Is gynaecological surgical training a cause for concern? A questionnaire survey of trainees and trainers

<p>Astract</p> <p>Background</p> <p>Concerns have been raised as to whether the current postgraduate training programme for gynaecological surgery is being detrimentally affected by changes in working practices, in particular the European Working Time Directive (EWTD). The purpose of this study was to investigate the surgical activity of obstetrics and gynaecology trainees and to explore trainees' and trainers' opinions on the current barriers and potential solutions to surgical training.</p> <p>Methods</p> <p>Two questionnaire surveys were conducted, one to obstetrics and gynaecology trainees working within the West Midlands Deanery and a second to consultant gynaecologists in the West Midlands region.</p> <p>Results</p> <p>One hundred and four trainees (64.3%) and 66 consultant gynaecologists (55.0%) responded. Sixty-six trainees (66.7%) reported attending up to one operating list per week. However, 28.1% reported attending up to one list every two weeks or less and 5 trainees stated that they had not attended a list at all over the preceding 8 weeks. Trainees working in a unit with less than 3999 deliveries attended significantly more theatre sessions compared to trainees in units with over 4000 deliveries (p = 0.007), as did senior trainees (p = 0.032) and trainees attached to consultants performing major gynaecological surgery (p = 0.022). In the previous 8 weeks, only 6 trainees reported performing a total abdominal hysterectomy independently, all were senior trainees (ST6 and above). In the trainers' survey, only two respondents (3.0%) agreed that the current program produces doctors competent in general gynaecological surgery by the end of training, compared to 48 (73.8%) respondents who disagreed.</p> <p>Conclusions</p> <p>Trainees' concerns over a lack of surgical training appear to be justified. The main barriers to training are perceived to be a lack of team structure and a lack of theatre time.</p

Maternal Serum Alpha-Fetoprotein in Normal Pregnancy at 11-13 Weeks' Gestation

&lt;i&gt;Objective:&lt;/i&gt; To establish a reference distribution of maternal serum alpha-fetoprotein (AFP) at 11–13 weeks’ gestation and define the contribution of maternal variables that influence the measured concentration of AFP. &lt;i&gt;Methods:&lt;/i&gt; Serum concentration of AFP at 11–13 weeks was measured in 1,500 singleton pregnancies which were not complicated by hypertensive disorders or diabetes mellitus and resulted in the live birth at or after 37 weeks of phenotypically normal neonates with birth weights above the 5th and below the 95th percentile. Multiple regression analysis was used to account for maternal characteristics that influence the measured concentration of AFP and a distribution of log multiples of the median (MoM) values was fitted. &lt;i&gt;Results:&lt;/i&gt; Log&lt;sub&gt;10&lt;/sub&gt; AFP increased with gestational age, decreased with maternal weight and was significantly affected by maternal racial origin, smoking status and method of conception. Compared with values in Caucasian women who were non-smokers and conceived spontaneously, AFP MoM was on average 23% higher in Afro-Caribbeans and 8% lower in East Asians, 11% higher in smokers and 10% higher in those conceiving by in vitro fertilization. &lt;i&gt;Conclusion:&lt;/i&gt; In normal pregnancies at 11–13 weeks, serum AFP increases with gestational age and is affected by maternal race, weight, smoking status and method of conception.</jats:p