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

Area of Science:

• Global Health
• Medical Education
• Surgical Training

Background:

• Caesarean section (CS) is a critical surgical procedure with varying training standards globally.
• Disparities exist in CS training practices between high-income countries (HIC) and low- and middle-income countries (LMIC).

Purpose of the Study:

• To identify and describe global caesarean section (CS) training practices.
• To compare CS training between HIC and LMIC.

Main Methods:

• Convergent parallel mixed-methods study utilizing a cross-sectional survey.
• Survey distributed via professional networks and social media; participation was voluntary and anonymous.

Main Results:

• 411 participants from 42 countries (42% HIC, 58% LMIC) were included.
• LMIC participants performed more CS annually but had fewer supervised cases and reported higher complication rates during training compared to HIC.
• Formal competence assessment was significantly lower in LMIC (9%) versus HIC (22%), with most training relying on informal feedback and apprenticeship models.

Conclusions:

• Significant differences in CS training practices and outcomes exist between HIC and LMIC.
• While patient and system factors influence CS outcomes, training is a modifiable component.
• Participants strongly supported formal, evidence-based educational practices to improve CS quality and safety globally.