OBSTETRICS AND GYNAECOLOGY - CURRICULUM

STRUCTURE AND REGULATIONS FOR THE FELLOWSHIP EXAMINATION IN ANAESTHESIA

STRUCTURE AND REGULATIONS FOR THE FELLOWSHIP EXAMINATION FACULTY OF OBSTETRICS AND GYNAECOLOGY I. CONDITIONS FOR OBTAINING THE FELLOWSHIP BY EXAMINATION Qualifications for Acceptance to the Programme A Candidate shall be admitted to the training programme if he/she possesses a qualification registrable by the local medical council and has obtained full registration to practice in the country of training Period of Training: (i) The period of training shall last for a minimum of fifty-four months. (ii) Exemptions from part of the training programme may be approved by the Council on the recommendation of the Faculty Board. II. COMMITTEES OF THE FACULTY FOR TRAINING AND EXAMINATION. A: Court of Examiners: i. There shall be a Court of Examiners appointed by Council on the recommendation of the Faculty Board. ii. The Court of Examiners shall have a minimum of FIVE and a maximum of NINE members. iii. The Court of Examiners shall be elected by the Faculty of Obstetrics and Gynaecology from amongst its members. iv. The Chairman of the Court of Examiners shall be the Chairman of the Faculty Board. The Secretary of the Faculty Board shall be the Secretary of the Court of Examiners. B: Education Committee: There shall be an Education Committee appointed by Council on the recommendation of the Faculty Board. The Chairman of the Faculty Board shall be the Chairman of the Committee. Functions of the Education Committee: (a) To work out the curriculum for the Diploma of Fellowship in the Faculty of Obstetrics and Gynaecology. (b) To organise postgraduate courses and symposia on behalf of the College. (c) To make recommendations to the Faculty Board for the development of manpower needed for the delivery of sound reproductive health care to the people of the sub-region. (d) To report to Faculty Board on all its deliberations. C: Examination Committee: There shall be an Examination Committee which will be responsible for the conduct of examinations in all its ramifications and recommend to the Council of the College, through the Faculty Board, eligible candidates for the award of the Fellowship of the College in Obstetrics and Gynaecology. The members of the committee shall be appointed by Council on the recommendation of the Faculty Board. The Chairman of the Faculty Board shall be the Chairman of the committee. The Secretary of the Faculty Board shall be the Secretary D: Board of Examiners: There shall be a ‘Board of Examiners’ which shall consist of Examiners at the fellowship examinations of the Faculty. The Chairman of the Faculty shall be the Chairman and the Secretary of the Faculty Board shall be the Secretary. The Board of Examiners shall publish the provisional results of fellowship examinations Examiners shall be appointed by the Faculty Board, on the recommendation of the Court of Examiners. The Examiners shall be appointed for a period not exceeding two years in the first instance and may be eligible for reappointment as examiner for a further period of two years. III. EXAMINATIONS: The examination leading to the award of the Fellowship of the College in Obstetrics and Gynaecology shall be in three parts. 1. Examination in Basic Sciences (Primaries): (a) The Primary Examination in the Basic Sciences shall be as applied to Obstetrics and Gynaecology and other relevant aspects of Reproductive Health. It shall cover the areas specified in the Syllabus (Appendix 1). (b) The Faculty may offer short courses in Basic Sciences preparatory to the Primary Fellowship Examination. (c) The examination shall consist of TWO multiple choice question papers. Each paper shall consist of 100 questions, each with a stem and five derivative statements which shall either be True or False. The grading system shall be as prescribed by the Faculty Board. 2. Part I Final Examination: The aim of this examination is to produce a specialist-in-training who has a firm grasp of Clinical Obstetrics and Gynaecology and is competent to handle difficult Obstetric and Gynaecological problems. The Training for the Part I Final Examination shall consist of: (a) Two years in Obstetrics and Gynaecology. (b) Six months General Surgery and Urology. (c) Two months in Neonatology. (d) Two months in Anaesthesiology. (e) One month in Anatomic Pathology (Histology & Cytology). (f) One month in Radiology. Before a candidate can proceed to the Part I Final Examination, he must have passed, or been exempted from the Primary Examination. The Consultant(s) under whom the candidate trained must certify that he has completed the stipulated period of training and that his work has been satisfactory. The Candidate must keep a LOG BOOK (obtainable from the College) which contains a detailed record of the activities done in the course of training. This log book must be submitted with