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the main treatment was to perform an amnioreduction. As a result of the imbalance one twin makes an excess of urine and this results in excess amniotic fluid. The amnioreduction is where a needle is placed in the uterus and often several litres of fluid are removed. It can work but often has to be repeated and doesn't address the issue of the blood vessel connections on the placenta. Around 15 years ago, an MFM doctor in the US developed a technique where a tiny telescope is placed in the uterus and then a laser fibre passed down the scope and used to cauterise the connecting vessels on the placenta. When these two treatments were compared the laser treatment had much better outcomes. At first there was only one centre in Brisbane in Australia performing these procedures and in time the women in New Zealand who were identified were sent to Australia for treatment. A second and third centre in Sydney and Perth then started. Starting this kind of service is complex and requires training which is hard if you are in different cities let alone different countries! The cases are also not that common. However, the two east coast Australian units fed back to us in 2008 that they felt they were seeing a lot of New Zealand women from the centres there and that it was time for us to start our own service. We then got onto the process of application of approval for a new service, fundraising for equipment and improving detection of cases for referral. Our service was officially started in May 2010 at a ceremony complete with ribbon cutting with Tony Ryall in attendance. What comment can you give on the students coming through the medical and midwifery education system? Are graduates more prepared now than they were 10-20 years ago? Of course I tend to look at this question through rose tinted spectacles. When I qualified, I thought I was good at my job and efficient, but looking back I cringe at some of the things I said and did. The training now is much less focussed on learning the facts and more on being able to find the facts. This is essential as there is so much information and it is increasing all the time that you can never know everything. So I think newly graduated doctors are similar to when I qualified. For midwives, I think the training has also changed a lot and for anyone involved in delivering babies in New Zealand (doctors or midwives) there is an increasing difficulty in getting enough hands on experience. A lot of this has come about as a result of birthing becoming a heightened experience where there is a lot of focus on who the woman's carer is. Women who may have been happy to have a student as part of their birth in the past are less inclined to do so. I think this is a shame and will be a problem for our daughters when they come to have babies as their doctors and midwives become less experienced. Do you believe the training in New Zealand is adequate? If not, how can it be improved? I think the Obstetrics and Gynaecology training is very good and that the Consultants we produce are world class. There is a difficulty in getting enough gynaecology operating experience as more conditions are managed conservatively without recourse to surgery. One way that this area is being tackled in our specialty is to use mannequins to practice procedures such as hysterectomy on. This has been shown in studies to accelerate learning in the real life environment and reduce the number of real cases needed to reach a desired level of competency. Across the whole specialty, there is a danger of sub-specialists such as myself allowing our general colleagues and trainees to opt out of areas which are bread and butter for all Obstetricians and Gyanaecologists. We are all at fault here! www.h e rmagaz in e .co.n z | 13