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A career in obstetrics and gynaecology
Abdelmageed Abdelrahman and Sandra McNeill outline the career path for obstetrics and gynaecology
Obstetrics and gynaecology has often been described as a mixture of medicine and hands-on surgery, and this combination is undoubtedly a major appeal for many doctors. The specialty has developed into several distinct subspecialties: as a consultant, you could work across a range of different areas or work in one particular field, such as infertility, maternal and fetal medicine, gynae-oncology, or uro-gynaecology. Whatever you choose to do, a career in obstetrics and gynaecology is flexible, exciting, and rewarding. It is a privilege to look after a generally well young patient population at a happy time in their lives. Sometimes it may be demanding and stressful, but the specialty is diverse and challenging.
Qualities needed to be an obstetrician and gynaecologist include good communication skills, teamwork skills, empathy, and sensitivity. Skills such as manual dexterity, problem solving, decision making, organisation, and coping with pressure are also vital.
Training in obstetrics and gynaecology
The specialty training curriculum for obstetrics and gynaecology is based on competency rather than numbers of procedures or time spent in training. Most trainees starting at specialty training year 1 (ST1) level can expect to take seven years to complete their training, subject to satisfactory assessment of progress. As the curriculum is based on competency, some trainees may take longer than others to achieve all competencies and their certificate of completion of training. In 2011-12, a total of 230 training posts were available at ST1 level and seven training posts at ST3 level in England, Northern Ireland, Scotland, and Wales. The number of posts available varies each year.
The curriculum for specialty training in obstetrics and gynaecology was devised by the Royal College of Obstetricians and Gynaecologists (RCOG). Day to day management and quality assurance of training are provided by the postgraduate deans, and the training programme at local level is supervised by the training programme director (fig 1).
Fig 1 Career pathway for obstetrics and gynaecology
Before applying for specialty training
If you are considering a career in obstetrics and gynaecology, you need to get as much experience as possible before you apply for specialty training.
Undergraduate medical students considering obstetrics and gynaecology should meet the head of department in their medical school early on in their degree, as they can advise on the training opportunities available locally. Medical students can obtain extra experience in the specialty by taking a special study module in obstetrics and gynaecology, which is available in most medical schools. If your school does not offer the special study module, you may be able to take it at another medical school.
Medical students can also spend their elective period gaining experience in the specialty in the United Kingdom or overseas. An attachment in the developing world will provide much hands-on experience in obstetrics and gynaecology. Alternatively, an attachment in a centre of excellence for laparoscopic surgery in Europe will be worthwhile if you envisage a career as a minimal access gynaecologist. The RCOG offers prizes to medical students for research project reports, electives, and case reports. Such prizes improve your CV considerably.
Many foundation year 2 posts and a few foundation year 1 posts entail a rotation in obstetrics and gynaecology. To improve your CV it is wise to spend time doing an audit, publishing a case report, or teaching. At present, part 1 of the exam for membership of the RCOG can be taken as soon as you have gained your medical degree. An early successful attempt during foundation training will mark you out as enthusiastic.
During the foundation programme, the budding obstetrician and gynaecologist is expected to have completed the women’s health module available on the RCOG website. It is also essential to have done formal hands-on training in basic life support in the 12 months before submitting an application for specialty training. This may be done in house or on a recognised course. Other desirable courses include a basic practical skills in obstetrics and gynaecology course, the Advanced Life Support in Obstetrics course, and the European Paediatric Life Support course.
Specialty training for obstetrics and gynaecology is a run-through scheme, so candidates apply for training at ST1 level and successful applicants progress to ST3 and beyond. When you have completed all the requirements of the programme you will be awarded a certificate of completion of training and appointed to the specialist register of the General Medical Council.
Applying for specialty training is a competitive process run via the RCOG ObsJobs website.In 2011 the competition ratio for specialty training in obstetrics and gynaecology was two applications for each post.
Basic specialty training
At ST1 and ST2 level you will gain knowledge and skills in many areas of obstetrics and gynaecology. You will see patients in antenatal and gynaecology clinics and will have the opportunity to do caesarean sections and instrumental deliveries in the delivery suite.
Progression through specialty training depends on achieving set competencies and success in your annual review of competence progression. Competencies required at ST1 and ST2 level include opening and closing the abdomen, uncomplicated elective caesarean section, non-rotational instrumental deliveries, perineal repair, and uncomplicated surgical uterine evacuation. All of your training achievements will be recorded in your training logbook and e-portfolio. As you progress, you will start to have competencies signed off.
