Upskilling

Part of the process of being allowed to practice medicine in a country in which you didn't train, is proving to the new country that your training and expertise is comparable/equivalent to their own trainees. Most countries have a list of countries whose physicians are allowed to practice without having to repeat all of their specialty training. There are only a handful of countries that accept American medical credentials and training, and not all specialties are accepted by each of those countries.

Australia

Belize

Canada

Cayman Islands

India

New Zealand

Singapore

United Arab Emirates: Abu Dhabi and Dubai

United Kingdom

Each of these countries have certain stipulations and some do require some extra training or further exams. New Zealand and Australia are two countries where board certification in a wide range of specialties is recognized and you don't have to repeat training or board exams, with very few stipulations.

As I described in previous posts, the process of proving to a receiving country that their people's lives would be safe in your hands is a tedious one, appropriately so. Especially for surgical specialties, there is a lot involved in the medical licensing process. If you recall, I had to compile the list of all of the surgeries and procedures I performed from first day of residency training to the present and include that detailed list with my application.

After being granted a provisional license, a few months into working here, the governing college for my specialty here in NZ (RANZCOG*) interviewed me. A panel including doctors and midwives as well as a representative from the community asked me questions. Their main goal was to make sure that I was truthful on my applications, I am capable of effective communication, and that my training is equivalent to what their own board certified Obstetrician Gynaecologists received. Sometimes if the number of certain procedures is not up to their standards, they may recommend some upskilling during the 1 yr "provisional" period. During the provisional period, they are also receiving feedback from a physician at your hospital that has been assigned to be your supervisor. They also encourage cultural competency training so that incoming doctors are equipped with the knowledge and sensitivity to care for their Maori and Pacifica population. Once they review your file, they produce an individualized list of things they want the physician to do during that preliminary year before they are able to have what is called a full Vocational Registration.

I was deemed to be cleared to practice medicine here in New Zealand, with training and experience comparable to what would have been expected of their own trained physicians. My list of conditions was not long at all. The main thing they wanted me to do, apart from enrolling in a cultural competency course that I actually thoroughly enjoyed, was that I needed to upskill in Forceps use.

In the United States, the use of Forceps to assist with births has decreased considerably over the past few decades. Less and less residents are reaching proficiency in forceps use before graduating from residency. More of us have been using different forms of vacuum instruments instead. In residency, I watched forcep use, did a few, and we definitely had to know everything about them- uses, types, risks, complications, indications and contraindications etc, for our written and oral specialty boards. There are many reasons for this. Forceps are extremely effective ways of assisting birth, especially in emergency settings where there is the bad combination of fetal distress, maternal exhaustion and an unavailable OR. However, they also come with the risk of causing vaginal lacerations, pelvic floor dysfunctions, bleeding and neonatal injury. As with any medical instrument, in skilled hands, they can do lots of good.

Many countries have decreased their forceps use due to these concerns, but Australia and New Zealand still train their residents on forceps use and expect them to be signed off as proficient before graduating from residency.

As an incoming OBGYN, responsible for supervising residents, it makes sense that this is a skill I should make sure to have so that if they need to use forceps while I am on duty, I can properly supervise and assist them.

I have mixed feelings about forceps, but I definitely love the process of acquiring new skills and having even more tools in my belt. I am very skilled with vacuum extractions, but now I am currently upskilling on forceps use.

Excellence is not destination, it is a continuous journey that never ends

Brian Tracy

* Royal Australian and New Zealand College of Obstetricians and Gynaecologists