The obstetric landscape in the United States has changed over the past several decades, during which there has been a decline in number of operative vaginal deliveries (OVD) performed. Obstetrician-gynecologist (OB/GYN) resident procedural cases are tracked in the Accreditation Council for Graduate Medical Education (ACGME) database, with a minimum requirement of 15 OVD prior to graduation. At present, it is unknown whether the decreasing OVD numbers are impacting OB/GYN resident delivery case volume and experience.
 The objective of this study was to analyze trends in the number and route of obstetric deliveries, including OVD, performed by graduating OB/GYN residents in the United States as logged within the ACGME database.
The ACGME case log data were examined for OB/GYN residents graduating between 2003 and 2019. Delivery case volume numbers for spontaneous vaginal delivery (SVD), cesarean delivery (CD), forceps-assisted vaginal delivery (FAVD), and vacuum-assisted vaginal delivery (VAVD) were extracted and analyzed over time using linear regression. To compare variability in logged cases, residents at the 70 percentile for number of cases logged were compared to residents at the 30 percentile for number of cases logged for each delivery type (SVD, CD, FAVD, and VAVD).
In total, obstetric delivery data for 20,268 OB/GYN residents was collected from 2003-2019. Over this period, the mean SVD numbers significantly decreased over time by 20% from 320.8±138.7 to 256.1±75.6 (slope -2.6, p<0.001), however, no significant difference was noted in reported CD cases, with an 8% increase from 191.8±80.1 to 206.8±69.7 (slope 0.136, p=0.873), per graduating resident. Notably, the mean reported FAVD cases decreased by 75% from 23.8±21.9 to 6±6.8 per graduating resident (slope -0.851, p<0.001). Similarly, the mean VAVD logs decreased by 37% from 23.8±17.1 to 15±9.5 (slope -0.542, p<0.001). The ratio of reported resident case logs comparing volume at the 70 percentile compared to volume at the 30 percentile demonstrated a significant decrease over time for SVD (slope -0.015, p<0.001), CD (slope -0.015, p<0.001) and VAVD (slope -0.033, p<.001), but was significantly increased for FAVD (slope .07, p=.0065).
In this study of the ACGME reported case logs, we identify that the reported number of obstetric deliveries performed by OB/GYN residents in the United States is changing, with a significant decline appreciated from 2003-2019 in logged numbers of SVD, VAVD and FAVD, without a difference in reported CD cases per graduating resident. Further, substantial variation is seen among resident volume nationwide, with the difference in high and low volume resident FAVD experience increasing over time. Awareness of these data should inform ACGME and educators about reasonable targets, increased need for simulation, and new ways to teach all modes of deliveries effectively in all residency programs.

Copyright © 2021. Published by Elsevier Inc.

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