Thursday 28 April 2011

Tutorial 28th. April 2011 a

Podcast.
Website.

Tonight I messed up (again) and had to record the tutorial in two sessions, a and b. We dealt with a woman with a probably bleeding ectopic pregnancy who did not want admission, epilepsy and pre-pregnancy counselling, screening for ovarian cancer and sepsis and maternal mortality. We also discussed the maternal mortality topics that were likely to come in the OSCE.

Tutorial 28th. April 2011 b

Podcast.
Website.

Tonight I messed up (again) and had to record the tutorial in two sessions, a and b. We dealt with a woman with a probably bleeding ectopic pregnancy who did not want admission, epilepsy and pre-pregnancy counselling, screening for ovarian cancer and sepsis and maternal mortality. We also discussed the maternal mortality topics that were likely to come in the OSCE.

Tutorial 26 April 2011

Podcast.
Website.

Tonight Ahmed Yassin gave a tutorial on urogynaecology. He produced a lot of printouts. I'll see if I can find a practical way to get these copied and onto the internet or into a form that can be e-mailed. The problem is that there are a lot of them and I have many other things to do. In addition, the file sizes are likely to be a problem. Even if I don't manage to do anything with the papers, the tutorial will still be worth listening to unless you are already expert in the subjet.

Monday 25 April 2011

Tutorial 25th. April 2011

Podcast.
Website.

Tonight we dealth with a patient enquiring if her treatment by her GP had caused her to have cancer and worsen her prognosis. Tricky stuff. We then had a very routine case of a woman referred to the colposcopy clinic after a smear had shown severe dyskaryosis. Finally we had a case of PMS with a hidden agenda.

Thursday 21 April 2011

Tutorial 21st. April 2011

Podcast.
Website.
On Monday we discussed how to go about the difficult business of asking the parents for permission to conduct a post-mortem examination on a stillborn baby. I have put something on the website to let you build a technique to deal with this. Practise it with a role-player!
We did a roleplay about dealing with an angry patient. I have started to write something for the webpage and hope to finish it later today.
We also discussed writing a protocol on Monday. This was at the end of the session. I had switched off the recording just before the discussion as the group was writing their thoughts. Unfortunately I forgot to switch the recording back on! All is not lost however. I have written a document that covers the topic. Write the headlines you would use for a viva on how to create a protocol. The question might be: "You have been asked to write a protocol. Discuss the key aspects of how you would go about this with the examiner". It doesn't much matter what the protocol is about. Send me your version and I'll e-mail mine to you.
Tonight we did Down's syndrome counselling. First as a role-play, then as a viva. It threw up quite a few areas in which knowledge was sketchy.
 The next tutorial will be on Monday evening, despite it being the Bank Holiday.

Monday 18 April 2011

Tutorial 18 April 2011

Podcast.
Website.

We did a lot tonight - a measure of how the group gets better as time goes by.
We covered five difficult stations:
Dealing with an intra-operative injury.
Dealing with an angry patient / relative.
Complaint procedures.
Breaking bad news: cancer.
Discussing PM examination after stillbirth.

Sunday 17 April 2011

Tutorial 17th. April 2011

Podcast.
Website.

We went over some of the difficult stations from yesterday's OSCE course at Bolton, in particular dealing with telling a girl of 17 that she had androgen insensitivity syndrome and another station dealing with domestic violence.
We also had some discussion about risk management, audit and how to prepare a protocol.
I use one laptop to record the tutorial for the podcast and another for Skype.
Unfortunately the one I use for the podcast decided to crash and to refuse to re-start, just as I was setting things up for the tutorial. Particularly annoying as the machine is only a few months old and with a top specification from one of the big manufacturers. I managed to rescue the situation, but too late to include the beginning of the tutorial.
I hope you find it useful.

Thursday 14 April 2011

Tutorial 14th. April 2011

Webpage: www.drcog-mrcog.info.
Podcast:    http://soundcloud.com/drtmcf/tutorial-14-april-2011

First we went through the technique applicable to a waiting list prioritisation.
Then we did a labour ward prioritisation. Again to look at technique. We had done this before, but it was one of the early tutorials and many people missed it.
The scenarios we used are below.
If you want my versions of the answers, send me an e-mail with your versions.

Waiting List Prioritisation.

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.

