A career guide to obs and gynae

[lignocaine]

ROYAL COLLEGE OF OBSTETRICIANS AND GYNAECOLOGISTS



A CAREER IN OBSTETRICS AND GYNAECOLOGY



J W Eddy FRCOG





August 2003

CONTENTS

ABOUT THIS GUIDE 1
Further information for medical graduates 1
INTRODUCTION 2
The National Health Service 2
About obstetrics and gynaecology 2
The future of the specialty 3
TAKING YOUR MEDICAL DEGREE 5
Choosing a degree course 5
If you are still at school 5
If you are a mature student 5
If you are a postgraduate student 5
TRAINING IN OBSTETRICS AND GYNAECOLOGY 6
After your degree 6
Table .1: The Training Process 7
Senior house officer 7
Specialist registrar (SpR) 8
Elective year 8
Subspecialty training 9
Special skills training 9
Flexible training 9
AFTER YOU HAVE QUALIFIED 11
Academic careers 11
Research 11
Obstetrics and gynaecology for general practice 11
Hospital practice 11
Hospital working hours 12
Career appointments 12
Consultants 12
Staff Grade 12
Continuing professional development 12
THE ROYAL COLLEGE OF OBSTETRICIANS AND GYNAECOLOGISTS 14
About the RCOG 14
College facilities 14
Setting clinical standards 15
RCOG Trainees’ Register 15
RCOG Trainees’ Committee 16
College Deanery Advisers 16
Overseas trainees 16
Mentoring 16
Publications 16
Faculty of Family Planning and Reproductive Health Care 16
European links 17
APPENDIX 1: RCOG APPROVED SUBSPECIALTY CENTRES 18
APPENDIX 2: RCOG TRAINING COURSES 21
APPENDIX 3: RCOG EXAMINATIONS 22
Diploma in Obstetrics (DRCOG) 22
Membership Examination (MRCOG) 22
Part 1 22
Part 2 22



ABOUT THIS GUIDE
This practical guide is intended for anybody interested in a career in obstetrics and gynaecology in the UK. It is based on frequently asked questions received by the Careers Adviser of the Royal College of Obstetricians and Gynaecologists (RCOG).

Medical training is very competitive; there are always more doctors who want training than there are places available. You will need to be very clear about what you want to do and to plan ahead as much as you can. We hope that this guide will help you do that, whether you are at school or university, considering returning to education or have already graduated.
Further information for medical graduates
If you are a UK medical graduate considering a career in obstetrics and gynaecology, please contact the Careers Office at the RCOG for further information.

If you are a graduate from outside the UK and you are interested in training in obstetrics and gynaecology in the UK, please contact the Careers Office and ask for a copy of Training in the United Kingdom for EEC graduates or Training in the United Kingdom for non-EEC graduates. Alternatively, access these documents on the website at: http://www.rcog.org.uk/mainpages.asp?PageID=1096

Telephone: +44 (0) 207 772 6271
Email: cwood@rcog.org.uk



INTRODUCTION
The National Health Service
The National Health Service (NHS), in England and Wales, was established in 1948. It delivers free health care, funded through general taxes. The health service is divided into primary and secondary care.
• Primary care is provided by general practitioners (GPs) in the community. It is not possible to get secondary care without initial referral from a GP, except for emergency treatment.
• Secondary care is provided in hospitals. All referrals are made by a GP and each patient is allocated to a particular consultant. The consultant has overall responsibility for the care of that person, whether they are an inpatient or an outpatient, until they are discharged.
In hospitals, doctors work in multidisciplinary teams. These teams include medical staff such as consultants, associate specialists, specialist registrars (SpRs), staff grades, senior house officers (SHOs), preregistration house officers (PRHOs), midwives, nurses, therapists, healthcare workers and a variety of scientific, technical and support staff.

Recent changes in the way the NHS works includes greater patient involvement in plans for their care.
About obstetrics and gynaecology
Tremendous advances have been made in obstetrics and gynaecology over the last 30 years, making it an exciting specialty in which to work.

The flexibility of this unique and challenging specialty allows you to develop a wide range of interests and skills. Whether you enjoy hands-on practical medicine or whether you like solving complicated therapeutic problems, obstetrics and gynaecology has something for you.

Where you go in obstetrics and gynaecology will depend upon your interests and abilities. Training programmes offer you the option of undertaking special skills or subspecialty training. As a consultant you could, for example, choose either to be a generalist or to concentrate purely on maternal and fetal medicine, ultrasound or oncological (cancer) surgery.

A career in obstetrics and gynaecology is exciting and rewarding, at times demanding and stressful but always varied and challenging.

