Thursday, 30 April 2015

30th. April 2015

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Viva. Systematic review – question from the UHSM course
Role-play. Maternity Dashboard.
Viva. Cochrane.
Role-play. Caesarean section on maternal request.

46.   Viva. Systematic review. The UHSM course on the 29th. April had a station on systematic review.
         The UHSM course on the 29th. April had a station on systematic review and most people did badly. The candidate was told that they had been asked to do a systematic review of Ulipristal v. a GnRH analogue for use pre-hysterectomy in women with fibroids. There was a 15 minute preparatory station and the viva was unstructured – the examiner was supposed to say nothing!

47.   Role-play. Maternity Dashboard.
         Candidate’s instructions.
         You are an SpR5 and your consultant has asked you to explain the Maternity Dashboard to a new FY1 who hopes to train as a specialist in obstetrics and gynaecology.

48.   Viva.
Candidate’s instructions.
You are a SpR in year 5.
1.   You have been asked to explain the Cochrane Collaboration and Cochrane Reviews to a new trainee.
2.   And to explain the main elements and findings of the Forest plot below.
The trainee will ask 8 questions suggested by your Consultant.

49. Role-play. Caesarean section on maternal request.
Candidate’s instructions.
You are a SpR5 in the antenatal clinic.
Your consultant is feeling unwell and has gone to lie down.
The midwife has just seen a primigravid woman who has requested Caesarean section.
She is healthy, with no significant medical history and the pregnancy has been normal.
The gestation is 36 weeks, the head is engaged and the baby seems to be of an average size.
The midwife has done all the routine investigations and has asked you to see her to discuss the request for Caesarean section.
It is your task to discuss her request as you would in a normal clinic.

Sunday, 26 April 2015

Tutorial 26th. April 2015

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Today we covered the topics from yesterday's NW OSCE course.
After lunch we also dealt androgen insensitivity as a role-play, perhaps the most difficult role-play.
Worth practising in case it comes up and because it is so difficult.
Master it and most others are easy!

Thursday, 23 April 2015

Tutorial 23rd. April 2015

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Roleplay with preparatory station. Cs technicalities
Roleplay. Pre-menstrual syndrome.
Role-play. Write a prescription
Role-play. Teach trainee fetal blood sampling.

40    Roleplay with preparatory station. Cs technicalities.
         Candidate’s instructions.
         You are a year 5 SpR and passed your membership 1st. time two years ago.
         You have been asked for help with OSCE preparation by a colleague who is sitting the OSCE for the first time in 1 month.
         The colleague went on the RCOG course last week and found the vivas especially difficult.
         Your consultant has suggested that you conduct a viva on the technical aspects of Cs: what should be done and what should not be done with some indication of the strength of the supporting evidence. To simplify things, you are to restrict the viva to singleton pregnancies, first Caesareans and elective procedures.
         You have 15 minutes in which to prepare a possible score sheet with all the topics you feel merit attention.
         If the colleague runs out of ideas for answers, ask for their opinion about the items on your list.

41    Viva. MBRRACE.
         The examiner will ask you 18 questions about MBRRACE.

42    Roleplay. Pre-menstrual syndrome.
Candidate's Instructions.
This is a roleplay station.
Your task is to take a history and advise about initial investigations and management.
GP Letter.
The Medical Centre,
Haversham Way,
XS89 9JH.
Re Jenny Smith,
55 Town Street,

Dear Doctor,
Please see this woman who complains of pre-menstrual syndrome. I don’t really believe in this condition so have not attempted to treat it.
Dr. N. O. G. Ood.

43    Role-play. Write a prescription.
         You have seen Mary Smith who wishes is trying to conceive. She has had a full work-up and has very infrequent periods. PCOS has been diagnosed. She is not overweight. You have discussed her treatment with the consultant and a trial of clomifene has been agreed.

         Your task is to explain this to Mary and write her a prescription for a one-month supply.
         Mrs. Mary Smith, DoB: 15 March 90.
              5 Mansion Row,
              Send me an e-mail for the prescription sheet to fill in.

