OSCEs in Obstetrics and Gynaecology for MRCOG-3 Richa Saxena
Page numbers followed by f refer to figure, fc refers to flow chart and t refers to table.
Abdominal cavity 58
Abdominal distension 58
Abdominal examination 48, 104, 151, 188, 218
Abdominal hysterectomy 54, 55, 75, 95, 104, 105, 107, 108, 109
Abdominal palpation 193
Abdominal trauma, history of 195
Abdominopelvic masses 55
Aborted baby 86
Abortion in great Britain, different methods for 86
Abruption, history suggestive of 195
Abruption placenta 69
Abscess formation 58
Acidosis 196
Acne 174
Adequate fluid replacement 140
Adnexal mass 154, 256
Adrenal tumour 177
Advanced preterm labour 198
Advanced training skills modules 5
Advice for examination 33
avoiding use of medical jargon 36
being natural and not taking stress 33
carefully observing and listening to role-player 35
drawings 36
facing examiner and the role-player 34
in-depth knowledge about the subject 39
practice with an exam buddy and a stop clock 35
reading the question carefully 34
resources for studying 38
strength 37
use of props 36
Advice related to smoking 225
ALSO See advanced life support in obstetrics Amenorrhoea 176, 256
cause of 174, 178
procedure of 88f
Amniotic fluid index 203
Amniotic fluid volume 248
Amoxicillin 105
Anaemia 154
correction of 75
features of 256
Androgen excess 175t
Androstenedione 178
Anencephaly 87
Anovulation 231
Antenatal care 83, 160, 162, 167, 213, 218
Antenatal care (midwifery system) in the UK 7
community level 7
hospital level 7
Antepartum haemorrhage 166, 218, 221
cases of 221
causes of 222
complications of 222
Anterior bladder wall incision 57f
Anticholinergic drugs 49, 50
Anti-D immune globulins 161
Anti-Müllerian hormone 230
Antipsychotic drugs 176
Apert syndrome 87
Apgar score 189, 204, 260
knowledge 135, 187
Approaching the role-player 35
Approaching the session 260
Asherman's syndrome 175, 177, 178
Assisted reproductive technologies 146
Asthma-related drugs 225
Atosiban 196
ATSMS See Advanced Training Skills Modules 5
Audio-visual aids 116
Audit and research, difference 243t
Audit cycle 244f
Audit cycle, steps of
comparing current practice 244
data collection and analysis 244
identification of standards 244
initial needs assessment 244
re-audit 245
Audit designing 268
Australian carbohydrate intolerance study in pregnant women 214
Autologous transfusion 102
Baby's arms 267
buttocks 124
chest 120
head 123, 134
heart trace 189
knee 124
suboccipital region 122
trunk 120
Backache 197
Beta-human chorionic gonadotropin 257
Biacromial diameters 263
Bilateral oophorectomy 184
Bilateral salpingo-oophorectomy 183
Bimanual pelvic examination 48
Biophysical profile 203
Biophysical tests 248
Bishop's score 197
Bladder injuries, steps for prevention of 58
Bleeding 197
amount of 153
in urine 63
Blood glucose 154
Blood-stained vaginal discharge 194
Blood transfusion 219
Bloody vaginal discharge of 74
BMI See body mass index
Boari flap 57f
Body mass index 12, 51, 213
Bonney's myomectomy clamp 156
Bowel injury 140
Breaking bad news 81
related to the presence of malignancy 91
Breastfeeding 208, 212, 216, 225
Breech using forceps 123
Breech vaginal delivery 118, 119
Budesonide 222
Burns-Marshall technique 120, 121f
Caesarean delivery 132
NCEPOD classification system for 220t
previous history of 166
Cancers, types of endometrial cancer 97
ovarian cancer 97
vulvar cancer 97
Caput 135
Carboxyhaemoglobin 162
Cardiotocograph 259
acceleration 201
baseline heart rate 201
baseline variability 201
decelerations 201
monitoring 189, 190
trace 191, 201 management based on interpretation of 206t
Care quality commission 238
CCG See Clinical Commissioning Group
CCT See Certificate of Completion of Training
Central venous pressure 219
Centre for Maternal and Child Enquiries 266
Cephalohematoma 215
Cephalopelvic disproportion 69
Certificate of Completion of Training 1
Certification of training and specialist registration 5
Cervical biopsy 73
Cervical cancer, cases of 93
Cervical effacement 198
Cervical intraepithelial neoplasia 73
Cervical length, measurement of 196
Cervical smear test 174
Cervical stenosis 175
Cervical tumour, presence of 219
Chlamydia testing 161
Chlamydia trachomatis 255
Chlamydial infection 144
Chorionic villus sampling 88f
Chronic lung disease 162
Clinical Commissioning Group 100, 210
Clinical governance 236
concept of accountability 236
environment for implementation 236
framework 236
quality for services 236
elements of 237
clinical audit 243
