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Why Obs and Gynae? by Rachel Boyce

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 Rachel Boyce, an FY2 at Southern General Hospital, Glasgow.

I’ve never wanted to be a surgeon. That’s why I was surprised when I decided on a career in obstetrics and gynaecology (obs and gynae). It’s a long story why I made this choice, so I’ll start at the beginning.

I was brought up in a church environment strongly involved in missions which helped people in the UK and around the world in a variety of ways without forcing their religious views on them. Although no longer involved in the church, I have a lot of respect for their commitment to doing good and making a difference in the world and feel this has influenced me a lot.

I got offered a job in a Boots chemist counter on the day I turned 16. Apart from doing medicine, this was the best part-time job I ever had as a student. I enjoyed the combination of a pressured environment with giving out health advice in a caring, simple way. On reflection, these are also aspects I like about obs and gynae. The day the ‘morning after’ pill became available over the counter was my first real encounter of gynaecology and was at first seen as controversial. I soon began to realise that access to the pill was difficult for many and I began to feel proud that I was part of a piece of history.

My reason for applying to medical school was very similar to a lot of people. I wanted to make a difference in the world and enter a caring profession. Naive? Possibly. I liked all specialties equally right from the beginning and struggled to settle on anything specific.

Therefore, I wanted more time to decide what I’d like to do with my life and what to specialise in, so I did an intercalated BSc in the genetics of breast cancer and tried out laboratory medicine. I enjoyed the subject matter and loved working in such a close team, but I found the lack of patient contact disappointing. The work in the laboratory, although relevant, seemed so far removed from the clinical environment.

After the year out, I joined 4th year which is a mix of specialty rotations. The obs and gynae department opted for a different format of teaching than other departments which revolved around group sessions and task/skill based teaching. My gynaecology sessions were excellent and I was heavily encouraged to be fully involved in all aspects of care. Unfortunately, my obstetric experience was very short and difficult to obtain due to the sheer volume of medical and midwifery students trying to train in the one maternity hospital. I enjoyed it, but felt disheartened that I didn’t get as full an experience that I’d hoped for. I applied for an extended placement in 5th year of university, however was given something completely different instead, so was again unable to look into it in more depth.

It was on elective in a small Zambian hospital that I began to think more broadly about what I wanted to specialise in. I completed an audit on ‘adherence to antiretrovirals in pregnancy’ which gave me an insight into the difficulties a woman may have looking after her health in pregnancy with different logistical and cultural pressures.

This was an important but very small part of my elective experience. On arriving at the hospital, the only doctor went on strike due to a pay dispute and left my me dical student colleague and me in charge of the hospital. On a rare occasion the doctor would come in for C sections or to do a brief round of the male wards, as these were his preferences. In general, the running of the hospital was left to us medical students and a few ‘medical officers’ (medically trained lay people who perform many of the same duties as a doctor. Similar, in a way, to advanced specialist nurse practitioners). I had a strong interest in infectious diseases, but soon realised that this was the speciality of the local medical officers.

I felt that women’s health was seriously being ignored. All the medical officers were male and had strong cultural opinions with regards to sexual practice/the role of women and had a general feeling that nothing could be done for many of the gynaecology patients. There seemed to be many cases of cervical and vaginal cancer patients which were simply sent home to die with no treatment and cases of illegal terminations where women were rebuked on entering hospital for care when they had complications. From a cultural point of view, it was very difficult for us to make a difference.

It was then I realised that it is not infectious disease specialists they need in areas like this – they need specialists skilled in other areas to, not only, offer their skills, but to help teach local doctors some of their specialty area. Doctors in this area are trained so broadly in medical school and are able to carry out C sections and some general surgery, but are poorly skilled in other areas. This trip has had a major influence on me. I have always wanted to help abroad in third world countries and after doing my elective in such a challenging environment, I feel that obs and gynae is in huge need in these areas. I truly believe that becoming skilled in obs and gynae would aid me to make a difference and I wholeheartedly intend to contribute my skills in the future to this area.

During my elective in Zambia I applied to foundation posts and ensured that I had a placement in FY2 in obs and gynae to get an idea of the specialty in the UK. This post guided towards the Southern General in Glasgow where I am still working. I have enjoyed the job from day one and have found new challenges every day. It is a very busy job, which I relish and a job which constantly re-evaluates its practices to ensure it maintains high standards. It has such a variety and, for the first time in my life, I have found myself enjoying my time in theatre and have become eager to learn.

My aims for my career are straightforward:

  • To do a career I enjoy and that I am enthusiastic about
  • To make a difference in the work I do
  • To gain skills that will be useful if I wish to work in any environment abroad
  • To do a specialty that is busy and fast moving

I feel obs and gyn fulfils these goals. I might have taken a long period of time to come to this conclusion, but it has been well thought through and I feel confident that this is the right decision 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