44    Role-play. Teach trainee fetal blood sampling.
Candidate's Instructions.
This is a roleplay station.
Dr. Jones has recently joined your team as a new trainee in obstetrics & gynaecology.
The labour ward is quiet and the consultant has asked you to teach Dr. Jones about fetal blood sampling.

Monday, 20 April 2015

Tutorial 20th. April 2015

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20th. April 2015.

Topics discussed tonight were:

Viva. Write a model for taking an obstetric history.
Viva. Bullying, harassment and undermining.
Role-play. Abnormal cervical smear.
Viva. Uterine inversion.
Send me your answers and I'll send mine.
It is important to answer under exam conditions.
No preparation and within the allotted time.
This helps you develop exam technique which is essential.
Don't spend an hour or two reading your references - you are wasting your time and mine!

Monday, 13 April 2015

Tutorial 13 April 2015

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13th. April 2015.

Viva. Waiting list prioritisation.
Roleplay. Teach a FY1 about shoulder dystocia.
Role-play. Neonatal jaundice.
Viva. Adverse incident report. 4th. degree tear.
Viva. Whooping cough & pregnancy.

31    Viva. Waiting list prioritisation
Candidate’s instructions.
Your consultant is away.
The waiting-list manager comes to see you.
The following patients have been listed by junior staff.
The waiting-list manager wants you to:
         confirm the appropriateness of the proposed treatment,
         decide the degree of urgency,
         confirm the appropriateness of the proposed venue,
         decide any special requirement(s) for each patient.

Clinical Problem
Proposed operation
chronic discharge.
? foreign body
Main theatre
1ry. infertility
Laparoscopy + tubal patency tests
Main theatre
Vulval cancer. Coronary thrombosis x 2. Unstable angina.
Radical vulvectomy agreed at MDT.
Main theatre
PMB x1. Weight 20 stones. (127 kg.)
1 kg. = 2.2 lb.
1 stone = 14 lb.

Menorrhagia. Fibroids. Anaemia.
Vaginal hysterectomy.

Main theatre.
Does not want children.
Lap. Steril.
Unwanted pregnancy at 10/52.
DCU. TOP list.
Anterior colporrhaphy.

Main theatre.
Vaginal discharge. Cervical ectropion.
Diathermy to cervix.

3 cm. ovarian mass.
Laparoscopy ? proceed to Hyst + BSO.

Main theatre.
Cone biopsy.
Laparoscopic ablation
Cystocoele/ rectocoele/ 2nd. degree uterine prolapse
Manchester Repair.

Main theatre.
Menorrhagia & copes badly with menstrual hygiene. Has Down’s syndrome. Sexually active.
Main theatre
Menorrhagia. 2nd. degree uterine descent. Been sterilised. Jehovah’s witness.
Vaginal hysterectomy and repair.
Main theatre.
Stage Ib cancer cervix. Been discussed at MDT. For Wertheim’s hysterectomy. Factor V Leiden. VTE on Pill. On warfarin.
Wertheim’s hysterectomy.
Main theatre.
Recurrent rectocoele.
Posterior colporrhaphy.
Main theatre.

32    Roleplay. Shoulder dystocia
Candidate’s instructions.
You are a year 5 SpR. It is a quiet afternoon on the delivery unit and your consultant has asked to teach a newly-arrived FY1 about shoulder dystocia.

33    Roleplay. Neonatal jaundice.
         Candidate’s instructions.
         Explain the important issues relating to neonatal jaundice to a newly-arrived FY1.

34    Viva. Adverse incident report. 4th. degree tear.
Candidate’s instructions.
         Mrs Penelope Jane Brown sustained a 4th. degree tear after the delivery of her second baby.
         Dr. James Peter White conducted the delivery and was asked to write a statement for the Risk Management Team (RMT), to whom the incident has been reported as an adverse clinical incident.
         You have been asked to look at Dr. White’s report, comment on it and identify issues that the RMT needs to explore further. You have 15 minutes to read Dr. White’s report, after which you will have a viva with the examiner. The examiner will not lead the discussion and will simply listen to what you have to say.

