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Objective To discover whether trainees in Wales are able to manage ectopic pregnancy using laparoscopic techniques, and to identify factors preventing trainees from acquiring and using these skills. Design Postal questionnaires. Setting Wales deanery of the Royal College of Obstetricians and Gynaecologists. Subjects All specialist registrars in obstetrics and gynaecology. Results Two surveys were completed. The initial survey in January 2000 had a response rate of 91% and found that 38% of trainees could independently manage an ectopic pregnancy laparoscopically. A more detailed survey in January 2002 with an 87% response rate found that 21% of trainees were able to manage an ectopic pregnancy laparoscopically. However, only 7% of specialist registrars in years 1–3 of training could do so. The main reasons why trainees could not manage ectopic pregnancies laparoscopically were lack of practical experience coupled with a lack of consultant supervision. Conclusions Over 2 years, there was a decrease in the number of trainees able to manage an ectopic pregnancy using laparoscopic techniques. This has important implications both for training and service provision.

ReferencesThe authors state that one aim of their study was to determine the current level of provision of computer facilities for postgraduate education within their deanery. The information presented is valuable, but I believe it gives an incomplete description of the level of IT provision.The numbers and type of machines in the Deanery forms only part of the wider picture of computer availability. The actual number of computers in each unit and even more crucially, the ratio of computers to trainees would give a better indication of levels of provision. Although the computer facilities were located in each unit and comment is made in general terms about the practical problems of access to these facilities, detailed information about location and access is not presented. Furthermore, it is not stated whether any computers are available solely for the use of trainees in obstetrics and gynaecology departments. Although the description of frequently inadequate provision of hardware is informative, consideration of these practical issues is need to describe fully the actual level of computer provision for trainees.As this study rightly notes, doctors need not just to have access to suitable IT facilities but also the skills to use such equipment. The computer skills of doctors in obstetrics and gynaecology have been discussed3, but the method used by the authors to measure such skills appears particularly well constructed. However, it is possible that choosing only to measure the skills of trainees in four non-randomly selected units may have affected the results. It is stated that the chosen hospitals did not differ from others in the region in terms of IT facilities. Yet it is later noted that IT provision in the deanery is patchy and the survey shows that four out of twelve units in the region lack equipment of a suitable standard for computer-aided learning. The test used to measure computer skills in part measures ability to use equipment suitable for computer-aided learning programmes. Presumably then, testing could be done in the selected hospitals precisely because they were amongst those with appropriate computers. Even though trainees rotate around a deanery, it cannot be assumed that all trainees have had similar exposure to good IT facilities. The authors tested 22 out of 46 specialist registrars (48%) in the deanery in just one-third of its hospitals. It seems that the four selected units were amongst the largest and best equipped in the region. This raises questions as to whether the computer skills of doctors in these units might be influenced by the access that they have to good quality equipment. A more reliable methodology to describe accurately the skills of registrars across the deanery would surely have been to study doctors from each hospital in the region. Nicholas Myerson AUTHORS' REPLY SicWe appreciate the interest in our paper and agree with many of the comments made. The data he requests, which describes more fully the actual level of computer provision for trainees were collected but w...