Tutorial 9th. September 2019

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10	Structured discussion. Labour ward scenario 1.
11	Structured discussion. The uses of MgSO4 in O&G.
12	Teaching. Breech delivery.
13	Role-play. Pre-pregnancy counselling. Dad recently diagnosed with Huntington’s disease.

10. Structured discussion. Labour ward scenario 1.

Candidate’s instructions.

You are the registrar on duty and responsible for the labour and gynae wards. You have just had the handover. Your task is to discuss the overall management of the wards with the examiner, to prioritise the patients and decide the allocation of staff to care for them.

This station was written for the first tutorial I ran for the OSCE exam when it was introduced more than 20 years ago. There are a number of phrases and concepts that reveal this distant origin, but I have retained them for nostalgic reasons. I ran the tutorial on a Sunday afternoon when I was on-call and using what was happening on the labour and gynae wards that day.

Labour Ward. Sunday 13.00 hours.

1	Mrs JH	Primigravida. T+8. In labour. 6 cms.
2	Mrs AH	Primigravida at T. In labour. 5 cms.
3	Mrs. BH	Para 2. 30 days post delivery. 2ry. PPH > 1,000 ml. Hb. 9.3.
4	Mrs SB	Primigravida. 32/52 gestation. Admitted 30 minutes ago. Abdominal pain + 200 ml. bleeding. Nephrostomy tube in situ - not draining since this morning. Low placenta on 20 week scan.
5	Mrs KW	Para 1. In labour. Cx. 5 cm. Ceph at spines.
6	Mrs KT	Para 0+1. 38 weeks. SROM. Ceph 2 cm. above spines. Clear liquor.
7	Mrs TB	Para 1. T+4. Clinically big baby. Cx fully dilated for 1 hour. Early decelerations.
8	Mrs RJ	Primigravida. Epidural. RIF pain. Cx fully dilated for 1 hour. Shallow late decelerations. OT position. Distressed ++. BP /105. ++ protein. Urine output 50 ml in past 4 hours.
9	Mrs KC	Transfer from ICU. 13 days after delivery of 32 week twins. Laparotomy on day 7 for pelvic pain and fever. Infected endometriotic cyst removed. IV antibiotics changed to oral.

Gynaecology ward.

8 major post-operative cases who have been seen on the morning ward round and are stable. The husband of a patient who had Wertheim's hysterectomy on the Friday was asking to see a doctor for a report on the operation.

1	Mrs JB	10 week incomplete miscarriage. Hb. 10.8. Moderate fresh bleeding.
2	Ms AS	19 years old. Nulliparous. Just admitted with left iliac fossa pain. Scan shows unilocular 5 cm. ovarian cyst.

Medical staff:

Consultant at home. Registrar - you.

Senior House Officer with 12 months experience.

Registrar in Anaesthesia.

Consultant Anaesthetist on call at home.

Midwifery staff:

Senior Sister. Trained to take theatre cases. Able to site IVs and suture episiotomies and tears.

3 staff midwives. 1 trained to take theatre cases. Two able to site IV infusions.

1 Community midwife looking after Mrs. KW.

2 Pupil Midwives.

11. Structured discussion. The uses of MgSO₄ in O&G.

Candidate’s instructions.

This is about the uses of MgSO₄ in O&G. It says ‘Structured discussion’, but I have made it like a viva to make it harder.

The examiner will not ask questions, prompt or otherwise assist. It is up to you to give as full an account of the uses as you can muster.

12. Teach a trainee the essentials of breech delivery.

Candidate’s instructions.

You are an SpR5 and on duty of the labour ward. Things are quiet and the consultant has asked you to teach a new FY1 about breech delivery.

13. Role-play. Pre-pregnancy counselling.

Candidate's Instructions.

You are the SpR in the pre-pregnancy counselling clinic.

Mary Smith has been referred.

The GP referral letter is brief. “Please see this woman who is considering becoming pregnant. Her father has Huntington’s chorea, about which I know very little.”

Your task is to take a history and advise about appropriate investigations.

Tutorial 2 September 2019

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7	Structured discussion. Pertussis.
8	Role-play. Woman attends for pre-pregnancy counselling as she plans her 1st. pregnancy. Her sister recently had a baby with Down’s syndrome.
9	Structured discussion. The uses of MgSO4 in O&G.
10	Role-play. Break bad news. Primigravida. 8 weeks. Some bleeding.
11	Viva. Labour ward scenario 1.

7. Pertussis. Structured discussion.

Candidate’s instructions.

The examiner will ask you 9 questions about pertussis & pregnancy.

1.     What is pertussis caused by, how is it spread, what kind of vaccine is available and can it be used in pregnancy? 

2.     What are the important epidemiological facts in relation to pertussis in the UK?

3.     What is the current advice in the UK about pertussis in pregnancy and who creates the advice?                 

4.     Critically evaluate the justification for the advice.                                                            

5.     What advice should be given to a woman who has been in close contact with pertussis?

6.     What advice should be given to a woman with suspected pertussis?

7.     What advice should be given to a woman with proven pertussis?

8.     Which vaccine is recommended for use in pregnancy in the UK and what are its main features?

9.     What does PHE recommend abut which antibiotic(s) to use and when in pregnancy.?

Boostrix

8. Pre-pregnancy counselling 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.

9. The uses of MgSO₄ in O&G. Structured discussion.

Candidate’s instructions.

