This page provides guidance from the RCOG’s Specialty Education Advisory Committee (SEAC) about the involvement of O&G trainees within Hospital at Night rotas.
About Hospital at Night
Hospital at Night (H@N) is a multiprofessional, multispecialty approach to delivering care at night and out of hours, with the aim of improving patient safety. It involves members of medical and nursing staff coming together to form a team that manages patients across many disciplines in a hospital.
H@N and obstetrics and gynaecology
The very nature of obstetrics means H@N teams aren’t involved in managing women in labour (and potentially also gynaecology patients, e.g. women with early pregnancy complications). O&G as a discipline needs to staff the emergency obstetric rota 24/7. This means that, in some units, O&G trainees receive directly supervised training out of hours on the labour ward. This is in direct contrast to many other specialties, where much of the consultant-delivered training occurs within standard working hours and there is more directly supervied training in the daytime, normally excluding weekends.
Many hospitals are reviewing their H@N set-up owing to various staffing issues, and are considering involving trainees from disciplines that traditionally haven’t been involved, such as O&G.
RCOG advice for O&G trainees about H@N
In light of these changes, SEAC has developed the following guidance for O&G trainees:
- The skills needed to be involved in H@N are those of doctors following successful completion of foundation training. The need for any additional competencies is determined by the individual H@N set-up and the need to cover high-intensity areas, such as a high-dependency unit. These highly specialised areas require doctors to possess a skill set beyond that of trainees immediately post-foundation training.
- H@N could provide a beneficial training experience for junior doctors in training, provided there’s evidence of educational assessment and feedback while undertaking the role
- The clinical experience gained during H@N could benefit O&G patients as the trainee progresses through specialty training.
- ST3 trainees are involved in O&G registrar rotas and shouldn’t be involved in H@N. The acquisition of O&G skills would almost inevitably be reduced owing to the requirement for compensatory rest secondary to involvement in H@N. This would affect educational progress and acquisiation of curriculum-related competencies.
- ST2 trainees have a significant training workload to ensure they acquire sufficient skills and competencies to be able to function independently on the labour ward by ST3. The RCOG considers that ST3s should undertake all of their out of hours training within O&G to ensure they attain these competencies.
- ST1 trainees could benefit from being involved in H@N. However, this involvement mustn’t detract from the pursuit of O&G training. Therefore, no more than 25% of a full-time ST1 O&G trainee’s out of hours commitment should be taken as H@N.
For more information, contact SEAC by emailing the committee secretary or calling +44 20 7772 6294.