the application for the Examination. The Part I Final Examination shall encompass the principles and practice of Obstetrics and shall consist of the following: (a) A Theory Examination of ONE multiple choice question paper of 100 single-stem, five-derivative statement (True/False Format) Questions. and TWO Essay papers of THREE Questions EACH in Obstetrics and Gynaecology. (b) A Clinical Examination in Obstetrics and Gynaecology. (c) An Oral examination in Obstetrics and Gynaecology. In order to be able to proceed to the clinical and oral examinations, a candidate must have scored a minimum mark (as prescribed from time to time by the Faculty Board) in the Theory Examination. In order to be successful at the examination, the candidate must pass in AT LEAST TWO of the three parts of the Examination. 3. Part II Final Examination: A: A Record of Cases/Procedures (“The Book”): A Candidate preparing for the Part II Final examination shall prepare a book of cases and commentaries for review by assessors. Assessors shall be members of the Board of Examiners. The book, for the purpose of Part II Final Examination, shall consist of:- (a) detailed accounts of 15 gynaecological cases together with a brief commentary on each case. (b) detailed accounts if 15 obstetric cases together with a brief commentary on each case. (c) Two long commentaries with adequate relevant references of not more than 2,000 words each, (one in obstetrics and one in gynaecology) demonstrating the candidate’s exposure to the use of the library. The book shall be presented for assessment at least 6 months before the Part II Final Examination. The regulations governing the assessment of “The Book” are outlined in Appendix 2. A candidate shall be allowed to take the examination only if “The Book” is assessed as satisfactory. B: Record of Training: Before proceeding to the Part II Final Examination, i the candidate must have passed or been exempted from the Part I Final Examination. ii. the Consultant(s) under whom he/she trained must certify that he/she has completed the stipulated period of training and that his work has been satisfactory. The Candidate must keep another LOG BOOK (obtainable from the College) which contains a detailed record of the activities done in the course of training after passing the Part I Examination. This log book must be submitted with the application for the Part II Final Examination. iii the training shall consist of eighteen months of obstetrics and gynaecology, six months of which shall be spent in any country other than the one the candidate has trained. The candidate must demonstrate a clear ability to lead a reproductive health care team and must have done different types of major obstetric and gynaecological procedures. These must be reflected in the candidate’s log book which must be submitted with the application for the Part II Examination. C: Examination Format: i. The Part II Final Examination shall consist of an ORAL examination at an advanced level. ii. The first part of the examination shall be based on the candidate’s “Book of Cases and Commentaries”. iii. The second part shall cover the entire specialty of Obstetrics & Gynaecology and other relevant aspects of Reproductive Health as the Examiners deem fit. The marks from both portions of the examination are added together to determine whether the candidate is successful or not. Where a candidate is successful in the portion on ‘The Book’ but did not succeed overall, he shall not be examined on the book again in a subsequent examination. He shall only take the oral examination on General Obstetrics & Gynaecology and other relevant aspects of Reproductive Health at the next attempt. 4. Centres for Examination: The centre(s) of examination shall be determined by Council at least one year before the proposed examination after considering the recommendations of the Faculty Board. 5. Frequency of Examination: The examination shall be held twice a year during the months of April and October. APPENDIX 1 BASIC SCIENCES SYLLABUS FACULTY OF OBSTETRICS & GYNAECOLOGY The subjects covered by Primary Examination include the Basic Medical Sciences as applied to the practice of Obstetrics & Gynaecology such as:- Anatomy Biochemistry Biophysics/Ultrasonology Cell Biology Clinical Chemistry Elementary Statistics Embryology Endocrinology Genetics Haematology Histology Immunology Medical Microbiology, Virology and Parasitology Molecular Biology Pathology (Anatomic Pathology) Pharmacology Physiology Radiation Biology Anatomy , Embryology & Histology: Early embryonic development Development of the placenta and amniotic fluid Embryology as related to female and male genito-urinary system. Developmental evolution of the vulva, vagina, cervix, uterine corpus, ovaries and breasts from in-utero through reproductive life. Gross and microscopic anatomy of the testis Anatomy of the bony pelvis. The female