Obstetrics and gynaecology

• 1. Introduction

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  Obstetrics and gynaecology is the medical specialty that wraps two distinct fields into one training pathway: obstetrics, covering pregnancy, childbirth, and the postpartum period, and gynaecology, covering the health of the female reproductive system. Together they are abbreviated in clinical shorthand as O&G, OB-GYN, or OB/GYN. What makes this pairing unusual is that a single physician is prepared to manage both the journey of new life and the full spectrum of female reproductive health across an entire lifetime. How does someone actually become qualified to do all of that? And what exactly happens inside those years of training? The answers reveal a specialty that demands more time and testing than almost any other in medicine.

• 2. Years of Training

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  In the United States, the path to board certification in OB-GYN adds up to between eleven and fourteen years of education and practical experience. The first seven to nine of those years are general medical training. That foundation begins with medical school, where a physician earns an MD or DO degree, as required by the American Board of Obstetrics and Gynecology, the body responsible for issuing OB-GYN certifications in the country. After that comes a four-year residency program that must be approved by the Accreditation Council for Graduate Medical Education. For the 2021 Electronic Residency Application Service match, there were 277 OB-GYN residency programs accepting applicants across the United States.

  In the United Kingdom, the structure differs in its details but is equally demanding. Medical school typically takes five years and leads to an MBBS or equivalent certification. After that, a doctor completes two years of foundation training. The first year of that training qualifies them for full registration with the General Medical Council. Then comes the Part 1 MRCOG examination administered by the Royal College of Obstetricians and Gynaecologists, followed by seven more years of specialist training and two additional exams, Part 2 and Part 3 of the MRCOG. That totals a minimum of nine years in specialist training alone, though some trainees take longer.

• 3. The Certification Exams

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  In their fourth year of residency, American OB-GYN residents face a two-stage examination process. With an affidavit from their program director confirming they are on track for completion, residents can apply to take the ABOG Qualifying Exam, a written test. Passing it signals that a resident possesses the knowledge and skills to potentially become a certified OB-GYN. They then become eligible for the oral Certification Exam.

  Before sitting that oral exam, residents must compile a list of patient cases they worked on throughout residency, offering a record of hands-on experience. The oral exam itself runs three hours and is held at ABOG's test center. Since 2013, at least 82% of all Certifying Exam examinees have passed. Physicians of other specialties can also earn a shorter credential called Advanced Life Support in Obstetrics, known as ALSO, which equips them to manage urgent OB/GYN situations without completing a full residency.

• 4. Subspecialties

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  Maternal-fetal medicine, sometimes called perinatology, focuses on the medical and surgical management of high-risk pregnancies and can include surgery performed directly on the fetus to reduce illness and death. Reproductive endocrinology and infertility addresses the biological causes of infertility and its treatment. Gynecological oncology covers the medical and surgical treatment of cancers affecting the reproductive organs. Female pelvic medicine and reconstructive surgery, sometimes called female urology by non-specialists, handles urinary incontinence and prolapse of the pelvic organs.

  The Accreditation Council for Graduate Medical Education and the American Board of Obstetrics and Gynecology formally recognize only those four as true subspecialties. Areas such as advanced laparoscopic surgery, family planning, pediatric and adolescent gynaecology, and menopausal and geriatric gynaecology are recognized as informal concentrations of practice rather than board-certified subspecialties. Earning formal subspecialty recognition requires completing an accredited fellowship and passing an additional standardized examination to obtain a Certificate of Added Qualifications.

• 5. What OB-GYNs Actually Do

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  Obstetricians handle fertility treatment, pregnancy healthcare, NICU care, vaginal births, cesarean section births, and general postnatal care. Gynaecologists cover reproductive wellness checks, cervical and breast cancer screenings, urinary tract problems, STI treatment, and treatment for uterine conditions. Both sides of the specialty share a range of common procedures.

  A colposcopy is performed when a Pap smear or HPV test returns abnormal results, allowing a closer examination of the cervix and vaginal tissues. The loop electrical excision procedure, known as LEEP, removes abnormal tissue from within the cervix using a local anesthetic. An endometrial biopsy collects tissue from the uterine lining and checks it under a microscope for abnormal cells or signs of cancer. IUD insertion places a T-shaped intrauterine device in the uterus through the cervix as a reversible form of contraception. The Nexplanon implant, about 4 centimetres long and placed in the upper forearm, releases birth control hormones and lasts up to three years, with a 99% success rate for pregnancy prevention. Dilation and curettage, or D&C, opens the cervix to collect endometrial tissue samples or to remove fetal tissue after a miscarriage. Tubal ligation, often called tying the tubes, closes the fallopian tubes surgically to prevent pregnancy. Ovarian cystectomy removes cysts that are solid in appearance, larger than three inches in diameter, at risk of becoming cancerous, or causing persistent pain, and the procedure can be done without removing the ovary itself.