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A letter from Sussex Place, November 2012

Ian Currie, Honorary Secretary, writes...

As I opened my laptop today, pondering about what to include in this months ‘Letter from Sussex Place’, I glanced at my desktop and noted some of the PowerPoint presentations that were sitting there before me. I thought to myself; how many colleagues all over the world have similar presentations for teaching sat before them, and who else has written the very same words that I have put together in order to educate others. It’s amazing the duplication there is in medicine with everyone reinventing the wheel. Granted, we have scientific research and personal data that is close to our hearts and that we may not want to share, but just imagine how many antepartum haemorrhage, eclampsia or prolapse lectures there are all over the world and how many hours of individual clinician’s time has been duplicated by a failure of our professional community to share intellectual property with each other. There are certainly legal aspects and copyright issues to overcome if we are to share our knowledge with each other but it is astonishing to me how inefficient we have become as a profession by not overcoming these issues.

Then I began to think about other aspects of obstetrics and gynaecology. Consider how many audit proformas have been written over the years for ectopic pregnancy or induction of labour by junior doctors. Every few months a new set of junior doctors arrive in our departments to embark on their audit project. We as a College and other organisations produce auditable standards of care which form the backbone of what we should be looking at when we carry out audit; but what about having standardised audit proformas for the use of everyone? Comparison across units may therefore be possible as well as the ability to have more collective audit topics where smaller numbers are involved. I personally have sat in far too many audits thinking that the sample size is too small to make any meaningful conclusions.

We do however also have national audit initiatives that provide useful national data but this will not replace the need for local audit and the requirement for individual units to assess whether they are adhering to their own protocols and guidelines. These audit processes are not just for the UK but are applicable worldwide.

ORCA is a collaboration between the Royal College of Obstetricians and Gynaecologists and the London School of Hygiene & Tropical Medicine and its aims are to enhance research in obstetrics and gynaecology and to encourage and support rigorous audit, performed to a high scientific standard. One example of such a national audit conducted by ORCA is the heavy menstrual bleeding project, of which I am sure many members and fellows have contributed to.

I could go on with regards to duplication. Patient information and guidance for consenting are all topics that I personally feel have occupied many hours of clinicians' time. The College does contribute in this area but I feel we have much to achieve particularly with communication with specialist societies. Hopefully we are not far off a national procedure specific consent form. I expect that some units have already gone far down this line in order to streamline processes and ensure good governance and safe practice. The fact that some units are almost there serves to emphasise my point about sharing knowledge. All around the community we have many examples of excellent care but somehow they all appear to stay locked in locally. How about sharing a little more!

Ian Currie
RCOG Honorary Secretary