Klein and colleagues1 overstate the case when they conclude that “the conventional wisdom related to volume and outcome is based primarily on surgical practices and should not be applied to other types of practice” (such as delivering babies). The authors studied this problem in a teaching hospital with residents, readily available obstetricians as consultants, teaching rounds, quality assurance programs and established maternal-care policies and procedures. This setting surely has an effect on the quality of obstetric care practised by family physicians. The problem of volume (experience) influencing practice outcomes should not be an issue in today's teaching hospitals, but it may be in rural areas. The findings of this study, therefore, should not be used as the basis for altering obstetric experience criteria set by the SOGC.
T.B. MacLachlan Retired Obstetrician University of Saskatchewan Saskatoon, Sask.
Reference
- 1.Klein MC, Spence A, Kaczorowski K, Kelly A, Grzybowski S. Does delivery volume of family physicians predict maternal and newborn outcomes? CMAJ 2002;166(10):1257-63. [PMC free article] [PubMed]