Resident training in obstetric anesthesia in the United States

Background

Limited information exists on obstetric anesthesia experience and training within residency training programs in the United States.

Methods

A survey was sent to every academic anesthesiology training program in the United States (n=120), with follow-up reminders to non-responders. The survey included 14 questions divided into staffing, didactic teaching and epidemiology regarding the practice of obstetric anesthesia at each academic institution.

Results

A response rate of 78% (93/120) was achieved. The returned surveys were grouped into three tiers by the number of deliveries/year from the lowest (Group 1) to the highest (Group 3). The total number of obstetric deliveries at each institution ranged from 340 to 15 800. The average number of residents/month rotating on obstetric anesthesia was 2.6 and the number of months spent on the obstetric anesthesia service was 2.7. The average number of obstetric anesthesia lectures given was 12 per month. A total of 21.5 obstetric anesthesia fellows were reported to train at these institutions, with fellows being more common in larger institutions. Group 1 institutions were more likely to have anesthesiologists covering the main operating room and obstetric suite simultaneously. The average number of obstetric anesthesia staff members/institution was 4.3. The average cesarean section rate was 27.8%, with 5.8% being performed under general anesthesia. Neuraxial techniques were used in an average of 70.3% of laboring parturients, with combined spinal epidurals accounting for 24.6% of the techniques.

Conclusion

The average number of obstetric deliveries per year for institutions with a resident training program was 3498±2383. Dedicated obstetric anesthesia staffing was more common when >3700 deliveries/year were performed; the presence of this staffing corresponded with a reduction in the use of general anesthesia for cesarean deliveries. Few differences in the resident lecture didactic exposure were observed in terms of numbers of lectures and months on the obstetric anesthesia service, although a significantly greater number of clinical cases was available to each resident in those institutions with greater overall numbers of obstetric cases.

Keywords: Academic obstetric anesthesia, Anesthesiology resident education