Management of obstetric emergencies and trauma (MOET): regional questionnaire survey of obstetric practice among career obstetricians in the United Kingdom

Abstract

Across specialties in the UK concern exists that the shortened training time, combined with the restriction on hours of work, will result in trainees being short of the necessary depth and breadth of experience for independent practice at the end of their defined training period. In terms of risk management, it is recognised that high reliability organisations anticipate the worst and equip themselves to deal with it at all levels in the organisation. Alternative methods of assessment and training need to be utilised, including models and scenario teaching. While it is important for clinicians to learn common skills well before practising on the labour ward, it is correspondingly more important that rare complications be rehearsed with models. In the UK, the MOET (Managing Obstetric Emergencies and Trauma) course has been developed to allow specialist obstetricians to learn, or revise, how to undertake procedures on models, and then to have their skills tested in scenarios. This survey aimed to ascertain the views of career obstetricians in terms of their ability to respond to some of the course scenarios and how frequently the rarest procedures have been undertaken. A one-page questionnaire with 15 questions, based on clinical scenarios taught on the MOET (Managing Obstetric Emergencies and Trauma), course was sent to all career obstetricians in the West Midlands region. Participants were asked to indicate whether they thought a particular management was 'good practice', 'bad practice' or 'good practice but would prefer a caesarean section' and to indicate the number of such procedures they had undertaken in their obstetric career. The response rate was 40% (97/243). There was a broad spectrum in obstetric views about 'good' and 'bad' practice. Overall the respondents agreed with the literature in terms of practices that are regarded as 'good' and 'bad'. A large proportion of respondents, however, would rather undertake a caesarean section than carry out a 'good' practice. Twenty-six obstetricians had experience in the rare obstetric procedures. Of these, 16 (66%) had worked outside the UK, either in the Middle East, South East Asia, Africa or the Caribbean. This survey highlights the need for training courses to teach and revise operative procedures.