education, training 237
openness or accountability 237
practice of evidence-based medicine 237
research and development 237
risk management 237
Clinical skills 187
assessment of 137f
Clomipramine 184
CMACE See Centre for Maternal and Child Enquiries
defect 153
screen 153
Cochrane library 38
Cognitive behavioural
therapy 182, 183, 184
Collagen implants 49
Colposcopic-directed biopsy 91
Colposuspension 49, 50
Communication 114
handover 114
skills 32, 150
with colleagues 17, 18, 112, 133
with GP 114, 146
with multidisciplinary team 115
with patients 79, 83, 113, 151
with patients and families 17
Competition ratio of clinical trainee to
specialty trainee (CT1:ST1) 2
Cone biopsy 94
Congenital abnormality 85
Congenital adrenal hyperplasia 230
Congenital anomaly 83
Congenital diaphragmatic hernia 85f
Congenital heart defects 87
Congenital infections 248
Congenital malformation 90, 214, 215
Continuing Professional Development,
Journal 38
Cord prolapse 206
Core training 3
progression from ST2 to ST3 level 4
years 1 and 2 (ST1 and ST2): basic
specialty training 3
years 35 (ST3–ST5): intermediate
training 4
years 6 and 7 (ST6 and ST7):
advanced training 5
Cot death 162
Counselling skills 80
Cranial irradiation 175
Critical incidents, understanding of 266
CTG See cardiotocography
Cushing's syndrome 174, 175, 177, 230
Cystocele 48
Cystoscope 63
Danazol 155, 156, 176, 183
Data collection 256
designing a pro forma to collect
information 246
Debulking surgery 152
Deep dyspareunia, diagnostic
laparoscopy for 64
Deep vein thrombosis 52, 170
Defect in congenital diaphragmatic
hernia 87
Delivery of after-coming head
using forceps 122
Delivery of posterior arm 265f
Delivery of the baby's legs 124
Depot medroxyprogesterone acetate 184
Detrusor overactivity 50
Diabetes mellitus 231
early symptoms of 234
Diabetic complications 216
DiGeorge syndrome 87
Disclosure of information 82
Disseminated intravascular
coagulation 220
Down's syndrome 169
Ductus venosus 248
DVT See deep vein thrombosis
Dysmenorrhoea 64, 185
severe 72
Dysplasia 94
Early labour 170
Early neonatal death 162
Early preterm labour 198
cases of 198
Ectopic pregnancy, 98, 126
causes of 255
diagnosis of 255
laparoscopic management of 100
management of 255
prevalence of 255
remains intact 97
e-learning resources in StratOG 39
End of diastole 248
curettage 94
swab 144, 145, 228
biopsy 154
cancer 232
hyperplasia, risks of 184
sampling 105
Endometriosis 234
case diagnosis of 65
on laparoscopy, case of 227
various lesions of 65f
lesions 143
spots 227
Enterocele 48
EPALS See European Paediatric Advanced Life Support
ePortfolio by the RCOG 1
ePortfolios 4
Erb's paralysis 267
European Paediatric Advanced Life
Support course 3
Evidence-based reviews of practice 38
Expectant management 257
Exploratory laparotomy 140, 141
Fasting blood glucose levels 49
Fasting insulin levels 230
Fatal accident 168
implications for 175
issues 174
dimensions of 154
large 105
size of 155, 157
small 105
treatment for 155
uterus 75
Fibronectin test 196
Fishbone diagram for root cause
analysis 242f
Fishbone diagrams 241
Fishbone tool 241
Flank pain 58
Fluoxetine 184
blood sampling 70, 202
cardiotocography 248
complications 162
face 264f
growth restriction 162, 166
causes of 247
defining the high-risk groups 246
definition of 246, 247
management of 248
head 123
station of 135
health 69
heart rate 206
types of 204
heart trace 204
karyotyping 248
monitoring 215
neck 123
pulmonary maturity 196
surveillance and monitoring 196
Foetomaternal medicine unit 87
Foley's catheter 86
Folic acid 160
supplementation with 169
Follicle-stimulating hormone 174, 228, 230
Forceps delivery 135
Foundation training (FY1 and FY2) 3
Fraser guidelines, principles of 131
Free thyroxine, measurement of 153
Fresh frozen plasma 221
Fryns syndrome 87
Full blood count 153
Funnelling of internal os 197
Galactorrhoea 175
Gastrointestinal disturbances 184
Gemeprost vaginal pessaries 86
Genetic syndrome 89
Gestational diabetes mellitus 214
diagnostic criteria for 217t
Gestational diabetes, treatment of 217
Gillick's competency 131
Glibenclamide 215
Glucose tolerance test 213
Glycosylated haemoglobin 154
GMC See General Medical Council
Gonadotropin-releasing hormone 75, 106, 155, 182
Good Medical Practice, guidelines 136
Good practice documents 38
Good practice guidelines 16
communication, partnership, and
teamwork 30
knowledge, skills, and
performance 29
maintaining trust 30
safety and quality 30
Gram-negative bacteria 139
Grand multipara 69
