Eligibility For Registration Research Articles

Trends in Patient Characteristics on the Japanese Waiting Lists for Deceased-Donor Kidney Transplantation. Are There no Eligibility or Ineligibility Criteria for Registration and Renewal?

BackgroundControversial issues in registering candidates for deceased-donor kidney transplantation (DDKT) comprise various factors, including age, life expectancy, and dialysis duration. We investigated patient characteristics on the waiting list and discussed suitable criteria in Japan, which has a long waiting period. MethodsThis study included 592 patients on the waiting list for DDKT at our institute between 1982 and 2023. We retrospectively reviewed patients’ medical charts and obtained their clinical information. Patient characteristics according to outcomes and eligibility criteria for applying for or renewing registration were investigated. No prisoners were used in the study, and the participants were neither coerced nor paid. ResultsApproximately 70%, 45%, and 14.5% of the registered patients were aged >60, >70, and 80 years, respectively. The number of patients aged ≥70 years gradually decreased over time. The median waiting periods of patients who underwent and interrupted DDKT were 13 and 7 years, respectively. Patients in their 70s with a >15-year dialysis period tended to have opportunities for DDKT. Living-donor kidney transplantation was performed in patients aged <60 years. Waiting patients were significantly younger and had a shorter dialysis duration. Advanced age at registration was associated with a significantly high risk of interruption. ConclusionsAdvanced age and longer dialysis periods were considered at registration because patients with these factors tended to experience interruptions despite the long waiting period and high cost. Although older patients can undergo DDKT, factors including surgical cost and risks are considered. Eligibility/ineligibility criteria should be established for DDKT waiting lists in Japan.

P050 Certificate of Eligibility for Specialist Registration (CESR) (portfolio pathway) satisfaction survey for dermatology trainees: a comparison of current CESR vs. national trainees, within a large UK teaching hospital

P050 Certificate of Eligibility for Specialist Registration (CESR) (portfolio pathway) satisfaction survey for dermatology trainees: a comparison of current CESR vs. national trainees, within a large UK teaching hospital

The history of Japanese lung transplantation: the unique pathway to establishing the program and its initial success.

Japan is a unique country in terms of organ transplantation. Despite the impressive progress in transplant medicine achieved during the late 20th century in many Western countries, Japan was unable to implement a program for organ transplants from brain-dead donors due to persistent public distrust regarding the ethical understanding of "brain death as human death". In 1997, the Japanese Organ Transplant Law was enacted, and organ transplantation from brain-dead donors was finally legalized. However, this law was strongly opposed by religious leaders, philosophers, politicians, and even medical personnel who did not accept the idea that brain death is human death, so transplant physicians had to start performing transplants in the face of strong social resistance. The Japanese National Lung Transplant System was established based on the following three philosophies: (I) an institutional certification system based on strict standards; (II) a rigorous central monitoring system for transplant results; and (III) a third-party review system to determine eligibility for patient registration. The purpose of these policies was to avoid ethical issues at lung transplant institutes, and to achieve high-quality transplant results. The actual progress of Japanese lung transplantation has been quite unusual compared to other countries. The number of brain-dead organ donations was extremely limited at first, so more than 60% of lung transplants were performed as living-donor transplants during the first 9 years [1998-2006]. The number of brain-dead donations subsequently increased, particularly after the revision of the Organ Transplant Law in 2010 such that the majority of lung transplants are now performed as brain-dead transplantations. Regarding the results of lung transplants, the most recent national registry report indicated that a total of 668 lung transplants including 447 from brain-dead donors and 221 from living donors, had been performed as of 2018. The 5- and 10-year survival rates for brain-dead donor lung transplantation were 71.9% and 57.8%, respectively, with no significant difference between the living-donor and brain-dead-donor groups. These results are comparable with the outcome of preceding programs in the US and European countries.

COVID-19 Vaccination: Willingness and practice in Bangladesh.

