Advanced Training Skills Module Research Articles

Did the COVID-19 pandemic affect mental health, training progression, and fertility planning of obstetrics and gynecology trainees? A survey of London trainees.

Purpose of StudyTo assess impact of COVID‐19 pandemic on mental wellbeing, workload, training progression, and fertility planning among London Obstetrics and Gynecology trainees.DesignAn anonymous survey comprising 41 peer‐validated questions was sent to London trainees. Anxiety and depression were screened using Generalized Anxiety Disorder Questionnaire 7 (GAD 7) and Patient Health Questionnaire‐9 (PHQ‐9).ResultsOne hundred and seventy‐seven trainees completed the questionnaire, of whom 54% were aged 25–34 years, 43% were senior trainees (ST6‐7), and 51% classified themselves as Black, Asian, and Minority Asian (BAME). Although the percentage of respondents with “moderate”/“severe” GAD 7 and PHQ‐9 scores was two to three times that of UK population estimates, median GAD 7 and PHQ‐9 scores were 7 and 6 (“mild”). Sixteen percent deferred their fertility plans and 26% of ST6‐7 trainees changed their Advanced Training Skills Modules. Other issues raised ranged from lack of assistance with electronic portfolio, postponement of examinations, poor senior input for mental health, lack of debriefing for redeployed trainees and requests for deferment of annual reviews.ConclusionsThe pandemic has incurred an impact on mental health, training progression, and fertility planning of London trainees. With recommencement of nonemergency consultations and elective gynecology theater, alongside Royal College of Obstetricians and Gynecologists' Recovery Blueprint to optimize learning opportunities, there is optimism that these challenges can be overcome. Trainers and trainees need to safeguard training opportunities and consider innovative forms of future learning, while anticipating potential effects of subsequent waves.

Obstetric medical care and training in the United Kingdom.

The UK confidential enquiry into maternal deaths identified poor management of medical problems in pregnancy to be a contributory factor to a large proportion of indirect maternal deaths. Maternal (obstetric) medicine is an exciting subspecialty that encompasses caring for both women with pre-existing medical conditions who become pregnant, as well as those who develop medical conditions in pregnancy. Obstetrics and gynaecology trainees have some exposure to maternal medicine through their core curriculum and can then complete an advanced training skills module, subspecialise in maternal-fetal medicine or take time out to complete the Royal College of Physicians membership examination. Physician training has limited exposure to medical problems in pregnancy and has therefore prompted expansion of the obstetric physician role to ensure physicians with adequate expertise attend joint physician-obstetrician clinics. This article describes the role of an obstetric physician in the UK and the different career pathways available to physicians and obstetricians interested in maternal medicine.

Centres that do not offer TLH as their primary method of hysterectomy should be considered outdated and not Fit for Purpose: AGAINST: To allow one their informed choice may mean others have no choice at all.

The delivery of a laparoscopic hysterectomy service presents many challenges, not all of which can be met by every centre. The availability of appropriately trained doctors is limited by access to Advanced Training Skills Modules (ATSMs) in Benign Gynaecology and Advanced Laparoscopy, which not all consultants have yet undertaken. In addition to the doctors, theatre personnel who know how to use and maintain the equipment are also essential. Affordability is another factor given that laparoscopic hysterectomies use more consumables and operative time. Training has a long learning curve and time taken to complete surgery can be many hours per case. Most health economic arguments that support this approach assume that all operators are equally skilled and take similar operative time, when we know that not to be true. Operative time is a finite and expensive resource, and targets from referral to definitive management currently drive the service more than quality-of-life outcomes. They also assume that all patients who have laparoscopic surgery only stay for 1 day. Remuneration is not the same across all institutions. Currently the tariff for laparoscopic hysterectomy is lower than for open hysterectomy. They also do not account for the cost of acquisition, amortisation, and maintenance, nor for the cost of higher complication rates, both in terms of re-operations and prolonged stays in hospital. As the surgical techniques are refined, the cases for which they are advocated increase in both number and complexity, with a commensurate increase in the equipment required delivering it. With time the cost of delivery can only rise. All these factors make affordability a major issue in most centres. The patient's anatomy, performance status, and pathology of the condition to be managed also have an influence. Treatments such as the intrauterine system (IUS), endometrial ablation, and hysteroscopic surgery means that hysterectomy is reserved for more challenging pathology, such as fibroids and endometriosis. Sometimes an open approach is intrinsically safer. It is no longer acceptable to reduce a fibroid in size in order to aid its removal because of the risk of disseminating previously unrecognised cancer. The US Food and Drug Administration (FDA) estimates this risk to be 1/350, and although this figure is debated, it would be a foolhardy surgeon that ignores it. Thus a fibroid that obstructs safe access to the uterine vessels, pelvic sidewall or cannot be removed intact is not suitable. Only surgeons trained in advanced laparoscopic techniques can manage rectosigmoid disease and dense adhesions safely. Advanced ovarian cancer will usually require an open approach. The needs and priorities of health care vary widely in resource-rich and resource-poor countries. The quality-of-life outcomes have little relevance when maternal and perinatal mortality is high. Training in these countries is quite appropriately focused on the improvement of maternity care. The supply of basics such as sutures, swabs, and an electrical supply are more pressing matters than the ability to deliver complex minimal-access surgery. In a state-provided service, the needs of the population supersede those of the individual. Thus an individual patient's ‘rights’ should be seen within the context of safety and affordability. To allow one their informed choice may mean others have no choice at all. None declared. Completed disclosure of interests form available to view online as supporting information. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

