Introduction: Delivery by vacuum extraction is a major risk factor for obstetric anal sphincter injury. The aim of this study was to assess risk factors for obstetric anal sphincter injury in vacuum extraction in nulliparous women, specifically operator-related factors. A secondary aim was to assess other complications of vacuum extraction that are dependent on operator experience. Material and methods:A historical cohort study of nulliparous women with a live single fetus ≥34 weeks, delivered by vacuum extraction at a teaching hospital in Sweden in 1 year (2013), using data from medical records. Risk of obstetric anal sphincter injury was assessed for obstetricians (reference), gynecologists, and residents, and adjusted for maternal, fetal, procedure-related, and operator-related covariates using unconditional logistic regression. Results are presented as prevalence and crude and adjusted odds ratio (aOR) with 95% CI. Results:In total, 323 nulliparous women delivered by vacuum extraction were included. Obstetric anal sphincter injury occurred in 57 (17.6%) women. Fifteen (11.5%) obstetric anal sphincter injuries occurred in vacuum extractions performed by obstetricians, 10 (13.5%) by gynecologists (aOR 1.84, 95% CI 0.72-4.70), and 32 (26.9%) by residents (aOR 5.13, 95% CI 2.20-11.95). Maternal height ≤155 cm (aOR 4.63, 95% CI 1.35-15.9) and conversion to forceps (aOR 19.4, 95% CI 1.50-252) increased the risk of obstetric anal sphincter injury. Operator gender, night shift work, or being a frequent operator did not affect the risk of obstetric anal sphincter injury. Postpartum hemorrhage and fetal complications did not differ between operator categories. Conclusions:The adjusted risk of obstetric anal sphincter injury in nulliparous women was five times higher in vacuum extractions performed by residents compared with those performed by obstetricians. Vacuum extractions performed by gynecologists did not carry an increased risk of obstetric anal sphincter injury. Experience in years of training, rather than frequency of the procedure, seemed to have the highest impact on reducing obstetric anal sphincter injury in vacuum extractions, which indicates a need for increased training and supervision. K E Y W O R D Snulliparous, obstetric anal sphincter injury, operative vaginal delivery, training in obstetrics, vacuum extraction

Aim  To describe the specialist training at the Faculty of Odontology in Malmö for eight specialities that are certified in Sweden and report the results of a questionnaire among former specialist trainees. Material and Method  The objectives of the specialist training are set on three levels: the national level according to the Swedish National Board for Health and Welfare, the faculty level, the so called Malmö model, and finally the specialist subject level.  The specialist training in Malmö is implemented in collaboration with the Public Dental Health Care in southern Sweden. The Postgraduate Education Board of the faculty scrutinizes and approves each trainee's individualized specialist training programme. The clinical part of the training is to be shared between the collaborating units and the theoretical part is the prime responsibility of the faculty. During the three‐year‐programme, seven core courses are held for all trainees irrespective of specialist subject parallel to the clinical training. Every semester there are two joint seminars: one seminar on a current odontological theme and one on the following subjects; epidemiology, ethics, migration and ethnic relations, environment, gender, leadership.  A written and oral programme evaluation is performed yearly by the Chair of the Postgraduate Education Board together with a representative of the Public Dental Health Care. As part of the 2003 evaluation a questionnaire was sent to 31 specialist graduates trained between 2000 and 2003. Twenty‐four specialists responded, 13 graduates from Malmö and 11 from other Swedish specialist institutions. Results and Conclusion  A majority of the 24 responding graduates express that the work as specialists suit them very well and that the education well serve the purpose to work as a specialist. A majority of the graduates from Malmö were positive to the joint courses during their training. Some thought that there should be more joint activities among trainees of different subject specialities.

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