MotivationMass adult immunization for COVID‐19, coupled with the urgency, is a challenge for any lower‐middle‐income country (LMIC) like Bangladesh. Our analysis focuses on demand‐side constraints early in the vaccination campaign to help gauge vaccine acceptability and potential contributing factors. Identifying registration and compliance challenges early on will help ensure a seamless immunization programme.PurposeWe seek to identify subgroups who may need specific interventions by comparing willingness to be vaccinated and registration behaviour, and to understand how actual registration and take‐up decisions compare between rural and urban slum regions.Approach and MethodsWe use data from three surveys conducted between late January and early September 2021. The article includes a nationally representative survey on vaccine acceptability and a study on vaccination rollout behaviour in rural and urban slums.FindingsWillingness was not an issue in Bangladesh, but the weak link was getting individuals to register. Once they did, compliance was very high. When the information gap regarding registration was addressed by campaigning, registration and take‐up increased. Confidence in public service delivery influenced favourable responses to mass immunization efforts. Women were falling behind initially in terms of both registration knowledge and completion. Online registration needed to be complemented with alternatives. Social networking was a vital source of information and encouragement.Policy implicationsCommunication strategies are necessary to inform the public at an early stage, which should provide information about registration eligibility and detailed registration instructions. Ensuring and sustaining service quality will also be beneficial. In LMICs like Bangladesh, low‐tech intensive registration methods are required. Information campaigns about the registration procedure should specifically target rural communities and women. Community‐based mechanisms may reduce transaction costs and increase confidence.

The specialty of oral and maxillofacial surgery (OMFS) in Europe – Part 1: service configuration, regulation, and provision

Oral and maxillofacial surgical (OMFS) practice and training in Europe is supported by the OMFS Section of the Union of European Medical Specialists (UEMS). Across Europe the number of OMFS specialists per 100,000 varies from 3.0 (Switzerland) to 0.28 (Ireland). The two types of OMFS within the European Union (EU) under Directive 2005/36 and European Free Trade Association (EFTA) treaties are dual degree dental, oral and maxillofacial surgery (DOMFS) and single medical degree maxillofacial surgery (MFS). Automatic recognition of OMFS specialist qualifications is possible only between nations which have the same (or both) types of medical OMFS. Otherwise, individual specialists must apply for a Certificate of Eligibility for Specialist Registration (CESR). DOMFS: 20 European nations have dual degree OMFS. Of these, 12 EU nations are DOMFS in Annex V, 3 are DOMFS in the European Free Trade Association (EFTA) Treaty, and one has mandated dual degree OMFS but is a dental specialty. The United Kingdom has dual degree OMFS. Two MFS nations have had mandated dual degree training for more than 10 years and one has both DOMFS and MFS training, with DOMFS recommended. Although no nation with dual degree DOMFS has transitioned back to single degree MFS, there are pressures to do so within Finland and Norway. MFS: 11 EU nations have single medical degree MFS (and 4 DOMFS nations also have MFS as a legacy specialty). Four nations in the EU/EFTA do not yet have a medical specialty of OMFS: Sweden, Iceland, Denmark, and Estonia.

A UK-wide survey of Balint, support groups and psychotherapy training opportunities for SAS (Specialty Doctors and Associate Specialists) Psychiatrists

AimsTo investigate SAS Psychiatrists’ opportunities for Balint-type, support groups and psychotherapy training opportunities nationwide, for which there is a lack of existing literature or established framework.MethodAn online questionnaire was sent to UK-wide SAS psychiatry doctors with the support of the RCPsych Speciality Doctors and Associate Specialist Psychiatrists Committee (SASC). The survey enquired about location, work experience, future plans, Balint-type groups, psychotherapy opportunities and support.Result122 doctors completed the questionnaire, estimated to constitute approximately 8% of SAS psychiatry posts (or more if considering all vacancies), based on the RCPsych Census (2015), from across all UK nations.Time spent in an SAS role varied widely between months (10%) to over 20 years (5%), with the median and mode being 8–12 years (25%). Regarding future career plans 61% responded that they would be considering either the Certificate of Eligibility for Specialist Registration (CESR) route, or applying for future training or both.24% reported being part of a Balint-type group whilst almost double this number (47%) said they would be interested to join but none were available. 31% were part of a reflective practice or support group whilst 44% reported that they were interested in joining but none were available. Only 7% said that they were not participating or not interested in either a Balint group or a reflective group. Free-response comments suggested these opportunities were usually reserved for trainees and service commitments prevented attendance.76% of respondents reported access to an SAS Tutor, but only 21% confirmed access to a psychotherapy tutor.Half of respondents indicated they did not have access to information and guidance they needed regarding accessing psychotherapy opportunities, with only 27% thinking they did.24% reported managing to gain experience in at least one psychotherapeutic modality, 44% of whom received medical psychotherapist supervision; whilst 13% said they did not intend to pursue this.ConclusionThe results highlight that interest in joining Balint and reflective support groups significantly exceeds local provision. As these groups are not mandatory requirements for CESR application, the interest expressed (including amongst those reporting to be SAS by choice) suggests that SAS Psychiatrists value these opportunities for their recognised professional developmental and clinical benefits; these include peer support, understanding doctor-patient interactions and having a space to reflect on the emotional impact of clinical work. Trusts should consider supporting SAS doctors wishing to join new or existing Balint-type or other supportive reflective clinician groups.

