title: Exploring the scope of practice and training of obstetricians and gynaecologists in England, Italy and Belgium: a qualitative study.
abstract: BACKGROUND
  This study explores the scope of practice of Obstetrics and Gynaecology specialists in Italy, Belgium and England, in light of the growth of professional and patient mobility within the EU which has raised concerns about a lack of standardisation of medical speciality practice and training.
  
  
  METHODS
  Semi-structured qualitative interviews were conducted with 29 obstetricians and gynaecologists from England, Belgium and Italy, exploring training and scope of practice, following a common topic guide. Interviews were recorded, transcribed and coded following a common coding framework in the language of the country concerned. Completed coding frames, written summaries and key quotes were then translated into English and were cross-analysed among the researchers to identify emerging themes and comparative findings.
  
  
  RESULTS
  Although medical and specialty qualifications in each country are mutually recognised, there were great differences in training regimes, with different emphases on theory versus practice and recognition of different subspecialties. However all countries shared concerns about the impact of the European Working Time Directive on trainees' skills development. Reflecting differences in models of care, the scope of practice of OBGYN varied among countries, with pronounced differences between the public and private sector within countries. Technological advances and the growth of co-morbidities resulting from ageing populations have created new opportunities and greater links with other specialties. In turn new ethical concerns around abortion and fertility have also arisen, with stark cultural differences between the countries.
  
  
  CONCLUSIONS
  Variations exist in the training and scope of practice of OBGYN specialists among these three countries, which could have significant implications for the expectations of patients seeking care and specialists practising in other EU countries. Changes within the specialty and advances in technology are creating new opportunities and challenges, although these may widen existing differences. Harmonisation of the training and scope of practice of OBGYN within Europe remains a distant goal. Further research on the scope of practice of medical professionals would better inform future policies on professional mobility.
authors.affiliation: European Centre on the Health of Societies in Transition, London School of Hygiene and Tropical Medicine, London, United Kingdom. Electronic address: Isabelle.Risso-Gill@lshtm.ac.uk.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Risso-Gill
authors.affiliation: Scientific Institute of Public Health, Brussels, Belgium.
authors.forename: Regine
authors.initials: R
authors.lastname: Kiasuwa
authors.affiliation: European Social Observatory (OSE), Brussels, Belgium.
authors.forename: Rita
authors.initials: R
authors.lastname: Baeten
authors.affiliation: Local Health Authority nr 10, Veneto Region, Italy.
authors.forename: Ilenia
authors.initials: I
authors.lastname: Caldarelli
authors.affiliation: Local Health Authority nr 10, Veneto Region, Italy.
authors.forename: Silva
authors.initials: S
authors.lastname: Mitro
authors.affiliation: College of Medical and Dental Sciences, University of Birmingham, United Kingdom.
authors.forename: Abi
authors.initials: A
authors.lastname: Merriel
authors.affiliation: Division of Oncologic Gynecology, Catholic University of Sacred Heart, Rome, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Amadio
authors.affiliation: European Centre on the Health of Societies in Transition, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Martin
authors.initials: M
authors.lastname: McKee
authors.affiliation: European Centre on the Health of Societies in Transition, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Helena
authors.initials: H
authors.lastname: Legido-Quigley
mesh_terms: D001530:Belgium; D004739:England; D005260:Female; D006176:Gynecology / Q000193:education* / Q000379:methods / Q000592:standards; D006801:Humans; D007558:Italy; D008297:Male; D009313:National Health Programs; D009774:Obstetrics / Q000193:education* / Q000379:methods / Q000592:standards; D010818:Practice Patterns, Physicians'; D011331:Private Practice; D036301:Qualitative Research; D012051:Reimbursement Mechanisms
keywords: Curriculum/standards; Europe; Gynaecology; Obstetrics; Qualitative; Scope of practice