Tutorial 16th. January 2023

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1	How to prepare. Part 3.  StratOG. Picking a course. Communication skills. Study partner. Importance of polished introduction to role-plays. ? adopt user-friendly name for role-play if you are ‘Clementina’, ‘Cressida’ ‘Maximilial’ or ‘Vladymir’. ‘Blurb’ to deal with GP referral letter. Senior doctor thinking: staffing, training, audit, critical incident reporting and analysis etc. Avoiding medical jargon, abbreviations and acronyms ‘registrar’, ‘anaphylaxis’, PCOS, PMB – OK if explained first.
2	Part 3. The 5 domains and creating an agenda. Safety must top your list.
3	Structured conversation. The Part 3 exam.
4	Basic “blurbs” to write and practise. Setting the scene for breaking bad news, dealing with the information in a GP referral letter, general pre-pregnancy counselling, recessive inheritance, x-linked inheritance, how to ask if the role-player has questions, dealing with information such as a relative with a serious problem. Normalising the abnormal before asking difficult questions – ‘many women in this situation find that they have scary thoughts about killing themself or the baby. Has this happened to you?’ Blurb to recognise the enormity of such an experience, but no reference to you – never ‘I feel your pain’ or its ilk. Dealing with an angry patient. Make a list.
5	Role-play. Freebirth.
6	EMQ. The Term Breech Trial
7	Structured discussion. WHO criteria for a screening test.
8	Structured discussion. WHO surgical safety checklist

1.           How to prepare for Part 3.

 

2.           Part 3. The 5 domains and creating an agenda.

 

3.           Structured conversation. The Part 3 exam.

Candidate’s instructions.

This is a viva station. The examiner will ask you 7 questions about the Part 3 exam.

 

4.           Basic “blurbs” to write and practise.

 

5.           Role-play. Freebirth.

Candidate’s instructions.

You are an SpR5 in charge of the antenatal clinic as the consultant is on sick leave.

GP letter.

The Health Centre,

Utopia-on-Sea.

Re Helen Jones,

287 Main Street, Utopia-on-Sea.

Dear Doctor,

Ms Jones has an appointment in the booking clinic when she will be about 10 weeks advanced in her first pregnancy. She intends to have no medical or midwifery care during the pregnancy or labour and delivery, planning what she calls ‘free birth’ after reading newspaper reports about the dangers of maternity hospitals. I have not come across ‘free birth’ before and plan to speak to my medical defence body about the implications for the medical and midwifery staff at the Health Centre.

Ms. Jones wishes to attend the booking clinic, but not to book! Her wishes are to arrange screening for Down’s syndrome and she would like to have a 20-week scan to check the baby looks normal, but does not want any other involvement with the maternity department or its staff.

She is an intelligent and articulate young woman with no significant health record. Her only dealings with the Health Centre have been to have cervical smears, which have been normal, prescriptions for the Pill and treatment a couple of years ago for a badly-sprained ankle.

I shall be most appreciative of your advice in this matter. I have asked her to return to see me and the midwife after the hospital visit so that we can clarify what we can do to help her and our responsibilities in this matter, which, I am sure, are going to cause the professionals with whom she has dealings a lot of head-scratching.

John Williams. FRCGP.

 

6.           EMQ. The Term Breech Trial.

Abbreviations.

Cs:              Caesarean section.

ECV:           external cephalic version.

VB:              vaginal birth.

VBD:           vaginal breech delivery.

Question 1.        What is the approximate incidence of breech presentation at 28 weeks?

A	3%
B	5%
C	7%
D	10%
E	12%
F	15%
G	20%

Question 2.        What is the approximate incidence of breech presentation at 32 weeks?

Option list. Use that from Q1.

Question 3.        What is the approximate incidence of breech presentation at 36  weeks?

Question 4.        What is the approximate incidence of breech presentation at 40 weeks?

Question 5.        What is the approximate incidence of breech presentation at 40 weeks after

successful ECV at 36 weeks? Don’t get bogged down looking for trick questions. You could argue that to be successful, ECV would need to ensure that all babies were cephalic at T, but the simplest meaning is that the baby was successfully turned at 36 weeks.

A	1%
B	2%
C	3%
D	4%
E	5%

Question 6.        What is the approximate incidence of cord prolapse with breech presentation in term

labour?

A	1%
B	3%
C	5%
D	7%
E	10%
F	12%
G	15%
H	20%
I	none of the above

Question 7.        Which, if any, of the following are included in the RCOG’s PIF about the risks

associated with Cs?

A	damage to bowel
B	damage to bladder
C	damage to ureter
D	damage to partner from fainting / falling
E	endometriosis
F	gestational trophoblastic disease
G	hysterectomy
H	miscarriage
I	placental accreta
J	placenta previa
K	postnatal depression
L	PPH
M	scar dehiscence
N	scar herniation
O	scar pregnancy
P	stillbirth
Q	thromboembolism

Question 8.        What are the 3 key questions in the RCOG’s PIF that patients are advised to ask?

Question 9.        Which, if any, of the following were in the main conclusions of the Term Breech Trial?

A	stillbirths were significantly fewer with planned C section
B	neonatal mortality was reduced significantly by planned C section
C	neonatal morbidity was reduced significantly by planned C section
D	serious neonatal morbidity was reduced significantly by planned C section
E	perinatal mortality was reduced significantly by planned C section
F	perinatal morbidity was reduced significantly by planned C section
G	serious perinatal morbidity was reduced significantly by planned C section
H	none of the above

Question 10.    Which, if any, of the following were in the main conclusions of the follow up at 2 years

of the children in the Term Breech Trial?

A	neonatal mortality was reduced significantly by planned C section
B	neonatal morbidity was reduced significantly by planned C section
C	planned C section reduced the risk of child death up to 2 years
D	planned C section reduced the risk of child morbidity up to 2 years
E	planned C section improved child neurodevelopment at 2 years of age
F	none of the above

Question 11.    Which, if any, of the following were included in the conclusions of the Premoda Trial?

A	fetal mortality was reduced by planned cs
B	neonatal mortality was reduced by planned cs
C	neonatal morbidity was reduced by planned cs
D	surgeons’ sleep patterns were improved planned cs
E	Cs should be offered as superior to planned vaginal delivery even in expert centres
F	VBD is a safe option in centres where it is commonly practised and strict criteria are met

Question 12.    Which, if any, of the following are listed as contraindications to VBD in GTG20a.

A	maternal height < 1.6 metres
B	maternal BMI > 30
C	gestation < 36 weeks
D	failed ECV at 36 weeks
E	reversion to breech presentation after successful ECV at 36 weeks
F	estimated fetal weight > 3.5 kg.
G	estimated fetal weight <25th. centile.
H	hyperextended fetal neck
I	footling presentation

 

7.           Structured discussion. WHO Surgical Safety Checklist.

8.           Structured discussion. WHO screening test criteria.