In this blog, Clinical Fellows Hannah and Naomi introduce the O&G Surgical Skills Project and the recently published interim report.
Hannah is a Trainee based in Wessex currently taking an out of programme as a Gynaecology Fellow alongside her role as a Clinical Fellow at the RCOG.
Naomi is an ST7 based in Sussex. Alongside her role with the RCOG, she is currently completing her ATSMs in Labour Ward and Benign Gynaecology.
The landscape of O&G has undergone significant transformation in the last few decades. Changing trends alongside other systemic challenges within the NHS have resulted in a disconnect between O&G training needs and the ability of the current system to meet those needs. Addressing these concerns and improving surgical skills training is a priority for the RCOG.
The surgical skills review is a three-year project aiming to assess the current climate of surgical skills within O&G, identify areas for improvement and recommend strategies to future-proof our workforce.
We are currently in Phase 1 and have just published our interim report, which we hope resonates with every O&G doctor.
How did we write our interim report?
The project started in April 2024, when key stakeholders attended a surgical training summit at RCOG’s Union Street home and discussed some of the current challenges facing the specialty.
After the summit, we wanted to understand some of these challenges in more detail from those delivering training, and from those receiving it. We sent a training needs survey to all Heads of School via the Specialty Education Advisory Committee and reached out to all O&G residents via the National Trainee Committee. We also looked at data from the annual Trainee Evaluation Form (TEF) from 2019-2024.
With the very kind help of the Getting It Right First Time (GIRFT) team, Hospital Episode Statistics data were analysed to demonstrate changing trends in key O&G operative practices in the UK. In addition, we also met with stakeholders and experts in O&G surgical training, our surgical societies in the UK and even with international Gynaecology colleagues in America and Malaysia!
What did we find?
We found five areas of focus for the next phase of the project.
Workforce of the future
Our future workforce face significant challenges shaped by the evolving healthcare landscape and the increasing complexity of patient needs. In particular, Gynaecology waiting lists have seen one of the biggest increases of all medical specialties, rising by over 69% since pre-pandemic levels. This is putting additional pressure on us to deliver care quickly, with less time available for training. We need new strategies to support our workforce to match shifting demands. We also need to develop strong progressive career support for each resident doctor and ensure we provide a workforce that can manage increased surgical complexity.
Simulation and virtual learning
Many residents are experiencing difficulty in meeting their basic, intermediate and advanced surgical training competencies. We believe that simulation training could help to address some of these concerns. For decades, it has been the cornerstone of safe obstetric training and there is a wide body of evidence across many surgical specialties showing that it can improve hand eye coordination, psychomotor skills and result in better uptake, retention and maintenance of practical skills and confidence. In the next phase of the project, we will look at how we can embed simulation training into the RCOG curriculum and will establish a Simulation Working Group to ensure equal access to training.
Hannah said,
“Surgical specialities across the board have recognised the importance of simulation training in supporting hands-on surgical training and enabling trainees/trainers to make the most of their time in theatre.”
Re-prioritising surgical training
In Gynaecology, professionals at every level have less time to receive or provide training, creating a critical risk in how the NHS will deliver high quality gynaecology care now and in the future.
We believe the focus should shift to earlier career development of surgical skills. This re-prioritisation would help to ensure that the next generation of gynaecologists are able to adapt to emerging healthcare technologies, enhance patient outcomes, and provide safe, effective care in an increasingly complex clinical environment. As part of this, we want to consider how investment in innovative technology like AI may improve the trainee experience and how earlier implementation of surgical skill assessment can be established into the RCOG training matrix.
Naomi said,
“As a speciality, it is essential that we address the current challenges in the surgical skills training in O&G in the UK. From my experience, the fundamentals of good surgical practice need to be instilled from day one, with every surgical procedure, from perineal repair to caesarean section, being used to teach and practice exemplary surgical finesse.”
Lifelong learning
It is often challenging for O&G consultants and senior specialists to continue their surgical skills acquisition whilst also balancing clinical responsibilities, rota pressures, and increasing patient demands.
The next phase of this project plans to focus on the role of structured mentorship. We want to support our O&G consultants and specialists through pilot projects of mentorship, buddy operating and effective job planning. For our more experienced senior consultants and specialists, time spent training and mentoring must be recognised and supported.
Investing in the educators
Investing in surgical educators and trainers is vital for the development of highly skilled, confident, and competent surgeons in the field. As surgical techniques in gynaecology evolve, there is a growing need for residents to receive hands-on guidance from experienced professionals. Skilled mentors not only provide essential technical training but also play a crucial role in shaping the decision-making, leadership, and patient-centred approach required for modern surgical practice. It is crucial that we invest in surgical trainers and educators to improve patient care.
Hannah said,
“We are a surgical speciality with a strong cohort of passionate and exceptional educators. Throughout this project, we plan to learn from them and explore ways to support and appreciate the work they do despite the many challenges thrown their way. They are our greatest asset in working to improve O&G surgical training across the country.”
We would love the whole O&G community to engage with the project, so if you see us at conferences please come and talk to us about surgical skills or email us (nharvey@rcog.org.uk or hpierce@rcog.org.uk) with your thoughts and ideas.
