We all need a bit of TOG time. I've been taught many things by many great teachers over the past 40 years (bit of an age giveaway there!), but one thing keeps coming to the fore as being more and more relevant as time goes on: ‘Always set aside time to think. A quiet room, blank sheet of paper, time to just think through things and jot down your ideas.’ This great advice was given to me by one of my supervisors when I was a research fellow. Did I listen? Probably not as much as I should have, but now with my revalidation looming I can see just how universally applicable that advice is to all of us.
What do I do with that time now? Well it's had to become a bit more than just ‘blue sky thinking time’. It's my reflection time for every aspect of what I do from clinical work to this; it's my time to prioritise and plan for the short- and medium-term jobs; it's my QA time, when I look back to ensure that I've delivered on commitments both in work and out; and it's TOG time, when I sit and do the CPD questions the same as everyone else. I'm trying to encourage my trainees to find time to reflect and it's pretty obvious to me now that I've been doing this now for many years. TOG time might start as exam revision as a trainee and ‘morph’ into CPD post training, but if the time is set aside it did, at least in my case, quite naturally become a time for reflection and I might say has actually made preparing for appraisals and revalidation much easier than I anticipated.
Some of what we have in this issue is not as purely clinical in its derivation as our usual content. Andrew Scally's article on medical statistics is a good example of this. I'm sure the trainees who read TOG regularly in preparation for the MRCOG will begin to salivate at the thought that someone might make this topic easy to understand, whereas the busy clinicians will be thinking this has less relevance to them than some of the clinical reviews that follow. I can recommend this review to all. Andrew takes us logically through common statistical variables, tests and populations. If you are a cynic and don't plan to read this then at least first read the section on statistical significance and clinical importance, and perhaps then you might be encouraged to read the rest of the article that adds weight to this section. I've read a lot on statistics in my time and I fully expect that this article will be rolled out at journal clubs around the world as a reference text for the review of the statistical component of the studies under discussion.
Similarly and some might say complimentary to the statistics paper we have an article from Jolly Joy and Neil McClure entitled ‘The art of reviewing a paper’. This one has us editors drooling as we long to have both more people coming forward to review papers and for the quality of those reviews to be high. Many of us do review papers but how many of us feel we could teach this skill or share this knowledge with others? This review looks at all aspects of this process from the very invitation to the final recommendations you might make as a reviewer. Another one for journal clubs up and down the country, but I suspect it will also see the quality of reviews go up as we all benefit from a reminder of the process that a good review entails. I'd have expected nothing less from my Editor-in-Chief predecessor!
On an educational theme we also have an article from Anna Fabre-Gray and Victoria Bills highlighting the challenges of providing an obstetric teaching programme in resource poor settings. This article continues a strong commitment within TOG to publish articles relevant to the improvement of women's health globally. I'd hope that what comes across from this article is the immense amount of work that goes into planning and organising such a venture but at the same time I suspect that it will be inspirational to some and as such the provision of such programmes will go up and small changes might occur.
We also have a paper from Madeline Macdonald and co-authors exploring the issues around the occurrence and investigation of Serious Incidents in Obstetrics and Gynaecology. Taking this issue and looking at it from the perspective of trainees and training is particularly pertinent in the current climate of revalidation, a subject that seems to induce palpitations in most of the trainees I speak to. This article gives clear and concise advice and should serve as a valuable reference to trainers and trainees when circumstances mean that such events need to be investigated.
Clinically we have a review of the medical management of miscarriage from Lucky Saraswat and colleagues. I cannot believe there are many gynaecologists who don't have this on their portfolio of relevant CPD articles but in fact I think it's just as useful for obstetricians and GPs given the frequency with which we all meet women affected by miscarriage in the first trimester and the authors also include a discussion of the management of miscarriage in the later stages of pregnancy when protocols might be more variable.
Also very current is the review from Moira Mugglestone's group on antibiotic prophylaxis for early onset neonatal infection. With the RCOG surveying practice in this area, this is a good time to review the NICE recommendations and to focus on those aspects of the guidelines that are most relevant to obstetricians.
Wrapping up, we also have two clinical reviews with a maternal medicine theme. Pregnancy in women with a spinal cord injury is obviously a rare event, however, with over 10 000 women in the UK currently affected by a spinal cord injury it is quite likely these women will present to obstetric units with increasing frequency. As with most rare conditions, what we all need is a group who see it more often to pull together all the evidence for the best practice they advocate and to then present that to us in a readable and practical format, and that's exactly what Rehana Dawood and co-authors have done. Not quite so rare is idiopathic intracranial hypertension. Having just come from the RCOG Maternal Medicine course it's not surprising that I found this an easy read but I would recommend it to all obstetricians as its incidence in women of reproductive age is likely to increase as obesity rates increase and its management can pose problems in pregnancy. The degree of anxiety around shunts in these women is often out of proportion to the actual risks that they might pose and Lakshmi Thirumalaikumar and co-authors do a lot to sensibly stratify the risks involved and outline the alternative management options.
With a further update from the UKOSS team and a reformatted book, website and app review section, that's about it for this issue. I'm off to get a bit of TOG time, which I wholeheartedly recommend to you all.
For more information on the RCOG Global Placement Committee and MTI scheme see http://www.rcog.org.uk/medical-training-initiative. Email: MTI@rcog.org.uk
Jason Waugh MRCOG
Royal Victoria Infirmary, Newcastle
Mohamed Abdel-Fattah MRCOG
University of Aberdeen, Aberdeen
Jo Anthony MA FRCOG
Northampton General Hospital NHS Trust
(Chair of the RCOG Revalidation Committee)
Kate Harding FRCOG
Guy's and St Thomas' NHS Foundation Trust, London
Euan Kevelighan FRCOG
Singleton Hospital, Swansea
Justin Konje FMCOG (Nig) FWACS MRCOG
University of Leicester, Leicester (CPD Editor)
Kate Langford MA MD FRCOG
Guy's and St Thomas' NHS Foundation Trust, London
David Parkin MD FRCOG
Aberdeen Royal Infirmary, Aberdeen
Nicola Mullin MFFP FRCOG
Countess of Chester Hospital NHS
Foundation Trust, Chester
Mark Roberts MD MRCOG
Royal Victoria Infirmary,
Newcastle Upon Tyne
Thomas Tang MD MRCOG
Regional Fertility Centre, Royal Maternity
International advisory board
Ben CP Chan FRCOG
Hong Kong Maternal & Fetal Medicine Clinic
Ki-Hong Chang MD PhD
Ajou University School of Medicine, Korea
Peter L Dwyer FRANZCOG FRCOG CU
Mercy Hospital for Women, Melbourne,
Amr El-Shalakany MSc MD FRCOG
Ain Shams University Maternity Hospital,
Kristen A Matteson MD MPH
Brown Medical School, Providence, USA
Henry Murray MRCOG
Dimitrios Koleskas MRCOG
Euroclinic, Athens, Greece
Duru Shah MD FCPS FICS FICOG DGO DFP FICMCH
Jaslok Hospital, Sir Hurkinsondas Hospital and Breach Candy Research Centers, India
David Shaker FRCSEd FRCOG FRANZCOG
University of Queensland, Rockhampton
Base Hospital and Mater Private Hospital, Australia
Ian Symonds DM MRCOG FRANZCOG ILTM
John Hunter Hospital, New South Wales
Dirk Timmerman MD PhD
University Hospitals Leuven, Belgium