A study of the safety of cesarean sections performed by residents aspiring obstetricians and gynecologists and the impact of this experience on the emotional state of the residents

This study aims to examine the safety of cesarean sections performed by residents aspiring to be obstetricians and gynecologists in our hospital, and to evaluate the psychological impact of cesarean section on the residents. The subjects were 213 patients who underwent caesarean section at our hospi...

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Published inJournal of Japan Society of Perinatal and Neonatal Medicine Vol. 59; no. 1; pp. 20 - 26
Main Authors Obata, Shintaro, Sanada, Michio, Hanawa, Shinsuke, Sato, Shiro, Nishikata, Noriko
Format Journal Article
LanguageJapanese
Published Japan Society of Perinatal and Neonatal Medicine 2023
一般社団法人 日本周産期・新生児医学会
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ISSN1348-964X
2435-4996
DOI10.34456/jjspnm.59.1_20

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Abstract This study aims to examine the safety of cesarean sections performed by residents aspiring to be obstetricians and gynecologists in our hospital, and to evaluate the psychological impact of cesarean section on the residents. The subjects were 213 patients who underwent caesarean section at our hospital from 2014 to 2019. Sixty six of these caesarean sections(residents group)were performed by 9 residents, and 147(instructors group)were performed by 8 instructors. Clinical backgrounds, surgical information, and outcomes were compared between the two groups. A questionnaire was also circulated among participating residents. Median surgery time and time from start of surgery to delivery of the fetus were 83.5 minutes and 14 minutes for the residents group. These times were 61 minutes and 7 minutes for the instructors group. The residents group significantly extended operation time and time from start of surgery to delivery of the fetus relative to the instructor group. Median Umbilical Artery pH values were 7.306 for residents and 7.33 for the instructors. The residents’ results were significantly lower than the instructors’ results(P=0.001). No significant differences were observed in other outcomes. The results of the questionnaire showed that there were positive opinions associated with having cesarean section experience, as it increased motivation for training and influenced on their career paths. The Cesarean section performed by residents is acceptable in terms of safety under supervision of a supervising instructors, and may contribute to the improvement of training motivation and recruitment of residents.
AbstractList This study aims to examine the safety of cesarean sections performed by residents aspiring to be obstetricians and gynecologists in our hospital, and to evaluate the psychological impact of cesarean section on the residents. The subjects were 213 patients who underwent caesarean section at our hospital from 2014 to 2019. Sixty six of these caesarean sections(residents group)were performed by 9 residents, and 147(instructors group)were performed by 8 instructors. Clinical backgrounds, surgical information, and outcomes were compared between the two groups. A questionnaire was also circulated among participating residents. Median surgery time and time from start of surgery to delivery of the fetus were 83.5 minutes and 14 minutes for the residents group. These times were 61 minutes and 7 minutes for the instructors group. The residents group significantly extended operation time and time from start of surgery to delivery of the fetus relative to the instructor group. Median Umbilical Artery pH values were 7.306 for residents and 7.33 for the instructors. The residents’ results were significantly lower than the instructors’ results(P=0.001). No significant differences were observed in other outcomes. The results of the questionnaire showed that there were positive opinions associated with having cesarean section experience, as it increased motivation for training and influenced on their career paths. The Cesarean section performed by residents is acceptable in terms of safety under supervision of a supervising instructors, and may contribute to the improvement of training motivation and recruitment of residents.  産婦人科志望の初期研修医が執刀した帝王切開の安全性と,その経験が初期研修医の心境に与える影響を検討した.2014-2019年に当院で産婦人科志望の初期研修医9名が執刀した帝王切開66例(初期研修医群)を対象とした.指導医8名が執刀した帝王切開147例(指導医群)を対照群とし臨床背景,手術情報,転帰を検討した.心的影響の評価に初期研修医へアンケート調査を行った.手術時間,執刀開始から児娩出までの所要時間の中央値は初期研修医群で83.5分と14分,指導医群は61分と7分で初期研修医群は有意に長かった.臍帯血動脈pHの中央値は初期研修医群で7.306,指導医群は7.33で初期研修医群は有意に低値であった.アンケートでは研修意欲向上や進路への影響など執刀経験による肯定的意見が多数みられた.初期研修医の帝王切開は指導医の管理下ならば安全性は許容範囲で研修意欲の向上やリクルートに寄与する可能性がある.
