The 5-year results of an institutional shadowing program aiming to train new senior "obstetricians on-call".

Abstract

Background: On-call night and weekend shifts are pivotal components of the clinical activity of any obstetric unit. Worldwide, these teams are usually led by a senior in-house attending obstetrician.

Objectives: This study presents the effects of a structured institutional shadowing program in which obstetricians shadow senior residents, with the aim of enhancing the residents' competencies and evaluating obstetric adverse outcomes.

Study design: In August 2022, we implemented a training program where senior residents improve complex obstetric and leadership competencies by performing repeated 24-hour calls shadowed by an experienced attending obstetrician. After each 24-hour call, the senior resident received structured oral and written feedback scoring their competencies. Additionally, the senior residents self-assessed their respective competencies upon entering and completing the program using structured questionnaires. Lastly, we compared the occurrence of major maternal and neonatal adverse outcomes before (January 2019 to July 2022 = P1) vs. after (August 2022 to July 2024 = P2) the program implementation.

Results: As of August 2024, we performed 151 shadowed 24-hour shifts, conducted by 8 senior residents trained by 15 attending obstetricians. The senior residents' skills were evaluated with a higher performance degree when compared between program entry and completion, as assessed by the attending obstetricians (p < 0.05 for all comparisons). Additionally, when comparing the 13,336 on-call deliveries in P1 to the 8,718 on-call deliveries in P2, the latter period was characterized by lower rates of maternal bleeding and transfusion (p < 0.001), shoulder dystocia (p = 0.04), neonatal Apgar score < 7 (p = 0.009), respiratory morbidity (p = 0.02), Erb's palsy (p = 0.03), and neonatal death (p = 0.05).

Conclusions: structured, real-time on call training for senior obstetrics residents can meaningfully enhance clinical competency, leadership skills, and preparedness for independent on-call responsibilities as well as better patient outcomes.