pelvis with particular reference to the anatomy of- The uterus and its appendages including peritoneal reflections. Supports of the uterus, The inguinal canal, The perineum, The anal triangle, Superficial and Deep perineal pouches, The bladder & ureters, Blood supply of the pelvis, Pelvic lymphatics, Innervation of the pelvis, Surface anatomy of the pelvis, Surgical anatomy of the pelvis, Applied anatomy of the pelvis. The Surgical Anatomy of the Abdominal Wall and Intra-abdominal structures Gross and Microscopic Anatomy of the Endocrine Organs, Anatomy of the Female Breast Biochemistry: Basic Biochemistry Carbohydrate metabolism, Lipid metabolism, Proteins and nucleic acid metabolism (Pathways) Metabolic inter-relationships of lipids, carbohydrates and proteins Purine and Urate Metabolism Metabolism of steroids, Biochemistry of pregnancy Acid-Base Chemistry (Maternal and Fetal), Detoxification, Enzymes in clinical medicine, Anti-Metabolites in medicine, Radioisotopes in Medicine Rudiments of Biochemical Genetics: General Principles, Inborn errors of metabolism, Biochemical Genetics in relation to Medicine The Kidneys: Renal Function Metabolism of haemoglobins and porphyrins Sickle cell anaemia: population biology, Other abnormal haemoglobins Biophysics & Radiation Biology: Biological Effects of Ultrasound Types of Radiation Principles of Radiation Dosimetry Principles of LASER Activity, Types of LASER with medical applications. Cell & Molecular Biology: The Cellular Organelles: the Nucleus, Cytosol, Mitochondria, Endoplasmic Reticulum, Lysosomes etc Membrane Structure and Membrane Transport; Membrane Receptors and Matrix Proteins Signal transduction, Extracellular signalling, Cytokines and Growth factors Diseases resulting from dysfunctional biochemical communication. The Cell Cycle, Cell Division. Nucleic Acid and Protein Synthesis, Reverse Transcription The Polymerase Chain Reaction (PCR) and its application in clinical medicine, Characterisation of Genes and Gene Products (Southern, Northern and Western Blotting). Clinical Chemistry Sodium, potassium and water metabolism. Calcium, phosphate and magnesium metabolism Plasma lipids and lipoproteins and the regulation of their metabolism Plasma enzymes in clinical diagnosis. Principles and practice of urinalysis Mineral Metabolism: Metabolism of Iron, Folic Acid and Vitamin B12 including daily requirements Endocrine and steroid metabolism, Chemistry of steroid Hormones: Oestrogens, Progestogens, Androgens,17-Ketosteroids, Adrenocortical hormones etc. Metabolism in injury and trauma. Clinical Chemistry of the Newborn. Elementary Biostatistics: Data Collection: Scales of Measurement (Nominal, Ordinal, interval, Ratio) Discreet & Continuous Variables, Populations & Sampling, Description of Data Measures of Location and Dispersion, Probability Theory, Normal Distribution, Confidence Intervals Parametric and Non-parametric Tests, Hypothesis Testing and Statistical Inference, Types I & II Errors, Choice of Statistical Tests, Clinical Trials (Principles), Assessment of new diagnostic tests. Endocrinology Endocrine Basis of the Menstrual Cycle, The Hypothalamus, Pituitary Hormones and their Functions, Ovarian Hormones and their Functions, The hypothalamico-pituitary-ovarian axis, Endocrine control of Testicular Function The endocrinology of pregnancy; the feto-placental unit. Endocrine functions of the pancreas, the adrenals, the thyroid and parathyroids. Hormones in Obstetrics & Gynaecology, Endocrine basis of intersexual conditions Recent advances in Endocrinology. Genetics: Principles of Cytogenetics. Abnormalities of Chromosome Structure, Transmission of Genes (heritability) Principles of Gene Expressivity (Penetrance etc), Impact of Genes on Susceptibility to Diseases. Haematology Haemopoiesis, the Anaemias, Abnormalities of leukocyte structure and function. Leukaemias Haemostasis. Haemorrhagic Disorders, Thrombo-Embolic Disorders. Haemoglobinopathies. Influence of Pregnancy on haematological parameters. Immunology General Principles of Immunology. Non-specific and Specific Immunity. Cell-Mediated Immunity, Humoral Immunity, The Complement System, Immunoregulation, Immunological Tolerance, Immunodeficiency states, Autoimmune Disorders, Immunology of Pregnancy. Information Technology relevant to Reproductive Health Data and its processing into Information Characteristics of Good Information Classification of Computers, Computer Parts and Accessories, Communication between Computers. Organisation of Data in Files and Databases (coding, entry, verification, validation, editing, updating) Keeping Data Safe. The Internet (e-mail; the world-wide web; search engines and information retrieval) Applications of Computers in Reproductive Health Care. Telemedicine in Reproductive Health. Medical Microbiology, Virology and Parasitology: Routine diagnostic methods for identification of bacteria, parasites, and