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Specialist training in OB-GYN; the future
European Journal of Obstetrics & Gynecology and Reproductive Biology 97 (2001) 4
Editorial
Specialist training in OB-GYN; the future Training OB-GYN residents must take account of changing patient and staff attitudes, medical developments, and new systems of health care. Tomorrow's patients are better informed, may have consulted Internet sites, and often come for discussion rather than advice. They want to see the specialist, not the trainee. They ask for time, as well as respect, and empathy. However, many young doctors have different opinions to established ones on the ideal balance between work and family life. They want to work for shorter periods, earn enough money, be seldom on-call, and many prefer to work part-time. Most residents will be female, and will want time for pregnancies and for parenthood and some of their male colleagues share this latter wish. Many organisational changes are already happening. Specialists are working in larger groups, working 4-day weeks, on-call once a week and sometimes splitting the weekends. Many meetings, including post graduate teaching are held of®ce hours. As a result changes are necessary. Every member of a group must be able to deal with the core of the speciality alone, especially when on-call. This means that no one any longer practices the whole speciality. Some members of a group will offer one subspecialty and others a different one. I think this will improve the quality of care. It will be normal to refer patients to other members of the specialist team. The obvious consequence for training is that we should no longer aim to teach our residents everything. For a basic specialist, basic training will do. We should consider shortening this training while improving its quality. By preventing repetitive case handling during residency, limiting on-call hours, using the of®ce hours better to teach applying more structured training and using skills-labs, we can raise the quality of training and complete it in less time, perhaps in 4 clinical years. A total training period of 5 years might include 1 year of research. This is essential to enable
specialists to understand and critically evaluate future developments. We must create a learning atmosphere, and make the manpower issue a secondary problem. Clearly de®ned end-points or goals of the training, subdivided for each year and even for every season, will enable both the trainee and trainers check progress and correct de®ciencies. At least 10% of the training time should be used for structured training and skills-labs. We prefer the idea of a whole day devoted to these activities every 2 weeks. Of course such structured training should be based on modern learning concepts such as problem steered, self-learning and evidence based medicine. The content should include psychology (how to deal with oneself and how to deal with dif®cult patients), critical appraisal of the literature, epidemiology, ethics, law and management and how to work in a team. At most 20% of the training time, say 25 working days per year, should be devoted to on-call duties, as a learning process. Of course people will ask who will do the normal job? The answer must be that we need more specialists, nurse practitioners and clinical midwives. The public will understand these changes well, and the government and health care bodies will have to accept them. Such changes will leave enough time for part-time training, pregnancy and parenthood. Gynaecologists especially must support the latter. It is our social responsibility to enable our future female colleagues to enjoy their training and have babies, both within a reasonable time.
0301-2115/01/$ ± see front matter # 2001 Published by Elsevier Science Ireland Ltd. PII: S 0 3 0 1 - 2 1 1 5 ( 0 1 ) 0 0 4 1 1 - 0
Otto P. Bleker Academic Medical Center, University of Amsterdam P.O. Box 22700, 1100 Amsterdam, The Netherlands Tel.: 31-20-566-3557; fax: 31-20-697-1651 E-mail address: [email protected] (O.P. Bleker) Accepted 2 May 2001
Editorial
Specialist training in OB-GYN; the future Training OB-GYN residents must take account of changing patient and staff attitudes, medical developments, and new systems of health care. Tomorrow's patients are better informed, may have consulted Internet sites, and often come for discussion rather than advice. They want to see the specialist, not the trainee. They ask for time, as well as respect, and empathy. However, many young doctors have different opinions to established ones on the ideal balance between work and family life. They want to work for shorter periods, earn enough money, be seldom on-call, and many prefer to work part-time. Most residents will be female, and will want time for pregnancies and for parenthood and some of their male colleagues share this latter wish. Many organisational changes are already happening. Specialists are working in larger groups, working 4-day weeks, on-call once a week and sometimes splitting the weekends. Many meetings, including post graduate teaching are held of®ce hours. As a result changes are necessary. Every member of a group must be able to deal with the core of the speciality alone, especially when on-call. This means that no one any longer practices the whole speciality. Some members of a group will offer one subspecialty and others a different one. I think this will improve the quality of care. It will be normal to refer patients to other members of the specialist team. The obvious consequence for training is that we should no longer aim to teach our residents everything. For a basic specialist, basic training will do. We should consider shortening this training while improving its quality. By preventing repetitive case handling during residency, limiting on-call hours, using the of®ce hours better to teach applying more structured training and using skills-labs, we can raise the quality of training and complete it in less time, perhaps in 4 clinical years. A total training period of 5 years might include 1 year of research. This is essential to enable
specialists to understand and critically evaluate future developments. We must create a learning atmosphere, and make the manpower issue a secondary problem. Clearly de®ned end-points or goals of the training, subdivided for each year and even for every season, will enable both the trainee and trainers check progress and correct de®ciencies. At least 10% of the training time should be used for structured training and skills-labs. We prefer the idea of a whole day devoted to these activities every 2 weeks. Of course such structured training should be based on modern learning concepts such as problem steered, self-learning and evidence based medicine. The content should include psychology (how to deal with oneself and how to deal with dif®cult patients), critical appraisal of the literature, epidemiology, ethics, law and management and how to work in a team. At most 20% of the training time, say 25 working days per year, should be devoted to on-call duties, as a learning process. Of course people will ask who will do the normal job? The answer must be that we need more specialists, nurse practitioners and clinical midwives. The public will understand these changes well, and the government and health care bodies will have to accept them. Such changes will leave enough time for part-time training, pregnancy and parenthood. Gynaecologists especially must support the latter. It is our social responsibility to enable our future female colleagues to enjoy their training and have babies, both within a reasonable time.
0301-2115/01/$ ± see front matter # 2001 Published by Elsevier Science Ireland Ltd. PII: S 0 3 0 1 - 2 1 1 5 ( 0 1 ) 0 0 4 1 1 - 0
Otto P. Bleker Academic Medical Center, University of Amsterdam P.O. Box 22700, 1100 Amsterdam, The Netherlands Tel.: 31-20-566-3557; fax: 31-20-697-1651 E-mail address: [email protected] (O.P. Bleker) Accepted 2 May 2001