In obstetrics, the doctor has a primary duty to two patients at the same time, mother and baby, as well as a responsibility to other members of the family and society. Past achievements have been so great that women now have high expectations for their care. This progress has not occurred in isolation. Close collaboration with other professionals, particularly midwives, anaesthetists, paediatricians, radiologists and radiographers, physiotherapists, genitourinary physicians, surgeons, healthcare workers, scientists, technicians and many others, has been crucial. This has been helped by increased pressure by service users and voluntary organisations on the Government to increase resources to the NHS.

In the past, antenatal diagnosis was difficult and the outcome of pregnancy could not be altered. The introduction of preconceptual preparation, antenatal diagnostic techniques and fetal monitoring has improved the prospects for mother and child. There have also been enormous improvements in paediatric and neonatal care. The last century saw a dramatic reduction in perinatal mortality rates, from one hundred deaths for every thousand births in 1900 to just six per thousand in 2000.

Preventive medicine is increasingly being used to diagnose and treat potential problems at an early stage, in order to stop them developing. It includes, for example:
• cervical cytology (smear test) – this is one of the most effective ways of screening for premalignant disease of the cervix and has provided a model for many other screening tests
• hormone replacement therapy – this is used to reduce osteoporosis in postmenopausal women. It is particularly important in our ageing population, where conditions such as osteoporosis place an increasing burden on limited healthcare resources
• family planning – new and more user-friendly techniques are being developed to allow couples to control their fertility safely. This increases choice and has a part to play in stabilising population numbers
• preconception preparation – this improves the prospects of a healthy baby. Significant successes include the use of anti-D immunoglobulin to reduce rhesus disease, the use of rubella screening and immunisation and the use of folic acid to reduce neural tube defects.
Modern technology has also brought about significant developments in other areas in recent years, including:
• antenatal ultrasound monitoring and improved diagnosis of fetal abnormalities
• screening mothers for specific congenital and acquired diseases
• electronic monitoring of the fetus during labour
• in vitro fertilisation (IVF)
• a reduction in deaths from cancer through screening programmes
• minimal-access (or keyhole) techniques for surgery.
Ultrasound imaging plays an increasingly important role in all aspects of obstetrics and gynaecology. High-quality images now enable doctors to measure and identify structures precisely; being able to assess the flow of blood through organs via ultrasound gives them important clues to the state of tissues.

Minimal access techniques for surgery rely on small-diameter viewing instruments and high-intensity light sources, which permit the surgeon to see body cavities through a system of flexible fibre optics.

This kind of surgery is carried out with specially designed instruments, harmonic scalpels or lasers. Keyhole surgery is transforming many routine procedures that would previously have required large incisions or a prolonged stay in hospital.
The future of the specialty
In the future, midwives will provide a high proportion of maternity care, with the back up of obstetricians for complex problems.

Consultants may become more specialised in the future. A number of hospitals already have consultants who specialise only in obstetrics or gynaecology. With the development of a consultant-delivered service, subspecialisation is likely to increase. Most hospitals require new consultants to have a special skill, so we may see, for instance, consultants in subspecialty of gynaecology or consultants in general gynaecology with a special interest.

The main subspecialties so far recognised are:
• gynaecological oncology
• maternal and fetal medicine
• urogynaecology
• reproductive medicine
• sexual and reproductive health.

TAKING YOUR MEDICAL DEGREE
A career in medicine is very demanding. It is not a nine-to-five job and it will affect your private life. As a doctor, you will need to be able to deal with people from all walks of life, nationalities and religions. You will need to have good communication skills, a nonjudgemental attitude and be able to treat the patient as a partner in the provision of their care.
Choosing a degree course
To become a consultant obstetrician and gynaecologist, you must first get a medical degree and then become fully registered as a medical practitioner with the General Medical Council (GMC). After that, you must do several years of specialist training (see the next section). Your first step, therefore, is to get into a university medical school.

There are three main types of degree course:
• The Oxford and Cambridge six-year course, which covers three years of preclinical study, leading to a BA (of which one year is in a subject of your choice, so you could study physiology or even law if you wished) and two years and four months of clinical training.
• Some universities, particularly the London colleges, offer an eighteen-month preclinical programme of anatomy, physiology and biochemistry. At the end of this time, you can either go straight on to your three years of clinical training or study for another eighteen months to get a BSc in a subject of your choice, ideally in a subject relevant or connected to medicine, such as medical journalism.
• Some of the newer universities offer an integrated course which lasts for four and a half years. It combines basic medical science with clinical medicine into an integrated course.
You will need to find out which universities run the type of training you prefer. Whichever kind you do, the course will provide you with an introduction to obstetrics and gynaecology, including antenatal clinics, ultrasound scanning, gynaecology clinics and the delivery of babies.
If you are still at school
You will need to decide which A-levels (or Highers in Scotland) to take and which universities to apply for. Your school careers officer should be able to help you with this. Choose subjects that will be useful to you later. Universities do not specify which subjects you should have for medical courses but it is probably best if you concentrate on medically related subjects such as chemistry, physics and biology. You will probably need at least ‘B’ grades in all subjects.
If you are a mature student
You do not have to go into medicine straight from school; some people take another degree or occupation first. Medical schools are happy to accept people who have decided on a change of direction. Some make a point of taking mature students: the University of East Anglia Medical School, for example, has no upper age limit for admission and does not require straight As at A level; Southampton University offers ten places to mature students who do not have A levels.
If you are a postgraduate student
A number of medical schools are introducing graduate entry to the medical career; that is, a four-year integrated course, following the award of a BA or BSc in any previous subject.

