Obstetrics & Gynaecology Forum Volume 29 | Issue 3 | 2019

medical doctors becomes of paramount importance. The Health Professions Council of South Africa (HPCSA) re- quires interns to perform a minimum number of 10 CDs. There is no further specification regarding expectation on the type of skill they should have attained by the end of their training. The current training program in Obstetrics and Gynaecology (O&G) is four months long for each intern. During this period they rotate through different hospitals, at different levels of care, and learn the manage- ment of both obstetric and gynaecological conditions. It is during this time that they are exposed to the skills training programme, es- sential steps in the management of obstetric emergencies (ESMOE), and are taught how to perform surgical procedures in O&G which includes CDs. ESMOE, the monographs on the management of postpartum hemorrhage and caesarean section, have been developed by a team of specialists and have been recommended by the national department of health (South Africa (SA)) to assist medical internship training. A study assessing the effectiveness of ESMOE training demonstrated that completion of the programme resulted in improved knowledge and skills compared to before taking the skills training and for those that had gone through the O&G rotation without the ESMOE train- ing. 2 Moran et al., (2015) reviewed the role of emergency obstetric training in reducing maternal mortality on a countrywide scale and concluded that ESMOE skills training was a successful tool. 3 While Nkabinde et al., (2013) reported on the adequacy of the internship program as a whole in KwaZulu-Natal, 4 the current study involves an in-depth perspective of specific surgical training in O&G, especially after the introduction and escalation in ESMOE skills training in SA. Methods A quantitative descriptive study was conducted in hospitals in the uMgungundlovu District of KwaZulu-Natal province. The study en- rolled CSMOs towards the end of their community service year, post internship. The inclusion criteria were medical doctors who were in their community service year, who studied in South African univer- sities and were willing to participate. With all the hospitals visited, there were none who declined; all CSMOs that were present on the days of the visits were willing to participate as they felt it offered them an avenue to air their views particularly as it was after the prac- tical application of what they had learned. A total of 48 CSMOs were enrolled and answered a structured questionnaire. The questionnaire was divided into three sections. The first section focused on background information, while the second section focused on surgical skills training during intern- ship training in O&G and the third section focused on communi- ty service practice in the discipline. Open and closed ended ques- tions were used to collect the data. Data was entered onto an excel data sheet and analyzed using simple descriptive statistical analysis, which included means, standard deviations, ranges, frequencies and percentages. The perception of training by the CSMOs was assessed on a five point Likert item with 1 corresponding to strongly agree and 5 to strongly disagree. Ethical clearance was obtained from the Biomedical Research Ethics Committee (BE: 555/16) at the Universi- ty of KwaZulu-Natal (UKZN) and health facility regulatory permis- sion was given by the provincial Department of Health. Results The vast majority of CSMOs were graduates of the Nelson R Man- dela School of Medicine (NRMSM), (UKZN). CSMOs working in hospitals in the uMgungundlovu District, Estcourt and Appelsbosch Hospitals were interviewed. The responses are listed below in Table 1. The majority of CSMOs had at least three months of exposure to undergraduate training in O&G in Medical Schools. A total of 55% had O&G training in the second year of internship. Forty five percent of the CSMOs had performed their CDs in the first year of internship (Table 1). Of the 26 doctors that did O&G in their second year, a total of 60% were in the category that performed 75% more CDs that HPCSA requires. Regarding the ESMOE skills training, 50% of the CSMOs had un- dergraduate exposure to the ESMOE skills in their respective univer- sities (Table1). Seventy five percent of the CSMOs had the opportu- nity to implement or at least learn by observation during internship. Only 6.2% felt that ESMOE skills training did not contribute to im- proving their skill in managing obstetric emergencies (Table 1). A total of 83% of all the respondents felt that their internship train- ing was adequate, while 17% felt they were not adequately trained at the end of their block in O&G (Figure 1). In addition, 29% performed the minimum required procedures as stipulated by HPCSA and the major- ity exceeded the minimum requirements (Figure 2). Interestingly, 27% performed approximately 50% more CDs than re- Table 1. Responses from Community Service Medical Officers training in Obstetrics and Gynaecology. Questions Response n % In which year(s) of study were you exposed to clinical obstetrics? 4th year 5th year 37 11 77.1 22.9 How long was your total rotation in Medical school? 04 weeks 06 weeks 08 weeks 10 weeks 12 weeks >12 weeks 00 05 04 04 04 31 0 10.4 8.8 8.8 8.8 64.6 In which Province did you do your internship training? KwaZulu-Natal Gauteng Eastern Province 33 03 09 73.3 6.7 20 Did you do your O&G block in the first year of internship or in the second year of internship? 1st year 2nd year 22 26 45.8 55.2 At the end of your obstetric block did you feel you had been adequately trained? Agreed Disagreed 40 08 83.3 16.7 Did you perform the minimum requirement of the surgical procedures as stipulated by the HPCSA in O&G? Minimum requirements > minimum requirement 1-25% 25-50% 50-75% >75% 17 09 07 08 07 35.4 18.8 14.6 16.7 14.6 Were you exposed to the ESMOE skills training in medical School? Yes No 24 24 50 50 Did you get to implement or witness the skills that you learnt during the ESMOE skills training at any point during your rotation in the management of complications in Obstetrics patients? Implemented or witnessed skills learnt Unsure 36 12 75 25 Did ESMOE contribute to your improved skill in managing obstetric emergencies? Agreed Disagreed 45 03 93.8 6.2 ESMOE - Essential steps in the management of obstetric emergencies HPCSA – Health Professional Council of South Africa O&G – Obstetrics and Gynaecology O&G Forum 2019; 29: 19 - 23 ORIGINAL OBSTETRICS & GYNAECOLOGY FORUM 2019 | ISSUE 3 | 20