This page provides an introduction to O&G, including what a career in O&G has to offer and an overview of how the specialty has evolved over time.
What does a career in O&G offer?
A career in obstetrics and gynaecology (O&G) can encompass a wide variety of different areas of medicine, making the specialty one of the most diverse areas of practice. O&G is often described as a mixture of medicine and surgery, and this is a major attraction for many doctors. If you choose a career in O&G, you’ll be able to develop a wide range of interests and skills, whether performing cutting-edge surgery or solving complicated therapeutic problems. The common link is women’s health – before, during and after the reproductive years – although, of course, O&G work also includes women’s partners and children.
Where you go in O&G will depend on your interests and abilities. After 5 years of training, you can choose which advanced skills you want to develop, or decide to undertake subspecialty training; alternatively, you may wish to pursue academic training. As a consultant, you could work across a range of clinical areas or choose to work purely in one field, such as maternal and fetal medicine, ultrasound or oncological (cancer) surgery.
Whatever you decide to do, a career in O&G will be flexible, exciting and rewarding; at times demanding and stressful, but always varied and challenging.
An evolving specialty
There has been significant progress in the care of women since the RCOG was founded in 1929. This has been achieved by close collaboration with other professionals, especially midwives, anaesthetists, paediatricians, radiologists and radiographers, physiotherapists, genitourinary physicians, surgeons, healthcare workers, scientists and technicians. The achievements have been so great that women now have high expectations for their care. Some of the key developments are listed below.
Pregnancy and birth
In the past, diagnosing and treating pregnancy problems was difficult and pregnancy outcome couldn’t be altered. The 20th century saw the introduction of pre-pregnancy preparation, prenatal diagnostic techniques, routine antenatal care and fetal monitoring in labour; there have also been enormous improvements in paediatric and neonatal care. This has resulted in a dramatic reduction in death rates of both mothers and their babies in the UK. Developments such as immigration, obesity and assisted reproduction provide an ever-changing spectrum of women to care for.
Fertility treatment was revolutionised in 1978, when the first successful in vitro fertilisation (IVF) baby was born in the UK. Since then, more than 1 million IVF babies have been born worldwide. Reproductive technology continues to advance:
- New techniques continue to be developed, such as intracytoplasmic sperm injection (ICSI), where a single sperm is used to fertilise 1 egg
- Preimplantation genetic diagnosis enables couples known to be at increased risk of specific conditions to screen their embryos and thereby maximise their chances of having a healthy baby
Ultrasound and other imaging techniques
Ultrasound and body imaging play an increasingly important role in O&G. High-quality images allow doctors to measure and identify structures precisely. Ultrasound is used:
- To assess organs precisely, improving the accuracy of diagnoses
- To assess the developing fetus, placenta and blood flow during pregnancy
- As a diagnostic tool for many gynaecological conditions, including cancer screening, fertility and urogynaecology
The recent development of 3D and 4D imaging is providing even more detail for the identification of many pathological conditions.
Minimally invasive surgery
Minimally invasive surgical techniques rely in small-diameter viewing instruments and high-intensity light sources, which allow surgeons 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. This ‘keyhole’ surgery is transforming many gynaecological operations into ones with small incisions and a short hospital stay.
Molecular genetics holds the key to many of the problems that need solving in gynaecology, including cancer and perinatal medicine. Stem cell research is an exciting part of the research being conducted by clinicians and scientists working together to provide new solutions.
Preventive medicine – identifying and treating potential problems at an early stage and stopping their development – is on the increase in all areas of medicine. In O&G, there are many well-established examples of how preventive medicine can make a difference to people’s lives:
Cervical cytology (the smear test)
This is the most effective way of population screening for changes that could indicate cancer of the cervix and has provided a model for many other screening tests. The cervical screening programme has directly led to a dramatic fall in death rates from cervical cancer.
New, more user-friendly techniques are being developed to allow couples to control their fertility safely. This increased choice plays a part in stabilising population numbers and protecting women from the health consequences of frequent pregnancies.
Care before pregnancy improves the prospects of giving birth to a healthy baby. Significant successes in this area include rubella screening and immunisation to reduce the risk of congenital anomalies in the fetus, and the use of folic acid to reduce neural tube defects. Preconception diabetes clinics help women to maintain strict blood glucose control periconceptually, reducing the risks of diabetes to both mother and baby during pregnancy.
Hormone replacement therapy (HRT)
HRT reduces menopausal symptoms and helps to prevent osteoporosis in postmenopausal women. The debate about the use of HRT is an exciting and controversial area of the specialty.
Find out more about a career in O&G
The O&G careers prospectus also includes:
- The medical student experience of O&G
- Foundation training
- Specialty training in O&G
- Research and academic training
- Assessment and exams
- How the RCOG supports and works with trainees
- Working life in O&G
- Personal profiles of O&G doctors