The "learning curve" for retropubic mid-urethral sling procedures: a retrospective cohort study.

Mid-urethral tape procedures brought a paradigm shift in surgery for stress incontinence; little research into the development and maintenance of surgical competence for the procedure exists. The hypothesis behind this study is that the "learning curve" for retropubic mid-urethral sling procedures, judged by the surrogate of bladder perforation, is longer than previously thought. This was a retrospective single-centre database and case note review of retropubic mid-urethral tape procedures. Unadjusted rates of bladder perforation, operating time, postoperative voiding difficulty, tape extrusion, and patient reported outcome were calculated; progress was evaluated using the cumulative sum method. Outcomes were assessed for 1 consultant, 2 subspecialty trainees (fellows), 7 advanced training skills module (ATSM) trainees (senior residents) and 6 core specialty trainees (residents) in years 4-7 of training. A total of 1,568 women were identified as having mid-urethral tape procedures; 568 (36 %) had additional procedures concurrently; 259 (20 %) were secondary procedures. The overall perforation rate for individual surgeons varied between 0 and 31 % and averaged 10.3 % amongst the core and ATSM trainees (a mean of 11 procedures), 4.5 % amongst the subspecialty trainees (a mean of 66 procedures) and 1.3 % for the consultant (1,284 procedures). The number of perforations for individual surgeons peaked at between 10 and 30 procedures undertaken. The number of cases performed to reach a target level of ≤ 5 % perforations varied between 20 and 80. Whilst seductively simple in concept, mid-urethral tape procedures are not without risk; their inherently "blind" nature makes them difficult to teach. The "learning curve" to independent practice may be longer than previously considered.

Advanced training skills modules in obstetrics and gynaecology

Advanced training skills modules have been designed to ensure future consultants in obstetrics and gynaecology have the skills necessary to work in the specialty. Abdelmageed Abdelrahman and Janet Acheson look at the background to these modules and discuss what trainees need to consider when choosing modules

Advanced training skills modules (ATSMs)

Urogynaecology with vaginal surgery 2.0 Subfertility and reproductive health 2.0 Acute gynaecology & early pregnancy 2.0 Oncology 2.0 Advanced laparoscopy for benign disease 2.0 Abortion care 1.0 Colposcopy 1.0 Hysteroscopy 1.0 Menopause 1.0 Paediatric & adolescent gynaecology 1.0 Sexual health 1.0 Vulval disease 1.0 Medical education 1.0 Obstetric ATSM Advanced antenatal practitioner 2.0 Fetal medicine 2.0 Maternal medicine 2.0 At the beginning of 2011 there were 21 ATSMs: medical education, five obstetric ATSMs and 15 gynaecology ATSMs. This article will consider the role of each ATSM to the practice of Obstetrics and Gynaecology and the recent revisions to their curricula, but first don’t forget the medical education ATSM. As essentially consumers of educational material, trainees can easily forget that there is a demand for high quality trainers. Delivering high quality training is difficult and takes time but the skills can be taught and are highly desirable. Medical education is a very flexible ATSM and it can be tailored towards obstetrics, gynaecology or both; currently hardly anyone chooses it. Obstetrics and Gynaecology is an extremely broad specialty and contains within it many skills that are only undertaken regularly by a few clinicians. Concentration of these skills allows expertise to develop more rapidly and then be maintained. The ATSM framework aims to maximize the development of these skills for interested trainees on top of the core and intermediate general O & G skills. Fifteen gynaecology ATSMs are arguably too many and trainees often need to combine several in order to create a balanced training programme. In contrast, there are only five ATSMS in obstetrics; this is in part because of their natural division into the broad clinical areas that obstetricians work in. Looking from the perspective of consultant working patterns and applying the same process to the gynaecology ATSMs suggests that certain ATSMs should be combined and that certain skills are not exclusive to one ATSM but feature in many (for example laparoscopic skills). Following discussion with the specialist societies, many of the ATSM have now been heavily revised. The result is that the Urogynaecology and Vaginal surgery ATSMs have been amalgamated, aspects of the three ATSMs in Laparoscopy, Hysteroscopy and Abdominal surgery are now gathered under the Benign abdominal surgery: open and laparoscopic ATSM, and laparoscopic skills feature within both the Oncology and the subfertility modules. It makes sense that anyone who performs laparoscopic surgery should be easily able to convert to open procedures. Whilst laparoscopic skills play an important part in both oncology and subfertility facets of the speciality, it is not necessary for the trainee to complete a full Laparoscopic ATSM in addition to Oncology or Subfertility ATSMs. Moving some of the laparoscopic skills into the Oncology or Fertility ATSMs can give the trainee the skills needed within a single self-contained module.

