A career in obstetrics and gynaecologyBMJ 2006; 333 doi: https://doi.org/10.1136/bmj.333.7575.s167-a (Published 04 November 2006) Cite this as: BMJ 2006;333:s167
- Dharani Hapangama, clinical lecturer in obstetrics and gynaecology,
- Melissa Whitworth, clinical lecturer in obstetrics and gynaecology
Dharani Hapangama and Melissa Whitworth explain the possibilities in the exciting field of obstetrics and gynaecology in the light of the changing world of Modernising Medical Careers
For obvious reasons, obstetrics (care during pregnancy and childbirth) is as old as human-kind. No other specialty gives the opportunity to be a surgeon and a physician and to save two lives for the price of one. Gynaecology complements obstetrics perfectly, allowing the practitioner to follow patients' reproductive health from infancy to old age. However, misconceptions among medics regarding stress levels and workload and misperceptions about career opportunities have left this dynamic and exciting specialty undersubscribed.
What does the job entail?
If variety is the spice of life, obstetrics and gynaecology must be the Red Savina Habanero of medicine (fig 1). The usual working week takes a meandering course through a variety of specialist activities, flowing through the white waters of gynaecology theatres, to the waterfalls of the labour ward, before settling down in the motionless pools of gynaecology and antenatal outpatient clinics. Contrary to common belief, we still “play God” by creating and regrettably sometimes destroying life, which means that ethical and moral discussions occur on a daily basis. Furthermore, in andrology clinics we occasionally treat male patients as well.
The training programme is currently being restructured with the advent of Modernising Medical Careers. At present, after a basic medical degree and house officer year or foundation year 1, up to three years are spent as a senior house officer completing a basic log book, acquiring basic skills in the specialty, and attempting part 1 of the exam for membership of the Royal College of Obstetricians and Gynaecologists—that is, accumulating enough points to be shortlisted for a national training number. Additional activities such as audit and research also pave the way to a national training number.
Specialist training includes three years geared towards acquiring generic skills in obstetrics and gynaecology and completing the membership exams and a core log book. After this, years 4 and 5 are spent gaining special skills, as outlined below, before acquiring a certificate of completion of training. A few trainees apply for a limited number of subspecialty training posts, which generally lead to the trainee following a purely gynaecological or obstetric path.
Changes are afoot regarding the membership exams for the Royal College of Obstetricians and Gynaecologists to try to bring them in line with more modern exam techniques and provide more of a continuum from the problem based learning methods of teaching and examining found in most medical schools. As yet, unlike the surgical specialties, there is no exit examination.
As with all specialties, the exact impact of Modernising Medical Careers on the training structure is not known. However, following problems with workforce planning in obstetrics and gynaecology in the late 1990s the Royal College of Obstetricians and Gynaecologists has been proactive in developing a new training pathway.
Subspecialisation currently occurs after year 3 of specialist registrar training. Following changes proposed by Modernising Medical Careers, this will occur after the certificate of completion of training is acquired. Trainees with a special interest in a relevant field will compete for the opportunity to subspecialise in five well established areas: maternal and fetal medicine, urogynaecology, reproductive medicine, sexual and reproductive health, and gynaecological oncology. This will provide intensive training in an area of interest and a higher degree of competence. The Royal College of Obstetricians and Gynaecologists is keen to enhance the profile of academic obstetrics and gynaecology and there will undoubtedly be opportunities to follow an academic career path akin to subspecialisation.
Currently, during the last two years of specialist training trainees work towards obtaining “specific skills that are beyond those required for the acquisition of a CCT (certificate of completion of training) in clinical, teaching, and managerial aspects of obstetrics and gynaecology” in selected areas. Modules have been developed, in conjunction with specialist societies, in the following areas:
Management of infertile couples
Preparing for obstetric leadership on the labour ward
Ultrasound imaging in gynaecological conditions
Advanced hysteroscopic surgery
Intermediate level laparoscopic surgery
Paediatric and adolescent gynaecology.