A UK-wide survey of speciality doctors and associate specialist (SAS) psychiatrists' psychotherapy case experience, barriers and benefits to professional development and clinical capabilities

AimsResearch suggests that seeing psychotherapy cases benefits psychiatric trainees’ professional development and clinical capabilities, however there is lack of such evidence for SAS psychiatrists, who require this experience for Certificate of Eligibility for Specialist Registration (CESR) applications.Having provided frequently requested psychotherapy training support to our Trust's CESR training programme in Birmingham we aimed to study nationwide SAS psychiatrists’ psychotherapy case experience, professional benefits and barriers to access.MethodAn online questionnaire was sent to UK-wide SAS Psychiatry doctors, with the support of the RCPsych Speciality Doctors and Associate Specialist Psychiatrists Committee (SASC), whilst being promoted on social media. It asked about psychotherapy-related experience, barriers and plans.Result122 doctors completed the questionnaire, estimated to constitute approximately 8% (or more if considering all vacancies) of SAS psychiatry posts based on the RCPsych Census (2015), from across all UK nations and regions.23% had gained experience in delivering psychotherapy (57% of whom confirmed CESR or training application plans), seeing cases mainly in CBT (52%) and psychodynamic psychotherapy (41%). Those who had delivered psychotherapy agreed or strongly agreed that it helped them become a better listener (82%), become more empathetic (75%), enjoy work more (71%), understand the unconscious communication better (82%), be more confident about referring for psychotherapy (82%) and overall be a better psychiatrist (86%).44% planned to start a psychotherapy case but had not started, of whom only 22% had identified a supervisor and 15% identified a case. Only 11% felt confident they could get the psychotherapy training experiences they needed. Barriers reported included it not being part of their job plan (70%), time constraints (57%), difficulties in accessing psychotherapy supervision (61%), difficulties in identifying suitable cases (32%) and limited knowledge about psychotherapy (30%).ConclusionDoctors who delivered psychotherapy reported benefits on many levels, making a strong case it develops their clinical capabilities, which may facilitate psychologically-informed care.The results indicate interest in psychotherapy training outstripped available opportunity and support. Whilst some barriers mirrored those previously reported for trainees (difficulties accessing supervision and cases) others identified particularly related to SAS workload (not being part of their job plan and time constraints) and lack of support (with trainees prioritised). This may highlight a potential concern given the SAS Charter covers CESR-related support and advocates appropriate Supporting Professional Activities (SPA) time.Trusts need to consider more actively supporting SAS psychotherapy training and including in job planning for those receiving, delivering and supporting these valued experiences.

Impact of COVID-19 on preparation for the Certificate of Eligibility for Specialist Registration (CESR) in Ophthalmology.

Impact of COVID-19 on preparation for the Certificate of Eligibility for Specialist Registration (CESR) in Ophthalmology.

Road to CESR (Article 14)- Is it for me?

“What lies behind us &amp; what lies ahead of us are tiny matters to what lies within us!” – Ralph Waldo Emerson Many clinicians across the world aspire to come to United Kingdom and work in NHS. Initial months could be challenging to work in completely new healthcare system. With some help from good colleagues, transition for overseas doctors can be less overwhelming. As an International Medical Graduate (IMG), there are several options for career progression in UK. Many doctors enter in the UK formal training program, however, Certificate of Eligibility for Specialist Registration (CESR) is an alternative pathway to achieve CCT. The CESR route could be helpful for clinicians trained in countries outside the UK or European Union as their training from their country of origin might not be recognized equivalent to CCT by General Medical Council (GMC). After obtaining CESR certification, your name is added to specialist register which is a absolute necessity to obtain a substantive consultant position in UK. There is ever increasing requirement for doctors in the UK due to staff shortages and now Covid-19 pandemic has pushed many trusts against the wall to fill these positions. Apart from recruiting overseas doctors, CESR certification has proven to be helpful in filling up these positions. The GMC made some favorable changes in the CESR process in recent years which has encouraged and many career grade/staff grade doctors to progress. On other hand, trainees who fail to obtain training post after several attempts are opting for CESR as an alternative route to progress. Annual statistics published by the GMC indicate that there is rising trend in number of applications for CESR certification in all specialties. There is a gradual change in the perception of CESR as an equally attractive route for career progression. However, there are many unknowns in this pathway as this has been a path less travelled. There is a general perception that CESR certification is difficult t