Groin traction 124
application of 124
types of 124
double groin traction 124
single groin traction 124
GTT See glucose tolerance test
Gynatresia 95
Haematological disorders 166
Haemoglobin level 76, 108, 169
Haemoglobin value 155
Haemorrhage 139
management of 141
Hands-on training 116
Hartmann's 219
Head injuries 175
Head of the
breech 120
Headache 174, 184
Heavy vaginal bleeding 247
Heparin 53
Hepatitis B 169
Hepatitis B and C screen 161
High perinatal morbidity 217
High vaginal swab 7, 144, 145, 161, 228
Hirsutism 174
HIV infection 154
diagnosis of 144
HIV-positive nulliparous woman 151, 152
Hodgkin's lymphoma 173
Hormone replacement therapy 51, 173, 182
Hospital's early pregnancy unit 97
HRT See hormone replacement therapy
Human Fertilisation and Embryology
Act 1990 85
HVS See high vaginal swab
Hydrocephalus 87
Hydronephrosis 87
biochemical features of 231
features suggestive of 230
symptoms of 174
Hyperbilirubinaemia 215
Hypergonadotrophic hypogonadism 177
Hyperplasia 154
Hyperprolactinaemia 175, 176, 230
history of 174
Hypocalcaemia 215
Hypomagnesaemia 215
Hypopituitarism 175
Hypothalamic cause 174, 175
due to inadequate fluid
replacement 140
case of 141, 143
causes of 140, 141
management of 141
Hypoxic ischaemic encephalopathy 258
Hysterectomy 48, 132, 156
different types of 107f
risks associated with 108
Hysterosalpingogram 144, 145
Hysteroscopy 154
Immediate management plan
clinical examination 140
intravenous fluids 140
intravenous line 140
outline of 140
theatre staff and the anaesthetist 140
Immunocompromised status 154
In vitro fertilisation 101, 146
Inappropriate galactorrhoea 174
Incision, discuss the type of 107
Infectious diseases, screening for 169
Influenza-like symptoms 184
Information gathering 17, 83, 149, 150
Information technology systems 114
Institute of medicine 40
Insulin-sensitizing agents 233
Intermenstrual bleeding 92, 153, 154
International Association of Diabetes and Pregnancy Study groups 217
Interventional radiology 157
Intestinal atresia 87
Intracranial haemorrhage 123
Intramuscular corticosteroids 220, 221
Intrauterine foetal death 162
Intrauterine growth restriction 17
development of 246
risk factors for the
development of 247t
Intrauterine hypoxia 162
Intrauterine insemination 146
Invasive tests 248
IOM See Institute of Medicine
Ipratropium bromide 222
Ischaemic heart disease 231, 234
Isoimmunisation 102
IUGR See intrauterine growth restriction
IVU See intraoperative intravenous
Karyotype analysis 178
Karyotypic abnormalities 89
Labium majorum 73
Labour management of 67, 188, 193, 200
examination 227
lymphadenectomy 94
port 59
salpingostomy 99
surgery 62
trocar 55
Laparoscopy for endometriosis 144
Large loop excision of transformation
zone 73
Large uterine fibroids 185
Late-onset congenital adrenal
hyperplasia 175
Laufe's forceps 123
Levonorgestrel intrauterine
contraceptive device 184
Levonorgestrel-intrauterine system 182
Luteinising hormone 174, 228, 230
Lymphovascular space invasion 94
Macrosomic baby 214, 262
Malar pressure 122
Male factor infertility 234
Mantoux test 178
Maternal and foetal complications 214
related to gestational diabetes 215t
Maternity unit trigger list for incident
reporting in 240t
manoeuvre 120, 121, 122f
McRoberts manoeuvre 263
MCV See mean corpuscular volume
Mean corpuscular volume 213
Meconium-stained liquor 67, 69, 192
Medical complications 162
presence of 166
Menorrhagia 73, 75
treatment of 157
bleeding 153
cramps 197
history 93, 143, 153, 174
Mental capacity, assessment of 129
Mesosalpinx 102
Meta-analyses 246
Metformin 214, 215, 233
Methicillin-resistant Staphylococcus
aureus 70
Methotrexate 257
Methyldopa 176
Middle cerebral artery 248
Mid-luteal phase, progesterone levels 144
Midstream urine 196
Midwife-led unit 8, 189
Mifepristone 86
Mixed incontinence 48
MLU See midwife-led unit
Montelukast 222, 225
Mother and the baby, adverse effects 162
Moulding 135
MRSA See methicillin-resistant
Staphylococcus aureus
Myomectomy 156, 177
for fibroid uterus 73
minimise blood loss at the time of 156
National Confidential Enquiries, clinical negligence scheme for trusts 238
National Health Service 5, 6, 10, 94, 113, 164
cervical screening programme 76
primary level healthcare 6
principles of 6
secondary level healthcare 6
Stop Smoking Services pathway from
maternity services to 165fc
tertiary level healthcare 7
National Institute for Health and Care
Excellence 146, 217
classification of foetal heart rate
features 204t
guidelines 38, 164, 246