TRAINING IN OBSTETRICS AND GYNAECOLOGY
After your degree
Once you have your medical degree, you must register as a medical practitioner with the GMC before you can undertake direct patient care. There are three forms of registration:
• provisional registration – when you have an acceptable undergraduate degree but have not completed a preregistration year that complies with GMC requirements
• limited registration – doctors who have obtained their medical degree from a country outside the European Union (EU) are eligible for limited registration.
• full registration – when you have completed a preregistration year that complies with GMC requirements. If you are an EU national with qualifications from your own country or from another EU state, you can get reciprocal full registration when you have completed satisfactorily one year of limited registration.
Once you are fully registered with the GMC, you must undertake at least another seven to nine years’ training to become an obstetrician and gynaecologist. In the future, the first year will be called the Foundation Year and will expose you to all aspects of medicine while you develop generic skills. It is further expected that the basic specialty training programmes will be time-limited (probably two years) and, during this time, it would be possible to transfer to another specialty if your first choice does not prove to be appropriate.
• You must spend at least two years (one year of which must be in obstetrics and gynaecology) as an SHO in a hospital.
• You will need to get several SHO posts (some preregistration house jobs are for six months but, increasingly, some are just four months long); they may include a stint in general practice.
• You must spend five years as an SpR, the first three years in core training followed by two years in advanced training.
• You must take an elective year complementary to your training in obstetrics and gynaecology during your time as an SHO or SpR.
• Following the completion of core training, you can, if you wish, undertake further training in a special skill or subspecialty.
Finally, when you have successfully completed the training programme you will obtain your Certificate of completion of Specialist Training (CCST), which allows you to apply for a substantive consultant post in the NHS.

Under new proposals, it is not necessary for you to start in obstetrics and gynaecology as soon as you are fully registered with the GMC, although many people do. As already indicated, it is possible to transfer from one specialty to another during the basic programme. You may, for example, decide to do some training in general practice, or even work abroad for a time, and this would be counted as your elective year. Such choices will certainly not be held against you and a broad base to your training tends to be an advantage. It is probably best that such choices are made in the SHO grade and can fit in with your elective year.

Table .1: The Training Process

Time period Training undertaken
SHO 1–2 years obstetrics and gynaecology One year elective
Complete basic logbook
Part 1 MRCOG
SpR years 1–3 Finish core training logbook
Part 2 MRCOG
SpR years 4–5 Either:
General obstetrics and gynaecology
or
Two years’ subspecialty training in general obstetric and gynaecology
Two years’ subspecialty with special skills
One year’s research

CCST
Subspecialty training: 2–3 years after SpR year 3 Gynaecological oncology
Maternal and fetal medicine
Reproductive medicine
Sexual and reproductive health
Urogynaecology
Special skills training: SpR years 4–5 Skills such as urodynamics, menopause, assisted conception (full list available from the RCOG)
Specialty Training Certificate can be obtained for:
RCOG/RCR Diploma in Obstetric Ultrasound
British Colposcopy Society Certificate
Senior house officer
These posts are advertised by individual hospitals in the career supplement of the British Medical Journal and on the journal’s website bmjcareers.com

At present, you must spend at least two years as a SHO; one year must be in obstetrics and gynaecology. Most people find that they have to spend two years in obstetrics and gynaecology before they can move on to a post as a specialist registrar.

During your time as an SHO you must take Part 1 of the Membership Examination of the Royal College of Obstetricians and Gynaecologists (the MRCOG). You can take it in a number of countries around the world.

During your time as an SHO you will keep a basic logbook and be regularly assessed.
Specialist registrar (SpR)
Before you apply for an SpR post you must have:
• been registered with the GMC for two years
• spent at least one of those years doing obstetrics and gynaecology
• passed Part 1 of the MRCOG
• completed the basic logbook.
You will need to plan and think carefully about your path in the years leading up to your application in order to make the most of your chances of being accepted. Under current proposals for reforms to the SHO grade, the time you can spend in it will be no more than three years. If you have not obtained an SpR post by then, you will have to move to another specialty or into a non-training-grade post.

