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Why Obs and Gynae? by Kathryn Basnayake

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 Kathryn Basnayake, an FY2 at City Hospital Birmingham. 


My story

The past

I wish to start from the beginning, so bear with me.

My story begins in 1977, not that this is the year I made the decision to embark on a career in Obstetrics and Gynaecology, more that this was the beginning of my journey. A journey leading to this moment in time, where experiences have shaped who I am, my knowledge, my personality, and my ability to interact with others.

My early years involved a moderate education in a middle class environment with a number of siblings, surrounded by many animals. I learnt to play the clarinet, saxophone and piano, and as a family we holidayed in country. At the age of 16, around the time of my GCSEs, I highlighted that medicine was a career I wished to peruse. I vocalised it at the time as a ‘wish to help others’. I don’t know if at 16 I truly understood what medicine meant, the lifestyle, the commitment, the constant accumulation of knowledge, the daily challenge, the excitement and enjoyment at treating patients.

After my A-levels, the results of which just weren’t good enough to pursue medicine, I spent time travelling the world and working as a carer. Looking back, although frustrated at the situation I found myself in, seemingly not moving forward towards my ultimate goal, the experience was valuable. Working, travelling and living with a variety of people from differing backgrounds help shape the ability I have now, to approach, work and communicate with others.

With parental support at the age of 19, I embarked on a career in Nursing. At this time, I thought that medicine was a pipe dream, a goal I was never meant to achieve. I graduated with a Bsc (Hons) and started to work as a nurse. Wishing to gain a variety of experience I rotated though many departments, including gynaecology. It was here that I started to become interested in women’s health, and the role healthcare professionals can play in empowering women to make informed decisions about their own health.

By my early twenties I had gravitated towards the bustle of the accident and emergency (A&E) department. Here I found the nurses role to have more autonomy, that motivated staff members were nurtured to learn more and develop their clinical skills. I thrived on the faster pace of the department, and on the variety in the presentation of the patients.  I enjoyed my time as an A&E nurse, I found it challenged, at the time, both my knowledge and clinical skills. Whilst working I came into contact with a large number of patients with complaints pertaining to pregnancy and women’s health. I tried to take a special interest in these cases and helped devise a pathway for women in the early stages of pregnancy attending A&E. However three years into my career and on the cusp of my second promotion I realised that I needed more, there was still an unfulfilled dream I had to pursue.

The postgraduate medicine course at Leicester University gave me the opportunity to follow this dream. It was on applying for this that I focused on Obstetrics and Gynaecology as a career path I would like to ultimately pursue. I found it to be a diverse speciality incorporating a wonderful blend of medicine and surgery to deal with a wide variety of problems in women of all ages.

Throughout my MBChB I harassed many Obstetrics and Gynaecology trainees and consultants for information about this career path, projects I could help with or undertake on my own, and for extra weeks of clinical experience.  It was a successful strategy. I spent my special study modules, extra weeks during the holidays and my elective placement gaining clinical exposure, working alongside many trainees at differing years experience and Consultants. I was also given a number of projects;

  • An audit into the outcomes of pregnancy for type one diabetics, which was presented at the diabetic association.
  • A qualitative research project into the expectations of women who have undergone prolapse surgery, this has been presented at the International Urogynaecology conference 2009, and a paper is in the process of being submitted.
  • A number of case reports, a few have been submitted to Royal College Prizes, others have been presented at local meetings.

Overall the exposure I gained in Obstetrics and Gynaecology whilst studying medicine confirmed that this is definitely the career I wish to engage in.

The present

I qualified in 2009 and in my first foundation year I developed my clinical skills and my knowledge in medicine immensely.  I have been challenged, exhausted, elated, been able to teach and felt a valuable member of diverse, elite wonderful teams. I now find myself working in my second foundation year, as a junior member of the team, in the speciality I greatly wish to join. It has been over the last few months and whilst writing this essay that I have realised how much my varied life’s experiences have prepared me for the professional role I now wish to undertake.  I feel I have the foundations in place, basic skills, motivation and commitment to be an Obstetrician and Gynaecologist.

