27 July 2023

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7	Role-play. Explain balanced translocation to FY1
8	Role-play. Cystic fibrosis. Brother has cystic fibrosis
9	Structured discussion.
10	Structured discussion.

7.        Role-play. Explain balanced translocation to FY1.

Candidate’s instructions.

You are an FY1 and keen to specialise in O&G. It is a quiet day on the labour ward. Yesterday you were in antenatal clinic and a patient with a 14:21 balanced translocation was seen for counselling about the associated risks. You have a vague recollection of this being discussed when you were a medical student but you did not understand the explanation that was given yesterday. You asked the consultant about it and she said she would get the SpR to explain it to you as they are preparing for the Part 3 exam and could have it as part of a station.

 

8.        Role-play. Cystic fibrosis. Brother has cystic fibrosis.

Candidate's Instructions.

This is a roleplay station. You are a year 4 SpR and are in the gynaecology clinic.

The consultant has just left you in charge as she is feeling unwell and has gone to lie down.

Your task is to deal with the patient as you would in real life.

The College would give definite instructions; I have made it harder - you have to decide the key tasks.

GP referral letter.

Best Medical Centre,

High Road,

Anytown.

Phone: 01882 78998.  E-mail: besthealth@gmail.com

Practice Manager: Mary Wright. B.SC., RGN.

Phone:  01882 78998 ext. 23.

E-mail:  MWbesthealth@gmail.com

Re. Mrs. Bonnie Black,

25 Low Road,

Anytown.

Phone: 07889 888 132.

Dear Doctor,

Please see Mrs Black who is planning her first pregnancy. Her main concern is that her brother has cystic fibrosis.

This was the first time I had met her although she has been registered with us for 5 years – her health is good and she has no history of serious illness or surgery.

I have explained that I don’t know much about the implications of the brother’s cystic fibrosis for her potential pregnancies and that she needs to talk to an expert. I have stressed that the risk of her having a child with cystic fibrosis is high and that she needs to be aware that there is a distinct likelihood that any pregnancy would be likely to be affected and need TOP.

Yours sincerely,

John P. Clatter.

9.        Structured discussion. Topic revealed on the day.

10.      Structured discussion. Topic revealed on the day.

 

24 July 2023

 

 

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 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	Importance of a good introduction. See: http://www.drcog-mrcog.info/communication.htm#introduce%20yourself.
6	Role-play. Pre-pregnancy counselling. Sister has babe with Down syndrome.
7	EMQ. The Term Breech Trial

 

1.  How to prepare. Part 3.

See above.

 

2.  The 5 domains and creating an agenda.

You need to memorise these as they are the basis of the scoring system.

 

3.  Structured conversation.

The examiner will ask a series of questions about the Part 3.       

 

4.  Basic “blurbs” to write and practise.

We will discuss the value of preparing “blurbs”.

 

5.  Importance of a good introduction.

This is really important and needs a practice.

 

6.  Role-play.

Candidate’s instructions.

You are the SpR in the gynaecology clinic. You have been asked to see Jenny Williams, who has come for pre-pregnancy counselling.

Letter from the General Practitioner.

5 High Street,

Deersworthy,

Kent.

DO9 1JY.

 

Re Mrs. J. Williams,

Manor Place,

Deersworthy.

Dear Dr.,

Please see this woman who is planning pregnancy. I understand that her sister has had a baby with Down’s syndrome.

Regards,

Dr. Jolly.

 

7.  Term Breech Trial. EMQ. Questions.

Don’t ignore this because you have passed Part 2 – it could be the basis of a viva or a teaching role-play.

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