Name
Age
Clinical Problem
Proposed operation
Venue
Special Needs
Urgency
JK
5
chronic discharge.
? foreign body
EUA
Main theatre


JM
32
1ry. infertility
Laparoscopy + tubal patency tests
Main theatre


GN
77
Vulval cancer. Coronary thrombosis x 2. Unstable angina.
Radical vulvectomy agreed at MDT.
Main theatre


RU
55
PMB x1. Weight 20 stones.
1 stone = 14 lb.
1 kg = 2.2 lb.
So, 1 stone = about 6.3 kg.
I think they would give you kg in the exam.
D&C.

DCU.


LD
32
Menorrhagia. Fibroids. Anaemia.
Vaginal hysterectomy.

Main theatre.


DT
22
Does not want children.
Lap. Steril.
DCU


HB
14
Unwanted pregnancy at 10.52.
TOP
DCU. TOP list.
.

JY
44
GSI.
Anterior colporrhaphy.

Main theatre.


JS
23
Vaginal discharge. Cervical ectropion.
Diathermy to cervix.

DCU


DT
55
3 cm. ovarian mass.
Laparoscopy ? proceed to Hyst + BSO.

Main theatre.


EV
32
CIN3.
Cone biopsy.

DCU


UW
34
Endometriosis
Laparoscopic ablation
DCU


HT
88
Cystocoele/ rectocoele/ 2nd. degree uterine prolapse
Manchester Repair.

Main theatre.


KN
58
Haematuria
Cystoscopy
DCU


JW
18
Menorrhagia & copes badly with menstrual hygiene. Has Down’s syndrome. Sexually active.
Hysterectomy
Main theatre


TB
30
Menorrhagia. 2nd. degree uterine descent. Been sterilised. Jehovah’s witness.
Vaginal hysterectomy and repair.
Main theatre.


BM
55
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.


NU
60
Recurrent rectocoele.
Posterior colporrhaphy.
Main theatre.



Scenario 2.

Monday. 0900 hours.  You have just come on duty.

1
Mrs A
Para 0+0
25 yrs
41 weeks. In labour 12 hours. Cx 8 cm. No progress for 4 hours. "Dips" reported on CTG
2
Mrs B
Para 1+2
31 yrs
28 weeks. Just admitted. "Show" + contractions
3
Mrs C
Para 5+3
40 yrs
In labour 8 hours. Cx 6 cm. dilated
4
Mrs D
Para 1+3
27 yrs
37 weeks. Diabetes. Admitted ½ hour previously. Previous Caesarean section.
5
Mrs E
Para 1+2
32 yrs
40 weeks. Previous 9 lb. baby. In the second stage for 1 ½ hours.
6
Miss F
Para 0+0
15 yrs
34 weeks. Concealed pregnancy. In labour. Just admitted. Undiagnosed breech presentation
7
Mrs G
Para 1+2

26 weeks. Admitted with severe abdominal pain
8
Mrs H
Para 2+1

39 weeks. In early labour.
9
Mrs I
Para 1+0

Delivered two hours previously by Caesarean section for severe pre-eclampsia. Diastolic BP / 110. Urine output 50 ml. since delivery
10
Mrs J
Para 1+0

Normal delivery + PPH >1,500 ml. one hour ago


Medical staff:

Consultant:               in his Rooms.
You:                            Registrar.
Foundation Year 2  six months’ experience.
Registrar in anaesthetics.

Midwifery staff:

Senior Sister.
Two staff midwives.
One community midwife.
Two student midwives.

Thursday 7 April 2011

Tutorial 7th. April 2011

Website: www.drcog-mrcog.info.
Podcast: http://soundcloud.com/drtmcf/tutorial-7-april-2011

Tonight we talked about diathermy, shoulder dystocia and "breaking bad news". There is eough stuff on the website to give you all you need about diathermy.

Monday 4 April 2011

Tutorial 4th. April 2011

Website.
Podcast.
Tonight was all OSCE basics. How to survive a viva. This one was on risk management. Then how to deal with a viva on an emergency case. Again there are techniques to learn. Finally explaining balanced translocation which took us into explaining chromosomes and genes. Very, very necessary to start practising such explanations so that you can do them fluently in the exam. You definitely do not want to be trying to find appropriate words for the first time in the exam.
The next tutorial is on Thursday.