Obstetrics and gynaecology: Specialty Training Interview Questions Australia

Why obstetrics and gynaecology, and what have you done to prepare for it?

Why O&G in terms of the work: the births, the emergencies, the surgery, the relationship with women across their lives. Evidence: the terms, the deliveries, the procedures, the diploma if held, the audit, the rural placement. Say what each taught you.

Tell us about your experience in O&G and the procedures and deliveries you have been involved in.

Specific: the deliveries attended and conducted, the caesareans assisted, the gynaecological procedures, the emergencies managed. Say what the experience taught you and what you want to learn next.

What do you know about the RANZCOG training programme, its rural requirements and its examinations?

The length, the rural requirement, the written and oral examinations and when they fall, the procedural log, the supervision. Two accurate sentences, then what will be hardest.

O&G has demanding on call and high medicolegal exposure. How will you sustain a career in it?

A strategy: sleep after nights, life outside the unit, the debrief after a bad outcome, peer support, knowing your warning signs, and who you would tell. For the medicolegal exposure, careful documentation, open disclosure, and the college's and the insurer's support. The panel has watched trainees leave.

Tell us about an audit or research project relevant to women's health.

The problem, the measure, what changed, the result, and your part. For research, your role, the question, what it found. If it was on the labour ward or in women's health, say why it mattered.

A woman has just had a stillbirth at 38 weeks. Begin the conversation with her and her partner.

Sit down, find out what they understand, a warning shot, the truth in plain words, silence for as long as they need. Then their questions answered honestly including why, and what happens next: the birth, the time with the baby, the investigations, the support. Say that you would be there. Do not fill the silence.

A woman at 39 weeks wants a caesarean without a medical indication. Discuss it with her.

Explore the reasons, which are often fear or a previous experience. Address the fear first. Give the evidence for both modes plainly. Offer what might help: a birth plan, an epidural, the anaesthetist, a tour. If she still wants a caesarean after an informed discussion, her choice is respected and you involve the consultant and follow the maternal request policy.

A woman refuses a recommended induction. How do you approach the conversation?

Explore the reasons, give the evidence and the risks of declining plainly and without pressure, offer alternatives and monitoring, respect the decision, document, and plan a review. Involve the consultant. A woman with capacity may decline.

A couple are angry about a delay in their emergency caesarean. Speak to them.

Acknowledge first and genuinely, listen to the whole complaint, explain what happened without defending or blaming, say what will happen now and what you will do about the delay, and offer the complaints process. Open disclosure if the delay caused harm.

A woman with capacity refuses a caesarean that you believe is needed for the baby's safety. What do you do?

A woman with capacity may decline treatment even if the baby is at risk. Confirm capacity, explore the reasons, explain the risks as clearly as you can, involve the consultant, the anaesthetist and the paediatrician immediately, offer alternatives, document, and respect the decision. Say that you would stay with her whatever she decides.

How would you provide culturally safe maternity care to an Aboriginal woman from a remote community?

Defined by the woman: care she experiences as safe and respectful. Your actions: the Aboriginal liaison officer or maternity worker early, the family's role, birthing on country where it is wanted and safe, the community health service for antenatal care, flexibility, and the humility to ask. One example makes it real.

A woman requests termination of pregnancy and a colleague refuses to be involved. What is your role?

Know your state's law on termination and conscientious objection. The colleague may object but must not obstruct access and in most states must refer or provide information. Your role: make sure the woman gets the care and the information she is entitled to, involve the consultant, and respect the colleague's position without letting it delay the patient.

You discover that a colleague did not obtain consent properly before a procedure. What do you do?

The patient's care first. Then tell the consultant what you observed, make sure the patient is properly informed now, open disclosure if there has been harm, and the incident process without blame. Say what you would do if the colleague asked you not to raise it.

A woman is bleeding heavily after delivery and the blood loss is now 1.5 litres. Talk us through your management.

• Follow-up: The uterus is well contracted and she is still bleeding. What now?

Call for help, two large bore cannulas, bloods including crossmatch and coagulation, fluids then blood, the massive transfusion protocol if it continues. Then tone, trauma, tissue, thrombin: uterine massage and the uterotonics in sequence with doses, bimanual compression, the examination for trauma, the check for retained tissue, the coagulation results. When the uterus is contracted and she is still bleeding, look for a tear, retained tissue or coagulopathy, and escalate to theatre, balloon tamponade and the surgical options with the consultant.

A woman at 36 weeks has a blood pressure of 170 over 110, a headache and brisk reflexes. What do you do?

Severe pre eclampsia with a risk of eclampsia: call for help, intravenous antihypertensives to a target, magnesium sulphate with its loading and maintenance doses and monitoring, fluid restriction, bloods for platelets, liver and renal function, and the plan for delivery, which is the treatment. The consultant, the anaesthetist and the paediatric team. Say what you would do if she seized.

A shoulder dystocia occurs at a delivery you are attending. Talk us through your actions.

Call for help at once, then the manoeuvres in order: the position change, suprapubic pressure, the internal manoeuvres, delivery of the posterior arm, and the further options if these fail. Know the time pressure. Document afterwards and say what you would tell the woman during and after.

A cord prolapse is diagnosed on the labour ward. What do you do?

Call for help, relieve the pressure on the cord by position and by elevating the presenting part, stop the oxytocin, and an immediate caesarean unless delivery is imminent. Say how you would explain it to the woman in the seconds available.

A woman at 32 weeks presents with painless vaginal bleeding. What is your approach?

Placenta praevia until proven otherwise: resuscitate, no vaginal examination until the placental site is known, the ultrasound, bloods and crossmatch, steroids for the baby, the consultant, and the plan depending on the bleeding and the baby's condition.

A woman presents with severe lower abdominal pain, a positive pregnancy test and a blood pressure of 85. What do you do?

A ruptured ectopic until proven otherwise: resuscitate, crossmatch, the bedside ultrasound, the consultant and the anaesthetist, and theatre now. Say what you would tell the woman and that you would not delay for a formal scan.

A fetal heart rate trace shows late decelerations. What do you do?

Assess the whole trace, the clinical context, the woman's position, the oxytocin, the maternal observations, and the fetal blood sample or the decision for delivery. Involve the consultant. Say how you would explain the plan to the woman.

What are the main challenges facing maternity services in Australia, including rural units?

Rural maternity unit closures and the workforce behind them, the rising intervention rates, the gap for Aboriginal women, the medicolegal climate, and the midwifery workforce. Say what a registrar can do about one.

What are the national maternity standards and how do they shape a labour ward?

The national standards and the maternity services framework: the requirements for monitoring, escalation, consent, continuity and the review of outcomes. Say how they shape the labour ward's protocols and audits from what you have seen.