Tutorial 30 April 2012

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Tonight we started with a waiting list prioritisation exercise.

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. (127 kg.) 1 kg. = 2.2 lb. 1 stone = 14 lb.	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.

We discussed sterilisation, particulrly consent issues.

We talked again about audit, this time in relation to the work of the audit department.

Then we discussed uterine perforation while doing evacuation of retained products after incomplete miscarriage.

If you send your answers, I'll send mine.

Regards,

Tom.

Tutorial 26 April 2012

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Tonight we started with an incomplete audit:
 

Candidate's Instructions.

Incomplete audit.

You have been given the work done on an incomplete audit. Discuss with the examiner what conclusions you can reach so far and what additional information you need.

Consultant A offers ECV from 35 weeks & has a success rate of 20%.

Consultant B offers ECV from 36 weeks in primigravidae & 37 weeks in mulitparae & has a success rate of 50%.

Consultant C does not offer ECV.

The next was a station based on one that caused problems in a recent exam.

We had a role-play with the daughter of a woman of 88 with recent PMB. The complication is that the woman has Alzheimer's.

Then we discussed shoulder dystocia.

We had done it before, but two of the girls had not attended and were keen to do it.

 

Tutorial 23 April 2012

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Tonight we discussed prescription-writing and then dealing with a primigravida at 39 weeks with a fetal death in utero.

Tutorial 19 April 2012

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We usually have an extra Sunday tutorial 8 days before the exam starts. A number of people are away, but we felt that there would be enough people around to make it worthwhile. So, we will have the tutorial on Sunday 6th. May. Probably starting about 10.30 a.m. UK time.
1. We started with a discussion about what you would do if a woman came for review to the clinic and wanted to know the results of her husband's semen analysis. If you don't have his permission to disclose information, you can't tell her anything. This is clearly not likely to be a station! If it was part of a roleplay, I am sure that there would be some evidence of his permission or the examiner would say that there was.
2. The next station was based on a role play from May 2010. The instructions were: "the parents of a 12-year-old girl with epilepsy and mild intellectual disability want her to have contraception. Please counsel".
This is not easy! Before you listen to the discussion, write what you think would be your plan for the station and send it to me. I'll write what I think and send it to you.
3. We then had a viva on breastfeeding. This is a station you need to prepare. It is 20 years this year since the Baby Friendly Initiative was set up. This could make an examiner think it a good time to have the question.
I made it a structured viva. The first question was: "what are the key facts and figures about the pracitce of breastfeeding in the UK and the advice from the WHO"? The next was "what are the benefits of and contraindications to breastfeeding"? And finally: "what are the key steps that must be taken for a hospital to be accredited as 'Baby Friendly'?
4. We then had a discussion about how to handle a station on domestic violence.
5. We had a quick roleplay with a patient coming to the colposcopy clinic after a smear showed severe dyskaryosis.
You can tell that we have been doing OSCE practice for sometime as we are getting better and quicker.