Management of labour

2017 ◽  
Keyword(s):  
Clinical Skills ◽  
Mode Of Delivery ◽  
Antenatal Clinic ◽  
Shoulder Dystocia ◽  
Traumatic Experience ◽  
Safety Communication ◽  
Course Of Action ◽  
First Child ◽  
Pros And Cons ◽  
Initial Reading

This task assesses the following clinical skills: … ● Patient safety ● Communication with patients and their relatives ● Information gathering ● Applied clinical knowledge … You are a ST5 doctor in the antenatal clinic. You are asked to see Lucy Rogers who is a 32- year- old lady in her second pregnancy. She is currently 21 weeks pregnant with a normal detailed ultrasound scan of her baby. She is booked under consultant care having had shoulder dystocia (SD) with her first child Molly two years ago. You have had a chance to review the previous delivery records. Mrs Rogers had an uneventful pregnancy and normal labour. The baby’s head delivered normally but then had a shoulder dystocia which required McRoberts manoeuvre and suprapubic pressure for delivery of the anterior shoulder. Molly weighed 3.5 kilogrammes with Apgar scores of seven and ten at one and ten minutes. The head to body delivery interval was three minutes. She is developing normally with appropriate milestones. Mrs Rogers is very apprehensive about having another shoulder dystocia as it was very traumatic experience. She is seeking reassurance but also quite disappointed that this was not predicted and a proper explanation was not provided at the time. You have 10 minutes for this task (+ 2mins initial reading time). Please read instruction to candidate and role player After initial consultation about the previous pregnancy and SD, tell the candidate that Mrs Rogers is keen to avoid a caesarean section and wants to go ahead with a vaginal delivery. Ask the candidate to explain the options of mode of delivery to Mrs Rogers along with pros and cons. What can be done to prevent this and what is the course of action if it happens again? Can you provide reassurance? You are Lucy Rogers, 32- year- old mother of two- year- old Molly. You had a straightforward pregnancy with Molly and a normal delivery which was unfortunately complicated by shoulder dystocia (difficulty in delivery of the baby’s shoulders after delivery of the head). Although, Molly is doing absolutely fine and growing normally, you are extremely worried about having another shoulder dystocia (SD). It was all very traumatic experience for you and your husband Nick. You are also disappointed and slightly annoyed that this was not predicted and no proper explanation was provided at that time.

Puerperal problems

2017 ◽  
Keyword(s):  
Communication Skills ◽  
Clinical Skills ◽  
Antenatal Clinic ◽  
Clinical Impression ◽  
Safety Communication ◽  
Case Record ◽  
Assessment Task ◽  
First Child ◽  
The Uk ◽  
Initial Reading

This task assesses the following clinical skills: … ● Patient safety ● Communication with patients and their relatives ● Information gathering ● Applied clinical knowledge … Anna Polanska, a 34- year- old woman, is ten days postpartum. Anna underwent induction of labour for reduced foetal movements and small for gestational age and had a ventouse delivery complicated by a third degree tear. She was discharged home, but her baby is on the neonatal unit. She has been referred by her GP as Anna is feeling very tearful over the last few days and is low in mood. She has not been sleeping well and has intrusive thoughts. You are the registrar on call on the delivery suite and have been asked to assess Anna. Your task is to: … ● Take an appropriate history ● Organize the immediate management … You have 10 minutes for this task (+ 2mins initial reading time). Please read instruction to candidate and role player. This clinical assessment task is to assess the communication skills of the candidates and assess their understanding of the factors predisposing to postnatal depression. It also assesses if the candidates are aware of the next steps of management in such a case. Record your overall clinical impression of the candidate for each domain (i.e. should this performance be pass, borderline, or a fail). For marking the impression on communication skills, please consult the role player. You are Anna Polanska, a 34- year- old, asylum seeker and have been in the UK for the last 18 months. You have no support from your ex- partner and do not have any family in the UK. You gave birth to your first child ten days ago. You booked late in this pregnancy as you were contemplating terminating the pregnancy but found out on your first scan that you were already 24 weeks pregnant and so decided to continue with the pregnancy. You were told your blood tests were normal at booking. Your community midwife has been on sick leave and you have no money to attend hospital visits. You have not attended a few of your antenatal clinic appointments. You smoke up to 20 cigarettes per day.

Management of delivery

2017 ◽  
Keyword(s):  
Reading Time ◽  
Clinical Skills ◽  
Breech Presentation ◽  
Antenatal Clinic ◽  
Information Gathering ◽  
Normal Vaginal Delivery ◽  
Clinical Impression ◽  
Safety Communication ◽  
Pregnancy And Delivery ◽  
Initial Reading