National Patient Safety Agency 238
death 162
hypoglycaemia 215
jaundice 215
Neural tube defects 87
NHS See National Health Service
NICE See National Institute for Health and Care Excellence
Non-sperm cell concentration 145
Non-stress test 203, 248
NPSA See National Patient Safety Agency Nuchal cord 134
Obstetrics and gynaecology
applying for the ST1 post 3
career pathway for 2f
career pathway in 1
contemporary approach to 13
course, basic practical skills in 3
Occipitoanterior position 135
Occipitoposterior position 190
Oestradiol patches 184
Oophorectomy 152
Oral contraceptive agents 92
Oral contraceptive pill 74, 176, 182, 183
Osteopenia 156
Ovarian cancer 232
Ovarian tumours 55
Oxybutynin 49, 50
Pallister-Killian syndrome 87
Paraesthesia 184
Patient's complaints algorithm for
dealing 41fc
Patient-doctor communication 80
Pelvic inflammatory disease 185
Perimenopausal age group 155
Perinatal mortality 215, 225
Perineal pain 209
Perineal repair 138
Persistent intermittent bleeding 154
Persistent trophoblastic tissue 103
Persistent vaginal discharge 157
Phenothiazines 176
Pinard's manoeuvre 120, 124, 125f
Pipelle biopsy of endometrium 154
Piper's forceps 123
Placenta praevia 221, 222, 219
Placenta praevia bleeding in cases of 219
Placental abruption 162, 219, 220, 221, 222
case of 220
history of 169
Placental edge bleed 219
Polycystic ovarian disease 229
Polycystic ovarian morphology
features of 231
important aspects of 231
ultrasound features of 231
Polycystic ovaries 231
Polycystic ovary disease 230
Polycystic ovary syndrome 175
diagnosis of 175
implications of 232
Polycythaemia 162, 215
Polydipsia 234
Polyhydramnios 214
Polyphagia 234
Polyuria 234
Popliteal fossa 124, 125f
Post-coital bleeding 93, 106, 153, 154
Postembolisation syndrome 157
Post-partum haemorrhage, management of 115, 117
Post-term pregnancies,
management of 203fc
Prednisolone 222, 225
Pre-eclampsia 216
Premature menopause 176
long-term problems related to 176
short-term problems related to 176
Premature ovarian failure 175, 177
Premature rupture of membranes 170
Premenstrual syndrome 179, 182
management of 182fc
Prenatal karyotyping 88
Preoperative counselling 104
Presenile dementia 106, 109
history of 108
Preterm foetus 196
Preterm labour 141, 162, 195, 197
diagnosis of 197
management of 198
Primary infertility, diagnosis of 73, 75
Prioritisation of the patients 77
Priority of tasks and staff allocation 71
Progesterone 181, 183, 184
use of 184
Progress through training during ST3 to
ST5 levels 4
Prolactin 178
Prolonged pregnancy 162
Prophylactic therapy for group B
Streptococcal infection 196
Provera 227
Psoas hitch 57f
Psoas muscle 57
Pulmonary embolism 240
Pulsatility index 248
Pyridoxine 183
Quadriplegia 123
Quitting smoking 224
Radical trachelectomy 94
Rapid eye movement sleep 38
Rauwolfia alkaloids 176
Raytec swab 212
Reason's organisational Swiss cheese model of accident causation 241f
Re-audit: demonstration of success of protocol 249
REM See rapid eye movement
Renal agenesis 87
Renal vein thrombosis 215
Resistant ovary syndrome 175
Respiratory distress syndrome 196
Retained placenta management of 138
Retroperitoneal urinoma 58
Retroplacental clot 196
Reverse Wood's screw manoeuvre 263, 265f
Risk analysis 241, 252, 266
Risk control 242, 252
Risk identification 238, 252
Risk in healthcare radical framework,
management of 239fc
Risk management 237
composition of 252
definition of 251
process of 238, 252
team 252
Risk register, compilation of 238, 252
Risk treatment 242, 252
Ritodrine use of 196
Rubin II manoeuvre 264f
Ruptured uterus 219
Salbutamol inhaler 222, 225
Salpingectomy 99, 101, 102f, 257
Salpingo-oophorectomy 72
Salpingostomy 100, 103, 257
Sarcoidosis 175
Screening for congenital
malformations 215
Secondary amenorrhea
cause 176
management plan of a patient
with 177fc
various causes of 175t
Selective serotonin reuptake
inhibitors 182
Semen analysis 75, 144, 227
Septicaemia 139
Sex hormone-binding globulin 178, 230
Sex-linked recessive 89
Sexual and reproductive health 179
Sexually transmitted diseases, high risk
of developing 161
Sheehan's syndrome 175
Shirodkar's clamp 156
causes of 139
clinical features 139
drug reaction 139
Shoulder dystocia 115, 259, 262, 266, 267
initial management in the
cases of 263t
management of 260, 262
Shoulder-tip pain 256
Sick patient’ role 81
Signs of foetal hypoxia 196
Sleep apnoea 231
Sliding scale insulin therapy 76
Sling procedure 50
Sperm concentration 145
Spina bifida 87
