Training needs in operative obstetrics for maternal-fetal medicine fellows.

Objective: To define residual operative obstetric training needs for first-year maternal-fetal medicine (MFM) fellows. Methods: We administered a web-based survey to all 100 first-year fellows. We used descriptive statistics to report frequency data for 13 procedures, and logistic regression to estimate odds ratios for comfort in doing and teaching selected procedures. Results: Response rate was 86% (n = 86). Fellows who completed residency in the Northeast/Midatlantic (n = 26) were less likely to report comfort doing or teaching low forceps deliveries (OR 0.21, 95% CI 0.05, 0.78; and 0.20, 95% CI 0.04, 0.85, respectively), while those completing fellowship in the West (n = 13), reported more comfort performing breech extraction of a second twin (OR 6.84, 95% CI 1.24, 51.50); fellows completing residency in the Southeast formed the referent group. Fellows reporting completion of the three selected procedures >5 times each during residency were significantly more likely to report comfort doing and teaching them as fellows. Type of residency program (community/academic) was not significantly associated with reported comfort. Conclusion: The wide range of operative obstetric experience fellows reported gaining in residency varies by region. Additional research is needed to understand competency and teaching ability for procedural skills, and many MFM fellows may need additional procedural experience.