Tutorial 27 October 2016

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27 October 2016

39	Role-play. Hydatidiform mole
40	Role-play. Maternity Dashboard
41	Viva. Laparoscopy & bowel injury.
42	Role-play. Laparoscopy & bowel injury. See patient.

39. Role-play. Hydatidiform mole.

Candidate's Instructions.

You are the SpR in the gynae clinic. The consultant has said that it will be a good experience for you to see the next patient.

She was recently an inpatient for evacuation of retained products after an apparent miscarriage at 8 weeks.

The histology report showed a complete mole.

The GP was contacted and asked to see her. An appointment was sent to her to attend today.

Your task is to take a history and explain the implications of the diagnosis

40. Viva. Maternity Dashboard.

Candidate’s instructions.

This is a viva station about the RCOG’s maternity dashboard.

The examiner will ask you 14 questions.

When you have finished a question, you will not be allowed to return to it as later questions may indicate the answer. If you return, no marks will be awarded, even for correct answers.

41. Viva. Laparoscopy & bowel injury.

Candidate’s instructions.

This is a viva station.

You are a SpR. You are in the process of performing laparoscopy for a patient with 1ry. infertility. On inserting the laparoscope you suspect that the cannula is in the bowel.

Your task is to explain to the examiner all the steps you will consider taking from recognising the possibility through to the woman’s discharge.

This is an “open” viva and the examiner will not assist you.

It is up to you to ensure that all the relevant issues are discussed.

42.  Role-play. Laparoscopy & bowel injury.

Candidate’s instructions.

This is a follow-on from the previous station.

It is now 4 hours since the operation: the woman had a laparotomy to repair the bowel defect. The woman has asked why she has not been allowed to go home. Her sister has come to collect her. The patient is still feeling drowsy and has some pain, so has asked her sister to find out what happened, when she can go home and what it means for her fertility.

are Mary White. Your sister Jane had laparoscopy as investigation of 1ry. infertility this morning. Something went wrong and she is to stay in hospital. She has delegated you to find out what happened, when she can go home and what it means for her fertility.

You are a solicitor and specialise in medical litigation. You also want to know whether the doctor was qualified to do the operation, what investigation will be done and what will be done to assist her in making a complaint, which you are sure she will want to do.

You want answers to the following questions, but don’t ask them until it is clear that the doctor is not going to give any answers.

1.           what went wrong?

2.           why did it go wrong?

Tutorial 13 October 2016

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13 October 2016

35	Role-play. Pre-op clinic. Abdominal hysterectomy
36	Role-play. Anencephaly. Does not want TOP.
37	Viva. Obstetric surveillance systems
38	Viva. Parvovirus

35. Role-play. Pre-op clinic. Abdominal hysterectomy.

Candidate’s instructions.

You are a fifth-year SpR and are running the pre-op clinic. You are about to see Mary Smith.

The notes say that her uterus is enlarged to the size of a 16 week pregnancy by fibroids and she has been listed for hysterectomy. She has menorrhagia and medical treatments have not worked.

Your task is to complete the tasks you feel are appropriate in the pre-op clinic.

36. Role-play. Anencephaly. Does not want TOP.

Candidate’s instructions.

You are an SpR5 and running the ante-natal clinic – your consultant has been called to help a consultant colleague with an emergency on the labour unit and is not available for advice.

You are about to see Jean Hathersage. She is 25 years old and had a 10-week scan last week that showed anencephaly. She stated that she did not want TOP. She was counselled, given information leaflets and asked to return to the antenatal clinical today for further discussion.

It is your task to conduct that discussion.

37. Viva. Surveillance systems & obstetrics.

Candidate's Instructions.

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.

38. Viva. Parvovirus.

Candidate's Instructions.

The examiner will ask you 22 questions. When you have answered each question you are not allowed to return as subsequent questions may contain hints as to the correct answer.

Tutorial 10 October 2016

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10 October 2016

30	Viva. Critique RCOG.s Pt. Info leaflet on Genital Herpes
31	Viva. Incomplete ECV audit
32	Role-play. Explain the processes of normal delivery
33	Role-play. Teach vaginal breech delivery
34	Viva. Apgar score

30. Viva. Critique RCOG.s Pt. Info leaflet on Genital H*r*es

The leaflet can be downloaded from  the RCOG website.