Standard matrix for grading risk 241t
Sterilisation procedure,
pregnancy after 104
Stop smoking services 164
Stress incontinence 47
Stress urinary incontinence 63
Subtotal hysterectomy 107
Sudden intrauterine death 215
Apert syndrome 87
Asherman's 174, 175, 177, 178
Cushing's 174, 175, 177, 230
DiGeorge syndrome 87
Down 81, 90, 169
Fryns syndrome 87
genetic 89
ovarian hyperstimulation 232
Pallister-Killian 87
polycystic ovary 175, 228, 231
postembolisation 157
premature ovarian failure 175
premenstrual 178, 179, 182, 183, 185
resistant ovary 175
respiratory distress 196
Sheehan's 175
sudden infant death 163
Syphilis 169
Tachycardia 139
Teaching 132, 251, 255, 267
Teaching skills 115, 266
Technique of instrumental delivery 136
TED See thromboembolic deterrent
Tension-free anastomosis 57f
Thromboembolic deterrent 52
presence of 52
risks of 52
Thromboprophylaxis 221, 269
mechanical 269
pharmacological 269
Thyroid dysfunction 175
symptoms of 174
Thyroid stimulating hormone 153
Tinzaparin 53
Tolterodine (Detrusitol®) 49, 50
Total abdominal hysterectomy 152, 107, 183
Total motile sperm 145
Trachelectomy 94
correct application of 133
directions of application of 135f
Transfusion of
cryoprecipitate 221
platelet concentrate 221
Transvaginal taping 50
Tubal factor infertility 234
Tubal pregnancy 99
Tubal sterilisation 110
Tube sparing salpingotomy 101f
Tuberculin skin test 178
Tumour 175, 178
adrenal 175, 177, 230
cervical 219
large uterine fibroids 55
ovarian 55
ovarian androgen-producing 175
Turner's mosaic 178
Ultrasound Doppler flow velocimetry 248
Ultrasound examination 144
indications for performing 154
Umbilical artery 248
Umbilical vein 248
Upper uterine segment, classical
incision 43f
Ureteric injury
common sites of 56f
management of 56
steps for prevention of 60
symptoms and signs of 58
Urethrocele 48
Urge incontinence 48
catheterisation 58
infection, history suggestive of 63
pregnancy test 257
tract infection 195, 216
culture sensitivity 63
frequency and volume chart 49
midstream specimen of 49
routine microscopy 63
Urodynamic studies 49
activity, monitoring 196
embolisation 157
transfixation of 156
causes 175
cavity, evaluation of 144
fibroids 55
hyperstimulation 206
intervention, history of 174
prolapse 48
rupture 240
Vacuum or forceps 192
birth after caesarean 17, 225
examination 188, 193
trachelectomy 94
Vasa praevia 219
Venous Doppler reversal of blood flow
in inferior vena cava 248
Venous thromboembolism 40, 162, 215, 240
cases of 267
Ventouse, application of 189
Veress needle, insertion of 55
VBAC See vaginal birth after caesarean
VTE See venous thromboembolism
Waiting times 95f
Weight-reduction drugs 233
Wertheim's hysterectomy 55, 73, 94, 95
for carcinoma 76
Wood's screw manoeuvre 263, 264f
Chapter Notes

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Training in Obstetrics and Gynaecology in the UKCHAPTER 1

The Royal College of Obstetricians and Gynaecologists (RCOG) has developed a curriculum for specialty training in obstetrics and gynaecology in the UK.1 The main aim of this specialty training curriculum for obstetrics and gynaecology is competency instead of considering variable steps or the amount of time spent on the training. As a result, it may take longer time for some trainees to achieve all competencies and their certificate of completion of training (CCT) as compared to others. Candidates who are starting at specialty training year 1 (ST1) level can expect to take 7 years for completing their training, subject to satisfactory assessment of progress. The number of posts available at ST1 to ST3 (specialty training year 3) level varies each year across the UK.
If the aspirants are thinking to pursue a career in obstetrics and gynaecology following their graduation in medicine, they are advised to gain as much experience as possible before applying for the specialty training. Before applying for specialty training in obstetrics and gynaecology, candidates must ensure that they develop appropriate skills required to be a good obstetrician and gynaecologist. Some examples of these skills are as follows: clinical problem solving, good communication skills, decision making, teamwork, empathy, sensitivity, manual dexterity, working under pressure, etc.2 Day-to-day management and quality assurance of training are provided by the postgraduate dean during the period of specialty training. Alternatively, the training programme director supervises the training programme at the local level.