One of the important assessment steps is moving from ST2 to ST3 level (from basic to intermediate training). At this stage, you will have met the requirements for increased clinical responsibility and will progress from first on-call to second on-call. At this level, you must be competent to handle the delivery suite independently, being aware of your limitations and when to seek senior assistance.
Compulsory requirements for progression from ST2 to ST3 level include successful completion of part 1 of the exam for membership of the RCOG, completion of the RCOG basic practical skills in obstetrics and gynaecology course, and attainment of the relevant competencies for independent practice highlighted in the trainee logbook. This includes modules in basic clinical and surgical skills, teaching appraisal and assessment, ethics and legal issues, and maternal medicine.
Higher specialty training
Training at ST4 to ST5 level teaches trainees to be more independent and to carry out procedures with indirect supervision (with a consultant available nearby). It also gives trainees the opportunity to pursue subspecialty interests by working closely with a consultant in a specific subspecialty. Satisfactory completion of ST5 corresponds to completion of intermediate training. You must have successfully completed part 2 of the exam for membership of the RCOG examination to progress to ST6.
During ST6 and ST7 you will continue expanding and improving your general skills in obstetrics and gynaecology, as well as furthering your special interest area. After you have completed all intermediate requirements, the training programme gives you the option to do advanced training skills modules or subspecialty training. There is a wide variety of these advanced modules, such as maternal medicine, oncology, forensic gynaecology, vulval disease, medical education, and menopause.
Abdelmageed Abdelrahman, ST1, Antrim Area Hospital,
I graduated from Queen’s University Belfast in 2009. I chose a career in obstetrics and gynaecology largely due to my fourth year placement at Altnagelvin Area Hospital, Northern Ireland. During the 8 week placement we were required to perform three normal deliveries and three caesarean sections. I was lucky to help with three normal deliveries and two caesarean sections during my first weekend on-call, thanks to the help of the midwives and doctors on the labour ward. The practical nature of this experience inspired me to pursue a career in the specialty.
Seeing a baby born, taking its first breaths, and gazing at the world in astonishment never fails to fascinate. Being an obstetrician combines medicine, surgery, physiology, and anatomy in a unique mix, offering a challenge to develop skills across the board. Being an obstetrician and gynaecologist is a privilege.
Kathy Niblock, ST3 Antrim Area Hospital, Northern Ireland Deanery
My undergraduate fourth year attachment in the Royal Jubilee Maternity Hospital Belfast certainly stood out as the most interesting and enjoyable placement I had undertaken. As a result Obs and Gynae [obstetrics and gynaecology] as a specialty was the forerunner for me when I came out of medical school.
I think the reason most people choose a career as an obstetrician and gynaecologist is the diversity it has to offer. The training can be hard but it offers a skill mix like no other specialty, including managing the labour ward, surgery, medicine, paediatrics, scanning, and the opportunity to teach medical students and juniors.
The patients in obstetrics and gynaecology tend to be young and the on-calls interesting. As you advance in a career in obstetrics and gynaecology, the range of subspecialties is diverse. Overall it has proved so far to be an incredibly rewarding and gratifying career choice.
Summary A career in obstetrics and gynaecology is exciting and gratifying owing to the fantastic range of subspecialties it offers. It is an immensely rewarding and satisfying job which presents a myriad opportunities to practise high quality medicine in an atmosphere of teamwork.
Competing interests: None declared.
References Modernising Medical Careers. Obstetrics and gynaecology ST1 person specification 2012. http://www.mmc.nhs.uk/pdf/PS%202012%20ST1%20O&G.pdfwww.mmc.nhs.uk/pdf/PS%202012%20ST1%20O&G.pdf. Royal College of Obstetricians and Gynaecologists. Student awards. www.rcog.org.uk/our-profession/careers/awards/Student±award. Royal College of Obstetricians and Gynaecologists. Obs Jobs. https://obsjobs.rcog.org.uk/. Jaques H. Specialty training competition ratios drop or level off for 2011. BMJ Careers 2011;http://careers.bmj.com/careers/advice/view-article.html?id=20002762. NHS ePortfolio. https://www.nhseportfolios.org/. Abdelmageed Abdelrahman specialty trainee year1 in obstetrics and gynaecology Northern Ireland Deanery, UK Sandra McNeill consultant obstetrician and gynaecologistdeputy head of school of obstetrics and gynaecology Altnagelvin Area Hospital, Western Health and Social Care Trust, Northern Ireland
By Abdelmageed Abdelrahman, Sandra McNeill