The leading recent article ‘The future obstetrician/gynaecologist’ by Susan Bcwley fails to address the central problem of training in modern obstetrics and gynaecology, which is the issue of subspecialization.
It is no longer tenable that consultants should be expected to practise at the appropriate level in the three major subspecialtics of perinatal medicine, reproductive medicine, and gynaecological oncology. The clear identification of subspecialty interest after general training would significantly reduce the time needed in training. For example, practitioners wishing to concentrate on gynaecological oncology would not need to gain irrelevant extensive skills in amniocentesis, antenatal fetal monitoring, or the management of complicated obstetric cases. Similarly, individuals interested in reproductive medicine would not need to undertake the detailed surgical training required to be a proficient gynaecological oncologist.
The immediate introduction of subspecialization would significantly improve the quality of care to patients, improve the calibre of consultant consultations, and significantly reduce the training time. The expansion of consultant numbers with the introduction of shortened training programmes, enabling present day senior registrars to be considered as consultants, would easily permit the widespread application of subspecialization. Continuation of the excessively long training programmes, employed to produce amateur obstetrician/gynaecologists, provides inadequately trained consultants of great age. Neither medicine nor surgery require senior consultants to maintain equivalent skills in the broad range of their specialties, and it is time that obstetricians and gynaecologists admitted this fact in their own subject.