When the candidate enters specialty training programme in obstetrics and gynaecology, they would be provided with an ePortfolio by the RCOG.3 This portfolio shall act as a log for the attainment of competencies in the curriculum. 2It also records their inductions and appraisals as well as workplace-based assessment. The RCOG and the concerned deanery shall keep in touch with the candidate via the ePortfolio.
Throughout the candidate's training period, the College shall set out the criteria and content for training. They will also provide guidance regarding the educational support material and training courses. Figure 1.1 represents the training programme in obstetrics and gynaecology in the UK and this training programme is also described next in details.
The candidates who are considering their career in obstetrics and gynaecology can apply for specialty training, which is a run-through scheme, following the completion of their foundation training (FY1 and FY2). Aspirants apply for training at ST1 level. Advancement to ST2 level, and then to ST3 and beyond (till the ST7 level) occurs; only if candidates are successful at subsequent levels. When the applicant has accomplished all the requirements of the programme, they will be awarded a Certificate of Completion of Training and registered in the specialist register of the General Medical Council.1 They can then practice at the consultant level in the UK.
Application process for specialty training in obstetrics and gynaecology is a competitive process initiated via the Health Education North West website (https://www.nwpgmd.nhs.uk/OG_Recruitment).4 The responsibility for national recruitment to obstetrics and gynaecology at ST1 level has been formally transferred by the Health Education England from the Royal College of Obstetricians and Gynaecologists to Health Education North West with effect from the August 2017 intake. In 2016, the competition ratio of clinical trainee to specialty trainee (CT1:ST1) in Obstetrics and Gynaecology was 2.03.5
zoom view
Fig. 1.1: Career pathway for obstetrics and gynaecology.1
(CCT: certificate of completion of training)
There were 2,133 consultants and 2,481 medical registrars in England in the year 2016 in the specialty of obstetrics and gynaecology.6
Foundation Training (FY1 and FY2)
A rotation in obstetrics and gynaecology is involved in many posts for foundation year 2 and a few posts for foundation year 1. For the candidates who have just completed their medical graduation and are interested in further pursuing their career in the field of obstetrics and gynaecology, it is a wise decision to spend some time doing an audit, publishing a case report, or conducting teaching sessions in the specialty of obstetrics and gynaecology. Presently, MRCOG part 1 of the examination can be attempted as soon as you have gained your medical degree. Successfully clearing the Membership of the Royal College of Obstetricians and Gynaecologists (MRCOG) Part 1 examination during the foundation training is likely to help you gain an edge over the other candidates while applying for the ST1 post in obstetrics and gynaecology.
During the foundation programme, the candidates who are wishing to pursue their specialty training in the field of obstetrics and gynaecology are expected to complete the Women's Health Module available on the RCOG website. Prior to the submission of an application for specialty training, it is essential for the candidate in the previous 1 year to undertake a formal hands-on training on basic life support. This may be undertaken in a hospital posting or on a recognised course. Other desirable courses which can be attempted by the candidates prior to the application for ST1 post include various courses such as:
  • The basic practical skills in obstetrics and gynaecology course: The content of this course is designed to complement the RCOG Training Portfolio Logbook and is linked to OSATs or Objective Structured Assessment of Technical skills.
  • The Advanced Life Support in Obstetrics (ALSO) course: This is an evidence-based, interprofessional, and multidisciplinary training programme. This training programme equips the entire maternity team to effectively manage various obstetric emergencies.
  • The European Paediatric Advanced Life Support (EPALS) course: It is a collaborative course between the European Resuscitation Council and the Resuscitation Council (UK). The aim of EPALS is to train the doctors and nurses in the efficient and prompt management of the children showing early signs of respiratory or circulatory failure.
Core Training
Years 1 and 2 (ST1 and ST2): Basic Specialty Training
Aspirants are likely to gain knowledge and skills in several areas of obstetrics and gynaecology at ST1 and ST2 level, while working together with other trainees at the similar level as well as those at advanced levels. Though the candidate is likely to work with several consultants across a range of specialties, there would be one consultant who would act as their educational supervisor. 4After satisfactory completion of the required assessments, the candidate is likely to progress to ST2. Within a minimum span of 2 years at the level of ST1-2, the candidate is likely to achieve all the required competencies.
The candidate is expected to see the patients in antenatal and gynaecology clinics during the basic specialty training. An opportunity to do caesarean sections and conduct instrumental deliveries in the delivery suite will also be provided to them. There are many other competencies required for the candidate at ST1 and ST2 level besides conducting uncomplicated elective caesarean sections and non-rotational instrumental deliveries and those include opening and closing the abdomen during various surgeries, perineal repair, and uncomplicated surgical uterine evacuation.7 The training achievements of all individuals will be recorded in their training logbook and ePortfolio.3
With the advancement of candidate's training, they will start to possess the various competencies in their logbook signed off. After the candidates attain set competencies and are successful in their annual review of competence progression, they are able to reach to the next level of their specialty training.