This task assesses the following clinical skills: … ● Patient safety ● Communication with patients and their relatives ● Information gathering ● Applied clinical knowledge … Rebecca Francis is a 34- year- old lady in her second pregnancy. She has had a normal vaginal delivery two years ago. Her pregnancy remained uneventful so far. At 36 weeks, her midwife detected that the baby was in breech presentation and has referred her to the antenatal clinic to discuss further management. You will then be given some information and asked questions by the examiner. You have 10 minutes for this task (+ 2mins initial reading time). Please read instruction to candidate and actor. After the consultation with the actor patient (or in the last two minutes), tell the candidate that Rebecca underwent an unsuccessful ECV and was booked for an elective caesarean at 39 weeks. You performed her caesarean and to your surprise, you delivered a cephalic baby by caesarean section. What should you have done to prevent this? What will you do next to prevent this kind of incidence? What will you explain to Rebecca? Record your overall clinical impression of the candidate for each domain (i.e. should this performance be pass, borderline, or a fail). You are Rebecca Francis, a 34- year- old mother of two- year- old Lucy. You had a straight forward pregnancy and delivery with Lucy. You are currently 36 weeks pregnant. You were seen by your midwife yesterday for a routine check and she found the baby to be in breech position. You were sent to the antenatal clinic and have had a scan confirming that the baby is in breech position. You were told that rest of the scan, including the baby’s measurements, fluid volume around the baby and the position of the placenta are normal. You are healthy. You do not smoke and have had no alcohol in pregnancy. Your pregnancy has progressed without any problems so far. The screening test for the baby showed low risk for Down’s syndrome. Temperament: You think you are mostly a calm, level- headed woman, but you do like to be organised and in control of things.

Teaching appraisal and assessment

2017 ◽  
Keyword(s):  
Patient Safety ◽  
Clinical Skills ◽  
Shoulder Dystocia ◽  
Clinical Knowledge ◽  
Doctor Who ◽  
Forceps Delivery ◽  
Safety Communication ◽  
Active Involvement ◽  
Practical Management ◽  
Initial Reading

This task assesses the following clinical skills: … ● Patient Safety ● Communication with colleagues ● Applied clinical knowledge … You are teaching practical management of shoulder dystocia to your ST1 doctor who has just started obstetrics. He/ she has witnessed a shoulder dystocia after a forceps delivery last week and is very stressed about facing one. You have a pelvis and baby model and today you are teaching the shoulder dystocia scenario. You have 10 minutes for this task (+ 2mins initial reading time). This station assesses the candidate’s ability to teach a practical skill. This will also assess their knowledge of managing shoulder dystocia. Please observe the teaching and do not interrupt. You are a ST1 doctor who has just completed the foundation training. This is your second week on the delivery suite. You have seen one shoulder dystocia after forceps delivery recently. You found the experience stressful and are now worried about facing such a scenario. Your Registrar has kindly agreed to teach you the practical management of Shoulder dystocia using the pelvis and baby model. Please do not prompt and follow the instructions of the candidate (registrar). Patient safety … ● Avoid dangerous manoeuvres fundal pressure and excessive lateral and downward traction ● Explain advanced techniques and advice the importance of using them only if experienced— Zavanelli’s manoeuvre and symphysiotomy ● Explains the importance of documentation… Communication with colleagues … ● Explains the objectives of the station ● Allows active involvement of the team/ trainee ● Promotes team working ● Makes the trainee demonstrate while talking through the steps and allows trainee to talk through while demonstrating ● Finally gives opportunity to the trainee to independently talk through and demonstrate the whole scenario… Applied clinical knowledge … ● Has knowledge of all the manoeuvres ● Demonstrates and talks through the steps ● Recognize the problem ● Call for help ● Mc Roberts manoeuvre ● Suprapubic pressure ● Consider episiotomy ● Posterior arm delivery or internal rotatory manoeuvres ● Turn into all fours ● Emphasize subsequent management ● If unsuccessful consider repeating the manoeuvres ● If experienced, consider advanced manoeuvres ● Complete delivery.

Core surgical skills

2017 ◽  
Keyword(s):  
Caesarean Section ◽  
Clinical Skills ◽  
Elective Caesarean Section ◽  
Mode Of Delivery ◽  
Large Family ◽  
Antenatal Clinic ◽  
Normal Delivery ◽  
Breech Delivery ◽  
To Come ◽  
Initial Reading

This task assesses the following clinical skills: … ● Patient safety ● Communication with patients and their relatives ● Information gathering ● Applied clinical knowledge … Sarah Bener is a 28- year- old lady in her second pregnancy. She has had an elective caesarean section in her last pregnancy for a breech delivery two years ago. She has no other health problems and her pregnancy has progressed well so far. She is currently 36 weeks pregnant and has presented to the antenatal clinic to discuss the mode of delivery. You have 10 minutes for this task (+ 2mins initial reading time) Please read instructions to candidate and actor. This station assesses the candidate’s ability to come to a shared decision after discussing the pros and cons of both the options. Please do not interrupt or prompt. Record your overall clinical impression of the candidate for each domain (e.g. should this performance be pass, borderline or a fail). You are Sarah Bener, a 28- year- old house wife. You are 36 weeks pregnant. You are healthy and so far your pregnancy had progressed smoothly. You feel good baby movements. The screening test as well as the baby’s scan at 20 weeks has been normal. You have one child, Imogen, born by caesarean section two years ago. It was an elective caesarean section as Imogen was in breech position. They did try turning her (ECV), but was unsuccessful. You were very much looking forward to a normal delivery and were disappointed that you needed a caesarean section. The caesarean section was straightforward, without any complications. But you needed a few days to recover at home. You are keen to have a normal delivery this time, but want to know the options and risks of the mode of delivery. Both you and your husband have always wanted a large family, so want to know the implications of a second section. If the candidate does not mention VBAC, say that you have heard of this and can they explain more about it.