Incidence of Type 1 Diabetes Among Children and Adolescents During Peace and War Times in Yemen

Background: The incidence of type 1 diabetes (T1D) among children and adolescents has been reported to be steadily increasing worldwide with considerable regional, national and ethnic differences. We aimed in this study to present a 30-year registry-based incidence data on T1D in Yemen, a low-income country, during peace and war times. Methods: A total of 461 children and adolescents aged more than 6 months to 18 years with newly-diagnosed diabetes were registered between1989-2018. We used a standardized registry protocol according to that established in the 155 center WHO Multinational (DiaMonod) Project for childhood diabetes. The registry as with other WHO DiaMond centers was primarily concerned with counting the frequency of new-onset cases of childhood diabetes over time across Sana’a city according to a standard set of specific criteria. Case reports registered were validated on the basis of a physician’s diagnosed diabetes in the records. Eligibility for registration was based on age < 19 years and permanent residence in Sana’a city. The annual incidence rates (cases/100,000 persons/year) were calculated from the numbers of new reported cases for each year (1989-2018) divided by the estimated numbers of person-years ‘at risk’ (population < 19 years) according to age and sex for that year. Completeness of case ascertainment for the identified number of cases was assessed with the use of the 2-source capture-recapture method throughout the study period. Findings: The mean annual incidence rate in children aged 0-14 years over the full observation period was 1.83/100,000/yr with 95% CI: (0.9, 2.74). With the use of 3-year time periods, the mean annual incidence rate was intermediate (5 per 100,000/yr) in the first time-period (1989-1991), low (1.56-2.3/100,000/yr) during subsequent 5 time-periods (1992-2006) and (1.2/100,000/yr) during the next 2 time-periods (2007-2012). Ultimately, there was a precipitous decline in incidence to a very low rate (0.5/100,000/yr) during the last two time-periods (2013-2018) which was the time when Yemen has experienced the conflict and war. The age-specific mean T1D annual incidence rates with the use of 3-year time periods for children aged 0-4 yr, 5-9 yr, 10-14 yr, and adolescents aged 15-18 yr over the full observation period (1989-2018) were 0.83, 1.82, 3.14, and 2.31/100,000/yr, respectively. On temporal trend analysis of incidence rates with the use of 3-years moving average, all trend curves indicated a decline for all participants aged 0-14 years and for other age groups, especially during the last 6 years of the observation period. The mean annual age-specific and sex-specific incidence rates over the full observation period were found to be increasing with increased age in both males and females, peaking at puberty (10-14 year old) with the associated gender effect. A seasonal trend in incidence of T1D was noted with more diagnoses of cases in the winter and autumn months and fewer in the summer months, a feature that was observed in both sexes and in all age groups. Interpretation: The mean incidence rate of T1D in children and adolescents in Sana’a city was found to be low. In children aged 0-14 years in particular, the rate was low during peace time, followed by a precipitous decline to a very low rate during the time of war. Economic destruction, poverty and shortage of food supply to a large sector of children and adolescents were likely associated with decreased incidence of childhood diabetes during war. Undernutrition and low standards of environmental hygiene with exposure to infections very early in childhood might have operated as a protective factor against pediatric-onset autoimmune diabetes. Funding Statement: The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. Declaration of Interests: None declared. Ethics Approval Statement: Patient consent for publication was obtained from patients’ families. Ethical approval statement: This work was approved by the Ethical Committee at the Faculty of Medicine and Health Sciences, University of Sana’a

Prospects and challenges for an Indian dermatologist in the United Kingdom

The United Kingdom is a sought-after destination to gain overseas experience and long-term employment for doctors trained in India. However, for many the path is unclear. This article aims to explain the various opportunities and the steps involved in securing a job in the National Health Service (NHS) for an Indian dermatologist. The steps to obtain the General Medical Council license to practice include demonstrating competency in English and passing the Professional and Linguistic Assessments Board examinations. Once the doctor is eligible to practice, career options are working as Core Medical trainee, Staff grade and Associate Specialists and Specialty doctors (SAS) or a locum consultant. One can become a consultant in the UK without retraining in dermatology through Certificate of Eligibility for Specialist Registration. In the NHS, a dermatologist typically works for 8 h a day on the weekdays. Time is allotted for professional development through the Continuing Professional Development sessions. Doctors earn well in the UK although the cost of living is high.

