OBJECTIVE: Achieving clinical competence in managing safe vaginal breech delivery (VBD) is challenging in contemporary obstetrics. Novel educational strategies are required, as exposure of obstetric trainees to VBD remains limited. The aim of this study was to identify the verbal and non-verbal skills required to manage VBD through filmed demonstration by experts. METHODS: Labour and delivery nursing staff at three large university-affiliated hospitals identified clinicians whom they considered skilled in VBD. Obstetricians consistently identified were invited to participate in the study. Participants were filmed performing a VBD on a birth simulator while discussing their assessment, technique, and providing clinical pearls based on their experience. Two study members reviewed all videos and documented verbal and non-verbal components of the assessment, grouped them into common themes, and produced an integrated summary. This was circulated to all participants and reviewed by senior obstetricians from outside Canada. RESULTS: Seventeen clinicians were identified; 12 (70 ) consented to participation. Themes identified were meticulous assessment and pre-pregnancy counselling; roles of the multidisciplinary team; need for careful and appropriate communication with parents; specific techniques of the delivery; and postpartum care and documentation. A clinical task list was generated based on this analysis. CONCLUSION: Derived from clinicians with extensive experience, we have developed a comprehensive task list outlining the important features involved in safe VBD. Common themes in the experts teaching for safe VBD included rigorous antepartum selection and counselling, appreciation for when to convert to Caesarean section, and a hands off delivery technique.
- vaginal breech delivery
- resident training
Secter, M. B., Simpson, A., Gurau, D., Snelgrove, J. W., Hodges, R., Mocarski, E., Pittini, R., Windrim, R., & Higgins, M. (2015). Learning From Experience: Qualitative Analysis to Develop a Cognitive Task List for Vaginal Breech Deliveries. Journal of Obstetrics and Gynaecology Canada, 37(11), 966-974. https://doi.org/10.1016/S1701-2163(16)30046-9