Each year, the RCOG invites foundation trainees to tell us why they've chosen a career in O&G for the Why Obs and Gynae? prize.
This is a submission from Harry Gibson, an FY2 at the Royal Free Hospital.
Why obstetrics and gynaecology?
Wanted: enthusiastic, hard-working, versatile, energetic applicants for a role that tests their ability to work well under pressure, adapt quickly to fast-changing situations, work closely with clients and colleagues from all ranges of backgrounds and ages, exercise careful manual dexterity and draw on knowledge of a wide- range of problems and their solutions...
A sensational job description like this could apply to anyone doing virtually anything. Yet, put it in the context of a career in obstetrics and gynaecology and it seems even more exciting. A medical specialty that half the population, regardless of their background, age (to some extent), and prior medical history, may at some point have cause to consult. A specialty that brings together the routine of clinics and ward rounds with the unpredictability and pace of labour ward emergencies. A specialty that combines the roles of physician and surgeon. This is my answer to “why obstetrics and gynaecology”; one I aim to offer when applications to specialty training open later this year.
Choosing a career in obstetrics and gynaecology is influenced strongly by prior work experience in the specialty, both as an undergraduate and junior doctor. For me these have been formative, especially as I remember naively starting my first student placement firmly in the belief that ‘this won’t be my cup of tea’.
8 weeks as a student in a North London teaching hospital and rural DGH offered many chances to get hands on experience, despite reported concerns that male students are often denied these opportunities due to patient preference or midwife reluctance.1,2 I was struck by how welcoming and enthusiastic both the doctors, midwives and nurses were, and I managed to deliver several babies myself, as well as assist in caesarean sections and laparoscopic hysterectomies. Witnessing people truly enjoying their profession, and furthermore putting their efforts into helping others to enjoy it as well, catalysed what were loosely formed career aspirations at that time.
In the environments of inner city and small country town, I quickly realised that I was seeing as broad a range of people as I had in any other placement, despite the obvious distinction that all the patients are women. Most women have cause to visit an obstetrician or gynaecologist at some point in their lives, so a great mix of people, healthy and unwell, young and old, from different socio-economic and racial backgrounds, were coming through the door. This variety was fascinating: such a wide spectrum of potential patients demands much of a doctor’s ability to understand and be understood, as well as giving the chance to learn much about society. I saw the same doctor in one morning of antenatal work speak to a 14 year old from a nearby estate followed by a 40 year old dealing with a diagnosis of foetal chromosomal abnormality; their stories, their concerns and the doctor’s skill of approaching each appropriately, were compelling.
Due to the variable nature of a job in obstetrics and gynaecology, one’s communication skills and ability to adapt are further put to the test in situations of emergency, stress or high emotion. Only in O&G are you called to explain to a young, tired and frightened woman the risks and benefits of a forthcoming operation, even as you rush to theatre with staff and alarms buzzing frantically around you. Later in the relative calm of the clinic, you must explain the ramifications of newly diagnosed infertility, or ovarian cancer, or foetal abnormality. A different patient, with a different problem, in a different setting, every time: never the same day in this profession and always the chance to learn more about people and yourself.
I wanted to see more, so through an 8 week elective placement in O&G in rural Tanzania and 4 months in an FY1 position in women’s health I had a real chance to discover ‘why obstetrics and gynaecology’, albeit in two very contrasting settings. Even the most basic services make a huge difference in quality of life for a population, so specialists in O&G play, and will play, an essential part in any medical system wherever it may be in the world.
Working as a doctor, rather than as a student, brought a healthy perspective to all the attractions so far encountered: I could appreciate the stress and demanding nature of the work, especially in obstetrics. There were the long hours, recurrent nights or weekends on call, even as a senior clinician, incessant bleeps, angry and upset patients with high expectations and low tolerance of failure, fear of making that mistake, and the spectre of litigation and blame skulking in the background. Yet these are drawbacks that are legion in all branches of medicine and surgery, to a greater and lesser extent, and any doctor must be prepared for them.
As if in recognition of this extra burden, the support and supervision available to me, the SHOs and registrars seemed excellent. I always had someone to turn to for advice in my early days as an FY1: even the simplest decision, when new and unfamiliar, had the automatic backup of a call to someone senior, such that next time I could be sure of making the right choice independently. I saw my colleagues given the same treatment, if they needed it: after a midnight case of prolonged shoulder dystocia with tragic results, the labour ward registrar and midwives were soon joined by the consultant and matron who provided much-needed reassurance and guidance in handling the subsequent events. This culture of mutual support and learning is particularly strong in obstetrics and gynaecology, and it goes some way in allaying the fears of a prospective trainee.
An obvious draw towards choosing this career, which I saw plainly abroad as well as in the UK, is the enviable mixture of medical and surgical skills. Indeed, it is one of the leading reasons junior doctors cite as influencing their choice.3 As my FY1 year neared its end, I realised this resonated with me too: I had enjoyed my medical and surgical jobs in equal measure, and could not reconcile choosing one at the expense of the other. I want to carry on scrubbing up for procedures, learn more about anatomy and dissection and have the chance to do the cutting and sewing myself. But I don’t want to lose the exposure to physiological and endocrinological problems, puzzling them out and still being the expert on how best to treat them. Furthermore, obstetricians are often working side by side with medical specialists or gynaecological oncologists with general surgeons: teamwork that delivers additional range of cases, skills and knowledge.
So, a career that offers variety in day to day activity and doctor-patient relationships, tests and develops communication skills, supports its juniors, and has something to offer all over the world. Yet, for me, a career in obstetrics and gynaecology would be even more than this. Here is a chance to play a part in some of the most significant and memorable moments of a woman’s life, be it pregnancy and childbirth, conception, or in the debilitation of long term gynaecological problems. From the panic and joy of the labour ward to the nervous anticipation of the antenatal ward, from the desperation of the sub-fertility centre to the weary resignation of the urogynaecology clinic, the relationships, short or long, one forms with one’s patient may well be etched on their mind for many years to come. At these times, a doctor has the opportunity to make a really positive impact where it really matters. Through as little as listening and understanding problems, or by decisive, confidant and timely intervention in an emergency problem, I know it is possible to transform a patient’s experience for the better.
I have often wondered ‘why obstetrics and gynaecology’, especially as it is perceived unusual in recent years for a male doctor to be making this choice.4 But ‘why not?’ As I have discussed, it is an occupation that goes beyond the catchy advertisement at the start. A varied, versatile and valuable career that is as rewarding for its doctors as it aims be for its patients.
1. Higham J, Steer PJ. Gender gap in undergraduate experience and performance in obstetrics and gynaecology: analysis of clinical experience logs. BMJ 2004; 328:142–3
2. Brown BC, Vause S. A career in O&G? No thanks! BJOG 2006; 113:975
3. Whitten SM, Higham J. Recruitment and retention into obstetrics and gynaecology: the influencing factors. Br J Hosp Med 2007; 68:42-6
4. Turner G, Lambert TW, Goldacre MJ, Barlow D. Career choices for obstetrics and gynaecology: national surveys of graduates of 1974–2002 from UK medical schools. BJOG 2006; 113:350–356