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Objective To report the trends in career choices for obstetrics and gynaecology among UK medical graduates.Design Postal questionnaire surveys of qualifiers from all UK medical schools in nine qualification years since 1974.Setting United Kingdom.Population All graduates from UK medical schools in 1974, 1977, 1980, 1983, 1993, 1996, 1999, 2000 and 2002. Methods Postal questionnaire surveys.Main outcome measures Career choices for obstetrics and gynaecology and factors influencing career choices for obstetrics and gynaecology.Results Seventy-four percent (24 623/33 417) and 73% (20 709/ 28 468) of doctors responded at 1 and 3 years after qualification. Choices for obstetrics and gynaecology fell sharply during the 1990s from 4.2% of 1996 qualifiers to 2.2% of 1999 qualifiers, and rose slightly to 2.8% of 2002 qualifiers. Only 0.8% of male graduates of 2002 chose obstetrics and gynaecology compared with 4.1% of women. Forty-six percent of those who chose obstetrics and gynaecology 1 year after qualification were working in it 10 years after qualifying. Experience of the subject as a student, and the influence of a particular teacher or department, affected longterm career choices more for obstetrics and gynaecology than for other careers.Conclusions The unwillingness of young doctors to enter obstetrics and gynaecology may be attributable to concerns about workforce planning and career progression problems, rather than any lack of enthusiasm for the specialty. The number of men choosing obstetrics and gynaecology is now very small; the reasons and the future role of men in the specialty need to be debated.

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General rightsThis document is made available in accordance with publisher policies. Please cite only the published version using the reference above. Full terms of use are available: http://www.bristol.ac.uk/pure/about/ebr-terms VOLUME 4 ISSUE 28 SEPTEMBER 2016 ISSN 2050 DOI 10.3310/hsdr04280 HEALTH SERVICES AND DELIVERY RESEARCHModels of care for the delivery of secondary fracture prevention after hip fracture: a health service cost, clinical outcomes and cost-effectiveness study within a region of England Andrew Judge, M Kassim Javaid, José Leal, Samuel Hawley, Sarah Drew, Sally Sheard, Daniel Prieto-Alhambra, Rachael Gooberman-Hill, Janet Lippett, Andrew Farmer, Nigel Arden, Alastair Gray, Michael Goldacre, Antonella Delmestri and Cyrus Cooper Models of care for the delivery of secondary fracture prevention after hip fracture: a health service cost, clinical outcomes and cost-effectiveness study within a region of England Declared competing interests of authors: Daniel Prieto-Alhambra has received unrestricted research and educational grants from Amgen and Bioibérica S.A. Nigel Arden reports personal fees from Merck Sharp & Dohme (MSD), grants and personal fees from Roche, personal fees from Smith and Nephew, personal fees from Q-Med, personal fees from Nicox, personal fees from Flexion, personal fees from Bioibérica and personal fees from Servier. Cyrus Cooper has received consultancy fees, lecture fees and honoraria from Amgen, GlaxoSmithKline, Alliance for Better Bone Health, Eli Lilly, Pfizer, Novartis, MSD, Servier, Medtronic and Roche. M Kassim Javaid has in the last 5 years received honoraria for travel expenses, speaker fees and/or advisory committees from Lilly UK, Amgen, Servier, MSD, Medtronic, Internis, Consilient Health and Jarrow Formulas. He also serves on the Scientific Committee of the National Osteoporosis Society and International Osteoporosis Foundation. Andrew Judge has received consultancy fees, lecture fees and honoraria from Servier, UK Renal Registry, Oxford Craniofacial Unit, IDIAP Jordi Gol and Freshfields Bruckhaus Deringer, is a member of the Data Safety and Monitoring Board (which involved receipt of fees) from Anthera Pharmaceuticals, Inc., and received consortium research grants from Roche.Published September 2016 DOI: 10.3310/hsdr04280 This report should be referenced as follows:Judge A, Javaid MK, Leal J, Hawley S, Drew S, Sheard S, et al. Models of care for the delivery of secondary fracture prevention after hip fracture: a health service cost, clinical outcomes and cost-effectiveness study within a region of England. Health Serv Deliv Res 2016;4(28). Health Services and Delivery ResearchISSN 2050-4349 (Print) ISSN 2050-4357 (Online) This journal is a member of and subscribes to the principles of the Committee on Publication Ethics (COPE) (www.publicationethics.org/).Editorial contact: nihredit@southampton.ac.ukThe full HS&DR archive is freely available to view online at www.journalslibrary.nihr.ac.uk/hsdr. Print-on-demand copies can be purchased from the repor...

A large epidemiological data set was used to identify 115 patients who died from a cardiovascular cause within 30 days of elective surgery under general anaesthesia. For each patient, a control was identified, matched for age (within 5 yr of the patient), sex, operation and consultant. Patients and controls were compared for cardiovascular risk factors in a matched analysis using conditional logistic regression, and a prognostic model was generated. Three risk factors were included in the final model: previous myocardial infarction (odds ratio 3.18 (95% confidence intervals (CI) 1.22-8.28), P = 0.018), history of hypertension (odds ratio 1.90 (0.99-3.62), P = 0.047) and renal failure (odds ratio 3.56 (1.04-12.10), P = 0.043).

The proportion of junior doctors wishing to become paediatricians has not changed much during the last 30 years. The planned increase in the number of medical school graduates is necessary to increase the number of UK-trained consultant paediatricians. Medical students who experience enthusiastic and stimulating training in paediatrics may be more likely to become paediatricians.

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Our study has several limitations. Answering questions about a sensitive topic on the telephone can be difficult, a questionnaire with a fixed choice of answers prevented doctors from qualifying or justifying their responses, and we lacked detailed information about doctors who did not respond.Previous studies found similar patterns, but the French counterparts to Italian general practitioners and US oncologists were more in favour of legalising euthanasia.3 4 Our findings contradict the argument that opinions on euthanasia are related to cultural differences in English speaking countries; comparative studies are needed.2 In France, the support shown for euthanasia may be due to a lack of professional knowledge on palliative care.5 Improving such knowledge would improve end of life care and may also clarify the debate over euthanasia.