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Title: Defining the skills of operative vaginal delivery for training and assessment
Author: Bahl, Rachna
ISNI:       0000 0004 2736 957X
Awarding Body: University of Bristol
Current Institution: University of Bristol
Date of Award: 2010
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Abstract Background: Approximately 11 % of women give birth with the aid of a ventouse or forceps in the UK. These deliveries are associated with significant maternal and neonatal morbidity. Inexperience of the operator is a contributory factor towards the morbidity. Objectives: 1. To define the technical and non technical skill of an operative vaginal delivery in simulation and to validate these skills in the clinical setting. 2. To develop and validate objective assessment tools for evaluation of the skills of an operative vaginal delivery. Setting: Two university teaching hospitals (St. Michael's Hospital Bristol and Ninewell's Hospital, Dundee). Participants: 1. Defining the skills: Ten obstetricians and eight midwives identified as experts in conducting or supporting operative vaginal deliveries. Eighteen women were recruited for validation of the skills in the clinical setting. 2. Validation of assessment tools: 28 obstetricians of varying level of experience. Methods: 1. Defining the skills: Semi structured interviews were carried out using routine clinical scenarios. The experts were video recorded conducting operative vaginal deliveries in a simulation setting. The interviews and video recordings were transcribed verbatim and analysed using thematic coding. The anonymised data were independently coded by three researchers and compared for consistency of interpretation. The experts reviewed the coded interviews and video data for respondent validation and clarification. The themes that emerged following the final coding were used to formulate a list of skills and to develop the assessment tools. Four real life operative births were video recorded and the videos reviewed to validate the findings of simulation. 2. Assessment tools: A formative assessment tool for technical skills was developed and the construct validity was assessed by using the assessment tool to evaluate the skills of six expert and seven novice obstetricians video recorded conducting operative vaginal birth in simulation. A script concordance test was developed for assessment of decision making skills and construct validity was assessed by recruiting 28 obstetricians of varying level of experience. These obstetricians completed a 59 part questionnaire. Results: 1. Defining the skills:The final skills list included detailed technical skills and non technical skills required for conducting an operative vaginal delivery. The combination of semi structured interviews and simulation videos allowed the formulation of a comprehensive skills tool for future evaluation. 2. Assessment tools: The formative assessment tool was a valid tool for assessment of technical skills with a significant T test of 5.01 (p= 0.001, 8.6-19.1).The script concordance test did not show a significant improvement with experience as the ANOVA test of variance amongst the groups was not statistically significant (F = 0.22). Conclusion: This explicitly defined skills list and formative assessment tool is a valuable first step to aid training in operative vaginal delivery.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available