viruses of medical importance, including serological methods in biological fluids. Sensitivity tests for Treatment; Chemotherapeutic control of microbial diseases Principles of Sterilization and Disinfection. Pathology (Morbid Anatomy): General principles of pathology to include inflammation and repair, coagulation, thrombosis, embolism, cell growth and its disorders, pigments and pigmentation, ionising radiation, chemical poisons and medical genetics. Regional Pathology: to include common diseases of the cardiovascular, respiratory, alimentary, endocrine, musculoskeletal and central nervous systems. Special focus on male and female genital regional pathology Pharmacology: General Principles of Pharmacology and Drug Action. Drug Receptors and mechanisms of inhibition. The pharmacology of common drugs used in Obstetrics and Gynaecology e.g. Oxytocics, Diuretics Hypotensive drugs, Steroids and analogues, Polypeptides and analogues, Analgesics, Antiemetics, Antibiotics, Anti-viral drugs etc. Drugs and pregnancy. Teratogenesis General Anaesthetics, Local Anaesthetics Physiology: Physiology of reproduction (including lactation) Physiology of the control of micturition Body fluids, Electrolyte balance, Exchange of fluid between blood and tissue space, Lymph Physiology of the kidneys: secretion of urine Chemistry of steroids and ovarian hormones, The menstrual cycle Relation of anterior pituitary to hypothalamus and ovary, The gonadotropins Plasma proteins, Coagulation of Blood, Haemostasis, Iron metabolism Cardiovascular Function and pregnancy-related changes; Regulation of blood pressure Pulmonary function and Pregnancy-induced changes Autonomic control of the pelvic viscera. Normal Human Sexual Response Foetal Physiology: Respiration, Circulation etc and Changes at Birth. The Placenta - structure and functions. The hormones of the placenta. The Feto-Placental Unit. Mechanism of skeletal muscle, cardiac muscle and smooth muscle activity. APPENDIX 2 WEST AFRICAN COLLEGE OF SURGEONS REGULATIONS GOVERNING THE ASSESSMENT OF THE BOOK OF CASES AND COMMENTARIES FOR THE PART II (FINAL) EXAMINATIONS IN OBSTETRICS & GYNAECOLOGY In certifying the Case-Book as being accepted for the Part II (Final) Fellowship Examination of the College, the assessor must be satisfied that: i. The Case Book was presented by the candidate for assessment by an external assessor only after the candidate successfully completed the mandatory 12 months minimum additional advanced training after his/her success in the Part I Examination. ii. The Case Book contains detailed accounts of 15 Gynaecological cases, at least 8 (eight) of which shall have been personally managed by the candidate after his/her success in the Part I Examination, with a brief commentary and a critical review of the literature at the end of each case. iii The Case Book contains detailed accounts of 15 Obstetrical Cases, at least 8 (eight) of which shall have been personally managed by the candidate after his/her success in the Part I Examination, again with a brief commentary and critical review of literature at the end of each case. iv. The Case Book contains Two long commentaries (one in Gynaecology and one in Obstetrics) of original research during the period of training with relevant references and literature review. Each commentary should not exceed 3,500 words. v. The references will be cited in the commentaries according to the Vancouver system and listed at the end of each commentary in the order of appearance in the text, also following the Vancouver system. vi. The Consultant under whom the candidate trained should ensure that the candidate’s work has been satisfactory and duly certified that the candidate successfully completed the requisite training. The assessor is expected to determine the independent ability of the candidate for clinical investigations and conduct of research, defence of the clinical management detailed in the book, critical review of the relevant literature and proficiency in the diagnosis and management of clinical conditions in the speciality at an advanced level. The candidate must be up to date with recent concepts and developments in the specialty. The Assessor is expected to recommend on the attached form, whether the case book is acceptable or not. Where the Case Book is unacceptable, a detailed write up of the deficiencies in the Case Book must be provided so as to assist the candidate in making the necessary corrections. Where the Case Book is acceptable, the assessor shall write a report to this effect. In addition, the assessor shall provide another confidential report marked “Confidential” and “For attention of Faculty Chairman only”. This second part of the report by the assessor is expected to highlight points in the Case Book on which examiners shall question the candidate further to ensure that the candidate has thorough mastery of the subject.