The 19th European Network of Trainees in Obstetrics and Gynaecology (ENTOG) meeting was held in Budapest, Hungary. The title of the meeting was ‘Modern Trends and Technologies in Obstetrics and Gynaecology and Their Impact on Practice.’
The meeting was held at Semmelweis University. We all know Ignaz Philipp Semmelweis (1818 – 1865) as the Hungarian physician who famously discovered that hand washing is paramount in preventing puerperal sepsis. The Semmelweis University was founded in 1769 and it is the oldest medical school in Hungary. The University also functions as the largest health care institution in Hungary and is one of the country’s most prestigious research institutions.
Our day began with trainees from France, Italy and Greece discussing their experiences of their hospital exchange programmes. All participants had found that Hungarian doctors are working in a health care system that is suffering from lack of public funding. For example, many hospitals can not afford to provide trainees with internet access. Training in Obstetrics and Gynaecology seems to vary depending on where a trainee is placed. The five year O&G training programme occurs in one hospital only and there are no sub-specialistation programmes.
The second part of the day concentrated on subspecialty training and the requirements for entry into training programmes. The availability of sub-specialty training still varies greatly throughout Europe. Some countries such as the UK and the Netherlands have very well established subspecialty training programmes but other countries have no formal training systems or only cater for some sub-specialties.
Professor Alan Templeton gave us a very entertaining and engaging talk on the epidemiology of infertility and the EBCOG recommendations for sub-specialty training in infertility.
Dr Jurgen Piek form the Netherlands outlined the ESGO consultation guidelines for gynaecological oncology training. He also reminded everyone of the existing data that proves that Gynaecological Oncologists have improved patient survival in ovarian and cervical cancers. The aim would be to provide all women in Europe with the opportunity to access specialist cancer services.
Dr Zoltan Ban from the Semmelweiss University discussed the lack of a formal Fetomaternal Training programme in Hungary. However, the provision of ultrasound training is very well organised and trainees have the opportunity to obtain a license in ultrasound varying from Level A to C. The Hungarian Society of Ultrasound in Obstetrics and Gynaecology was established in 1992. It currently has over 1000 members that consist of Obstetricians and Gynaecologists, Radiologists, and specialist midwives.
To obtain a ‘License A’ trainee must complete 400 obstetric scans, 200 gynaecology scans and pass an oral and practical exam. To obtain a ‘License B’ a trainee must perform 5000 obstetric scans, 2000 gynaecology scans and complete a further exam and attend one course or conference a year. The obstetric scanning for this license includes 20 week anomaly scanning. A ‘Level C’ license is only held by specialists working at tertiary referral centres and includes the need to provide evidence of lecturing and scientific activity in ultrasound scanning.
There are currently 80 license holders in Hungary. In addition, although a formal training programme in FMM is not provided there is an option of completing a ‘Clinical Genetics Module’ which in spite of its name includes training in fetal diagnostic procedures including amniocentesis, CVS and fetal blood sampling as well as laboratory training and genetic counseling.
Interestingly, all women in Hungary have an NT scan and 18 week scan. Patients do not consent for the scan and the possibility of an abnormal finding is not really discussed with the women prior to the scan. This provoked a heated discussion amongst the audience and highlighted a difference in attitude to patient care in European countries.
The ENTOG executive committee then presented the results of a survey looking into implementation of the EWTD across Europe. The results of the survey should appear on the ENTOG website in due course. Overall 43% of respondent countries are not compliant with the EWDT, 33% are prepared to be compliant by August 2009 and 24% are ‘partially’ prepared.
After lunch we heard a fascinating talk by Dr Jacky Nizard from France about the use of ‘E-teaching’. At the Université de Versailles there is an option for health professionals to complete an online diploma in High Risk Pregnancy Management. There are 120-130 hours of lectures available online and twice weekly online tutorials that are conducted via Skype conferencing. The final examination is also done online.
The lectures were specifically taped for the diploma. The lectures consist of the written slides with the tutors lecturing in real time. This posed several challenges as, to make the lectures interesting the lecturers had to be taped providing the lecture rather than pretending to lecture. The initial plan was to provide a film of the lecture in progress but in the end the best format appeared to be one with text and audio only.
Each student opens 240 hours of lectures and tutors receive approximately 10 calls per Skype tutorial. Peak viewing times are at 6pm and 9-11pm. Initially in 2005 there were 17 students accessing the online diploma but this has now grown to 80 in 2007.
The reason this online diploma was started is that there are a large number of students who due to work commitments are unable to attend a University lecture during the day. The programme is accessed by students all over the world in French speaking nations. There are plans to implement a similar training programme in Fetal Medicine and O&G Ultrasound. The ultrasound module is posing some new challenges as this will require practical training sessions as well.
Dr Eric Hodgson from the United States provided us with and overview of training in the US. There is a drive to provide trainees with simulation based training and currently there are 9 centres in the USA that are able to provide all trainees with 2 days of simulation based training. The aim is to increase this to a total of 23 centers. There is also work being done on ‘electronic mentorship’ including a DVD ROM that aims to help trainees deal with issues such as litigation. In addition, ACOG have recently launched a video on their website with the aim of improving recruitment into the specialty.
In our final session of the day we heard from Dr Yves Van Belle who discussed methods of laparoscopic skills testing and training and showed us a video example of the laparoscopic trainer that they currently have in use. Dr Robert Poka from Hungary gave us an outline of Hungarian training. Finally, Dr Anna David from the UK presented the results of the Academic Trainees Survey that has been sent out to all ENTOG member countries. The aim of the survey was to gain more information about the state of academic training in Europe. Throughout Europe PhDs are available in all countries. Overall, there is great variation in funding, access to posts, standards and most importantly there is a lack of links between academic trainees in Europe.