{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T04:47:16Z","timestamp":1777870036393,"version":"3.51.4"},"reference-count":30,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T00:00:00Z","timestamp":1764720000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T00:00:00Z","timestamp":1764720000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Gynecology &amp; Obste"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study identifies and describes global caesarean section (CS) training practices, comparing high\u2010income countries (HIC) and low\u2010 and middle\u2010income countries (LMIC).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A convergent parallel mixed\u2010methods study was conducted with a cross\u2010sectional survey. The survey was distributed through professional networks and social media. Participation was voluntary and anonymous.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 411 participants from 42 countries were included, with 42% (172) representing HIC and 58% (239) LMIC. Most participants were working in obstetrics and gynecology as specialists (52%, 214) or trainees (26%, 107). Participants from LMIC performed more CS annually, with a mean of 138 (\u00b1221) cases, compared to those from HIC with 44 (\u00b164) cases (\n                      <jats:italic>P\u2009&lt;<\/jats:italic>\n                      \u20090.001). Most were taught by an apprenticeship model (75%, 310). Feedback practices were predominantly informal, reported by 64% (263), while formal competence assessment was reported by 22% (38\/172) of HIC participants and 9% (21\/239) from LMIC (\n                      <jats:italic>P\u2009&lt;<\/jats:italic>\n                      \u20090.001). Participants from LMIC completed fewer supervised cases compared to their HIC counterparts, with a median of 10 (interquartile range 5\u201320) compared to 50 (interquartile range 30\u2013100) (\n                      <jats:italic>P\u2009&lt;<\/jats:italic>\n                      \u20090.001). LMIC participants reported a higher incidence of major complications or mortality during training: 11% (24\/202) versus 3% (3\/120). Seventy percent (174\/250) of the participants advocated for a formal training program for CS, suggesting that it could improve the quality and safety of CS.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The study highlights current practices and differences in CS training in LMIC and HIC. The outcomes associated with CS are influenced by multiple patient\u2010 and system\u2010level factors, including access to care, patient risk profiles, and resources. However, training remains an essential and modifiable component, which, according to participants in this study, could be strengthened by incorporating evidence\u2010based educational practices.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ijgo.70696","type":"journal-article","created":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T10:48:18Z","timestamp":1764758898000},"page":"1012-1025","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Current practices in caesarean section training: A cross\u2010sectional study comparing high\u2010 and low\u2010middle\u2010income countries"],"prefix":"10.1002","volume":"173","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9582-7825","authenticated-orcid":false,"given":"Liesl","family":"de Waard","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynaecology Stellenbosch University  Cape Town South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9739-3730","authenticated-orcid":false,"given":"Elize","family":"Archer","sequence":"additional","affiliation":[{"name":"Department of Health Professions Education Stellenbosch University  Cape Town South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8923-7447","authenticated-orcid":false,"given":"Kathryn","family":"Chu","sequence":"additional","affiliation":[{"name":"Centre for Global Surgery Stellenbosch University  Cape Town South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0942-3478","authenticated-orcid":false,"given":"Christoffel Joseph Brand","family":"Muller","sequence":"additional","affiliation":[{"name":"Department of Statistics and Actuarial Science Stellenbosch University  Stellenbosch South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefan","family":"Gebhardt","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Stellenbosch University  Cape Town South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,12,3]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(19)30036-1"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)32386-9"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.7196\/SAMJ.2019.v109i4.13578"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12909-023-04772-6"},{"issue":"3","key":"e_1_2_12_6_1","first-page":"518","article-title":"The fruition of Hasteld's concept of surgical training","volume":"32","author":"Carter B","year":"1952","journal-title":"Surgery"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/qshc.2007.023903"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/SIH.0000000000000367"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.12055"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpobgyn.2010.06.001"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000483334.43402.5d"},{"issue":"8","key":"e_1_2_12_12_1","first-page":"1003","article-title":"Assessment of competence for caesarean section with global rating scale","volume":"63","author":"Qureshi RN","year":"2013","journal-title":"J Pak Med Assoc"},{"key":"e_1_2_12_13_1","unstructured":"New World Bank country classifications by income level: 2022\u20102023. 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