Scanning for all: a national trainees ultrasound training survey

BackgroundUltrasound imaging is central to service provision in obstetrics and gynaecology and vital for all subspecialty training. To meet training needs the advanced obstetric ultrasound diploma was replaced with five...

Curriculum evaluation from the trainees' perspective: Application to the ALWP ATSM

Curriculum evaluation is a way to assess the quality of a curriculum or an educational intervention. The Advanced Labour Ward Practice (ALWP) ATSM (Advanced Training Skills Module) is the module that most advanced trainees pursue in their final years of training. Competencies gained in the module equip trainees to function as future consultants providing 24-h presence on the delivery suite. Evaluation is a four stage process: planning, data collection, analysing information and reporting the results. In this paper, we propose ways to evaluate this educational intervention (the ATSM itself), using two well established models in medical education: the RUFDATA principles relate to framing of decisions and the Kirkpatrick model deals with programme evaluation at four levels: reaction, learning, behaviour and results. The barriers to successful evaluation and the ways to overcome them have been discussed. On an ethical perspective, we ask whether one would be content with surrogate measures of better clinical outcome in the highest level of evaluation. Curriculum evaluation helps in programme expansion, modification and validation

Outcome-based education: Principles and practice

Outcome-based education is a recent development in modern curriculum planning. The attributes of a good trainee are defined first and the ways to achieve them are suggested next. Outcome-based educational models have been used successfully. This paper deals with the application of 12 learning outcomes to a very relevant educational intervention from the Royal College of Obstetricians and Gynaecologists (RCOG): the Labour Ward Advanced Training Skills Module (ATSM, relating to advanced labour ward practice) and assessing their suitability for the same. The second part of the paper deals with principles and methods of assessment. Assessment is important in an outcome-based model, as it allows us to decide whether trainees have learnt what was expected to be learnt. The assessment tools in the labour ward ATSM have been critically appraised. It has been stressed that a good doctor's practice is a congruous blend of knowledge, skills and attitudes, rather than executing these domains in isolation.

A guide to the ATSM in Medical Education. Article 2: assessment, feedback and evaluation

Key content Assessment drives learning. Assessments should test learning achievement against agreed objectives. Feedback is a teaching aid. Appraisal considers the trainee's personal as well as educational development. Evaluation forms a cycle of continuing improvement of training. Learning objectives To learn about the main medical education theories on assessment, feedback and evaluation. For trainees to understand how to use the theory in practice. For Advanced Training Skills Module (ATSM) in Medical Education trainers to be able to offer learning opportunities to their trainees and then provide feedback. Ethical issues How far should the trainer become involved when a trainee has personal problems? How can the trainer give constructive criticism without discouraging the trainee? Please cite this article as: Shehmar M, Khan KS. A guide to the ATSM in Medical Education. Article 2: assessment, feedback and evaluation. The Obstetrician & Gynaecologist 2010;12:119–125.

A guide to the ATSM in Medical Education. Article 1: principles of teaching and learning

Clinical teaching needs to be contextual. Everyday clinical situations provide teaching and learning opportunities. Work‐based assessment tools can be used to teach and learn ‘on the go’. Learning objectives: Trainees and trainers should gain an introduction to the main medical educational theories on teaching and learning. An Advanced Training Skills Module (ATSM) in Medical Education trainee should be able to show an understanding of the practical application of the main educational theories. An ATSM in Medical Education trainer should be able to deliver a training module incorporating the educational theory behind effective teaching and learning. Ethical issues: A trainee has a responsibility to use all the available training opportunities that are offered. Trainers and trainees are both responsible for ensuring that no patient identifying information is kept in the training portfolio. Please cite this article as: Shehmar M, Khan KS. A guide to the ATSM in Medical Education. Article 1: principles of teaching and learning. The Obstetrician & Gynaecologist 2009;11:271–276.