Obstetrics and gynaecology as a discipline is ever more complex and ever more demanding. Historically, the O&G Fellow self-selected by having parents able to afford a six year medical course, choosing a career in O&G (often without much competition) and undertaking a 3 or 4 year unstructured training program. This has now evolved to highly competitive entry into both medical school and then FRANZCOG training. Subspecialisation will lead to further competitive entry. The six year training program has continually evolved to meet the changing needs of women’s health. The array of knowledge, skills and attributes is so vast that it is blatantly impossible to achieve ‘excellence’ across the entire discipline of O&G. The inevitable result has been the evolution of ‘sub-specialisation’ and more recently an increasing recognition of ‘special interests’ amongst the generalist O&G Fellows.
This drive toward greater and greater specialisation potentially results in an increasingly skilled workforce across smaller and smaller areas of practice. This risks a worsening of patient care as narrow scopes of practice result in reduced equity of access for patients and potentially poorer outcomes for the overall health of the patient.
The task of FRANZCOG training is to produce a product that achieves the best outcomes for women in Australia and New Zealand. That in turn means defining training pathways that result in scopes of practice that meet the needs of women – both quantitatively and qualitatively. Excellence is achieved in each pathway through: a) beginning training with the most suitable trainee; b) the trainee pathway itself; and c) continued professional development beyond training in that scope of practice.