THEY say there’s one born every minute – an old adage that manages to make the miracle of childbirth sound positively humdrum. However, the specialty of obstetrics and gynaecology (O&G), and the unexpected challenges it can bring, is anything but.
This wide-ranging field offers a stimulating and rewarding career for doctors. While much of the focus is on childbirth – providing support and ensuring safety in maternity care – O&G extends beyond this, treating women’s health issues at all stages of their lives.
The past 30 years have seen the development of many new techniques. Improvements in ultrasound and body imaging, for example, have made care of the baby in the womb a central part of the specialty and have dramatically improved diagnostic accuracy. Three and four-dimensional imaging are among the most recent advances.
The discipline remains at the cutting edge of medicine and continues to evolve, with many research arms, both at clinical and molecular levels.
Entry and training
Core training in O&G starts after completion of F2 and lasts seven years, from ST1 to ST7. After two years of basic training (ST1-ST2), doctors must pass the first part of the exam for membership of the Royal College of Obstetricians and Gynaecologists (MRCOG), the body in charge of setting the content and structure of the training programme. The second part of the exam is taken three years later, after completion of intermediate training, at ST5. Two further years of advanced training follow (ST6-7), leading to the Certificate of Completion of Training (CCT).
During ST1-5, O&G trainees follow a core curriculum which is made up of 19 modules including two basic ultrasound modules. Trainees work towards achieving the various competencies contained in each module.
During advanced training (ST6-7), doctors start to develop the specific skills needed for the areas in which they would like to practise as a consultant by choosing advanced training skills modules (ATSMs), or by applying for subspecialty training. Those interested in an academic career would complete the academic curriculum at the same time as the core curriculum.
Desirable personal qualities are varied and include: communication skills; problem solving and decision making; manual dexterity; empathy and sensitivity; and an ability to cope with pressure. The RCOG website offers extensive information to would-be specialists, from training pathways and a career prospectus to FAQs and case studies. Recruitment is accessible centrally and online only at http://obsjobs.rcog.org.uk
Most consultants work in both obstetrics and gynaecology. Many have a major special interest in a particular area, such as high-risk obstetrics, fertility care or minimal access surgery. Some also work in subspecialties such as maternofetal medicine; gynaecological oncology; urogynaecology and reproductive medicine.
Most trainees and an increasing number of consultants work on a shift system in this 24/7 specialty, often described as a mixture of medicine and hands-on surgery. Potential work locations include theatre, outpatients, labour wards, scanning or other specialist clinics, and community and outreach clinics.
The surgical work is varied and involves close co-operation with other specialties such as midwifery, neonatology and paediatrics, anaesthetics, oncology, urology and colorectal surgery.
There is no such thing as a “typical” day in O&G, but it will likely involve ward rounds, seeing inpatients, new admissions and arranging any required investigations. A major feature of the role is working as part of the multidisciplinary team on the labour ward, but it can also involve antenatal or gynaecological outpatient clinics. Trainees’ duties are wide-ranging. They could be responsible for seeing emergencies in the labour ward, or work in gynaecology without other commitments during the day or night.
In obstetrics, doctors have a primary duty to both mother and baby as well as a responsibility to other members of the family (and, more widely, to society). Obstetric patients tend to be generally fit and healthy but some may suffer acute or chronic medical problems that complicate their pregnancy. Gynaecology covers a broader spectrum, dealing with all aspects of women’s health in patients of all ages. Treatment may be for chronic, non-life threatening disorders or for acute emergency presentations indicating a gynaecological problem.
The unpredictable specialty of O&G offers great potential for trainees to work across a range of clinical areas as well as the appealing prospect of helping a new life safely into the world.
Joanne Curran is an associate editor of FYi
Q&A Dr Matthew Prior, ST5 Obstetrics & Gynaecology Royal Preston Hospital and Chair of the RCOG Trainees’ Committee
What first attracted you to obstetrics and gynaecology?
After a bad experience as a third year medical student during a placement in women’s health, gynaecology was the one specialty I had decided that I did not wish to pursue! But I soon changed my mind after spending time at a rural hospital in Africa during an elective. I saw first-hand that obstetricians make a huge difference and save lives of mothers and babies, something which we take for granted in the UK.
What do you enjoy most about the job?
It is a privilege to be a part of the birth of a new baby, probably the most special and unforgettable part of a mother’s life. But in contrast to other specialties, O&G provides a huge variety of work, so you can never get bored. We get to practise both medicine and surgery. I have developed my skills in ultrasound scanning and no two gynaecology or antenatal clinics are the same. Each day is different, providing new challenges.
What do you find most challenging?
Obstetrics isn’t exactly the most stress-free specialty. Whilst it is exciting to be providing care for women in labour, it is also a massive responsibility. When emergencies happen they tend to happen quickly and it is important to be able to make decisions but also to work closely with other members of the team.
Has anything surprised you about the specialty?
Being well informed before applying for O&G training is important so that you are not surprised. Babies come at all times of the day and night and so the hours and shift work can be demanding. This is not only the case as a trainee, but also increasingly for consultants.
What do you consider the most important attributes of a good O&G specialist?
As with all doctors, the ability to show empathy and listen to your patients is the most important aspect of being a good O&G specialist. O&G can at times be very demanding and unfortunately it is inevitable that bad outcomes will sometimes happen. It is therefore important to be able to reflect on what has happened and have resilience to carry on. Thirdly, being able to balance risk and make decisions under pressure is key to being a good obstetrician and gynaecologist.
Is there any advice you could give to a final year or FY trainee considering O&G?
Speak to lots of trainees and consultants, each person will give you more of an idea of what O&G is like. Reflect on what parts of medicine you like and dislike. If you like to have a lot of time to ponder questions and hate night shifts perhaps O&G is not for you. Take advantage of arranging taster days to further develop your experience, interest and insight into the specialty. Attend the RC OG careers fair in London on 15 November 2014 www.rcog.org.uk/events/careers-day-junior-doctors