Table 3 Descriptive theme iteration and SoF development

Q1

Clinical skills to avoid instrumental birth

Non-technical skills

Non-technical skill expertise is essential to the optimal use of AVD

Bahl 2010; Bahl 2013b; Simpson 2015; Alexander 2001; Sarangapani 2018 [17, 19, 21, 41, 43]

Behaviours

Decision making (multiple points of decision-making)

Clinical skills-assessing the clinical picture

Clinical skills-assessing the clinical picture

Broader clinical skills are essential to the optimal use of AVD

Bahl 2013b; Hodges 2015; Alexander 2001; Ramphul 2012; Sarangapani 2018; Simpson 2015 [16, 20, 34, 36, 40, 42]

Additional tools

Technical skills

Technical skills expertise is essential to optimal use of AVD

Bahl 2008; Bahl 2013a; Simpson 2015 [17, 19, 42]

Rotating the fetus

Angles and force

Checklist

Q2

Specific training

Proactive teaching, specific training and supervision

Proactive teaching, specific training and supervision are essential to achieving competence and expertise

Evans 2009; Smith 1991; Simpson 2015; Hamz 2020; Hankins 1999; Healy and Laufe 1985 [28, 31,32,33, 42, 43]

Close supervision

Proactive teaching

Poor communication by staff (rationale/lack of explanation)

Implementing learning following training

Exposure to being taught AVD

Exposure and gaining experience

Exposure to AVD including a range of instruments and the provision of opportunities to gain experience is essential to achieving competency and expertise

Bofill 1996a; Bofill 1996b; Healy and Laufe 1985; Saunier 2015; Crosby 2017; Eichelberger 2015; Powell 2007; Rose 2019; Sanchez del Heirro 2014; Smith 1991; Wilson and Casson 1990; Alexendar 2001; Al Watter 2017; Chinnock 2009; Fauveau 2009; Friedman 2020; Hamza 2020; Robson and Pridmore 1999; Sarangapani 2018 [15, 16, 22,23,24,25, 29,30,31, 33, 35, 37,38,39,40,41, 43, 45, 46]

Experience

Expectation of the course/program leads

Lack of exposure/opportunity

Safety and/or litigation concerns

Attitudes /beliefs

The attitudes and beliefs evident in the training programme, work environment or individual practitioners appears to influence the attainment of competence and continued use of AVD

Bofill 1996a; Bofill 1996b; Hankins 1999; Devjee 2015; Eichelberger 2015; Powell 2007; Ramphul 2012; Robson and Pridmore 1999; Smith 1991; Wilson and Carson 1990 [23, 24, 27, 33, 36,37,38, 44, 46, 47]

Attitudes /beliefs

Q3

Challenges when teaching others

Access (or lack of) to teachers/training

Access (or lack of) to training courses and/or willing clinical mentors influences the implementation of AVD training

Devjee 2015; Powell 2007; Healy and Laufe 1985; Rose 2019; Wilson and Casson 1990; Sarangapani 2018; Bahl 2008; Al Watter 2017 [15, 17, 26, 33, 35, 38, 40, 45]

Lack of opportunity

Lack of experienced teachers/mentors

Increased consultant cover

Access to teachers/ training

Colleagues proactive in teaching skills of AVD

Q4

Wanting more training

Training needs

Access to training in AVD is sought after and valued by some practitioners

Biringer 2019; Al Watter 2017; Devjee 2015; Bofill 1996b; Wilson and Casson 1990; Powell 2007 [15, 21, 23, 26, 35, 45]

Concerns regarding lack of training/skills

Training increases competence and confidence

Training relates to competence, confidence, job satisfaction and influences later clinical practice

Training enhances competence, confidence, job satisfaction and influences later clinical practice for some practitioners

Evans 2009; Alexander 2001; Biringer 2019; Eichelberger 2015; Powell 2007; Al Watter 2017; Chinnock 2009; Smith 1991 [15, 16, 21, 24, 28, 35, 43, 46]

Increased job satisfaction

Competence influences later clinical practice

Videos as a supportive teaching tool

Supportive teaching tools

Practical teaching tools were valued by participants

Sarangapani 2018; Al Watter 2017; Devjee 2015; Healy and Laufe 1985; Rose 2019 [15, 26, 33, 38, 40]

Simulation as a supportive teaching tool