Recommendation for implementation at national level: Need for uniform training program. Develop curriculum Consultant lead training. TOT courses, (electronic training) Yearly appraisal for trainers . Yearly assessment of trainees (In depth workplace assessment of trainees) Obligatory Courses: basic & advanced Offer simulators, videos. Revise obstacles at hospitals Investigate workload & no of trainees at hospitals.

1. Training in OBGYN Post in Egypt
Where we stand???
A Trainees Questionnaire
Wafaa B Basta
MRCOG , ERC Member
Consultant Obstetrics & Gynaecology
Mataria Teaching Hospital
ERC-RCOG International Conference, Sonesta , March 2015

2. • OBGYN Department in Multi-speciality
hospital
• Deliveries/year: 5000
• 24 hours shift/month: 5
• Operative lists/month: 3-5
• Voluntary participation
• Anonymous recording
• Hospital& OBGYN department approval

5. 3-4ys
Registrar
Master degree
5ys
Assistant
Specialist
10ys
Specialist
Consultant
5ys
Training
7ys
Specialist
(4ys ;Master Degree)
(5ys ; Diploma)
Consultant
With the Egyptian Board
Without the Egyptian Board

6. 30%
43%
27%
Participants (30)
Junior Registrar (9)
Senior registrar(13)
Assistant specialist(8)

7. Age Graduation Work length
Junior Registrar 27-31ys
28.5ys
2008-2012 9month-3ys
2.2ys
Senior Registrar 30-37ys
32ys
2001-2008 4-7ys
4.8ys
Assistant
Specialist
31-38ys
34ys
2002-2007 6-11
8.6ys

8. 20%
53%
3%
30%
6.60% 6.60%
30%
0%
10%
20%
30%
40%
50%
60%
1st
Master
Master
degree
Diploma 1stEgyp
Board
Egyp
Board
MD
Register
1st
MRCOG

9. Obstetric Experience

10. 0%
20%
40%
60%
80%
100%
Junior Registrar
Senior Registrar
Assistant Specialist
Which of the following procedures do you feel happy to perform
independently?

11. 0
0.2
0.4
0.6
0.8
1
1.2
Junior Registrar
(9)
Senior Registrar
(13)
Assistant Specialist
(8)
Which of the following procedures do you feel happy to
perform independently?

12. Do you think that you are getting enough obstetric
experience?
3%
37%
20%
30%
10% Yes
definitely
Yes
unsure
no
definitly not

13. Do you think you are getting enough practical teaching
on obstetric?
3%
40%
30%
17%
10%
Yes definitely
Yes
unsure
no
definitly not

14. What do you think are the major barriers to you
gaining more obstetric experience?
• Lack of consultant involvement in teaching: 70%
• Consultants are not inclined to teach: 43%
• Lack of continuity with the same consultant &same unit:
40%
• Consultants are not surgically confident to teach:
27%
• Inadequate no of shifts : 20%
• High work load due to staff shortages : 13%
• Lack of time to allow training : 13%

15. What do you think would improve your obstetric
skills?
• More consultant involvement in labour ward: 73%
• Access to models: 53%
• Attachment with a specific trainer: 43%
• DVDs demonstrating obstetric procedures : 27%
• More labour ward shifts : 23%
• Access to obstetric text books : 10%

16. Any other ways that your obstetric skills could be
improved?
• Training program with timely assessment of each
registrar.
• Consultants supervision on seniors to teach juniors.
• Training courses & workshops (emergency
obstetrics) with affordable costs & suitable timing.

17. Gynaecological experience

18. Which of the following Gynae procedures do you feel
happy to perform independently?
0%
20%
40%
60%
80%
100%
120%
Junior Registrar
Senior Registrar
Ass Specialist

19. Which of the following Gynae procedures do you feel
happy to perform independently?
0
0.2
0.4
0.6
0.8
1
1.2
Junior Registrar
Senior Registrar
ass Specialist

20. Do you think that you are getting enough
gynaecological surgical experience?
0%
7%
17%
56%
20%
Definitly yes
yes
unsure
No
Definitly not

21. Do you think you are getting enough practical teaching
on gynaecological surgery?
0%
13%
13%
54%
20%
definitly yes
yes
unsure
No
definitly No

22. What do you think are the major barriers to you
gaining more gynaecological surgical experience?
• Lack of theatre time to allow training: 50%
• Lack of continuity with the same consultant: 47%
• Some consultant are not inclined to teach: 37%
• Some consultant are not surgically confident to teach 27%
• Unable to attend theatre sessions due to time off following
on calls 17%
• Unable to attend theatre sessions due to staff shortages
10%

23. Any other barriers to you gaining obstetric& surgical
experience?
• Low number of patients admitted compared to medical
staff.
• Lack of organized training system with specific targets.
• Inco-operative patients.
• Unfair distribution of work.
• Too few workshops ,bad timing ,expensive.
• Lack of encouragement & support from seniors.
• Old management protocols.
• Limited operative lists to 2 cases .

24. What do you think would improve your surgical skills?
• Surgical lists specifically designated as training lists
73%
• Access to models/laparoscopic trainers 67%
• More theatre sessions 60%
• Attachment with a specific surgical trainer 57%
• Attachment to a gynae oncology team 53%
• DVDs demonstrating surgical procedures 43%
• Access to surgical text books 10%

25. Any other ways that your surgical skills could be
improved?
• Protocol for admitting different cases to increase
admission no.
• Workshops with appropriate time & cost.
• Timely clinical & scientific assessment of trainers
& trainees
• Upgrading according to evaluation not time spent
in department.
• More involvement of expert consultants in
teaching.

26. Recommendations (Local)
• Introduction of instrumental delivery training &
practice is crucial.
• More consultant involvement in labour ward
• Attachment of each trainee to surgical trainer.
• More operative lists.
• Yearly appraisal & assessment of both trainers &
trainees.
• Basic & advanced workshops, simulation(local).
• Emergency algorithms.
• Improve endoscopy training.

27. Recommendations (National)
• Need for uniform training program.
• Develop curriculum
• Consultant lead training.
• TOT courses, (electronic training)
• Yearly appraisal for trainers .
• Yearly assessment of trainees (In depth workplace
assessment of trainees)
• Obligatory Courses: basic & advanced
• Offer simulators, videos.
• Revise obstacles at hospitals
• Investigate workload & no of trainees at hospitals.

30. Proposed Training courses
• Basic Practical Skills in Obstetrics and Gynaecology
course.
• CTG Interpretation
• Basic obstetric ultrasound theoretical course
• Perineal trauma course
• Basic laparoscopy course.
• Basic hysteroscopy course.
• Basic neonatal resuscitation

31. Proposed Training courses
• ALSO/MOET or PROMPT
• Shoulder dystocia drill
• Eclampsia drill
• Drill for obstetric collapse
• Massive obstetric haemorrhage

32. Thank you