This is about the uses of MgSO₄ in O&G. It says ‘Structured discussion’, but I have made it like a viva to make it harder.

The examiner will not ask questions, prompt or otherwise assist. It is up to you to give as full an account of the uses as you can muster.

10. Role-play. Break bad news.

Candidate’s instructions.

You are the SpR in the ante-natal clinic. The Consultant who was in clinic has been asked to assist her Consultant colleague in the labour ward theatre. She is unlikely to return for some time as the case is one of massive PPH and hysterectomy may be necessary. 

One of the midwives asks you to see a patient who has just had a scan in the EPU.  She is primigravid and the gestation is 8 weeks. She has had some bleeding.   

An ultrasound scan = IUP.  CRL = 12 mm.  No fetal heart activity.  No adnexal masses.

Your instructions are to deal with the patient as you would in clinic.

11. Structured discussion.

Labour ward scenario 1.

Candidate’s instructions.

You are the registrar on duty and responsible for the labour and gynae wards. You have just had the handover. Your task is to discuss the overall management of the wards with the examiner, to prioritise the patients and decide the allocation of staff to care for them.

This station was written for the first tutorial I ran for the OSCE exam when it was introduced more than 20 years ago. There are a number of phrases and concepts that reveal this distant origin, but I have retained them for nostalgic reasons. I ran the tutorial on a Sunday afternoon when I was on-call and using what was happening on the labour and gynae wards that day.

Labour Ward. Sunday 13.00 hours.

1	Mrs JH	Primigravida. T+8. In labour. 6 cms.
2	Mrs AH	Primigravida at T. In labour. 5 cms.
3	Mrs. BH	Para 2. 30 days post delivery. 2ry. PPH > 1,000 ml. Hb. 9.3.
4	Mrs SB	Primigravida. 32/52 gestation. Admitted 30 minutes ago. Abdominal pain + 200 ml. bleeding. Nephrostomy tube in situ - not draining since this morning. Low placenta on 20 week scan.
5	Mrs KW	Para 1. In labour. Cx. 5 cm. Ceph at spines.
6	Mrs KT	Para 0+1. 38 weeks. SROM. Ceph 2 cm. above spines. Clear liquor.
7	Mrs TB	Para 1. T+4. Clinically big baby. Cx fully dilated for 1 hour. Early decelerations.
8	Mrs RJ	Primigravida. Epidural. RIF pain. Cx fully dilated for 1 hour. Shallow late decelerations. OT position. Distressed ++. BP /105. ++ protein. Urine output 50 ml in past 4 hours.
9	Mrs KC	Transfer from ICU. 13 days after delivery of 32 week twins. Laparotomy on day 7 for pelvic pain and fever. Infected endometriotic cyst removed. IV antibiotics changed to oral.

Gynaecology ward.

8 major post-operative cases who have been seen on the morning ward round and are stable. The husband of a patient who had Wertheim's hysterectomy on the Friday was asking to see a doctor for a report on the operation.

1	Mrs JB	10 week incomplete miscarriage. Hb. 10.8. Moderate fresh bleeding.
2	Ms AS	19 years old. Nulliparous. Just admitted with left iliac fossa pain. Scan shows unilocular 5 cm. ovarian cyst.

Medical staff:

Consultant at home. Registrar - you.

Senior House Officer with 12 months experience.

Registrar in Anaesthesia.

Consultant Anaesthetist on call at home.

Midwifery staff:

Senior Sister. Trained to take theatre cases. Able to site IVs and suture episiotomies and tears.

3 staff midwives. 1 trained to take theatre cases. Two able to site IV infusions.

1 Community midwife looking after Mrs. KW.

2 Pupil Midwives.

Tutorial 12th. August 2019

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1	How to prepare. Picking a course. Communication skills. Study partner. What topics did not feature in the part 2?
2	Possible specialist tutorials: urodynamics, statistics, paper critique
3	Viva. Part 3 exam. The examiner will ask you 6 questions about the part 3 exam.
4	Basic “blurbs” to write and practise.
5	Role-play. How to introduce oneself.
6	Role-play. Healthy, nulliparous. Brother with cystic fibrosis. Pre-pregnancy counselling.
7	Viva. Pertussis.

1. Preparation for Part 3.

How to prepare. Picking a course. Communication skills. Study partner. What topics did not feature in the part 2?

2. Possible specialist tutorials.

I usually arrange specialist tutorials e.g. urodynamics, statistics, paper critique. ? neonatal resucitation.

3. Viva. Part 3 exam structure.

Candidate’s instructions.

This is a viva station. The examiner will ask you 6 questions about the Part 3 exam.

4. Basic ‘blurbs’.

It is important to prepare basic blocks of text that are likely to feature in the exam. E.g. 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 role-player has questions, dealing with information such as a relative with a serious problem etc. Make a list! Then practise until they flow from the tongue.

5. How to introduce yourself.

Candidate’s instructions.

You are about to see a patient referred for pre-pregnancy counselling.

The GP letter just asks you to ‘see and advise’ about pregnancy.

This station is intended to make you think about how best to introduce yourself and get a conversation ‘up and running’.

6. Role-play. 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.

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.

DOB: 28 January 1990.

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.

7. Viva. Pertussis.

Candidate’s instructions.

The examiner will ask you 6 questions.