European OMFS in the time of Brexit – where did the UK fit and how might the future look?

The specialty of OMFS in the UK is a dual degree specialty which was recognised in Europe within Annex V of Directive 2005/36/EU. Currently UK law matches that of the EU. Brexit may change this. DIRECTIVE 2005/36/EU: Defines two specialties within European nations, Dental, Oro-Maxillo-Facial Training DOMFS (Basic dental & medical training) and Maxillofacial Surgery (basic medical training). The UK sat within DOMFS and so specialists from DOMFS nations could travel and work in the UK. Specialists from all other nations were required to use the Certificate of Eligibility for Specialist Registration (CESR) route. DIRECTIVE 2013/55/EU: This directive updated 2005/36/EU regarding Mutually Recognised Professional Qualifications (MRPQ) including creating an international alert system for doctors in difficult Entry onto the UK OMFS Specialist List by CESR Route CESR application is a large and complex portfolio of evidence to demonstrate knowledge, skills and experience are equivalent to a Certificate of Completion of Training (CCT) holder. To date, no EU applicants have successfully completed a CESR application. Even after Brexit, the UK will remain a full member of UEMS. The OMFS Section of UEMS is a source of information and support for specialists wishing to work in other nations and for nations wishing to develop an OMFS specialty in their nation. Applicants meeting the person specifications for approved OMFS specialty training (ST) posts in the UK are welcome to apply to the national selection process for OMFS specialty training in the UK. Many have done so successfully. Fixed term appointments and Fellowships are advertised and represent a useful route to gain support for application for training or through the CESR Route. The UK remains part of the diverse OMFS community in Europe. There is support from within the UK and from UEMS for trainees and specialists interested in coming to the UK to train or to work.

Methodological Challenges in Web-Based Trials: Update and Insights From the Relatives Education and Coping Toolkit Trial.

There has been a growth in the number of web-based trials of web-based interventions, adding to an increasing evidence base for their feasibility and effectiveness. However, there are challenges associated with such trials, which researchers must address. This discussion paper follows the structure of the Down Your Drink trial methodology paper, providing an update from the literature for each key trial parameter (recruitment, registration eligibility checks, consent and participant withdrawal, randomization, engagement with a web-based intervention, retention, data quality and analysis, spamming, cybersquatting, patient and public involvement, and risk management and adverse events), along with our own recommendations based on designing the Relatives Education and Coping Toolkit randomized controlled trial for relatives of people with psychosis or bipolar disorder. The key recommendations outlined here are relevant for future web-based and hybrid trials and studies using iterative development and test models such as the Accelerated Creation-to-Sustainment model, both within general health research and specifically within mental health research for relatives. Researchers should continue to share lessons learned from conducting web-based trials of web-based interventions to benefit future studies.International Registered Report Identifier (IRRID)RR2-10.1136/bmjopen-2017-016965

Experience Versus Report: Where Are Changes Seen After Exposure-Based Cognitive-Behavioral Therapy? A Randomized Controlled Group Treatment of Childhood Social Anxiety Disorder

A considerable number of children and adolescents with social anxiety disorder (SAD) do not benefit from treatment as much as expected. However, treatment success should not be measured with social anxiety reports alone; the cognitive, behavioral, and physiological components of social stress should also be assessed. The authors examined an exposure-based SAD-specific group cognitive behavioral therapy (CBT) in a randomized controlled trial (N = 67, age 9–13 years, blind randomized allocation to treatment [CBT; n = 31] and waitlist control [WLC; n = 36] groups). Success was operationalized as a clinically significant reduction of symptoms measured with SAD-specific questionnaires, structured interviews, and changes in response to the Trier Social Stress Test (TSST). In the CBT group, there was a trend toward a significant increase in positive cognitions in the TSST after treatment (d = 0.37), whereas these positive cognitions decreased in the WLC group (d = 0.40). No significant results involving group appeared for negative cognitions, behavior and physiology. Children in the CBT group, but not parents, further reported less social anxiety in one questionnaire from pre- to post-treatment (d = 0.89). A structured interview confirmed a decrease in severity of SAD in the CBT group. While the gold standard of a blind interview showed efficacy of treatment, not all trait and state measures demonstrated similar success patterns.Trial registration Eligibility criteria and some of the dependent variables (cognitions, physiology) for treatment success were registered with the German Research Foundation (TU 78/5-2, HE 3342/4-2) prior to recruitment. Clinical assessment of diagnosis and behavioral data were not a priori planned as outcome measures for this trial and therefore analyzed in a post-hoc approach.