         Dr. White’s Report.
         I am Dr. J. White. I have been SpR in obstetrics and gynaecology at the Royal Infirmary for over a year.
         On the 27th. September I was bleeped by a midwife on the labour ward and asked to see a Mrs Brown who needed to be delivered as there had been delay in the second stage and she was becoming exhausted.
         On arrival on the labour ward I felt that Mrs Brown was not trying very hard to deliver the baby naturally and that the midwives were not making much effort to encourage her. I advised that they should get her pushing properly and that I would go for a coffee and return in half an hour.
         I returned in 50 minutes, having had an important phone call from my wife about arrangements for our forthcoming holiday which was under threat of cancellation. The situation was unchanged and I was not impressed with either the woman’s endeavours or the midwives’ encouragement of her efforts..
         Examination showed the head to be mid-cavity. I felt that it could get it out using forceps. The midwives told me that her bladder was empty. I applied the forceps with ease. The baby delivered in good condition. I then noted that she had a 4th. degree tear. I repaired this in the usual way.
         I went on holiday the next day for two weeks and did not see this woman again.

35    Viva. Whooping cough and pregnancy.
         Candidate’s instructions.
         The examiner will ask you 4 questions about pertussis and pregnancy.

Thursday, 9 April 2015

Tutorial 9 April 2015

I messed up with the podcast for this tutorial - I forgot to record it. Aged brain, I reckon!
However, I have written fairly detailed answers, so send your answers and I'll link you to my versions on Dropbox.

Viva. Enhanced recovery
Roleplay. Phenylketonuria
Viva. Diathermy.
Viva. Obstetric surveillance systems.

27    Viva. Enhanced recovery
You are a newly-appointed consultant.
The Clinical Director has asked you to develop a programme for enhanced recovery for inpatient gynaecological surgery.
As a first step, she has asked you to deliver a talk to a unit meeting (all staff can attend) to outline the key features of enhanced recovery.
She suspects that little is known by most of the staff about the subject and hopes that your talk will encourage their enthusiastic participation.
Your task is to tell the examiner the key points you would wish to cover in the talk.
This is not a structured viva: the examiner will not ask questions or help you in any way.

28    Roleplay. Phenylketonuria
Candidate’s instructions.
You are the SpR in the pre-pregnancy clinic. Your consultant is off on sick leave and you are the most senior doctor in the clinic.
You are about to see Jane White who is planning her first pregnancy. Your task is to take a history and discuss the optimum management now and during pregnancy.

The GP letter reads:
Prime Health Practice,
Practice Manager:
Mrs Willhelmina Bland.

Dear Doctor,
Please see Jane White, 35 years of age and planning her first pregnancy. Her health is good – she seems only to attend the Practice for routine checks such as cervical smears – the most recent of which was taken last year and was normal. From talking to her and examining her records, it is clear that she is very healthy and has always had good physical and mental health. Her social circumstances are good. The one thing of concern is that she told me she was on a diet in childhood supervised by the local paediatric team. She can’t recall what it was about and she stopped the diet at about the age of 14. Both of her parents are dead – her mother fifteen years ago at the age of 40 and her father two years ago in a RTA, so cannot shed light on what the diet was for. Fortunately, when I checked through her notes I came across correspondence indicating that the problem was phenylketonuria. I have told her that I am no expert in phenylketonuria and the implications for pregnancy, so have eschewed the temptation to provide any advice.
I look forward to receiving your expert report.
Dr. John Worthy.

29    Viva. Diathermy.
The examiner will ask you 8 questions about diathermy.

1.   What is diathermy?


2.   What kind of current is used?


3.   Why use high frequency current?


4.   What types of diathermy are used?


5.   How is diathermy applied?


6.   Risks of diathermy.

7.   Discuss direct coupling and its implications

8.   Discuss capacitive coupling and its implications.

30    Viva. Obstetric surveillance systems.
This is a viva station.
The examiner will ask you 2 questions about surveillance systems used in obstetrics.
The examiner will suggest that you move to the next question when you appear to have completed the one you are answering to ensure that you have time for the remaining answers.
1)    What general data collection systems exist in the UK?                                          4 marks
2)    What obstetric surveillance systems exist in the UK and what do they do? 16 marks