Intro:
My name is Beth Routledge, and I’m a consultant in Acute Medicine working in Forth Valley Royal Hospital, in central Scotland.
I live in Glasgow. I’m an enthusiastic (but slow!) long distance runner and take every opportunity to get out to the many green spaces and waterways of the city, and an enthusiastic (but also slow!) knitter.
I graduated from the University of Glasgow in 2012, and went on to train in hospitals throughout the west of Scotland in foundation, core, and higher specialist training. I took a year out after the Foundation Programme and split my time between a trust grade post in Haematology and a lot of locum shifts in Acute Medicine, and this was where I really found my love for Acute Medicine. I completed my acute medical training in August 2022, and took up my current consultant post.
What got you interested in Obstetric Medicine?
In my first year of specialist training, I worked in a busy district general hospital where I was the only registrar in the building overnight – a scenario that will be familiar to many physicians. We admitted lots of pregnant patients with medical problems to our acute medical unit, and I was terrified of them – a feeling that will also be familiar to many physicians! Eventually, I decided that the way to conquer my fear of these patients was to try to become an expert in them. The more I learned about Obstetric Medicine, the more fascinating I found it.
How did you train in Obstetric Medicine?
I was the first trainee in Acute Medicine in Scotland to do Obstetric Medicine. The established pathway for acute physicians in England was an out-of-programme experience (OOPE) in an Obstetric Medicine centre, which at the time were concentrated in London and the South East of England.
I was very keen to stay in Scotland to do my training. I had some good contacts through other specialists, mainly in endocrinology, who had done a lot of Obstetric Medicine, and they were invaluable in helping me to make contacts in Obstetrics. I was able to make my own timetable, and did a combination of sessional exposure throughout training as well as a dedicated six month placement. This enabled me to get good experience in combined medical obstetrics clinics including specialist clinics in e.g. obstetric cardiology, obstetric endocrinology, and obstetric haematology. I spent time on labour ward and with the obstetric anaesthetists in Obstetric High Dependency. In my dedicated six month placement, I was the liaison medical registrar for the maternity assessument unit in my base hospital which meant that I got lots of experience with acute presentations and made lots of contacts with the obstetric team very quickly. My dedicated six month placement also meant that I had the flexibility to go to interesting clinics in other hospitals, and to spend some time in the Perinatal Mental Health Unit learning about that aspect of maternity care.
Were there any challenges?
Being the first person in Scotland to really try to do this, I felt very much as if I were trying to write my own training programme from scratch. That was a challenge, but it was also fun. There’s a good curriculum for the Obstetric Medicine specialist skill, so I focused on making sure that I was hitting all the points on that and on getting the education and training that I’d need for acute work in the future. As I hadn’t done Obstetrics and Gynaecology since medical school, spending time with the obstetricians and on labour ward was also hugely valuable for me just to gain that extra experience.
How does this fit into your consultant working?
My interest is in developing acute liaison pathways. As I’m a relatively newly appointed consultant who has come into a hospital where this service needs to be built from scratch, this is something that I’m very much still working on and at present most of my work is still quite ad hoc. We have an established medical obstetric clinic which is run by our local obstetrician whose interest is in maternal medicine. This clinic has well established links to the relevant medical specialties, so my focus is more on the acute and inpatient side of things.
I’m the co-chair of the Maternal Medicine group for the Scottish Perinatal Network. We aim to build and develop multispecialty and multidisciplinary networks of professionals interested in the care of pregnant patients, to improve teaching and training in Obstetric Medicine, and to develop national guidelines for medical problems in pregnant patients.
I deliver regular teaching, both regionally and nationally, to medical trainees in Scotland. It isn’t too long since I was the medical registrar being called to labour ward in the middle of the night, and I’m passionate about making sure that all our medical trainees – not just the ones who have a specific interest – have the tools in their toolbox to deliver good medical care to their pregnant patients.
Do you have any tips for trainees who may be interested in Obstetric Medicine?
I think this is a really interesting and valuable speciality skill that comes with a huge amount of job satisfaction, and that has the opportunity to add crucial expertise to our acute medical units and SDECs/RACUs. There are options to take it in lots of different directions – some people develop combined medical/obstetric clinics with their obstetric colleagues, some work on developing pathways for acute care and acute liaison, and some are focused on teaching and training the next generation of physicans in the care of pregnant patients.
The Royal College of Physicians have now accredited a Professional Diploma in Obstetric Medicine, a 12 month OOPE which is available to medical trainees who are ST5 or above and who are involved in working on the acute medical take. The first cohort of trainees started in August 2024, and I think this is a great opportunity for acute medical trainees who want to make Obstetric Medicine their specalist skill and who are able to take an OOPE. The placements are currently available in London, Manchester, Bristol, East Anglia, and Oxford.
For trainees who prefer to stay in their own region or who simply wish to build their own timetable for this specialty, I recommend early networking with obstetric and obstetric physician colleagues, exploring the Obstetric Medicine curriculum, and getting your Training Programme Director involved early to make sure that you can get the time you need. And if you have any questions, please do get in touch!