Cultural Resources Report for the Cane Island Branch Section of the Buffalo Bayou Project Between Katy-Flewellen Road and Kingsland Boulevard in Fort Bend County, Texas

Cultural Resources Report for the Cane Island Branch Section of the Buffalo Bayou Project Between Katy-Flewellen Road and Kingsland Boulevard in Fort Bend County, Texas

Machinations of the British Medical Association: Excluding Refugee Doctors from Queensland’s Medical Profession, 1937–1942

Abstract When medical practitioners fled from the Nazi regime in the 1930s, the British Medical Association (hereafter BMA), the representative body of the medical profession in the British Empire, agitated strenuously to prevent ‘refugee doctors’, as they were described, from practising medicine throughout the Empire. Prominent BMA representatives pursued this agenda in Australia through their appointment to statutory state-based authorities that registered and regulated doctors'. This article investigates how, between 1937 and 1942, they sought to use those bodies’ registration and disciplinary powers in Queensland to exclude refugee doctors. They were particularly persistent in this state given its government's resistance to BMA pressure to pass legislation restricting refugee doctors’ eligibility for registration. In so doing, the article contributes new perspectives to scholarship that analyses the BMA’s effectiveness as a pressure group. This article’s exploration of motives for the BMA’s animosity towards refugee doctors also builds on histories of the medical profession and of ethnicity within it.

Internationally educated nurses’ competency assessment and registration outcomes

PurposeThe purpose of this paper is to examine relationships between internationally educated nurses’ (IENs’) performance in a registered nurse competency assessment process and the outcomes of their nursing registration applications. Assessments of nursing practice competencies, IEN applicant characteristics and registration outcomes were explored.Design/methodology/approachThis is a secondary statistical analysis of a subset of IEN application data from a previous study in combination with assessment data from an additional database. Application data between 2008 and 2011 were analyzed using univariate/bivariate analyses and regression models to explore the relationship of performance in the assessment process and outcomes of the registration process.FindingsCompetency categories IEN applicants had difficulties with (from least to most) were Professional Responsibility and Accountability, Ethical Practice, Self-Regulation, Service to the Public, Knowledge-Based Practice: Specialized Body of Knowledge and Knowledge-Based Practice: Competent Application of Knowledge. IENs educated in the UK and USA had the highest scores and odds of meeting competencies. Applicants educated in India and Asia had lower scores and odds ratios. All national entry-to-practice examination and registration eligibility competencies were significantly related to registration outcomes. Applicants passing the exam had higher competency scores while applicants ineligible for registration had lower competency scores.Research limitations/implicationsLimitations include integrity of data extracted from active databases, IEN motivation to complete the RN registration process and conversion of assessment scales for research analysis.Originality/valueResults inform regulation policies that improve IEN registration processes and may be informative to regulators, assessment centers, educational institutions and IENs.

Training the future trainer – The “double-barrel” postgraduate training model: A pathway to the development of sustainable obstetrics and gynecological specialists in the West African subregion

