I was lucky to be chosen to attend the 26th ENTOG exchange 2016. We took part in an exchange programme hosted by the Sant’Anna Womens Hospital on 16 - 18 May , and on the 19 May we joined the ENTOG scientific programme at the EBCOG meeting.
The planned exchange venue had been Turkey, but for various reasons Turin stepped in and organised the programme with relatively little notice.
The aim of the scheme
The aim of the scheme is to strengthen links between European trainees and allow us to gain an insight into how different European countries practice Obstetrics and Gynaecology. A key part of that is staying with local trainees; getting an insight into the Italian training scheme, working hours and career prospects.
Gathering for a welcome dinner on the Sunday evening we got our first experience of Italian hospitality; generous portions of fabulous food, washed down with a wide ranging discussion of health, politics and training across Europe.
On Monday we attended the hospital. My group had the chance to work in the training lab. This involved completing hysteroscopy and laparoscopy training exercises, using the Medaphor US trainer and practicing forceps, kiwi and breech deliveries. The difference between training and practice across Europe became very clear; many trainees could scan to a relatively high level and reported that they regularly scanned in gynaecology and antenatal clinics, however very few had any experience of vaginal breech births or forceps use.
A small group of us were due to be in theatres, but after a short visit we found our way onto Labour Ward. A Swede, two Estonians and a Brit were given a tour of the delivery suite by an Italian midwife speaking a mixture of German and Spanish.
Some interesting facts that came out of the discussion were: there is an expectation that a doctor will attend each birth; epidurals are available only privately out-of-hours; and there is no community midwifery service, so most women will stay in hospital for 3 to 5 days regardless of method of delivery.
On Wednesday, I attended an ultrasound list. Trainees scanned in their own rooms, with a senior available for consultation. Cases could be gynaecological or obstetric, and could be referred from clinics within the hospital or from doctors in the community. Full medical notes rarely accompanied the patient, so a history would be taken at the time of the scan. Italy has had a large influx of refugees and we had several patients who spoke little or no Italian. Interpreters were not available, so some patients brought a friend, or rang a relative who would translate over the phone.
The scientific programme on Thursday looked at how trainee societies work and at the new EBCOG initiatives aimed at harmonising training across Europe. EBCOG have already produced guidelines on care and introduced a fellowship examination, they also offer hospital accreditation visits to ensure training at those sites meets their standards. A current project is to produce a European curriculum for Obstetrics and Gynaecology training.
The souvenirs I brought home with me include a deep belief in the importance of discussion with European colleagues. Differences in practice and training exist, and we need to be open to learning from others and helping others learn from us.