ASSESSMENT OF NEURAXIAL PROCEDURES IN OBSTETRIC ANESTHESIOLOGY: A DELPHI STUDY

Abstract

Introduction: Assessment of resident competency in obstetric neuraxial procedures is limited by the absence of clearly defined, observable criteria within existing competency−based frameworks. Although ACGME milestones and entrustable professional activities (EPAs) emphasize performance, they provide limited guidance on what competent procedural execution actually looks like in clinical practice. This lack of specificity contributes to variability in teaching, reliance on a hidden curriculum, and inconsistent assessment. Methods: A three−round Delphi study with one modification was conducted to develop expert−informed assessment criteria for obstetric neuraxial procedures. Twenty−seven U.S. experts in obstetric anesthesiology were recruited through purposive sampling. Panelists rated statements derived from ACGME Milestones 2.0, ACGME Milestones 2.0, Supplemental Guide, Tanaka’s neuraxial EPA, and three expert interviews using a 7−point Likert scale. Consensus was defined a priori as ≥85% agreement. Investigator−led iterative revisions were guided by expert feedback to improve clarity and alignment with competency at graduation. Results: Consensus increased across rounds from 29.17% (Round 1) to 82.35% (Round 2), to 100.0% in Round 3. Ratings were consistently clustered in the “essential” range, with minimal disagreement regarding clinical importance. Variability in early rounds was primarily related to wording and expectations for graduation−level performance rather than disagreement about underlying core clinical importance. The final set of criteria reflects convergence on key domains including patient selection, communication, procedural technique, troubleshooting, and clinical decision−making. Conclusion: This study provides a set of expert−informed, observable assessment criteria that offer a more practical and clinically grounded definition of competency for obstetric neuraxial anesthesia. Beyond standardizing assessment, these criteria may support more consistent teaching, targeted feedback, and progression from competence toward higher levels of performance. This framework may serve as a model for defining procedural competency across anesthesiology and other medical specialties.