Obstetrics & Gynaecology Forum Volume 29 | Issue 3 | 2019

CSMOs also made suggestions towards improving internship training. These included the use of live models or simulated emer- gencies to improve practical skills. They also expressed a need to conduct more complicated CDs so as to give them a chance to im- prove their skills; exposure to performing laparotomies for ectopic pregnancy and PID, improved and continued ESMOE skills train- ing even in community service, availability of consultants in district hospitals and a formal practical test at the end of their training. Discussion Community service medical officers provide bulk of the health care services in the public sector hospitals in SA. Their practical train- ing, which entails application of the theoretical knowledge gained in Medical School, mainly occurs during their internship. The tran- sition from internship training under supervision by specialists and registrars to CSMOs working independently without any direct support requires meticulous preparation to overcome any type of difficulties especially those associated with surgery in rural district hospitals. The key findings in this study showed that the CSMOs who performed more than the minimum required number of CDs during the internship training had more confidence in their skills, performed a higher percentage of the other surgical procedures and showed confidence in having adequate skill and ability to manage complications that arise at CDs during the community service (Table 2, Figure 3). These findings compare with Bola et al., (2015) 5 which found that although the majority of interns from urban areas felt adequately skilled to perform CDs, lump excisions and the drainage quired, another 27% performed 75% more while 17% performed 100% more CDs than required. Other surgical procedures performed during their internship training during their O&G rotation included evacu- ation of retained products of conception, manual vacuum aspiration, laparotomy for ectopic pregnancy, cautery of warts and bilateral tubal ligation. Figure 3 shows that in the cohort interviewed, the CSMOs that per- formed 50% more than HPCSA requirements were more con dant to perform other procedures and they were better able to manage compli- cations that arose during procedures. In addition, there were a sizeable number of medical doctors that were not placed in O&G during their community service and felt they had adequate skill. ey reported a need for them in Anaesthetics or that they already had experienced doctors in Obstetrics and Gynaecology. Table 2. Community Service Practice in Obstetrics and Gynecology Questions n % Have you rotated through O&G? Yes No 33 15 68.8 31.2 How long was your rotation? 4 months 6 months 8 months 12 months 12 07 07 07 36.4 21.2 21.2 21.2 How many Caesarean Deliveries have you done in your community service year? None 10-20 20-30 30-40 40-50 >50 15 06 05 06 02 14/33 31.2 12.5 10.4 12.5 4.1 29.1 Were there any difficulties encountered? Yes No 23 06 69.7 15.2 Did you manage the complications encountered? Yes No 10 13 43.5 56.5 Did you manage to apply temporizing measures prior to transfer, where the patient needed to be transferred? Yes No 21 05 63.6 15.2 Figure 1. The number of CSMOs that perceived being adequately trained at the end of O&G block. Figure 2. Number of CSMOs per category of Caesarean Deliveries performed during internship. Figure 3. Demonstration of performance in relation to the number of CDs performed A: Number of CDs performed -Group 1: 1-10 CDs; Group 2: 10-15 CDs; Group 3: 16-20 CDs; Group 4: >20 B: Performed other surgical procedures C: Managed complications successfully O&G Forum 2019; 29: 19 - 23 ORIGINAL OBSTETRICS & GYNAECOLOGY FORUM 2019 | ISSUE 3 | 21