What is expected of me?
During your attachment in our department, you will have a series of formal assessments along the way. These are to give you feedback on your progress and hear from you how work is going.
1. Knowledge base
As an RMO, there will be an expectation that you develop your knowledge base above that of a medical student level. You will progress from text-book regurgitation of lists to a deeper and more clinically relevant understanding of disease processes in Obstetrics & Gynaecology. Areas that you will be expected to have a sound knowledge about include:
- Postnatal care
- Early pregnancy problems – threatened miscarriage, management of miscarriage, understanding & interpreting ultrasound & basic laboratory findings.
- Assessment and management of common antenatal obstetric presentations, such as APH, term PROM, threatened preterm labour and obstetric emergencies.
- Management of menstrual disorders in gynaecology clinic
2. Clinical skills
You need to be able to take a thorough and relevant history in both O&G. An excellent candidate will present their histories succinctly with appropriate emphasis on the important points relevant to the presenting complaint. You need to develop the skills of speculum and bimanual examination and be able to present & document your findings in such a way that another clinician knows exactly what you found, just as if they had performed the examination themselves.
3. Clinical judgement/decision-making skills
Although you will not be expected to manage many patients independently early in your career, as you progress you will develop the skills to combine the above two criteria and come up with sound differential diagnoses and management plans. Even if you are only presenting your findings to your registrar, the exceptional candidate will have considered the history/exam findings, developed a differential diagnosis and recommend initial investigations and an appropriate management plan.
4. Emergency skills
Due to the nature in O&G in a tertiary centre, you will have good support from your registrar in the management of emergencies. In the emergency situation, your role will be initial response and assistance. This means e.g. for labour ward emergencies, ABC, gaining IV access, sending off appropriate bloods quickly and liaising with other specialties or services that need to be involved, such as anaesthetists, booking theatre, etc.
5. Procedural skills
There are opportunities to gain procedural skills in Obstetrics & Gynaecology, which can include:
- Pap smear/endometrial biopsy
- Mirena insertion, hysteroscopy D&C, evacuation of retained products of conception (ERPOC) in theatre
- Normal delivery and perineal repair on Birth Suite
It is not a requirement to develop these skills.
6. Communication with patients and family.
As one of the doctors who will spend a lot of time on the ward, you will be expected to develop a rapport with your patients, to help them to understand the disease processes that are affecting them and answer questions that they or their family members may have. Empathic communication is one of the most, if not the most important skills to have as a doctor. A patient who doesn’t feel listened to or who doesn’t trust their doctor will not engage in a therapeutic relationship.
Care of postnatal patients is usually delegated to you and although the medical aspect of their care is often straightforward, you need to ensure that women who have had a complicated labour and birth understand what happened and why. You may not always know the answer yourself, but you will have a friendly registrar to help you!
7. Medical records/Clinical documentation
High quality medical record keeping is another essential skill to develop as a doctor. The reasons for this are both for excellent clinical practice – so your colleagues can tell immediately what has taken place and understand your thought processes and management plans – but also for medico-legal protection. It is unfortunate, but the dictum of ‘if it isn’t in the notes, it didn’t happen’ is the current standard. Absolutely all entries in the notes must be legible if handwritten, include your name, designation and signature. All entries have to be dated, and those which are time specific (e.g. on birth suite), must include the time in 24-hour notation. Please get used to including all these details as habit and you’ll never have to think about it again. When using electronic medical records, if there is a time delay between when the consultation occurred and the time you write in the record, you must include the actual consultation time. Again, this can be important from a medico-legal point of view.
Often note-taking will be delegated to you on ward rounds and unless you have had experience in obstetrics before, please ask your registrar or consultant what to document. Shared decision-making, risks/benefits and advice that is declined by the patient must be meticulously documented to protect all of us in case of complication or unexpected outcome. Obstetrics is unfortunately litigious, the medico-legal journey can be painful and the payouts substantial. Meticulous documentation will help you avoid the hassle of being on the wrong end of a frivolous complaint.
In clinics, your letters to GPs and other health professionals should be informative but succinct.
8. Professional responsibility
The attitudes assessed under this heading include punctuality, reliability, honesty and self-care. Punctuality and reliability in our daily work means arriving on time to the morning meeting and attending other clinics, theatres or meetings when expected. It means not turning up to work dressed inappropriately, chewing gum or hung over (not frequently, in any case!)
9. Teaching and learning
You are expected to demonstrate a commitment to learning, reflective thinking and teaching others. As the most junior member of the team, you may think that you don’t have much to offer others in the way of teaching. The year 5 medical students who are on our teams will not agree. Once you’re orientated, encourage them to tag along and as you get up to speed and more confident in the specialty, pass what you learn onto them. You only need to be one step ahead, and preparing for teaching others keeps us all on our toes. You won’t be expected to give a department presentation as part of the weekly programme, but RMOs have done so in the past (as have medical students), so feel free to get involved when your registrar has been allocated a session.
10. Time management skills
A large part of your role as a junior doctor is ensuring a variety of jobs get done, e.g. referrals to other health professionals, investigation requests, ensuring test results are followed up at the end of a day and patients you are concerned about are checked on before going home and handed over to the on-call team. As an RMO, you don’t have to be a high flying clinician to excel at your work. Prioritising and completing your daily job list, knowing your inpatients, dotting ‘i’s, crossing ‘t’s and generally making things happen and telling people about it, is where it’s at.
11. Teamwork and colleagues.
Developing a team working focus and being able to get on well with colleagues – medical, midwifery, nursing, secretarial, admin – is an important skill for all doctors to develop. As you advance in your career these aspects of your practice become as important as your clinical skills when you are shortlisted for jobs. Obstetrics has its own challenges, as does each medical specialty – the obstetric and midwifery philosophies sometimes seem to be polarised, but there is always a line of common ground, that of providing high quality, safe care to women. You will learn these skills from registrars and consultants who keep the patient’s wellbeing central and who work together as a team.
Don’t dump on your colleagues – it’s unprofessional and will come back to you in buckets!
Finally, welcome to the department and good luck with your attachment in Obstetrics & Gynaecology. Please don’t hesitate to approach any of the consultants if you have any concerns or questions.