Our study demonstrates both the similarities and variation between undergraduate teaching skills courses across England. However, further research will be necessary to determine whether the long-term impact of such training will result in better educators, and ultimately in improved patient care.
Physician dissatisfaction in the workplace has consequences for patient safety. Currently in the UK, 1 in 5 doctors who enter specialist training in obstetrics and gynaecology leave the programme before completion. Trainee attrition has implications for workforce planning, organization of health-care services and patient care. The authors conducted a survey of current trainees' and former trainees' views concerning attrition and 'peri-attrition' - a term coined to describe the trainee who has seriously considered leaving the specialty. The authors identified six key themes which describe trainees' feelings about attrition in obstetrics and gynaecology: morale and undermining; training processes and paperwork; support and supervision; work-life balance and realities of life; NHS environment; and job satisfaction. This article discusses themes of an under-resourced health service, bullying, lack of work-life balance and poor personal support.
Foetal fibronectin testing (fFN) has a high negative predictive value for preterm delivery, but it has a cost implication. This two-stage prospective study evaluated the real patient costs and clinical impact of introducing the fFN test in women presenting acutely with threatened preterm labour in a tertiary UK obstetric hospital. Introduction of the fFN test for women with threatened preterm labour reduced antenatal admissions and in utero transfers, and reduced steroid treatment and tocolysis, even at 1 year after implementation. The total number of bed days for women with threatened preterm labour who did not deliver during admission fell from 132 (mean 8.8 days) to 25 days (mean 3.6 days). The mean cost of admission per woman before introduction of the fFN test was £1032 (95% CI £880 to £1184); after it was £339 (95% CI £261 to £417). In this small single centre study, the introduction of the test produced a cost saving of £693 per woman (95% CI, £464 to £922) which over 12 months potentially saves £74844 (95% CI £50,112 to £99,576). Further studies are needed to formally evaluate the cost-effectiveness of the fFN test and its impact on clinical decision-making in large populations.
Key content:• Women decline blood products in pregnancy for religious reasons or because of concerns regarding their safety.• Mortality is significantly increased in pregnant women who decline blood products.• Antenatal counselling and planning must involve a senior multidisciplinary team.• Considerable efforts are needed to optimise pre-delivery haemoglobin and identify risk factors for haemorrhage.• Intrapartum techniques to avoid blood transfusion include cell salvage and early recourse to definitive surgical management in the event of massive obstetric haemorrhage. Learning objectives:• To understand the reasons why women decline blood and blood products in pregnancy and how this impacts on their health.• To understand the law relating to women who decline treatment in pregnancy.• To learn how to make the most of antenatal care opportunities.• To be able to plan labour and postpartum care.• To review the differences in managing massive obstetric haemorrhage between women who decline blood products and those who do not. Ethical issues:• Women's autonomy can be supported with accurate information and empathic counselling.• Given real concerns regarding the safety and availability of donor blood transfusion, should blood conservation techniques in obstetrics be applied to all women?
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