Tutorial 9 May 2013

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Tonight we started off writing a prescription.

Candidate’s instructions.

Writing a prescription would only be part of a station and would probably not get more that 2 or 3 marks. But they are easy marks if you know what you are doing.

In this case, you would probably see her with a batch of results that show no abnormality other than infrequent or absent ovulation. You would be told to discuss the results, the diagnosis and to write a prescription if one is appropriate.

Or, more probably, you would have a structured viva about a series of results at the end of which the examiner would ask you about treatment and you would decide on clomiphene. The examiner would ask you to write a prescription. They might also ask you about the advice you would give about monitoring the effects of the treatment, the number of cycles, the doses to be used in each cycle and the possible side-effects.

Now, write a prescription for this patient.

Mrs. Mary Smith, DoB 15 August 90.

5 Mansion Row,

Richtown.

CR16 5PQ.

I can't get this software to take the prescription form that I have constructed. I have sent it to the MRCOG group by e-mail. If you don't have it, e-mail me.

Then we had two roleplays: one about a patient who wished to complain, the other about menorrhagia.
Complaint procedures are covered here:
http://www.drcog-mrcog.info/Topics%20not%20in%20the%20textbooks.htm

Then a viva about neonatal jaundice. http://www.drcog-mrcog.info/mcq%20P7,%20q12.htm. This is derived from MCQ paper 7, question 12.

Neonatal screening was mentioned:  http://www.drcog-mrcog.info/mcq%20p12,%20q10.htm and in MCQ paper 12, question 10

Tutorial 2 May 2013

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We started with a roleplay:

You are a year 5 SpR in the antenatal clinic. The consultant if off sick and you are the senior doctor in the clinic.

You are about to see Jane Jones, a healthy, low-risk primigravida who has been having her antenatal care with the community midwife. She has been referred as she has expressed a wish to have Caesarean section. There are no medical grounds for her to have the operation.

Her admin details are:

Date of birth:                     11 May 1983.

Address:                              1 High Street, Bigtown.

Hospital number:             M1111.

Your task is to take an appropriate history and to counsel the patient.

Note that when the documentation gives you admin details like hospital number, you need to check them to get an extra mark or two. The candidates did not pick this up in the tutorial and I forgot to mention it. I had put in an error to make sure that they were paying attention. But it would only be 2 marks at most and probably only 1.

Then we had a viva on male infertility.

We then set out to do a roleplay with a trainee being taught about the management of shoulder dystocia, but it evolved into a general discussion.

 

Tutorial 29 April 2013

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Tonight we started with a tutorial on how to criticise a paper by Julie Morris.
Julie is the head of medical statistics at the University Hospital of South Manchester.
More important for tonight's purposes, she is one of the editors of the British Medical Journal.
A real expert!
She has a number of useful tutorials on her website, in particular Basic Statistics I & II and Critical Appraisal.
http://www.south.manchester.ac.uk/medicalstatistics/information.asp.
If you did not receive the papers she used for tonight's exercise, send me an e-mail.

I think that this is a most useful tutorial.
You only have 15 minutes to prepare in the exam and this gives you a practical template that you can use so that you are not just floundering.

Then we had a viva about breast-feeding and a role-play about a woman referred with an abnormal cervical smear.

Tutorial 25th. April 2013

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Tonight we started with a roleplay.

Obstetric history.

Candidate’s instructions.

You are to conduct a tutorial with junior obstetricians.

You have 15 minutes to prepare the headlines you would put in a model for  taking an obstetric history and to consider how you would conduct the tutorial.

Then you will have 15 minutes with the "junior doctor".

Then we had a waiting list prioritisation.

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.

 

Then another roleplay.

 

Booking. Previous stillbirth. Roleplay.

Candidate's Instructions.

This is a roleplay station.

You are an SpR in the booking clinic. You are about to see a woman who is at 10 weeks gestation in her second pregnancy. Her first baby was stillborn.

She has had all the routing booking issues, including investigations, dealt with by the midwife who has asked you to see her to advise about her first pregnancy and its implications for the management of this pregnancy.

Take an appropriate history, advise about the necessary investigations and how the history of stillbirth will influence the management of the pregnancy.