Graduate medical students' perception of obstetrics and gynaecology as a future career specialty.

The aim of this study was to explore the perceptions of graduate-entry medical students of obstetrics and gynaecology as a specialty, in order to understand how to increase its appeal to them, and therefore enhance recruitment to the specialty. A total of 90 questionnaires were returned out of 145 questionnaires distributed to years 2 and 4 graduate-entry medical students (62% response rate). Although fewer than 4% of respondents are considering the specialty as their career choice, more than half of the respondents would consider the specialty as a second option, which shows that there is room to persuade them to have a second look. Gender was the only factor that significantly affected views regarding obstetrics and gynaecology. There is a need for more information about the specialty and its training opportunities and exposure to areas of special interest and subspecialisation, as well as role models, rather than focussing on labour ward in timetables. Areas of apprehension about the specialty, such as the risk of litigation, need to be aired and addressed through career days, as well as formal tutorials within teaching programmes.

Delivery of the deeply engaged head: a lacuna in training.

The percentage of second stage caesarean sections is on the rise. The delivery of a deeply engaged head in the second stage by caesarean section is an experience feared by most junior registrars. Among the different delivery techniques described, the pull technique has been proven to have a lesser morbidity than the push technique. However, trainees do not receive any structured training in either of these methods. We undertook a survey among 150 UK trainees in SPROGS 2008 in order to understand their experience in dealing with a deeply engaged head in second stage by CS, to ascertain whether trainees feel that they need training to deal with the situation and to discover the means by which this training can be delivered. The questionnaire return rate was 94%. More than 80% agreed that they had faced difficulties in the past while trying to deliver a deeply engaged head. Only 20% used the recommended semi-lithotomy position during caesarean section for an impacted head. Among the trainees who had received only UK training, only 42% were confident of doing a pull method if the need arose. More than 80% of the trainees agreed that supervised sessions to teach alternative techniques for delivery, such as the reverse breech/pull method would be useful and that it would improve their confidence when doing a trial of vaginal delivery. The RCOG agreed that there is little formal training in delivery of a deeply engaged head and is considering recommending trainees complete 2 OSATS (Objective Structured Assessment Tools) in this area. It has also asked the authors to form a skills and drills protocol, which the authors have done and submitted to the RCOG.

Innovations in teaching obstetrics and gynaecology--the Theme Afternoon.

The Theme Afternoon is an exciting and popular new innovation in teaching that we have successfully introduced in Obstetrics and Gynaecology. It utilizes many of the elements of the SCORPIO and SPICES models of teaching. In particular, it involves problem-based learning and an integrated approach to teaching. One afternoon per week is set aside for each theme. So far we have introduced Theme Afternoons in Contraception and Sterilization, The Menopause and Hormone Replacement Therapy, Screening for Disease in O&G and Examination Techniques. All Theme Afternoons follow a similar structure: a targeted tutorial, 10 MCQs, a 15-minute coffee break, OSCEs, and role-play with feedback. An evaluation form is completed by each student assessing the session and the tutor. The Theme Afternoon provides the student with stimulation to learn. It has a wide appeal and has been well received by learners. Students learn at a more controlled pace and in a more sheltered environment, which may be less stressful to them. It evaluates well and is flexible in its structure. The changes that occur are student-led and the desire for it to continue is student-driven. It is easily adaptable to other medical specialties or even nonmedical curriculums. We recommend it as a realistic opportunity to raise standards and enthusiasm in medical education.