SpR posts are advertised twice yearly by the regional deaneries in the careers supplement of the British Medical Journal. If you are appointed to a deanery during the next five years, you will move around within that region. While you may have some say in which hospitals you go to, in general it is up to the training committee of the appropriate deanery.

Each year there are a limited number of SpR posts in obstetrics and gynaecology for training towards a CCST. In recent years, it has been fixed at two or three per region (there are currently 22 regions in the UK), which has resulted in a shortage of further CCST holders, so that the number will increase over the next few years, which makes obstetrics and gynaecology an expanding specialty with good prospects for training.

By the end of year 3 as an SpR, you will need to have:
• fulfilled the core logbook criteria;
• taken Part 2 of the MRCOG examination.
There are a number of training options open to you for your fourth and fifth years as an SpR. These may vary from region to region. You could, for example:
• apply in open competition for subspecialty training in one of the five subspecialties
• work in general obstetrics and gynaecology with a special skills interest (though not all of them may be available in your region
• work in general obstetrics and gynaecology.
At the end of your fifth year as an SpR, provided that you have passed all your annual assessments satisfactorily, you will be awarded a CCST. You will then go on the Specialist Register and you will be eligible to apply for a post as a consultant.
Elective year
The elective year is a year when you concentrate on some aspect of medicine other than obstetrics and gynaecology, such as:
• a surgical specialty
• a medical specialty, such as the management of endocrine problems, for example.
There are no strict rules on what you should do in your elective year. The general view is that the broader the base to a doctor’s training before specialising in obstetrics, the better. Whatever you choose for your elective year, it should equip you with skills that you can also use in obstetrics and gynaecology.
Subspecialty training
You also have the option of training in a special skill or subspecialty. You can train in a subspecialty any time after you have completed year three of your SpR training, completed the core logbook and passed Part 2 of the MRCOG examination, or you can do subspecialty training before or after you get your CCST.

Subspecialty training covers five disciplines and lasts for three years: two years’ clinical experience and one year of research. If you have already held a research post, however, that may count as your research year.

Posts in subspecialty training are advertised in the British Medical Journal. The RCOG has a worldwide list of recognised hospitals for subspecialty training (see Appendix 1).

Your training programme is laid down by the subspecialty concerned and you will be assessed annually, mid-term and at the end of the training. You will probably undertake some on-call work in general obstetrics and gynaecology during this training.
Special skills training
In October 2002, the RCOG launched six special skills modules as part of general training for SpRs in years four and five. A skill module consists of 50–100 sessions spread over one to two years. The training will be organised by your deanery specialist training committee. You may not be able to follow the special skill you wish, but your preferences will be taken into account by the committee when they interview you in year three of your SpR post.

Special skills include:
• assisted reproduction
• menopause
• urodynamics
• maternal medicine
• management of infertile couples
• ultrasound imaging in the management of gynaecological conditions
• Labour ward leadership.
Special skills training should be flexible enough to allow you to acquire additional skills that will help you in your future career as a consultant.

Courses you could take include:
• a colposcopy training programme ending in a certificate of competence
• the RCR/RCOG Diploma in Obstetric Ultrasound
• external courses in medical education
• an MBA.
Flexible training
If you wish to work part-time, you may do so through flexible training posts funded by your regional postgraduate dean or by job-sharing. The RCOG strongly supports the concept of flexible training, although, at present, special arrangements must be made on an individual basis. Approximately 20% of trainees use flexible training schemes. You can still take up a full-time appointment later on or stay in part-time appointments, either as a consultant, associate specialist or staff grade.

Job-sharing posts are arranged by individual trusts or departments. The RCOG has an adviser on flexible training who can give you more information; please contact the Postgraduate Training Department at the College.

