Working hours of obstetrics and gynaecology trainees in Australia and New Zealand.

BACKGROUND: The importance of doctors' working hours has gained significant attention with evidence suggesting long hours and fatigue may compromise the safety and wellbeing of both patients and doctors. This study aims to quantify the working hours of The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) specialist trainees in order to better inform discussions of working hours and safety within our region. METHODS: An anonymous, online survey of RANZCOG trainees was conducted. Demographic data were collected. The primary outcomes were: hours per week at work and hours per week on-call. Secondary outcomes included the frequency of long days (>12 h) and 24-h shifts, time spent studying, staff shortages and opinions regarding current rostering. RESULTS: Response rate was 49.5% (n = 259). Full-time trainees worked an average of 53.1 ± 10.0 h/week, with 11.6% working on-call. Long-day shifts were reported by 85.8% of respondents, with an average length of 14.2 h. Fifteen percent reported working 24-h shifts, with a median duration of uninterrupted sleep during this shift being 1-2 h. Trainees in New Zealand worked 7.0 h/week more than Australian trainees (P ≤0.001), but reported less on-call (P = 0.021). Trainees in Western Australia were more likely to work on-call (P ≤0.001) and 24-h shifts (P ≤0.001). CONCLUSION: While 53.1 h/week at work is similar to the average Australian hospital doctor, high rates of long days and 24-h shifts with minimal sleep were reported by RANZCOG trainees in this survey.

Fatigue and training of obstetrics and gynaecology trainees in Australia and New Zealand.

BACKGROUND: Several studies have linked doctor fatigue with adverse patient events and an increase in risk to doctors' personal safety and wellbeing. The present study assesses the rostering structure of Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) trainees and its association with trainees' reported fatigue levels, training opportunities and wellbeing, which were secondary outcomes of a larger study of trainee working hours which has been separately reported. METHODS: An anonymous, online survey of RANZCOG trainees was conducted. Demographic data collected included: age, gender, level of training and current rotation. Data were also collected on hours worked per week, long shifts (>12 h), self-reported fatigue levels, and opinions regarding current rostering and training. RESULTS: A majority (72.9%) of respondents regularly felt fatigued, with higher fatigue levels being associated with more hours worked per week (P = <0.001) and working long shifts (>12 h) (P = 0.007). Fatigue was associated with an increased risk of dozing while driving (P = 0.028), with 56.1% of respondents reporting that this occurs. Trainees appeared to be less confident in achieving their technical skill requirements, with increasing hours not increasing confidence in achieving these skills (P = 0.594). Trainees who worked under 50 h per week were less likely to report fatigue (P = <0.001) and more likely to report greater work enjoyment (P = 0.043), and working hours being conducive to learning (P = 0.015). CONCLUSION: Fatigue was frequently reported by RANZCOG trainees with increased working hours and long shifts being significant factors in fatigue levels. Strategies should be developed and trialled to enable trainees to obtain adequate case exposure and teaching without compromising patient and doctor safety.

Spontaneous Uterine Rupture in a Preterm Pregnancy following Myomectomy.

A 44-year-old nulliparous woman was transferred to a tertiary obstetric hospital for investigation of acute onset abdominal pain. She was at gestation of 32 weeks and 2 days with a history of previous laparoscopic fundal myomectomy. An initial bedside ultrasound demonstrated oligohydramnios. Following an episode of increased pain early the following morning, a formal ultrasound diagnosed a uterine rupture with the fetal arm extending through a uterine rent. An uncomplicated classical caesarean section was performed and the neonate was delivered in good condition but with a bruised and oedematous right arm. The neonate was transferred to the Special Care Nursery for neonatal care. The patient had an uncomplicated postoperative course and was discharged home three days following delivery. This is an unusual presentation of uterine rupture following myomectomy where the fetal arm had protruded through the uterine wall.

Outcomes of Total Laparoscopic Hysterectomy Using a 5-mm Versus 10-mm Laparoscope: A Randomized Control Trial.

STUDY OBJECTIVE: To determine if the use of a 5-mm umbilical incision and laparoscope would result in a higher likelihood of earlier discharge from hospital after total laparoscopic hysterectomy (TLH) compared with a 10-mm umbilical incision and laparoscope. Secondary objectives of the study were to determine if the use of a 5-mm laparoscope would lead to a reduction in postoperative pain scores and a shorter operating time without an increase in complication rates. DESIGN: Prospective, randomized, double-blinded, clinical trial (Canadian Task Force classification I). SETTING: A tertiary care setting. PATIENTS: Seventy-eight patients scheduled for TLH were prospectively recruited. INTERVENTIONS: Women undergoing TLH were assigned to either a 5-mm umbilical port and laparoscope (5LH) or a 10-mm umbilical port and laparoscope (10LH). All patients underwent a standardized operative technique and anesthetic protocol. Patients and research assistants responsible for postoperative pain assessment were blinded to group. Analysis was by intention-to-treat. MEASUREMENTS AND MAIN RESULTS: The primary outcome measure was length of hospital stay. Secondary outcome measures were operating time, pain scores on postoperative days 1 and 7, and complication rates. There was no difference in length of hospital stay between the 2 arms. Compared with the 10LH group, the 5LH group had shorter operative times (32.6 vs 40 minutes; p = .01) and less postoperative pain on day 1 (2.5 vs 3.3; p = .03 for "pain with movement") and on day 7 (.92 vs 1.8; p = .002). Complication rates were similar between the 2 groups. CONCLUSION: TLH with a 5-mm laparoscope resulted in shorter operative times and less pain on postoperative days 1 and 7, compared with a 10-mm laparoscope, with similar length of stay and complications.

The evolving role of a gynaecologic oncologist in a tertiary hospital.

INTRODUCTION: Whilst the prime role of a gynaecologic oncologist is the comprehensive management of women with a gynaecologic cancer, their surgical skills are increasingly utilised for general gynaecological and obstetric surgery. Within tertiary centres, there is increasing provision of support by gynaecologic oncologists for both emergency and complex elective cases. AIM: The aim of the study was to investigate and define the expanding role of the gynaecologic oncologist within obstetrics and gynaecology. METHOD: A retrospective analysis of all nongynaecological oncology unit cases from 2006 to 2012 which required the presence of a gynaecologic oncologist in the operating theatre. RESULTS: A wide variety of cases that required the involvement of a gynaecologic oncologist were identified. These ranged from complications such as bowel injuries and haemorrhage to gynaecological surgeries in complicated patients, and obstetric patients with placenta accreta and intra-operative diagnosis of unexpected malignancy. CONCLUSION: The role of the gynaecologic oncologist within a tertiary centre is expanding to include the provision of support to general gynaecologists and obstetricians. There is increasing utilisation of the gynaecologic oncologist whereby their attendance is often pre-arranged prior to the surgery. However, emergency cases requiring their assistance are not uncommon.