Monday, 21 May 2012

Tutorial 21 May 2012

Tutorial: there is no tutorial to listen to: see below
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Tonight we started with a discussion about how to prepare for the written.
The key things are already in the document that I send to people when they first get in touch with advice about reading etc.
 
Key things:
You need to know what to read.
Start with the syllabus.
Read the advice on the website.
            And have a system that makes you read analytically and enables revision.
Write lots of essays under exam conditions.
You need to start making a list of topics for last-minute revision.
staging of cancer, primary amenorrhoea, ten top recommendations from the Maternal Mortality Report etc.
these need to be in note format so that you are revising them, not learning them from new.
You need to arrange study leave in the week or so before the exam.
Consider going on a course.
If you haven't had a copy, send me an e-mail - see "contact" above for the address.

We discussed the MCQs.
Some people find them useful, some don't.
Their main virtue is that they more or less cover the syllabus.
But they are preliminary reading, so you need to get through them in a month or so, not longer.

We discussed the courses available in the NW.
There are two courses in the NW.
The first is the written course in July: http://www.drcog-mrcog.info/north_west_mrcog_course.htm
This is run by Dr. Varsha Mulik and is a good course with lots of essay-writing and EMQs.
Then there is the Bolton OSCE course.
The date has not yet been fixed, but it is usually 3 or 4 weeks or so before the OSCE.

The course is run by Mr. Phil Chia, who is not interested in making money, so it is a fraction of the cost of other courses.
You do two full circuits and there is none of the business of going round in twos, one active, one an observer.
The organiser is Carol Hardman.
You can book a place now and if you don't get through the written, you can let Carol know and she gives the place to someone else.
There is no financial penalty for doing this.
The main virtue of this course is that it takes place on a Saturday and on the Sunday, I have an all-day tutorial to deal with the stations that were a problem.
The course always overbooks, so, if you want to go on it, book a place early.

We then wrote an essay:
 
A 55 year old woman is referred by her General Practitioner after a single episode of post-menopausal bleeding. Critically evaluate the management.
I allowed 25 minutes for the essay and then we discussed it.
Write the essay in 25 minutes with no preparation and send it to me.
I'll send my version, which has the above discussion included.

We discussed the importance of starting now with preparation for the OSCE.
In particular communication skills.
If you decide on the words you are going to use to introduce yourself, you can start practising them with your patients.
They are then completely normal by the time you come to the OSCE.
There is a section of the website about this: http://www.drcog-mrcog.info/communication.htm

Then we did an EMQ.

This question is about cystic fibrosis.
For each scenario choose the option that gives the best answer.
Each option can be used once, more than once or not at all.
And, to make you behave in a model fashion, there is no option list, so you have to decide the correct answer.
Scenario 1.
A woman is 8 weeks pregnant and known to be a carrier of cystic fibrosis.
Her husband is Caucasian.
What is the risk of the child having cystic fibrosis?
Scenario 2.
A healthy woman attends for pre-pregnancy counselling.
Her brother has cystic fibrosis. Her husband is Caucasian.
He has been screened for cystic fibrosis. The test was negative.
What is the risk of them having a child with cystic fibrosis?
Scenario 3.
A healthy woman is a known carrier of cystic fibrosis.
She attends for pre-pregnancy counselling. Her husband has cystic fibrosis.
What is the risk of them having a child with CF?
Scenario 4.
A healthy woman attends for pre-pregnancy counselling. Her sister has had a child with cystic fibrosis.
What is her risk of being a carrier?
Scenario 5.
A woman attends for pre-pregnancy counselling. Her mother has cystic fibrosis.
What is the risk that she is a carrier?
Scenario 6 .
A woman attends for pre-pregnancy counselling. Her mother has cystic fibrosis.
The partner’s risk of being a carrier is 1 in X.
What is the risk that she will have a child with CF?
Scenario 7.
A healthy Caucasian woman is 10 weeks pregnant.
Her husband is a known carrier of cystic fibrosis.
Which test would you arrange?
Scenario 8.
A woman attends for pre-pregnancy counselling. She has read about diagnosing CF using cffDNA from maternal blood. Is it possible to test for CF in this way?
Scenario 9.
A woman and her husband are known carriers of cystic fibrosis.
What is the risk of them having an affected child.
Scenario 10.
A woman and her husband are known carriers of cystic fibrosis.
What can they do to reduce the risk of having an affected child?
Scenario 11.
A woman and her husband are known carriers of cystic fibrosis.
Can CVS exclude an affected pregnancy?

We discussed the answer, but I think the best thing is for you to answer the EMQ and send it to me.
I'll then send my version of the answer, which has full explanations.
So, for once, there is nothing to listen to.

Thursday, 10 May 2012

Tutorial 10 May 2012

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Tonight we had an excellent tutorial by Alison Jobling, Consultant Paediatrician, on neonatal resuscitation. Her expertise shone!
Unfortunately, I was so engrossed listening to her talk, that I forgot to switch on the recording and the first five minutes or so were lost. Fortunately, she discussed the background physiology during this time and I had remembered to turn on the recording by the time she got to the clinical issues.
The physiology and the other key aspects of the subject are covered in the Resuscitation Council's document which you can find here: http://www.resus.org.uk/pages/nls.pdf.
I would recommend that you read it.
One other point that she stressed that was not recorded is the need to avoid hypothermia. All babies need to be dried and wrapped. The heater on the resuscitaire should be on maximum. Premature babies should be dried and put in a plastic bag up to their necks. She stated that a major determinant of outcome was the temperature on admission to the neonatal unit.
For all of you who are sitting the exam, my best wishes go with you and a plea that you write down everything you can remember and e-mail it to me.
I look forward to seeing your name on the pass list.

Monday, 7 May 2012

Tutorial 7 May 2012

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We ranged over a number of topics, which I hope will be of use.
One document was used for background information.
I'll e-mail it - I tried to paste in in here, but it did not work




 

Thursday, 3 May 2012

Tutorial 3 May 2012

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Tonight we started with a tutorial in which an SpR had to teach a junior trainee the basics of suturing. Not ideal to listen to with no video! You need to practise suturing and knot-tying. I find that most trainees have not been taught the basic principles and we discussed them during the tutorial. You also need to sort out a plan for a training station as there are a lot of elements that are the same, whatever you are teaching.
Then we had a pre-pregnancy counselling station with a nulliparous woman whose brother has Fragile X Syndrome. On reflection, we spent a lot of time on it yet didn't cover everything, e.g. PIGD. I think that a role-play would be too much to do in the time and that a structured viva would be more likely.

Monday, 30 April 2012

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.

Thursday, 26 April 2012

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.