AFTER YOU HAVE QUALIFIED
Academic careers
Academic obstetrics and gynaecology is responsible for the medicine of the future by organising training and performing research. Departments of obstetrics and gynaecology may be independent or integrated into larger units. All work closely with their NHS counterparts. Career paths in academic medicine are now clearly defined in collaboration with clinical colleagues. To progress to a senior position in an academic department you will need to undertake an academic clinical career path involving a first period of research training leading to a higher degree such as PhD or MD. This may be taken as an undergraduate in an MB or PhD programme. A second period of research experience will be needed to obtain a senior position and may occur after completion of the CCST.
Research
Research is the basis on which modern medicine is practiced. This may be through basic research, which identifies the causes of disease, clinical research, which deals with the disease process, or health services research, which deals with the provision of care. Research may be undertaken in a laboratory setting or as part of a clinical research team.
Obstetrics and gynaecology for general practice
General practitioners increasingly take on responsibility for particular areas of medical practice in which they have specialist knowledge within their health centres. This may well include obstetrics and gynaecology. A GP’s role may be on the basis of:
• shared care where the GP is responsible for antenatal care in conjunction with the hospital consultant
• full obstetric care, where the GP is also responsible for the delivery of the mother, either at home or in hospital
• shared care where the GP and a midwife are responsible for the care of the pregnant woman.
If you have a particular interest in obstetrics and gynaecology and are in, or are going into general practice, your training will be arranged around your particular needs. You should take the Diploma of the Royal College of Obstetrics and Gynaecology (DRCOG), once you are fully registered with the GMC or by the Medical College of Ireland. Candidates for the Diploma must complete a recognised combined appointment for six consecutive months. It is not essential to complete this training by the time of the examination. However, successful candidates will be required to produce a certificate confirming the completion of six months’ recognised training at the time of applying for registration as a Diplomate of the College.

In special circumstances, part-time clinical training in recognised posts is permitted provided approval of the College is obtained in advance.
Hospital practice
Most hospitals have a team of consultants who are responsible for providing obstetric or gynaecological care to the people who use their services. They train other doctors, who together undertake antenatal and gynaecological clinics, ward rounds, operating and emergency cover of the delivery suite. Routine managerial responsibilities for the delivery suite is the responsibility of the lead consultant in obstetrics with the clinical midwife or manager. Emergencies may arise at any time and so 24-hour cover is necessary. These emergencies are dealt with by the on-call team resident within the hospital; senior help is always available.

The number of doctors available at any one time will depend on the workload of the unit. In general, it is based on the delivery rate. The RCOG recommends that there should be a minimum of one consultant on the labour ward on weekdays between 9am and 5pm and a consultant on call within 30 minutes of the hospital at other times. The hospital should have a resident SpR capable of performing caesarean sections and at least one other doctor for units with a delivery rate of more than 2000. This may need to be increased as the delivery rate goes up.

Major centres undertaking teaching and research will contain multiple teams of interdisciplinary specialists and provide an exciting environment in which to practice your specialty.
Hospital working hours
The European Union working time directive (which, among other things, states that all workers must have at least 11 hours of uninterrupted rest in every 24 hours) and consequent reduction in junior doctors’ hours has meant that the old system of consultant, registrar and houseman has disappeared from many hospitals. Nowadays, you may find one SpR to every one or two consultants or a number of consultants but no SpRs. The 56-hour week will require the introduction of shift patterns. The reduction of junior hours to 48 hours per week in 2010 will mean that much out-of-hours work will be done by non-training-grade doctors (i.e. either staff grades or consultants). The number of posts will therefore have to increase significantly to cope with the workload. We will see considerable changes over the next few years in the working practice of all grades in obstetrics and gynaecology.
Career appointments
Consultants
Consultants are appointed through open competition. Between 1992 and 2002, the number of consultant posts available each year ranged between 35 and 112. In the United Kingdom, an average of 35 consultants retire each year. To be able to apply you should:
• have obtained a CCST or equivalent
• be fully registered with the GMC
• be on the specialist register.
If you are a non-EEC national you will need a work permit from the Home Office.

Academic staff will have honorary consultant appointments with the NHS trust but their primary appointment is with the university.
Staff Grade
Non-training staff-grade posts are frequently combined with the SpR on-call rota in hospitals; they are limited to a 48-hour week. This grade is open to doctors who are fully registered but who do not have a CCST. Those applying for these posts need to have completed a minimum of four years in obstetrics and gynaecology and have obtained the MRCOG. Application is by open competition.

Non-EEC nationals will need a work permit from the Home Office.
Continuing professional development
To maintain your registration as a doctor with the GMC, and for revalidation of current hospital practice, you must take continuing professional development (CPD) courses. Programmes available include:
StragOG StratOG is the major new distance learning programme from the College designed to provide support for trainees in their specialist training and support for trainers in the development of regional training programmes.
LOGIC Learning in Obstetrics and Gynaecology for In-Service Clinicians. Trainees can use LOGIC on the Web as a self-assessment tool.
DIALOG Distance interactive learning in Obstetrics and Gynaecology. A system of self-evaluation with instant interactive feedback.
TOG The Obstetrician & Gynaecologist (TOG) journal, published by the College, contains review articles written by senior members of the profession. It includes true/false questions for each review, which can be submitted for marking by the CPD Office at the College. This can be done in print or online.
The RCOG runs training programmes for trainees and consultants. Trainees can take courses in:
• basic surgical skills
• Parts 1 and 2 of the MRCOG
• Objective Structured Clinical Examination (OSCE) skills.
The College runs seminars on essay practice two or three times a year.