Several other modules are being prepared, and on average a trainee is expected to complete two special study modules during specialist registrar years 4 and 5. As yet it is not clear how these modules will fit into the post Modernising Medical Careers picture, but we would envisage them being undertaken during specialist registrar years 4 and 5.
Obstetrics and gynaecology is a diverse specialty. You can start your day dealing with a woman with menstrual problems and end the day managing a shoulder dystocia in which you have five minutes to deliver a baby before the onset of cerebral ischemia. The ability to adapt to rapidly changing situations is essential, and a sense of humour is useful when you are faced with difficult situations. Enthusiasm, agility, and an intention to enjoy life are key features for this role.
How can I improve my chances of getting a job in obstetrics and gynaecology?
At many medical schools there is the opportunity to do a special study module and gain extra exposure to obstetrics and gynaecology. Many foundation year 2 and a few year 1 posts include obstetrics and gynaecology, and it is wise to spend this time doing an audit or some teaching to improve your curriculum vitae. At present, the part 1 exam for membership of the Royal College of Obstetricians and Gynaecologists can be taken as soon as you get your medical degree. An early successful attempt will mark you out as an enthusiast in the specialty. The college is currently setting up a mentoring scheme for those keen on a career in obstetrics and gynaecology, which is expected to be introduced to every medical school in the United Kingdom.
Pros and cons of obstetrics and gynaecology
As with any specialty there are pros and cons to obstetrics and gynaecology. Many of the cons are related to uncertainty about how Modernising Medical Careers will affect the specialty and therefore apply equally to all aspects of hospital medicine.
Huge case mix combining medicine and surgery
Currently undersubscribed, which therefore increases the opportunity to obtain a post in your chosen area
Most patients are fit and well
Flexibility in training to achieve the end career expectations (that is, to get a certificate of completion of training and be a generalist, subspecialist, or academic)
Opportunity to develop private practice once consultant level is reached
Most patients still remember to say thank you, even years after their original contact
Babies arrive at any hour of the day, so the labour ward remains busy out of hours. However, with the European Working Time Directive compensatory rest is provided
Litigation is increasing, although this is true of most areas of medicine
The effects of Modernising Medical Careers on training in a hands-on specialty will probably not be clear for a couple of years
What does the future hold?
For budding obstetricians and gynaecologists, the future is bright. Currently, the UK has about 1500 consultants in obstetrics and gynaecology. If the college plans for the future are realised, 1000 more consultant posts will be created over the next decade or so. Flexibility in training is greater than ever, and the Royal College of Obstetricians and Gynaecologists is pursuing many changes to improve training, in particular with regard to part time training posts.
The college is also keen to develop a strong, clear academic career pathway for budding academics to combine clinical training and research from early years—that is, just after the foundation year training. With changes imposed on obstetrics and neonatology as a result of the European Working Time Directive, it is likely that future consultants will work in larger units. This will increase the case mix and give more opportunity to subspecialise.
The future consultant's role is being redefined and restructured with a work-life balance in mind. The service demands of the NHS require most future consultants to provide an obstetrics and emergency gynaecological service, while only a few will do major gynaecological surgery. Therefore, the future consultant is likely to be one who enjoys the job more, will be rewarded better for the on-call commitments than at present, and will have shorter working hours.
Typical week for a specialist registrar in obstetrics and gynaecology
8 30 am: Labour ward—a mix of accident and emergency, intensive care, and surgical theatre
1 30-5 pm: Gynaecology outpatient clinic
9 am-12 30 pm: Antenatal clinic
1 30 pm: Gynaecology theatre
9 am: Emergency room—a mix of accident and emergency, general practitioners' surgery, intensive care, and surgical theatre
12 00 pm: Gynaecology or fetal scanning
9 am-11 am: Labour ward or special interest (colposcopy, outpatient hysteroscopy, fetal or gynaecological scanning, specialist clinics)
11 30 am: Gynaecology theatre
8 30 am: Research meeting
9 30 am-12 30 pm: Specialist antenatal clinic or gynaecology specialist clinic
2-5 pm: Teaching
So, if you want a challenge, excitement, and an adrenaline rush, but also a fulfilling career, look no further than obstetrics and gynaecology. ■