The percentage of second stage caesarean sections is on the rise. The delivery of a deeply engaged head in the second stage by caesarean section is an experience feared by most junior registrars. Among the different delivery techniques described, the pull technique has been proven to have a lesser morbidity than the push technique. However, trainees do not receive any structured training in either of these methods. We undertook a survey among 150 UK trainees in SPROGS 2008 in order to understand their experience in dealing with a deeply engaged head in second stage by CS, to ascertain whether trainees feel that they need training to deal with the situation and to discover the means by which this training can be delivered. The questionnaire return rate was 94%. More than 80% agreed that they had faced difficulties in the past while trying to deliver a deeply engaged head. Only 20% used the recommended semi-lithotomy position during caesarean section for an impacted head. Among the trainees who had received only UK training, only 42% were confident of doing a pull method if the need arose. More than 80% of the trainees agreed that supervised sessions to teach alternative techniques for delivery, such as the reverse breech/pull method would be useful and that it would improve their confidence when doing a trial of vaginal delivery. The RCOG agreed that there is little formal training in delivery of a deeply engaged head and is considering recommending trainees complete 2 OSATS (Objective Structured Assessment Tools) in this area. It has also asked the authors to form a skills and drills protocol, which the authors have done and submitted to the RCOG.

The aim of this study was to explore the perceptions of graduate-entry medical students of obstetrics and gynaecology as a specialty, in order to understand how to increase its appeal to them, and therefore enhance recruitment to the specialty. A total of 90 questionnaires were returned out of 145 questionnaires distributed to years 2 and 4 graduate-entry medical students (62% response rate). Although fewer than 4% of respondents are considering the specialty as their career choice, more than half of the respondents would consider the specialty as a second option, which shows that there is room to persuade them to have a second look. Gender was the only factor that significantly affected views regarding obstetrics and gynaecology. There is a need for more information about the specialty and its training opportunities and exposure to areas of special interest and subspecialisation, as well as role models, rather than focussing on labour ward in timetables. Areas of apprehension about the specialty, such as the risk of litigation, need to be aired and addressed through career days, as well as formal tutorials within teaching programmes.

The aim of this study was to explore the impressions of second year graduate-entry medical students of Obstetrics and Gynaecology, before their attachment in the speciality in the subsequent year, so as to improve its appeal to them and increase their recruitment into it. A total of 74 questionnaires were distributed at the end of the Learning Opportunities in Clinical Setting (LOCS) week in the speciality and 66 (89.19%) completed questionnaires were returned. Over 4% of the respondents were considering the speciality as their career choice and less than half would consider it as a second option. Whilst more than a third perceived some of the demerits of the speciality, more than a third endorsed its merits. This showed the need to explore and address their concerns about training and working in the speciality. Having a health-related primary degree, prior employment and being female were significantly associated with choosing the speciality as a career (p < .001). Barriers for male respondents were flagged, which need to be addressed, and a bias towards Obstetrics was noted, which reflects the narrow focus on the Labour Ward and necessitates a broader exposure to the speciality. Impact statement What is already known on this subject? The perception of third year graduate-entry medical students of Obstetrics and Gynaecology is biased towards Obstetrics, and they have apprehensions about the challenges of training and working in the speciality. What do the results of this study add? The views of second year graduate-entry medical students are consistent with the views of third year graduate-entry medical students, which shows that these views may be formed early. What are the implications of these findings for clinical practice and/or further research? More research is needed to establish and understand the perception of the speciality earlier than second year and explore the value of practical steps that may improve this perception and increase the interest in it and recruitment into its training programmes.

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This brief report raises the ethical dilemma encountered by an obstetrician involved in the care of a pregnant woman with life-threatening disease. This is a particularly difficult issue if the maternal well-being is in conflict with the survival of the unborn child.