Forceps and vacuum delivery: Expectations of residency and fellowship training program directors

The objective of this study is to compare current forceps training practice s in North American obstetrical residency training programs with that in ma ternal-fetal medicine fellowship programs. We sent a survey to all obstetri cs and gynecology residency training programs and to all maternal-fetal med icine fellowship programs in North America. After sending out 354 questionn aires, 219 were returned for a response rate of 62%. The response rate for fellowship programs (52 of 59; 88%) was significantly greater than that of residency training programs (167 of 295; 56.6%) (p < 0.05). All fellowship training programs were using the 1988 ACOG forceps classification system, a s were 98% of the residency training programs. Eighty-five percent of fello wship directors and 80% of residency directors felt the same system should be used for vacuum deliveries. All residency and fellowship directors expec ted proficiency with both instruments for outlet deliveries. For low delive ries requiring less than or equal to 45 degrees of rotation, at least 92% e xpected proficiency with both instruments. For low-forceps deliveries with >45 degrees of rotation, 82% of fellowship directors and 80% of residency d irectors expected proficiency. For low-vacuum deliveries with >45 degrees o f rotation, 80% of fellowship directors and 76% of residency directors expe cted proficiency. Significantly more fellowship directors expected midforce ps proficiency(47%) than did residency program directors (38%) (p < 0.05). Midvacuum proficiency was expected by 73% of fellowship directors and 69% o f residency directors. The ACOG 1988 forceps classification system has now achieved wide acceptance and is taught by both residency and fellowship pro gram directors. Most program directors favor using the same classification system for vacuum extraction deliveries. In general, the expectations of th e residency program directors mirror those of maternal-fetal medicine fello wship directors. While outlet and low operations with less than or equal to 45 degrees of rotation are taught and proficiency is expected, most progra ms no longer expect proficiency in midforceps delivery, but do expect profi ciency in midvacuum delivery. Proficiency in low operations with rotations less than or equal to 45 degrees is still expected.