This descriptive cross-sectional survey was conducted from 1 April to 30 June 2025 among trainees enrolled in the UCAD Obstetrics and Gynecology DES. Affiliated sites included Principal Hospital of Dakar, Pikine National Hospital, Dalal Jamm Hospital, the Social Hygiene Institute, and the Philippe Maguilen Senghor, Gaspard Camara, and Nabil Choucair health centres.

Eligible participants were hospital interns and other physicians regularly enrolled in years 1 - 4 of the DES, clinically active at an affiliated site, and willing to participate. Incomplete or invalid questionnaires were excluded. The survey targeted the entire eligible population, and the link was circulated through institutional WhatsApp groups.

Enrolment lists comprised 112 trainees: 23 in year 1, 33 in year 2, 33 in year 3, and 23 in year 4. Individual receipt of the link and the number of questionnaires opened but not submitted were not traceable. The proportion of valid questionnaires relative to enrolment is therefore reported as target-population coverage rather than a strict response rate. The form did not record participant category (hospital intern versus other DES physician).

The self-administered questionnaire was developed specifically for this study and programmed in KoboToolbox. It covered age, sex, year of training, experience before entering the DES, self-reported weekly cesarean exposure, operating-room position, self-assessed technical competence, and views on training. No formal content-validation process or documented pretest could be established from the available records. The exact instrument is provided as Supplementary Material S1.

The form asked whether participants believed that they had the skills to perform cesarean delivery in three uterine contexts and three haemostatic procedures. No predefined competence criterion, experience threshold, autonomy instruction, or validated rating scale was provided. Responses are therefore interpreted as self-assessed competence rather than objective performance.

Operative exposure was measured with the item: “How many cesarean sections do you perform per week (on average)?” The form specified neither a recall period nor a definition of “perform.” The variable is consequently reported as a self-reported weekly average, according to each respondent’s interpretation. Primary operator and assistant were separate, non-exclusive positions. Counts by role, level of supervision, complete versus partial performance, and procedure-specific exposure to haemostatic surgery were not collected.

Data were exported and analysed in Microsoft Excel 2021. Categorical variables are presented as counts and percentages. Continuous variables are summarised using the mean, standard deviation, median, and range, as available. Item-specific denominators are reported for missing data. No inferential analysis was performed.

The Chair of Obstetrics and Gynecology was informed of the study and raised no objection to its conduct. The study was not submitted to an ethics committee or any other formal review authority; consequently, no formal ethical approval or exemption was issued. Participation was voluntary, and respondents provided informed consent before completing the questionnaire. No directly identifying information was collected, and anonymity was maintained throughout data collection and analysis.

Eighty-four valid questionnaires were analysed among 112 enrolled trainees, corresponding to 75.0% target-population coverage. Respondents numbered 17/23 (73.9%) in year 1, 26/33 (78.8%) in year 2, 22/33 (66.7%) in year 3, and 19/23 (82.6%) in year 4. Because individual receipt of the invitation could not be verified, no strict response rate was calculated.

Mean age was 30.38 years (range 25 - 47), and 52 participants (61.9%) were women. Thirteen participants (15.5%) had performed at least one cesarean section before entering the DES; 71 (84.5%) had not.

The mean self-reported number of cesarean sections per week was 5.57 ± 3.53 (median 5; range 1 - 20). Group means were 4.5, 4.8, 6.0, and 7.2 in years 1 - 4, respectively. These figures compare distinct groups at one time point and do not describe longitudinal change within individual trainees. Seventy-five participants (89.3%) had served as primary operator and 31 (36.9%) as assistant; responses were not mutually exclusive and did not indicate the level of supervision. Participant characteristics and self-reported operative exposure are presented in Table 1.

Table 1. (a) Participant characteristics and self-reported operative exposure; (b) Coverage of the enrolled target population by training year.

Continued

As shown in Table 2, self-assessed competence in cesarean delivery was reported by 65/84 participants (77.4%) for an unscarred uterus, 61/84 (72.6%) for a scarred uterus, and 63/84 (75.0%) for a multiply scarred uterus with adhesions. Thus, the ordering of these proportions was not strictly parallel to the assumed case complexity. Reported mastery of haemostatic procedures was 73.8% for vascular ligation, 53.6% for uterine compression sutures, and 38.1% for haemostatic hysterectomy. These responses were not accompanied by counts of procedures performed or assisted.

Table 2. Self-assessed technical competence.

Seventy-five participants answered the item on the number of cesarean sections considered necessary to achieve technical mastery. Among them, 41/75 (54.7%) selected 1 - 10 procedures, 18/75 (24.0%) selected 11 - 20, 12/75 (16.0%) selected 21 - 50, and 4/75 (5.3%) selected more than 50. Nine responses were missing.

Fifty-five participants (65.5%) considered that a medical student could not correctly perform a cesarean section after a two-month clinical placement. In addition, 53 (63.1%) opposed integrating technical cesarean training into the undergraduate medical curriculum.

The survey included all four training years in a multisite programme and covered 75.0% of enrolled trainees. Important limitations remain. Individual receipt of the link was not traceable, preventing calculation of a strict response rate, and participant category was not collected. Data were self-reported and susceptible to recall, interpretation, and social-desirability biases. Competence was neither defined using standardised criteria nor directly observed. The weekly-average item specified neither a recall period nor what counted as performing a procedure. Training site, current rotation, case complexity, role-specific counts, complete versus partial performance, degree of supervision, and procedure-specific exposure to haemostatic surgery were not recorded. No formal questionnaire validation or documented pretest could be reported. Finally, the cross-sectional design compared distinct cohorts and cannot establish individual educational progression; generalisability is limited to a single university programme, albeit a multisite one.

This study did not evaluate operative logbooks, OSATS, or simulation. Based on the literature, these approaches warrant prospective evaluation: progressive objectives and explicit supervision levels; documentation of role, case complexity, and supervisor feedback in an operative logbook; repeated direct observation using a cesarean-specific instrument; and simulation as an adjunct for rare or critical procedures [6]-[10]. A prospective study should follow the same trainees and examine relationships among exposure, supervision, objective scores, and autonomy.