1. Marion Ek MD, PhD Specialist in Obstetrics and Gynaecology Director of Studies at Södersjukhuset in Stockholm Ida Bergman MD Trainee in Obstetrics and Gynaecology at Södersjukhuset in Stockholm Boardmember of OGU – the Swedish national society for young gynaecologists and obstetricians Boardmember of NFYOG

3. The traineeprogram in Gynaecology and Obstetrics Superviced by the National Board of Health and Welfare The National Board of Health and Welfare (Socialstyrelsen) is a government agency in Sweden under the Ministry of Health and Social Affairs Uppdated and more strict regulations where published sept 2008

4. Description of goals Contains 21 milestones of which each must be fullfilled The trainee collects written proof of his/her achievements Medical competence 1-12 specific for ob/gyn Communication skills 13-15 Leadership skills 16-18 common Expertise in medical science and qualitywork 19-21

5. Milestone 1: To be abel to master normal pregnancy, delivery and puerperium Learningmethods Follow-up Clinical work under supervision Course Certificate of approved clinical duties and skills acquired (issued by the current tutor) Course certificate

6. Checklist for milestone 1 -knowledge Describe conception and implantation Describe early embryonal development Describe the physiology of the placenta Describe the development avd physiology of the featus Compare the physiology of non-pregnant and pregnant woman Describe the cause of the common pregnancy disorders Identify patients who should be recommended genetic counseling Describe the pros and cons considering vaginal delivery versus c-section Describe and understand the principals of normal delivery Describe the pelvic anatomy Compare and evaluate different methods in obstetrical analgesia Describe the physiology in normal puerperium Analyze the cause of mastitis/breast abscess Explain the principals of the maternitycareprogram in Sweden

7. Checklist for milestone 1 - skills Identify a riskpregnancy and refer to right unit Treat hyperemesis Treat and give advice to women with normal pregnancydisorders Preform Leopold´s maneuvers and evaluate the findings Evaluate Bishop-score Basic obstetrical ultrasound – position of the featus, identify multiple pregnancy, cardiac activity, position of the placenta, amount of amniotic fluid Analyze CTG Evaluate progression of the labour Interpret the partogram Identify rupture of membranes Preform amniotomy Preform episiotomy Proper management of premature rupture of membranes Preform fetal scalpblood testing Evaluate if a woman is in labour Suture perineal tear I-II etc

8. The scientific work The trainee gets 10 weeks to do a scientific work Includes a course in research methodology The tutor must have a PhD

9. Positive aspects It is good to have national milestones so that every trainee knows what he/she needs to manage after 5 years of trainee-program We get the chance to do a scientific work and get more experience that field

10. Positive aspects Courses The trainee gets an opportunity to attend two courses per year 2-4 days financed by the home clinic gives the trainees opportunity to meet and network provides a better theoretical base for the trainee

11. Positive aspects We have well functioning national societies SFOG (national society in gynaecology and obstetrics) and OGU (the national society for the young obstetricians and gynaecologists) that organizes courses, meetings and provides national guidlines

12. Challanges Big problems with getting structured surgical training There are many expanding private clinics which do more and more of the benign surgery --› less for the trainees in the hospitals We lack good tools for evaluation / structured feedback

13. Challanges Many trainees have problems with getting all the courses done There are big differences between big and small hospitals

14. How can we make it better?

15. Improve our surgical training Ongoing campaign “pass the knife on” Every operation should be an opportunity for the trainee to learn The tutor and the trainee should be more prepared Structured feedback

16. Drivers license We think there should be some standard courses that comes before practical training The trainee gets a drivers license Ex laparoscopy, colposcopy, ultrasound, ctg Increases patient safety

17. Evaluation Mandatory sit-ins Mandatory exam More structured feedback

18. Divide the training into half in a smaller county hospital and half in a bigger university hospital University hospital Rare patientcases Tutor medical students Bigger patientvolumes Expert knowlegde County hospital More responsibility Smaller groups -› the tutors have a closer eye on the trainee

19. Is 5 years enough? Longer periods in surgery sidetraining? More time to do the scientific work?