Emergency training

With the reduced duration of junior doctors' training combined with the dramatic cuts in their working hours, it is unsurprising that their clinical experience of obstetric emergencies is much less than that of their predecessors. They rely increasingly on formal training which can be gained locally to an extent but tends to be supplemented by regional or national courses, afew of which are listed below:

ALSO - Advanced life support in obstetrics - This course is aimed at midwives, obstetric senior house officers (SHOs) and junior specialist registrars (SpRs) and deals with the main obstetric emergencies in a structured systematic fashion. Candidates should gain a sound understanding of the problems and the structured approaches in how to manage them (http://www.also.org.uk).

MOET - Managing obstetric emergencies and trauma -This course is organized for a more senior and multidis-ciplinary groups, for example, obstetric consultant and senior SpRs (Post-Membership of Royal College of Obstetricians and Gynaecologists (MRCOG) and at least year 3), anaesthetic consultant and senior SpRs, and senior accident and emergency doctors. These courses also include midwives (as 'observers' as they are not formally assessed) who receive the same training during the course and their presence emphasizes and promotes the team approach, which is so important in the obstetric emergency. This course deals with more advanced and complex aspects of emergency obstetrics (http://www.moet.org.uk).

MOSES - Multidisciplinary Obstetric Simulated Emergency Scenarios - This course focuses on emergency behaviour and teamworking dynamics as they apply to the obstetric patient, rather than training on knowledge or techniques. It involves midwives, anaesthetists and obstetricians who often attend together from the same department. This course is very different from, but complements MOET or ALSO ([email protected] bartsandthelondon.nhs.uk).

Although acute obstetric emergency training courses are now well established, their formal evaluation is limited [6] and they are certainly no substitute for clinical exposure or indeed for ongoing local training. Most units are now incorporating multidisciplinary emergency drills and scenarios within their teaching programmes. These serve not only to improve knowledge and teamwork, but can also be invaluable aids to identifying problems within the system [7,8].

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