Marion EkMD, PhD Specialist in Obstetrics and Gynaecology Director of Studies at Södersjukhuset in Stockholm

Ida BergmanMDTrainee in Obstetrics and Gynaecology at Södersjukhuset in StockholmBoardmember of OGU – the Swedish national society for young gynaecologists and obstetriciansBoardmember of NFYOG

The traineeprogram in Gynaecology and ObstetricsSuperviced by the National Board of Health

and Welfare

The National Board of Health and Welfare (Socialstyrelsen) is a government agency in Sweden under the Ministry of Health and Social Affairs

Uppdated and more strict regulations where published sept 2008

Description of goalsContains 21 milestones of which each must be

fullfilled The trainee collects written proof of his/her

achievements

Medical competence 1-12 specific for ob/gynCommunication skills 13-15Leadership skills 16-18 commonExpertise in medical science

and qualitywork 19-21

Milestone 1: To be abel to master normal pregnancy, delivery and puerperium

Learningmethods Follow-upClinical work under

supervision

Course

Certificate of approved clinical duties and skills acquired (issued by the current tutor)

Course certificate

Checklist for milestone 1 -knowledge Describe conception and implantation Describe early embryonal development Describe the physiology of the placenta Describe the development avd physiology of the featus Compare the physiology of non-pregnant and pregnant woman Describe the cause of the common pregnancy disorders Identify patients who should be recommended genetic counseling Describe the pros and cons considering vaginal delivery versus c-

section Describe and understand the principals of normal delivery Describe the pelvic anatomy Compare and evaluate different methods in obstetrical analgesia Describe the physiology in normal puerperium Analyze the cause of mastitis/breast abscess Explain the principals of the maternitycareprogram in Sweden

Checklist for milestone 1 - skills Identify a riskpregnancy and refer to right unit Treat hyperemesis Treat and give advice to women with normal pregnancydisorders Preform Leopold´s maneuvers and evaluate the findings Evaluate Bishop-score Basic obstetrical ultrasound – position of the featus, identify multiple

pregnancy, cardiac activity, position of the placenta, amount of amniotic fluid

Analyze CTG Evaluate progression of the labour Interpret the partogram Identify rupture of membranes Preform amniotomy Preform episiotomy Proper management of premature rupture of membranes Preform fetal scalpblood testing Evaluate if a woman is in labour Suture perineal tear I-II etc

The scientific workThe trainee gets 10 weeks to do a scientific

workIncludes a course in research methodologyThe tutor must have a PhD

Positive aspects

It is good to have national milestones so that every trainee knows what he/she needs to manage after 5 years of trainee-program

We get the chance to do a scientific work and get more experience that field

Positive aspects

CoursesThe trainee gets an opportunity to attend two

courses per year2-4 daysfinanced by the home clinicgives the trainees opportunity to meet and

networkprovides a better theoretical base for the

trainee

Positive aspects

We have well functioning national societies SFOG (national society in gynaecology and obstetrics) and OGU (the national society for the young obstetricians and gynaecologists) that organizes courses, meetings and provides national guidlines

ChallangesBig problems with getting structured surgical

training

There are many expanding private clinics which do more and more of the benign surgery --› less for the trainees in the hospitals

We lack good tools for evaluation / structured feedback

Challanges

Many trainees have problems with getting all the courses done

There are big differences between big and small hospitals

How can we make it better?

Improve our surgical trainingOngoing campaign “pass the knife on”

Every operation should be an opportunity for the trainee to learn

The tutor and the trainee should be more prepared Structured feedback

Drivers licenseWe think there should be some standard

courses that comes before practical training The trainee gets a drivers license Ex laparoscopy, colposcopy, ultrasound, ctg Increases patient safety

EvaluationMandatory sit-ins

Mandatory exam

More structured feedback

Divide the training into half in a smaller county hospital and half in a bigger university hospital

University hospital Rare patientcases Tutor medical students Bigger patientvolumes Expert knowlegde

County hospital More responsibility Smaller groups -› the tutors have a closer eye on the

trainee

Is 5 years enough?Longer periods in surgery sidetraining?

More time to do the scientific work?