Australia

The general gynaecologist in Australia will have been signed off for basic vaginal surgery (anterior and posterior repair), intermediate vaginal surgery (vaginal hysterectomy), and minor perineal surgery. The expectation prior to sign‐off is that the candidate will have completed 20 basic surgeries and 20 intermediate surgeries, which are guides and not mandatory numbers. While there is no sign‐off assessment for continence procedures, the logbook recommendation is the performance of five continence surgeries during training. It is also expected that trainees will have spent at least 100 hours in gynaecology outpatient clinics.

The Royal Australian and New Zealand College of Obstetrics and Gynaecology (RANZCOG) introduced Advanced Training Modules in 2019. There are two compulsory and four optional modules. One of the optional modules pertains to urogynaecology – the pelvic floor disorders module. This can be undertaken over a 12–24 month period during advanced training and should include a minimum of 45 urogynaecology theatre sessions and 45 urogynaecology outpatient clinic sessions per 12 months. Requirements for this module include a logbook, presentation at morbidity and mortality meetings, and presentation of an audit of pelvic floor treatment outcomes. The suggested numbers for logbook procedures include: urinary stress incontinence procedures (10), vaginal hysterectomy (10), anterior and/or posterior vaginal repair (20), post‐hysterectomy vaginal vault suspension procedures (5), urodynamic studies (10) and cystoscopy (20).

United Kingdom (UK)

The Royal College of Obstetricians and Gynaecologists (RCOG) offer advanced training skills modules (ATSM) in the final two years of obstetrics and gynaecology. This training allows trainees to develop the skills required to practice in various subspecialty areas as part of a generalist job with a particular focus or interest. The relevant module is Urogynaecology and Vaginal Surgery (UGVS). An optional laparoscopic urogynaecology module is also available, but can only be undertaken after completion of the UGVS ATSM or concurrently with it (i.e., it cannot be undertaken as a stand‐alone module). On completion of the ATSM, it would be expected that a trainee would be competent in: anterior repair, diagnostic cystourethroscopy ± biopsy, mid‐urethral tape (retropubic or trans‐obturator approach), posterior repair ± perineorrhaphy and vaginal hysterectomy.

Australia

Training in Australia is managed by RANZCOG. The training is three years in duration at a minimum of two prospectively approved training sites. RANZCOG trainees can undertake up to one year of subspecialty training as part of their advanced training for their fellowship of the College. The first year of training must be undertaken on a full‐time basis. Selection is via a process of online application including covering letter, personal statement, curriculum vitae, and three references. Suitable applicants will then be invited to attend a panel interview.

Requirements for training include maintenance of a logbook, written examination, research project, formative review (at 3 and 9 months each year) and summative appraisals (at 6 and 12 months each year). Multisource feedback is also sought in the first year of training.

Minimum numbers are set for anti‐incontinence procedures and reconstructive procedures (100 of each). Attendance at urogynaecology lectures, tutorials, demonstrations, and conferences is also expected.

The examination is of 3.25 hours duration and consists of 10 short answer questions.

Some procedures are considered compulsory and need to be formally assessed and signed off by a supervisor. There are two categories – generic procedural, of which there are 8, and surgical procedural, of which there are 11.

Some time spent during training in an overseas unit is considered desirable.

The following objectives are from the handbook for the certification in urogynaecology:

It is expected that the subspecialist in urogynaecology will:

• Demonstrate a detailed knowledge of:
  
  
  
  • The embryology and anatomy of the pelvis, the pelvic musculature, and the pelvic viscera
    
  • The physiology of urinary and faecal control
    
  • The pathology of abnormal urinary and faecal control
    
  • Neurotransmission and the pharmacology of drugs acting directly and indirectly on the lower urinary tract
  
  
• Have a basic knowledge of:
  
  
  
  • Imaging of upper and lower urinary tracts
    
  • The design and statistical analysis of clinical trials
    
  • The function of urodynamic equipment
  
  
• Have an extensive personal experience in the assessment of patients with lower urinary tract disorders by:
  
  
  
  • Clinical assessment
    
  • Urodynamic assessment
    
  • Cystourethroscopy
    
  • Organ imaging
  
  
• Have a clinical competence in the following:
  
  
  
  • The medical and surgical management of pelvic floor dysfunction including genital tract prolapse
    
  • The surgical and medical management of lower urinary tract dysfunction
    
  • The long‐term care of patients with intractable incontinence
    
  • Organisation of community care of the incontinent community assessment procedures liaison with nursing and general practitioner services