Evaluating graduating OBGYN residents' training in postpartum permanent contraceptive procedures.

OBJECTIVES

Postpartum permanent contraception (PPPC) surgeries via minilaparotomy following vaginal delivery are effective and safe. We evaluated PPPC case volume and confidence among graduating obstetrics and gynecology (OBGYN) residents.

STUDY

DESIGN

We conducted a cross-sectional survey between August 10, 2021, and January 31, 2022 of fourth-year obstetrics and gynecology residents at Ryan Residency programs to evaluate case volume, barriers to completion, and confidence. We used descriptive statistics for baseline characteristics. We assessed associations between case volume and region using a linear mixed-effects model with square-root transformation and evaluated associations between case volume and procedural confidence using multivariable mixed-effects logistic regression with random intercepts for programs.

RESULTS

One hundred and thirty-three of 654 eligible residents (20%) from 62 of 98 eligible programs (63%) completed the survey. Respondents reported performing a median of 10 PPPC surgeries (interquartile ranges 5-20). By graduation, 78% felt comfortable performing PPPC surgeries, and 86% felt prepared to do so independently in emergencies (proxy for surgical independence). Confident residents performed more PPPC surgeries than less confident peers (15.0 vs 3.0 and 13.5 vs 3.0, p < 0.0001). Each additional surgery increased the odds of confidence by graduation (odds ratios 1.24, 95% CI 1.12-1.38, p < 0.0001) and in emergencies (odds ratios 1.22, 95% CI 1.07-1.38, p = 0.004), adjusting for race, ethnicity, and gender identity. Residents felt less confident performing salpingectomies (64%) and managing complications (63%). Barriers included lack of operating room (66.9%) and nursing availability (51.9%), obesity (64.7%), and invalid consents (56.4%).

CONCLUSIONS

PPPC case volume remains low. Higher procedural volume correlates with greater confidence, though gaps remain in managing complications and salpingectomies.

IMPLICATIONS: PPPC case volume during residency is low, limiting residents' confidence across procedural steps. Reported barriers reduce training opportunities, though surgical confidence parallels minimally invasive hysterectomy. Removing systemic barriers can enhance patient autonomy, strengthen resident education, and prevent future provider shortages, an especially urgent priority in today's shifting reproductive health landscape.