Progression from ST2 to ST3 Level
One of the important assessment steps of progression from ST2 to ST3 level (i.e. from basic to intermediate training) for a candidate is to pass the first part of the RCOG membership examination (Part 1 MRCOG). They should have completed the RCOG basic practical skills in obstetrics and gynaecology course, and should have attained the relevant competencies for independent practice as highlighted in the trainee logbook. This includes modules in basic clinical and surgical skills, teaching appraisal and assessment, ethical and legal issues, and maternal medicine. At this stage, the candidate is likely to take increased clinical responsibility and progresses from first on call to second on call. At this level, the candidates become competent to handle the delivery suite independently. At the same time, they must be aware of their limitations and should know when to seek senior assistance.
Years 3–5 (ST3–ST5): Intermediate Training
Once the candidates have progressed to ST3 level, they will have to spend the next 3 years obtaining further experience in all areas in the specialty of obstetrics and gynaecology. By the time, the candidates reach ST4 to ST5 level, they have become capable to carry out almost all the obstetric and gynaecological procedures with indirect supervision (with a consultant available nearby). By the time candidates reach ST5 level, they have acquired a broad base of knowledge and expertise on which to develop advanced skills and make future career plans. During this time, trainees get the opportunity to follow their subspecialty interests. They get a chance to work closely with a consultant in a specific subspecialty. Satisfactory completion of ST5 marks the completion of intermediate training.
To progress through training during ST3 to ST5 levels, the candidates need to achieve set competencies as mentioned in their ePortfolios and logbooks. 5They also need to have regular assessments. In order to progress towards advanced training (ST6 level) following the completion of intermediate training, the candidate needs to complete all the intermediate competencies and pass the second part of the membership examination (Part 2 and Part 3 MRCOG examination). Once the candidate has completed all intermediate requirements, they move to ST6 level. Here they have the option to complete advanced training skills modules (ATSMs) or do subspecialty training.
Years 6 and 7 (ST6 and ST7): Advanced Training
During ST6 and ST7 level, the candidates continue to expand and improve their general skills in obstetrics and gynaecology. Besides consolidating the clinical skills they have already learned during specialty training, they are likely to expand their knowledge in topics such as medical management and clinical governance. This would ensure that they are properly prepared for the non-clinical aspects of working as a consultant in the National Health Service (NHS).
During this period, the candidates also get a chance to gain more knowledge and experience in their area of special interest. They have the option to do ATSM or the subspecialty training.8 Following these two final 2 years of training, the candidate can apply for their final qualification, the Certificate of Completion of Training.
Advanced training skills modules: The candidate can choose from 20 ATSMs, based on the skills suitable for future career progress as a consultant. Some of the advanced training modules include, maternal medicine, oncology, forensic gynaecology, vulval disease, medical education, and menopause.9
Subspecialty training: Subspecialists are obstetricians and gynaecologists who are recognized to have subspecialty expertise in their field. They have undertaken appropriate additional higher training beyond that which can be achieved in normal advanced training. There are four subspecialties in obstetrics and gynaecology: gynaecological oncology, maternal and foetal medicine, reproductive medicine, urogynaecology and sexual and reproductive healthcare. The training programme is set out by the relevant subspecialty. The candidate would, however, continue to undertake on call work in general obstetrics and gynaecology during their subspecialty training. The subspecialty training lasts for 3 years: 2 years of clinical training and 1 year of research. If the candidate has already published appropriate publications, it may count towards the research component.
For the candidates to be able to practice as a consultant in the NHS, they need to be entered on the Specialist Register. On successful completion of their advanced training, they would be conferred certificate of completion of training. The RCOG would then recommend them to the General Medical Council for inclusion on the Specialist Register. This would enable the candidate to independently practice as a consultant in obstetrics and gynaecology in the UK.6
While attempting the MRCOG Part 2 or 3 examination, it is especially important for the overseas candidates to be familiar with the working of healthcare system in the UK. NHS or the National Health Service is a publicly funded national healthcare system for England. The four national health services in the United Kingdom include NHS (England), NHS (Scotland), NHS (Northern Ireland), and NHS (Wales).10 It is the largest and oldest single-payer healthcare system in the world and covers all healthcare services including the antenatal care, screenings, maternity services, long-term healthcare, and end of life care. Three core principles of NHS are as follows:
  1. Based on clinical needs and not on the ability to pay
  2. Meeting the requirements of everyone
  3. Free at the point of delivery.
Funding for NHS directly comes from taxation. Various levels of healthcare in the NHS include primary level, secondary level, and tertiary level. As per data of March 2017, there are 233 NHS providers of secondary and tertiary care. Of these 233 NHS providers, there are 152 foundation trusts and 81 aspirant trusts.11 Additional non-NHS organisations also provide secondary and tertiary care services.