Qualified doctors can take courses leading to:
• the Diploma in Colposcopy
• the Diploma in Obstetric Ultrasound RCR/RCOG
• Special Skills qualifications.
The RCOG holds regular symposia throughout the year on specific topics. There are annual training weeks for SpRs and for consultants, all of which count towards CPD.

THE ROYAL COLLEGE OF OBSTETRICIANS AND GYNAECOLOGISTS
About the RCOG
The mission statement of the Royal College of Obstetricians and Gynaecologists is:
• Setting standards to improve women’s health.

The main objectives of the College are:
• to provide a common standard to all obstetricians and gynaecologists
• to maintain the unity of obstetrics and gynaecology as one specialty
• to establish training programmes and ensure adequate facilities for teaching and examining students
• to be a representative body for all obstetricians and gynaecologists
• to improve the health of women and their babies by promoting research in obstetrics and gynaecology.
The RCOG is responsible for setting standards for postgraduate training in the UK and in many countries around the world. It provides guidance to the postgraduate deans of the British Postgraduate Medical Federation (BPMF) about the educational requirements of trainees, for whom both the RCOG and the BPMF have responsibility. The College also provides the professions with advice to the Government on matters relating to obstetrics and gynaecology.

There are approximately 11,000 Fellows and Members of the RCOG, of whom just over half are based outside the UK. The College is the examining board for the Diploma (DRCOG) and Membership (MRCOG) examinations. About 12 years after doctors have taken the MRCOG, they become eligible for election to a Fellowship (FRCOG).

The College is governed by an elected Council, which is made up of:
• five honorary Officers
• Fellows and Members elected on a regional basis
• invited members; e.g. Chairman of the College’s Consumers’ Forum
• co-opted members from the UK and the Republic of Ireland.
The RCOG seeks advice from many sources but particularly values that of its Fellows and Members. It canvasses their opinion through a network of committees that review aspects of training, resources, examinations and planning. A number of joint committees have been set up between the RCOG, other Royal Colleges and public bodies.
College facilities
The College’s many facilities include:
• RCOG Bookshop, which offer a comprehensive range of books, videos and CD-ROMs on obstetrics, gynaecology and related topics to Fellows, Members and registered trainees (who all receive a 25% discount on all RCOG publications) and others; the Bookshop also offers online sales.
• an extensive library with electronic information resources
• an education centre, which houses a lecture theatre and training rooms, a basic surgical skills training laboratory and training modules for minimal access surgery
• the Nuffield Hall, which is used for lectures, admission ceremonies, examinations and College dinners
• the President’s House, where Fellows and Members may stay when in London.
Setting clinical standards
There is a long tradition in obstetrics and gynaecology of using scientific evidence to set standards for clinical practice. This process is aimed at improving standards of care. The RCOG’s Guidelines and Audit Committee develops clinical guidelines covering key areas of obstetrics and gynaecology. These provide standards that enable fellows and members to audit their own practice. The College’s ‘Green-top’ guidelines on best practice are published periodically, with information sheets for both the doctor and the patient regularly produced on current topics in obstetrics and gynaecology.

Fellows and Members of the College have also worked closely with the Confidential Enquiries into Maternal Deaths (CEMD, first established in 1953, and the first of its kind in the world) and the Confidential Enquiry into Stillbirths and Death in Infancy (CESDI). The CEMD report Why Mothers Die 1997–1999 was published by RCOG Press. The new Confidential Enquiry into Maternal and Child Health (CEMACH) will now be based at the RCOG.

The College is a lead consortium member of the National Collaborating Centre for Women’s and Children’s Health, which is part of NICE (the National Institute for Clinical Excellence) and also based at the College.
RCOG Trainees’ Register
Once trainees have passed the Part 1 MRCOG, they are entitled to join the Trainees’ Register. Upon joining the Register, trainees will receive the quarterly mailings of the College. These mailings include:
• The Obstetrician & Gynaecologist journal (print version)
• RCOG News, a quarterly newsletter, which includes:
– changes that may occur in the MRCOG examination regulations
– news and updates about issues affecting training
– a calendar of obstetric and gynaecological meetings and courses
– details of available research grants
– items of scientific interest
– College news
• RCOG Green-top Guidelines, Statements, Clinical Governance Advice, SAC Opinion Papers
• RCOG Working Party reports.

Registered trainees also have full online access to The Obstetrician & Gynaecologist journal, and to a dedicated secure area of the College website for Trainees.

Registered trainees are also be entitled to a 25% discount on all RCOG publications purchased through the RCOG Bookshop, either in person or by mail order, or via the Online Bookshop.