This study aims to examine the safety of cesarean sections performed by residents aspiring to be obstetricians and gynecologists in our hospital, and to evaluate the psychological impact of cesarean section on the residents. The subjects were 213 patients who underwent caesarean section at our hospital from 2014 to 2019. Sixty six of these caesarean sections(residents group)were performed by 9 residents, and 147(instructors group)were performed by 8 instructors. Clinical backgrounds, surgical information, and outcomes were compared between the two groups. A questionnaire was also circulated among participating residents. Median surgery time and time from start of surgery to delivery of the fetus were 83.5 minutes and 14 minutes for the residents group. These times were 61 minutes and 7 minutes for the instructors group. The residents group significantly extended operation time and time from start of surgery to delivery of the fetus relative to the instructor group. Median Umbilical Artery pH values were 7.306 for residents and 7.33 for the instructors. The residents’ results were significantly lower than the instructors’ results(P=0.001). No significant differences were observed in other outcomes. The results of the questionnaire showed that there were positive opinions associated with having cesarean section experience, as it increased motivation for training and influenced on their career paths. The Cesarean section performed by residents is acceptable in terms of safety under supervision of a supervising instructors, and may contribute to the improvement of training motivation and recruitment of residents.
Author Obata, Shintaro
Sato, Shiro
Nishikata, Noriko
Sanada, Michio
Hanawa, Shinsuke
Author_FL 佐藤 史朗
西方 紀子
塙 真輔
真田 道夫
小幡 新太郎
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DocumentTitleAlternate 産婦人科医志望である初期研修医が執刀した帝王切開の安全性とその経験が初期研修医の心境に与える影響についての検討
DocumentTitle_FL 産婦人科医志望である初期研修医が執刀した帝王切開の安全性とその経験が初期研修医の心境に与える影響についての検討
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References 6) Fok WY, Chan LY, Chung TK:The effect of learning curve on the outcome of caesarean section. BJOG 2006;113:1259-63
5) Waalewijn BP, van Duinen A, Koroma AP, et al.:Learning Curve Characteristics for Caesarean Section Among Associate Clinicians: A Prospective Study from Sierra Leone. World J Surg 2017;41:2998-3005
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2) 公益社団法人日本産科婦人科学会:未来委員会臨床指導補助ツール <https://www.jsog.or.jp/modules/committee/index.php?content_id=134>(取得日2022.7.24)
10) 公益社団法人日本産科婦人科学会:産婦人科医への扉 データで見る産婦人科医の実態.<https://www.jsog-tobira.jp/tobira/environment>(取得日2022.7.24)
4) Soergel P, Jensen T, Makowski L, et al.:Characterisation of the learning curve of caesarean section. Arch Gynecol Obstet 2012;286:29-33
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7) Madsen K, Grønbeck L, Rifbjerg Larsen C, et al.:Educational strategies in performing cesarean section. Acta Obstet Gynecol Scand 2013;92:256-63
8) Weiss JL, Malone FD, Ball RH, et al.; FASTER Research Consortium:Obesity, obstetric complications and cesarean delivery rate ‒ a population-based screening study. Am J Obstet Gynecol 2004;190:1091-97
9) Hollowell J, Pillas D, Rowe R, et al.:The impact of maternal obesity on intrapartum outcomes in otherwise low risk women: secondary analysis of the birthplace national prospective cohort study. BJOG 2014;121:343-55
References_xml – reference: 3) 公益社団法人日本産科婦人科学会:令和3年度委員会報告 周産期委員会.日本産科婦人科学会雑誌 2022;74:692-714
– reference: 7) Madsen K, Grønbeck L, Rifbjerg Larsen C, et al.:Educational strategies in performing cesarean section. Acta Obstet Gynecol Scand 2013;92:256-63
– reference: 5) Waalewijn BP, van Duinen A, Koroma AP, et al.:Learning Curve Characteristics for Caesarean Section Among Associate Clinicians: A Prospective Study from Sierra Leone. World J Surg 2017;41:2998-3005
– reference: 6) Fok WY, Chan LY, Chung TK:The effect of learning curve on the outcome of caesarean section. BJOG 2006;113:1259-63
– reference: 4) Soergel P, Jensen T, Makowski L, et al.:Characterisation of the learning curve of caesarean section. Arch Gynecol Obstet 2012;286:29-33
– reference: 8) Weiss JL, Malone FD, Ball RH, et al.; FASTER Research Consortium:Obesity, obstetric complications and cesarean delivery rate ‒ a population-based screening study. Am J Obstet Gynecol 2004;190:1091-97
– reference: 9) Hollowell J, Pillas D, Rowe R, et al.:The impact of maternal obesity on intrapartum outcomes in otherwise low risk women: secondary analysis of the birthplace national prospective cohort study. BJOG 2014;121:343-55
– reference: 1) 厚生労働省:医師臨床研修指導ガイドライン -2020年度版- <https://www.mhlw.go.jp/content/10800000/ishirinsyokensyu_guideline_2020.pdf>(取得日2022.7.24)
– reference: 2) 公益社団法人日本産科婦人科学会:未来委員会臨床指導補助ツール <https://www.jsog.or.jp/modules/committee/index.php?content_id=134>(取得日2022.7.24)
– reference: 10) 公益社団法人日本産科婦人科学会:産婦人科医への扉 データで見る産婦人科医の実態.<https://www.jsog-tobira.jp/tobira/environment>(取得日2022.7.24)
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resident
training
Title A study of the safety of cesarean sections performed by residents aspiring obstetricians and gynecologists and the impact of this experience on the emotional state of the residents
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