An obstetrician and gynecologist is a physician specialist who provides medical and surgical care to women and has particular expertise in pregnancy, childbirth, and disorders of the reproductive system. Obstetrics and gynecological practice is usually generalist, although four distinct primary subspecialties have been recognized globally – reproductive medicine (reproductive endocrinology and infertility), uro‑gynecology (female pelvic medicine and reconstructive surgery), maternal and fetal medicine, and gynecological oncology. The past two decades have witnessed an evolution in the pattern of training of resident doctors in obstetrics and gynecology, the world over. The West African subregion harbors countries ravaged by poverty and poor health system, with resultant poor reproductive health indices to the extent that calls to question the relevance of the present pattern of Obs/Gyn specialist training toward addressing the reproductive healthcare needs of the subregion. The objective of the study is to evaluate the evolution of postgraduate medical training in some developed countries and Nigeria; highlight the pattern of Obs/Gyn postgraduate training in the United Kingdome, the United States, West African, and Nigeria; and recommend a dual training model that is expected to produce sustainable obstetrics and gynecological specialist in West African subregion. Material and Methods used was a Review involving Internet and literature search. Postgraduate medical training in Nigeria and other Anglophone West Africa countries commenced as a hybrid of UK, USA, and Canadian postgraduate training models. The postgraduate Ob/Gyn educational training program in the United Kingdom has three components – basic, intermediate, and advanced – related to 7 years duration – ST (Specialist Training) 1 to 2 (basic), ST3–ST5 (Intermediate), and ST6–ST7 (advance). They are determined in context and structure by the Royal College of Obstetricians and Gynaecologists and approved by the Postgraduate Medical Education and Training Board. There are three‑part assessment to the exam: Part 1 MRCOG, Part 2 MRCOG, and Part 3 MRCOG – which on completion leads to the award of a Certificate of Completion of Training or a Certificate of Eligibility for Specialist Registration. The obstetrics and gynecological postgraduate residency training program of West Africa College of Surgeons has a minimum duration of 3 years (after passing the primary exams for the award of membership certificate (Part I), and additional minimum of 2 years for the award of fellowship certificate of West Africa College of Surgeons. The training program in Obs/Gyn of the National Postgraduate Medical College adopts a similar pattern to that of West African College. After passing the primary exams, the resident trainee is expected to carry out a 2.5 years training as a junior resident, and an additional 2 years senior residency training to become eligible for the award of the fellowship certificate (FMCOG). American MD/PhD programs are specifically designed for those who want to become research physicians (physician‑investigators or physician‑scientists). The program runs a “2‑3‑2” or “2‑4‑2” track, consisting of 2 years of basic medical science courses; 3–4 years of PhD research and completion of thesis; and a further 2 years of clinical residencies. The proposed “double‑barrel” (dual) postgraduate training model requires that the doctor commencing residency training in Obs/Gyn simultaneously enrolls to commence the master’s degree program in any of the subspecialties of Obs/Gyn. By the completion of Part I section of residency training program, the trainee will have also completed the master’s degree in the subspecialty of choice, and by the completion of the full training program for award of fellowship, he/she will also be completing the doctorate degree program in the subspecialty. The dual postgraduate training model will produce robust research‑strengthened Obs/Gyn subspecialist clinicians; add value to the present fellowship certificate and thereby conform to the qualification demand of National University Commission for academic lecturership; encourage the establishment of Obs/Gyn subspecialty centers with appropriately skilled personnel and stem the exit of wealthy nationals abroad to seek such expert healthcare; and encourage the wide spread deployment of Obs/Gyn clinicians with subspecialty skills to various parts of the West African subregion, thereby providing expert reproductive health services to both the rich and the poor alike in the subregion. Keywords: Double‑barrel postgraduate training model; sustainable obstetrics and gynecological specialist; training the future trainer; West African subregion

GMC has sped up CESR and CEGPR application process

The General Medical Council has cut the amount of time it takes to process applications for the certificate of eligibility for specialist registration (CESR) or the certificate of eligibility for GP registration (CEGPR). The GMC said that, in 2014, 95% of CESR and CEGPR applications were processed within the three …

Nursing students’ intentions to enter primary health care as a career option: Findings from a national survey

This paper reports findings from the first phase of a national study conducted to identify the intention of nursing students' to work in a Primary Health Care setting following registration. An online survey of final year nursing students enrolled at Australian universities offering education leading to eligibility for registration as a nurse with the Australian Health Practitioner Regulation Agency was undertaken during July-August 2014. Data were collected about students' intention to enter Primary Health Care as a career option, as well as their exposure to primary health care during their nursing education and whether they had undertaken practice placements in a primary health care setting. Analysis was conducted on 456 completed surveys. The findings demonstrated that, despite the majority (98.2%; n = 447) of students being exposed to Primary Health Care during their studies, less than a quarter (22.8%; n = 104) of the students who responded identified this as an area in which they intended to work following registration. No association was found between students' clinical experiences and their identification of primary health care as a career preference. Given the ageing population in Australia, the increased prevalence of chronic health issues and the predicted ongoing primary health care workforce shortages, educational and workplace strategies aimed at attracting new graduate nurse into Primary Health Care settings are imperative.