There is an annual (SPROG) Conference for trainees, supported by RCOG, held in different cities around the UK annually.
RCOG Trainees’ Committee
The RCOG Trainees’ Committee aims to encourage two-way communication between the College and trainees from the beginning of their training. If you subscribe to the Trainees’ Register, you will be kept informed automatically of this Committee’s activities. You will be entitled to vote for your Regional Representative, who sits on the National Trainees’ Committee and should be kept informed about meetings at a local level by your Regional Committee.
College Deanery Advisers
The RCOG has a College Deanery Adviser (elected by Fellows and Members) for each regional deanery in the UK. These advisers work in conjunction with the postgraduate dean. Deanery College Advisers play a pivotal role in providing an interface between the RCOG and the workplace.
Overseas trainees
There are now overseas boards that have agreements with the RCOG regarding exemption from the Part 1 MRCOG examination. See Membership Examination Regulations. The Royal Australian and New Zealand College of Obstetrics and Gynaecologists training is recognised as equivalent to the British CCST training. The Hong Kong six-year training programme in obstetrics and gynaecology has also been recognised as equivalent training for CCST. Many other countries stay in regular contact with the College through their own reference committees. If you are a trainee from outside the UK, please contact the RCOG Examinations Department or Careers Adviser for more information on your specific needs.

The College runs an Overseas Doctors Training Fellowship Scheme enabling young obstetricians and gynaecologists to come to the UK for part of their training – see the College website for further details.
Mentoring
The College runs a mentoring scheme for Fellows and Members in obstetrics and gynaecology as well as an academic career mentoring scheme.
Publications
There are many specialist journals published in the UK. RCOG publications include:
• BJOG: An International Journal of Obstetrics and Gynaecology – this monthly journal includes original articles and research topics, case reports and details of forthcoming meetings
• The Obstetrician and Gynaecologist – this quarterly College journal presents reviews and educational topics as part of the College’s commitment to continuing professional development, in line with General Medical Council requirements
• Regular newsletters and bulletins on forthcoming meetings – displayed in every department of obstetrics and gynaecology.
The College also produces guidelines and patient information on best practices. RCOG publishes books aimed at trainees, among its wide range of titles in obstetrics and gynaecology produced under the RCOG Press imprint.
Faculty of Family Planning and Reproductive Health Care
The Faculty was set up in 1993 in order to give academic status to the discipline of family planning and reproductive health care and to recognise the expertise within it. Its aim is to maintain and develop standards of care and training.

The Faculty grants diplomas, certificates and equivalent recognition of specialist knowledge and skills in family planning and reproductive health care. It also promotes conferences and lectures, provides members with an advisory service and publishes The Journal of Family Planning and Reproductive Health Care.

The Faculty was established by the RCOG, the National Association of Family Planning Doctors and the Joint Committee on Contraception. It represents the interests of those working in this discipline at national and international level and has over 10,000 members from a wide variety of backgrounds. It has its own website: www.ffprhc.org.uk.
European links
Members of the RCOG are encouraged to join the European Board and College of Obstetrics and Gynaecology (EBCOG). EBCOG aims to facilitate the development of Europe-wide standards for obstetrics and gynaecology and to establish qualifications recognised by all member states. The European College aims to develop in parallel with national organisations, offering mutual support. Its website address is: www.ebcog.org.

