparing high-income countries (HIC) and low- and middle-income countries (LMIC).

A convergent parallel mixed-methods study was conducted with a cross-sectional survey. The survey was distributed through professional networks and social media. Participation was voluntary and anonymous.

A total of 411 participants from 42 countries were included, with 42% (172) representing HIC and 58% (239) LMIC. Most participants were working in obstetrics and gynecology as specialists (52%, 214) or trainees (26%, 107). Participants from LMIC performed more CS annually, with a mean of 138 (±221) cases, compared to those from HIC with 44 (±64) cases (P < 0.001). Most were taught by an apprenticeship model (75%, 310). Feedback practices were predominantly informal, reported by 64% (263), while formal competence assessment was reported by 22% (38/172) of HIC participants and 9% (21/239) from LMIC (P < 0.001). Participants from LMIC completed fewer supervised cases compared to their HIC counterparts, with a median of 10 (interquartile range 5-20) compared to 50 (interquartile range 30-100) (P < 0.001). LMIC participants reported a higher incidence of major complications or mortality during training: 11% (24/202) versus 3% (3/120). Seventy percent (174/250) of the participants advocated for a formal training program for CS, suggesting that it could improve the quality and safety of CS.

The study highlights current practices and differences in CS training in LMIC and HIC. The outcomes associated with CS are influenced by multiple patient- and system-level factors, including access to care, patient risk profiles, and resources. However, training remains an essential and modifiable component, which, according to participants in this study, could be strengthened by incorporating evidence-based educational practices.