Primary Level Healthcare
Primary care acts as the first point of contact for someone and covers everyday health services. It can be regarded as the ‘gateway’ to receiving more specialist care. It is usually delivered by primary care trusts such as GPs (general practitioners), dentists or opticians. NHS provides funds to the GP surgeries that are responsible for delivering primary care to the patients. There is a clinic called GP surgery in every community, which covers the population in their catchment area. People living in that area can get themselves registered with that GP surgery. The medical records of a person are usually held by the GP. The GP also knows the patient's complete medical history. Patients usually cannot refer themselves to a specialist except in two conditions:
  1. Referral to A&E
  2. Referral to sexual health clinics or genitourinary medicine (GUM clinics).
All the preliminary work-up of the patients before referring them to the secondary care (hospitals) is usually done at the GP surgery. When the patient is referred to secondary or tertiary care, the GP surgery pays the hospital for that visit. Therefore, hospitals earn money through these referrals. No payment is done for any further follow-up. As a result, the patients are usually followed up in the GP surgeries based on the recommendations made by the specialists. The specialist may call the patient for further follow-up based on their discretion depending upon the patient's clinical condition.
Secondary Level Healthcare
Secondary level healthcare includes hospital-based as well as community-based care. It can either be planned (elective) care such as a cataract operation, 7or urgent and emergency care such as treatment for a fracture. Hospital-based care is usually provided by the specialists. A patient is referred to a secondary care professional from primary care. A specialist in secondary or tertiary care will see only those patients who have a referral letter from GP, which outlines the patient's background, the treatments initiated so far, and the patient's response to treatment. Once the specialists have seen the patient, they would write back to the GP their recommendations and observations. Based on the results of the observations or investigations, the specialist may decide to call the patient back to the hospital or refer them back to the GP for further follow-up. In either case, a letter is issued to the GP updating regarding what was done. For example, if the specialist discovers a microbial growth on high vaginal swab (HVS), they can refer the patient back to the GP who would then prescribe appropriate antibiotics to the patient. On the other hand, if the investigation reveals CIN, the patient would be referred to the hospital's colposcopy clinic.
Tertiary Level Healthcare
Tertiary level of healthcare is known as specialized consultative healthcare. This type of healthcare service is usually for inpatients and on referral from primary and secondary healthcare for advanced medical investigation and treatment.
Midwifery system prevails in UK for the care of pregnant women. Midwives act as lead professionals for providing maternity care to all healthy pregnant women. They deliver all aspects of pregnant woman's physical, psychological, and social care. They also act as the first point of contact for the women who want to access maternity services. In case of complicated pregnancies, midwives act as the prime co-ordinators of care within the multidisciplinary team, where they closely work with the obstetricians, GP, specialist services, social services, breast feeding services, etc.
Midwives can conduct a normal vaginal delivery, suture episiotomies, and repair first and second degree tears. In the maternity triage and antenatal day care assessment, midwives can check a patient's presentation and treat the patient on their own unless they encounter a problem and feel the requirement to involve a doctor. In the NHS, following grades of midwives are available: student midwives, middle grade midwives, senior midwives, and specialist midwives. In the UK, midwives can work in the following sectors as discussed next.
Community Level
Community level midwives provide home visits to the patients, antenatal care, postnatal assessments, assessment of the patient's social support needs, etc.
Hospital Level
  • Hospital obstetric units: Each pregnant patient gets one-to-one midwifery care in the hospital's labour room. The doctors are only involved in the patient's care if the midwives feel requirement for the same.8
  • Midwife led unit (MLU): These are separate birth centres other than the labour room where the midwives conduct delivery themselves without using any medical intervention. These units are usually next to the main hospital's maternity unit. Facilities for water birth are also here. In case any complication is anticipated during labour, the midwife would advise the patient to change her plan and deliver in the obstetric unit.
In the NHS, the obstetricians or doctors are involved in antenatal care or delivery of patients only when the midwife encounters a complication or feel the requirement for their involvement.
Obstetrics and gynaecology is a unique specialty which is a combination of both medicine and surgery. This specialty is not only concerned with the care of pregnant woman and her unborn child, but also the management of diseases specific to women. A career in obstetrics and gynaecology is likely to be both thrilling and rewarding due to the broad range of subspecialties it offers. It presents countless opportunities, enabling the budding obstetrician and gynaecologist to practise high-quality medicine in an atmosphere of multidisciplinary team. A career in obstetrics and gynaecology in the UK warrants an understanding regarding the working of NHS as well as the role of midwives in imparting care to the pregnant women.
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  1. Rimmer A. (2017). Postgraduate training will be more flexible under new standards, says GMC. [online] Available from http://careers.bmj.com/careers/advice/Postgraduate_training_will_be_more_flexible_under_new_standards%2C_says_GMC [Accessed July 2017].

  1. 9 Abdelrahman A, McNeill S. (2012). A career in obstetrics and gynaecology. BMJ Careers. [online] Available from http://careers.bmj.com/careers/advice/view-article.html?id=20008722 [Accessed July 2017].
  1. NHS choices. (2016). About the National Health Service. [online] Available from https://www.nhs.uk/NHSEngland/thenhs/about/Pages/overview.aspx [Accessed December 2017].
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