APPENDIX 1: RCOG APPROVED SUBSPECIALTY CENTRES
Centres are usually recognised for a six-year period. In addition all training programmes are approved on an individual basis.
Gynaecological oncology
Aberdeen Royal Infirmary
Birmingham and Midland Hospital for Women
Edinburgh Royal Infirmary
Groote Schur Hospital, Cape Town, South Africa
Guy’s and St Thomas’ Hospital, London
Hammersmith and the Samaritan Hospitals, London
Leeds Teaching Hospital
Leicester Royal Infirmary
Liverpool Women’s Hospital
Hallamshire Hospital, Sheffield.
Portsmouth/Southampton
St Michael’s Hospital, Bristol, Royal United
Hospitals, Bath
Stobhill Hospital, Beaston Oncology Centre, Glasgow
St Bartholomew’s, London
Toronto University
University Hospital of Wales
Addenbrookes Hospital, Cambridge
Queen Mary’s Hospital, Hong Kong
Royal Hospital for Women, Sydney
St Mary’s Hospital, Manchester
Queen Elizabeth Hospital, Gateshead
Klinkum der Friedrich Schiller Universitat, Jena, Germany
Queens Medical Centre and City Hospital, Nottingham
Maternal and fetal medicine
Aberdeen Maternity Hospital
Birmingham Women’s Hospital
City University Hospitals, Nottingham
Guy’s and Thomas’ Hospital, London
Homerton Hospital, London
King’s College Hospital, London
Leicester Royal/General
Liverpool Women’s Hospital
Ottawa General Hospital
Royal Infirmary, Newcastle
Queen Charlottes Maternity Hospital/Chelsea Hospital for Women, London
Hammersmith Hospital, London
Princess Royal Maternity/Queen Mothers Hospital, Glasgow
Royal Maternity Hospital, Belfast
St Mary’s Hospital, Manchester
St Michael’s Hospital, Bristol
The John Radcliffe Hospital, Oxford
The Princess Anne hospital, Southampton
UCL, London
Centre for Reproductive Biology, Edinburgh
University of Toronto
University Hospital of Wales
Leeds Teaching Hospitals
St George’s Hospital Medial School
St Mary’s Hospital, Hong Kong
St Mary’s and King’s College Hospitals, London
Reproductive medicine
Aberdeen Royal Infirmary
Birmingham Women’s Hospital
Rosie Maternity Hospital, Cambridge
Chelsea, Westminster and Lister Hospital, London
Guy’s and St Thomas’ Hospital, London
St Mary’s and Hammersmith Hospital, London
Jessop Hospital for Women, Sheffield
Liverpool Women’s Hospital
Manchester University
McGill University, Montreal/Royal Victoria Hospital
Monash University, Melbourne
Queen Mary’s Hospital, Hong Kong
Rotunda hospital, Dublin
St Michael’s Hospital, Bristol
Princess Royal Maternity Hospital, Glasgow
Royal Maternity Hospital, Belfast
Royal Victoria Infirmary
Royal Infirmary, Edinburgh
Leeds Teaching Hospitals
The John Radcliffe Hospital, Oxford
The Princess Anne Hospital, Southampton
The Royal London Hospital, Whitechapel
UCL, London
University Hospital of Wales
Sexual and reproductive health
Birmingham Women’s Hospital
Central Health Centre, Bristol
Lothian PCT, Family Planning and Well Women
Grampian Health Centre NHS Trust, Aberdeen
Sandyford Initiative, Glasgow
Palatine Centre, Manchester
St Giles Optimum Healthcare NHS Trust, London
St Mary’s Hospital, Portsmouth
Centre Abacus Centre, Liverpool
Margaret Pyke Centre, London
Royal Victoria Infirmary, Newcastle
Urogynaecology
St George’s Hospital, London
King’s College Hospital, London
Plymouth/Bristol/Cheltenham
Liverpool Women’s Hospitals
Royal Victoria Infirmary, Newcastle
UCL, London
Leicester General Hospital

For a up-to-date list of recognised subspecialty centres, please contact Bettina Muller on
+44 (0)20 7772 6203 or bmuller@rcog.org.uk.

There are several hospitals that offer training in special skills towards recognised diplomas, e.g. accreditation in colposcopy and the RCOG/RCR Diploma in Obstetric Ultrasound. A list of hospitals can be obtained from the RCOG.

APPENDIX 2: RCOG TRAINING COURSES
Training courses run by the Royal College of Obstetricians and Gynaecologists include:
• Basic Surgical Skills
• RCOG/Ethicon Advanced Surgical Skills
• Obstetric Ultrasound
• Colposcopy Course
• Labour Ward Management
• Understanding Clinical Research Methods
Revision courses:
• Part 1 MRCOG Course
• Part 2 MRCOG Course
• Objective Structured Clinical Examination (OSCE)

APPENDIX 3: RCOG EXAMINATIONS
Diploma in Obstetrics (DRCOG)
This is primarily for doctors who wish to go into general practice and who are fully registered as medical practitioners with the General Medical Council or the Medical Council of Ireland.

Evidence of having completed six months of recognised combined training is only required from successful candidates who wish to register as a Diplomate of the College.

Membership Examination (MRCOG)
Part 1
You may take the Part 1 examination at any time after you are fully registered. You must have passed it in order to be eligible for appointment to a specialist training grade post. It is a multiple-choice paper divided into sections on:
• anatomy
• embryology
• statistics and epidemiology
• endocrinology
• microbiology
• immunology
• pharmacology
• physiology
• pathology
• genetics
• biochemistry
• biophysics
Part 2
You will have to pass the Part 2 examination by the end of year 3 as an SpR. The written component consists of a multiple-choice paper followed by ten short essay questions.

You must score a specific minimum mark in the written papers to be able to progress to the clinical examination. The pass mark for the written papers will vary from year to year depending upon the degree of difficulty of the questions, as the College exams are criteria-based examinations set to maintain a standard and not a pass rate.

The clinical examination takes the form of the objective structured clinical examination (OSCE) with 10–12 stations that are set to test the candidates’ communication skills as well as their ability to treat and manage specific clinical problems.

The pass mark is a total of the written papers and the OSCE. The examination is held twice a year.

Further information on all these examinations can be obtained from the RCOG Examination Department or from the College website.