Development and validation of a technical skill score for internal version and total breech extraction of the second twin: An interventional prospective study.

Objective: To develop and test an Objective Structured Assessment of Technical Skills (OSATS) score for the internal version and total breech extraction of the second twin if in a non-engaged cephalic position.

Materials And Methods: This prospective interventional study took place in a tertiary obstetrics department in France. An objective scoring system was developed, and a standardized simulation scenario was set up. Score evaluation was blinded and analyzed according to group and number of past successful vaginal twin deliveries in real life. A satisfaction evaluation was performed, based on the "Student Design Scale" questionnaire.

Results: Simulation was performed on 33 participants in three groups: novice group (15 first- and second-year residents), intermediate group (11 third- to sixth-year residents), and expert group (seven senior obstetricians). The total score obtained by experts was higher than that of the intermediate group (P = 0.001), which was higher than that of the novice group (P < 0.001). In the intermediate group, no correlation was found between OSATS score and number of past successful vaginal twin deliveries. Participants' satisfaction was excellent.

Conclusion: The OSATS score developed was reliable and valid to evaluate an internal version and a total breech extraction of the second twin, and to differentiate novice, intermediate, and expert practitioners.