Apologies for the asterisks! If I put the full word in, there will quickly be a load of testimonials about Dr. Magic and his guaranteed cures for this and all other ailments.

The conmen use clever software that visits all websites looking for key words and automatically uploads their rubbish when they find them. 

I would not like to think that anyone thought I was endorsing such nonsense.

31 Viva. Incomplete ECV audit

Candidate’s instructions.

A colleague who has left the hospital was conducting an audit of ECV.

The audit is incomplete.

The data are:

Consultant A offered ECV to one group of women and had an 70% success rate,

Consultant B offered ECV to a different group and had a 30% success rate,

Consultant C did not offer ECV at all.

Instructions.

Tell the examiner how you would go about completing this audit.`

32. Role-play. Explain the processes of normal labour & delivery

Candidate’s instructions.

You are the SpR on call for the delivery unit. It is unusually quiet. The on-call consultant has asked you to explain normal labour and delivery to a medical student who started with the department yesterday.

33. Role-play. Teach vaginal breech delivery

Candidate’s instructions.

You are the SpR on call for the delivery unit. It is still unusually quiet. The on-call consultant has been told that you did a brilliant job of explaining normal labour and delivers. She has asked you to explain vaginal breech delivery to a new FY2, who is keen on a career in O&G.

34. Viva. Apgar Score.

Candidate's Instructions.

This is a viva station.

The examiner will ask you 8 questions.

You are not allowed to return to earlier questions. You will not be awarded any marks if you do, even for correct answers.

Tutorial 6 October 2016

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6 October 2016

27	Viva. Headache
28	Role-play. Explain, dyskaryosis, dysplasia, CIN etc.
29	Viva. HPV immunisation programme

27. Viva. Headache.

Candidate's Instructions.

This is a viva station.

The examiner will ask you 13 questions.

28. Role-play. Explain dyskaryosis and endometrial hyperplasia.

Candidate's Instructions.

This is a role-play station. You are a 4^th. year SpR.

Jane Smith is a 1^st. year student nurse who has joined the department. She has heard the following terms used in the gynaecology and colposcopy clinics:

mild, moderate and severe dyskaryosis in relation to cervical smears,

simple, complex and atypical endometrial hyperplasia,

She would like to know what they mean and their significance as the explanations given by the medical staff in the clinics were not clear and patients asked her for clarification. Her knowledge was insufficient for her to provide this, which she found very unsatisfactory for the patients and her. Your consultant has delegated the explanation to you.

29. Viva.

Candidate’s instruction HPV immunisation programme.

This is a viva station about the UK programme for routine HPV immunisation.

The examiner will ask you 18 questions.

When you have finished a question, you will not be allowed to return to it as later questions may indicate earlier answer. If you return, no marks will be awarded, even for correct answers.

Tutorial 3rd. October 2016

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23	Viva. Clinical governance and the labour ward
24	Role-play. Fragile X syndrome
25	Viva. Diathermy
26	Role-play. Teach an FY1 the basics of audit.

23. Viva. Clinical governance & the labour ward.

Candidate's Instructions.

This is an unstructured viva. Your task is to explain to the examiner the key issues in relation to clinical governance in the labour ward.

24. Role-play. Fragile X syndrome.

Candidate's Instructions.

You are about to see Mary White who has been booked in with her first pregnancy by the midwife in the antenatal clinic. The midwife has asked you to see her as Mary has told her that there is a family history of Fragile X syndrome. There were no other significant issues in the history.

Your task is to discuss Fragile X syndrome and the implications for Mary.

25. Viva Diathermy.

Candidate's Instructions.

This is a structured viva station about diathermy and its uses and complications.

The examiner will ask you 8 questions.

When you have completed an answer you are not allowed to return.

26. Roleplay. Teach an FY1 the basics of audit.

Candidate’s instructions.

You are the SpR on call for the labour ward.

It is a quiet afternoon: all the patients are healthy and in normal labour.

Dr. Jane Jones has started in the department as a new FY1. She is keen to specialise in O&G and has already passed the Part 1 examination.

A measure of her enthusiasm is that she has asked her consultant if she can be involved in doing an audit, but she is aware that she knows little about it.

Her consultant happens to be the consultant on duty for the labour ward and has asked you to ensure that she has enough knowledge to be a useful member of a team conducting an audit.