Methods
A single-center prospective study (CHU Lille, France) was conducted among obstetrics and gynecology residents from November 2017 to November 2018 whatever their degree of competence (residency lasts 5 years in France).
The evaluation of the residents was conducted in 3 stages. The first evaluation session was organized before our teaching session called ”pre-training period”. After this first evaluation session, the residents received one hour and half of teaching on fetal physiology and FHR analysis. The second evaluation session, called ”post-training period”, was organized after this teaching and these three sessions were realized at 3 different times during their internship.
Each assessment session (pre- and post-training period) was organized into 2 parts: a theoretical part of multiple-choice questions (MCQs), and a practical part on clinical cases. During the theoretical evaluation, the residents had to answer a series of 7 multiple-choice questions. For each question, five answers were proposed and several answers were possible. They got one point to the question if all the answers were correct, 0.5 point if they made a mistake and no point beyond an error. These questions focused on the fetal response to hypoxemia and thus to fetal physiology during labor.
The practical part was based on 6 clinical cases resulting from real clinical situations chosen by 2 investigators of the study. These were cases of singleton pregnancy in labor (spontaneous or induced) at term and with presence of abnormalities of the FHR for which the medical team had been solicited. Among the 6 files selected, 5 had been the subject of one or more FBS for a total of 10 fetal pH measurements actually achieved. For each of these clinical cases, 3 to 5 periods (27 in total) were chosen during the labor and at each period the residents had to analyze the FHR according to the CNGOF classification (10) divided into 5 categories: normal, low risk of acidosis, intermediate risk of acidosis, significant risk of acidosis, major risk. They were then asked if they achieved FBS or not, and the estimate of the result of this pH measurement : below 7.20, between 7.20 and 7.25 or above 7.25 (3). The second evaluation session (after teaching) was based on the same clinical cases, the neonatal outcome was not given at the end of the first session so as not to influence the answers (11).
The teaching session consisted of a 1.5 hour course. During this session the basics of fetal physiology and FHR analysis were recalled. This class was based on the literature on this topic (12,13) and carried out in a team working in experimental development of a new fetal monitoring tool based on the analysis of the autonomic nervous system (14,15).