Tips for Locuming in a New Specialty – Obstetrics and Gynaecology
You may have chosen to do an F3 year for lifestyle reasons, to try out different specialties you didn’t get during your foundation rotations, or to gain more experience in a specialty you’re particularly interested in. Of course, if you’re a current F2 or F3, you might have missed out on rotating on to different specialties because of the coronavirus pandemic.
Whatever the reason, at some point you may find yourself working in Obstetrics and Gynaecology (O&G) for the first time, with no previous experience, and this is sometimes known to be a bit of a daunting prospect for some doctors.
To make that transition easier for you, this article will explain what the job will be like, highlight the common clinical scenarios you’ll likely come across, and share some tips to help you prepare for starting the job!
Where Will I Cover?
Most hospitals have a similar spread of clinical areas you may work in as an O&G SHO.
In different units you could cover both Obstetrics and Gynaecology on night shifts, on weekends, in the evenings, or all the time depending on how busy they are.
Delivery Suite/Labour Ward – Different hospitals will give this ward different names, and they’ll always be of varying sizes. Some will have a midwifery-led birth centre attached to them for low-risk labourers who are under midwifery-led care. These tend to be run by a Labour Ward Coordinator, in charge of each shift, so this is usually the best person to ask if you need help with something.
Obstetric Theatres – Most units have one or two dedicated theatres which are usually very close to the delivery suite, for both elective and emergency procedures.
Maternity Triage/Day Assessment Units – This is a midwifery-run unit open during the day, but in larger units may be open overnight too. Women can attend these for monitoring blood tests, CTG monitoring, scans (if these have been organised outside their usual clinic appointments), and in the case of any problems or symptoms. Women can either call to make an appointment directly, or can be referred in from their community midwife or GP.
Antenatal/Postnatal Ward – Depending on the size of the unit, these will either be in one ward or separate wards. Antenatal wards tend to have patients who are being monitored for some reason (such as pre-term tightening, PV bleeding, raised blood pressure/pre-eclampsia), or are receiving inpatient treatment (such as steroids for likely pre-term deliveries, blood pressure treatments, maternal sepsis, etc). But antenatal patients are generally reviewed by the registrar rather than SHOs. Postnatal women who stay in hospital tend to stay because they need support with feeding, some form of treatment, because they’re recovering from surgery, or because their baby needs extra observations or treatments.
Gynaecology Ward – These wards may have post-op patients from elective or emergency procedures, and patients that have been admitted for treatment or observation for acute Gynaecology problems. They’ll also usually have a Gynaecology Assessment Unit or Acute Gynae Unit (GAU/AGU) and an Early Pregnancy Assessment Unit (EPAU) attached or run from within.
Clinics – If you do spend time in a clinic as an SHO you’ll find it will be very well supported by senior colleagues, so the rest of this article will focus on your on-call role.
What’s the Day-to-Day Like?
Your daily responsibilities will include participating in ward rounds with the consultant or registrar on the Delivery Suite.
You’ll attend Obstetric emergencies, such as postpartum haemorrhage (PPH), shoulder dystocia, foetal bradycardia, or maternal collapse. Usually your role in these situations will be to cannulate and take bloods, or to provide any general help like scribing, gathering equipment, or checking observations.
You’ll assist in theatre with elective or emergency C-sections. Normally you’d also be present in theatre for trials of instrumental deliveries, and managing PPH or manual removal of placenta, but won’t necessarily need to assist unless you're keen to.
You’ll probably be prescribing for the Delivery Suite, Triage, and postnatal or antenatal wards.
Reviewing postnatal women on the ward and providing discharge letters or prescriptions will also be common. Most will get discharged on day one postnatally after a C-section, or if they’ve had birth complications, but some may need to stay in longer for further monitoring. This could be for pre-eclampsia or maternal sepsis. If they’re medically fit to go home but are staying in for the baby then you’ll document that they’re being discharged to “midwifery-led care” so once the baby is ready they’re able to leave without waiting for another review.
You’ll also be reviewing women in Maternity Triage. This could be for problems like raised blood pressures, abdominal pain, reduced foetal movements, PV bleeding, or any other issues. When you first start you’ll mostly discuss these patients with the registrar before you send anyone home, but as you get more experience you may be happy to manage some things independently. The midwives running these units are usually very helpful and will point you in the right direction.
Here you’ll be reviewing women with early pregnancy problems through EPAU, such as ectopic pregnancy, hyperemesis of management, or miscarriage. Depending on the unit you’re working in, Gynaecology may accept gestations below 16 weeks or 20 weeks, and women who are further along than this would go to Maternity Triage.
EPAU is run by nurses who are very knowledgeable, but if patients need examinations or a clinical review then they’ll ask you to see them. Generally, if the EPAU nurses are monitoring serial beta HCG levels for pregnancy of unknown location (PUL) they’ll ask the registrars to review these and make follow up plans.
Ultrasound scans for these ladies can often be done through special EPAU USS slots, or in the main USS department if outside of these times.
You’ll also be reviewing women with acute Gynaecology problems through GAU. These are referred to you from A&E or GPs. Generally, referrals from other specialties in the hospital go through the registrar in most places. Most women seen in GAU present with lower abdominal pain or heavy PV bleeding, with problems you may encounter like ovarian cysts or torsion, endometriosis, pelvic inflammatory disease, fibroids, or problems with coils. Other things you may encounter are vulval discharge-related problems like herpes or thrush, but usually these patients will have seen their GP first.
Additionally, you’ll often be reviewing post-op women and inpatients on the Gynaecology Ward. Post-op inpatients will generally have had laparoscopic or abdominal procedures like hysterectomy, oopherectomy, or ovarian cystectomy.
Our Top Tips to Get You Started
1. Get some initial experience if you can, to try it out beforehand
2. Practise assisting in theatre – all surgical skills are relevant!
3. Recap your understanding of the common O&G problems and examinations (including speculums and bimanual examinations)
4. Read up on Obstetric emergencies so you know what to expect when you’re called to one
5. Use the Trust guidelines as the basis for your management
6. Ask for help if you need it!
Going into an unfamiliar speciality is never easy, but the key thing to do is remember that you’ll have plenty of support around you. O&G is very different than other specialties and you’re likely to need a lot of help and advice at the beginning, but this is completely normal and expected. Seniors are very approachable and helpful in O&G, and the midwives also provide great guidance.
If you’re heading into O&G for the first time, follow the above advice and the process of starting work should prove to be far less daunting. By taking our tips on board, you’ll be able to hit the ground running when you start!
We're also working hard to provide you with a guide for each of the main specialties, giving you tips on how to settle into those departments. These will be especially useful if you haven’t rotated through that specialty in your Foundation Training rotations before.
Tips for Locuming in a New Specialty - Trauma & Orthopaedics (Coming soon)
Tips for Locuming in a New Specialty - Emergency Medicine (Coming soon)
This article is part of a wider series, supporting doctors like yourself with a comprehensive set of guides to ensure your F3 year is a success. These guides cover everything from initial planning, options for moving abroad, help with finding work, and tips for making the most of the experience. Click here to visit our F3 Resource Hub to explore the full list of guides and articles.
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