Thursday 28 September 2017

Tutorial 28th. September 2017


Website


8
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 etc.
9
Role-play. Woman attends for pre-pregnancy counselling as she plans her 1st. pregnancy. Her sister recently had a baby with Down’s syndrome.
10
Viva. The uses of MgSO4 in O&G.
11
Viva. Labour ward scenario 1.

8. Basic “blurbs”.
There are a lot of chunks of text that come up time and again when chatting to patients. It is good to get these practised so that you can deliver them quickly and efficiently and not miss important points. An absolute basic is the GP referral letter. Likewise basic pre-pregnancy counselling, which gets and extra mark or two in any appropriate station.

9. Roleplay. Pre-pregnancy counselling.
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.

10. Roleplay. Magnesium sulphate in O&G.
Candidate’s instructions.
This is a viva station about the uses of MgSO4 in O&G.
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.

11. Roleplay. Labour Ward Scenario 1.
Candidate's Instructions.
You are the senior trainee and are starting your shift on the labour ward. Explain to the examiner how you will prioritise the patients, allocate staff and the reasons for your decisions.

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. Husband of patient who has had Wertheim's hysterectomy 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 IV infusions 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.





Monday 18 September 2017

Tutorial 18th. September 2017




18 September 2017
1
How to prepare. Picking a course. Communication skills. Study partner
2
What topics did not feature in the part 2 and might be expected in the part 3?
3
Urodynamics, CTG interpretation, Statistics, Paper critique
4
Barriers to communication. What communication barriers exist between me and those attending the tutorial? We can use this as a basis to consider the communication problems between us, patients and colleagues.
5
Viva. The examiner will ask you 2 questions about the part 3 exam.
6
Role-play. How to introduce oneself.
7
Role-play. Healthy, nulliparous. Brother with cystic fibrosis. Pre-pregnancy counselling.

1. Background information.
How to prepare. Picking a course. Communication skills. Study partner

2. Trying to ‘spot’ topics.
What topics did not feature in the part 2 and might be expected in the part 3?

3. Specialist tutorials we can arrange if there is enough interest.
Urodynamics, CTG interpretation, Statistics, Paper critique

4. Barriers to communication.
Good communication skills are essential for the Part 3. A starting point is to work out likely barriers to good communication in any situation.

5 Role-play.
Candidate's Instructions.
You need to know the format of the exam. The examiner will ask you 2 questions about it.

6. Role-play.
Candidate's Instructions.
It is essential to get Role-plays off to a fluent start, something that needs preparation and practice. We will cover the key aspects. There is additional advice on the website.

7. Role-play.
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.

Practice Manager: Mary Wright. B.SC., RGN.
Phone: 01882 78998 ext. 23.

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.