Every doctor needs excellent communication skills and the ability to work effectively as a member of a diverse multidisciplinary team. In women’s health it is no different, and I feel a number of factors in my life have prepared me well. Travelling, playing the saxophone and clarinet in a variety of orchestras and bands, diving and nursing have, I believe given me a calm, articulate, unassuming, non-judgemental approach to communication, and given me the vital tools to be a valuable member of a team. From breaking bad news to celebrating and laughing with patients and communicating daily with colleagues in a variety of situations, I have developed a relaxed manner, individualising each conversation as I understand that communication is personal.  I have also come to realise that the expression of pain and emotion is grounded in personal experience, beliefs and culture. In a team I am at ease in a multitude of roles; leading, for example, as in an emergency situation, being directed, as part of an orchestra or ward/on call team, having an equal partnership, as in diving or in the consultation and working at a distance, as in research/audit. Fundamentally all teams require a similar approach, understand one’s role and where you fit into the team, know the limitations you have and how to ask for help, and respect the roles and knowledge of the other members of the team, watching out for when you can help them. Working as part of a multidisciplinary team is something I enjoy and I have observed how it is a vital part of Obstetrics and Gynaecology, i.e. on the delivery suite, in the antenatal clinics and in Gynae-oncology. Being an effective member of the team can be a challenge at times when faced with a stressful environment, such as on the delivery suite. As an A&E nurse being a member of a team at highly stressful times is something I have experienced, and I understand the importance of remaining calm to make sensible decisions and working collectively together to achieve the best outcome for the patient. My role as an A&E nurse also made me aware that an active career which holds daily variety is something that I want. I believe that Obstetrics and Gynaecology is just that, Clinics, Delivery suite, Theatre, meetings, ward work, audit and teaching all create a busy day, full of variety.

Outside of the professional boundaries, I enjoy music and play the clarinet, saxophone and piano. This helps me relax. Additionally I believe it develops and helps to maintain dexterity in the fingers, a useful skill when thinking about surgery.  I also love to cook, sew, dive and garden, activities which keep me entertained and relaxed!

Overall, I feel that I am a motivated person who loves to live life to the full. I enjoy being continually busy and know I will thrive on the challenges and achievements a career in Obstetrics and Gynaecology can provide.

I am currently posted in Obstetrics and Gynaecology for four months and I look forward to going to work, waking up each morning with a smile, I don’t want this time to end. Obstetrics and Gynaecology; is a fantastic mix of Medicine and Surgery working in harmony, it works closely with a variety of specialities from urology to rheumatology.  It facilitates supports and aids the birth of the next generation, and overall empowers women to make informed choices about their own health. There is a wealth of opportunities for teaching, being taught, and continued professional development in the form of research, audit, presentations and developing guidelines. I don’t believe there is another speciality that can give me the same satisfaction, enjoyment and challenge that Obstetrics and Gynaecology is doing, and hopefully will do in the future.

The future

As time marches on, there is speculation of how healthcare will be shaped and Obstetrics and Gynaecology, like all specialities has to adapt to change.

The European working time directive has meant trainee hours have been reduced; this translates that my clinical exposure and experience will be markedly less than that of my predecessors. I therefore need to plan strategies to overcome this reduced clinical experience if I am wishing to be a competent surgeon at the end of my training. Also the impact of the reduction in junior doctor hours has meant that other healthcare professionals have had their roles extended. I recognise the importance of these practitioners, understanding that nurses and midwives are a fantastic resource and should be respected for their clinical knowledge and experience.

Reduced NHS budgets will shape all hospital specialities. We will need to deliver high quality care more efficiently. This may have to involve NHS-private sector partnerships, something which we will need to adapt to.

Laparoscopic surgery is now increasingly being utilised for more procedures, benefiting patients and hospitals with reduced inpatient stays and quicker recovery time. It will be exciting to see how minimally-invasive techniques progresses, and what other technologies emerge, e.g. what place will robotic surgery have.  Pharmacological therapies are emerging for conditions which were once mainly treated surgically; this is following a trend towards more conservative management of patients in many areas, i.e. the medical management of some ectopic pregnancies. I am keen to contribute to the evolution of the specialty.

I am someone who is motivated towards research, audit and clinical governance, and I have been inspired by how much there is in this speciality and the enthusiasm of my colleagues. In the couple of months I have been in post I am undertaking an audit, a research project and developing a patient information leaflet, that’s just to begin with! I also have many ideas of my own in this area for the future.

Conclusion

I think it is clear that I want to very much become an Obstetrician and Gynaecologist. I hope I have outlined how I came to the decision that this was the career path for me, and the life and professional skills I have attained that I believe are fundamental to this role. I feel there has never been a more exciting time to join the speciality. Finally I hope I have shown some insight into the challenges of Obstetrics and Gynaecology and the course it may take as a speciality in the future. Overall I hope I have shown my enthusiasm and motivation towards this speciality, and that this is the career path I want to take with it also being the right one for me.

Elsewhere on the site

Specialty training in O&G
An overview of the specialty training programme in obstetrics and gynaecology
Applying for specialty training
How to apply for the specialty training programme in O&G