Developing professionalism

2017 ◽  
Keyword(s):  
Communication Skills ◽  
Reading Time ◽  
Clinical Skills ◽  
Antenatal Clinic ◽  
Induction Of Labour ◽  
Safety Communication ◽  
Assessment Task ◽  
Foetal Growth ◽  
Normal Ultrasound ◽  
Initial Reading

This task assesses the following clinical skills: … ● Patient safety ● Communication with patients and their relatives ● Information gathering ● Applied clinical knowledge … You are in the antenatal clinic and are about to see Kelly Morgan, a 23- year- old nulliparous patient. She is 37 + 3 and this is her first pregnancy. She has been classified as low risk, and has been under midwifery care until now. Her community midwife has sent her to the clinic because she has been requesting induction of labour because she is exhausted and ‘unable to cope’. There have been no concerns about foetal growth or movements, her blood pressure and urinalysis are normal, and she has no medical co- morbidities. She had a normal ultrasound scan at 36 weeks. The clinic is running over an hour late as your consultant is off sick. You have been told by the clinic staff that she has already been complaining about the delay. The hospital has a very definite policy against induction of labour for non- obstetric reasons. Your task is to explore Kelly’s concerns and to explain to her that her request for IOL is not something that is usually done in this context. You have 10 minutes for this task (+ 2mins initial reading time). This clinical assessment task assesses the candidate’s ability to professionally deal with an angry patient. This needs robust communication skills to defuse the situation at the same time exploring the patient’s concerns and making a safe plan. Please do not interrupt or prompt the candidate. Please mark each domain as pass, borderline, or fail. At this station, you are very angry and upset. You are Kelly Morgan, a 23- year- old admin assistant. This is your first pregnancy, and you have found it difficult from the very beginning. You had morning sickness until 18 weeks, and ever since 30 weeks you have felt absolutely exhausted. You have no energy, your back hurts and you just want this baby delivered. Your midwives keep telling you that this is all normal, and that it’s better to wait for natural labour, but you don’t care if you end up with a caesarean section. You are fed up with being fobbed off by people who don’t know what they are talking about.

Subfertility

2017 ◽  
Keyword(s):  
Normal Forms ◽  
Clinical Skills ◽  
Semen Analysis ◽  
Hormone Replacement ◽  
Treatment Options ◽  
Visual Disturbance ◽  
Oocyte Donation ◽  
Safety Communication ◽  
Consultation Skills ◽  
Initial Reading

This task assesses the following clinical skills: … ● Patient safety ● Communication with patients and their relatives ● Information gathering ● Applied clinical knowledge … You are a ST4 doctor working in an infertility clinic. A couple who were referred to the clinic by their GP have returned for review. She has had oligomenorrhoea for the past year. She does not report headaches, visual disturbance, galactorrhoea or hyperandrogenism, she has been trying to conceive for two years. Her partner had an orchidopexy at the age of two. The assessor will ask you some questions and then give you the results of their investigations. You will be asked to explain the results and next steps to the patient. You have 10 minutes for this task (+ 2mins initial reading time). Please check that candidate and actor have read instructions. Ask the candidate what investigations they would like to organize for this patient and her partner. Give them the results of investigations (if asked for): Pregnancy test— ve LH 45, FSH 40, E2 120 (day two of cycle) PRL— 200 TSH— 1.2 Testosterone— 0.8 USS— NAD HSG— Patent tubes Rubella immune Chlamydia swabs— ve Smear— ve Semen analysis— 10m/ ml, 32% motility, 3% normal forms Ask them if they want to arrange any further investigations. Expect candidate to ask to repeat gonadotrophins more than a month after initial measurement in order to confirm the diagnosis of Premature Ovarian Insufficiency (POI). They should also repeat the semen analysis. Tell them that repeat gonadotrophins were again elevated— FSH 35, LH 20, E2 120. Repeat semen analysis was 15m/ ml, 34% motile, with 4% normal forms. Ask the candidate to explain these results to the patient and explain next steps, including further investigation and treatment options. They should then recommend that further investigations are arranged including karyotype, an auto-immune screen, lupus anticoagulant and vitamin B12 levels to try and identify a cause for the POI. Treatment options should include the role of hormone replacement therapy and oocyte donation with IVF. Observe consultation skills including the candidate’s ability to break bad news. Record your overall clinical impression of the candidate for each domain (i.e. pass, borderline, or fail).

Surgical procedures

2017 ◽  
Keyword(s):  
Hip Replacement ◽  
Reading Time ◽  
Clinical Skills ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Safety Communication ◽  
Safety Issues ◽  
Problem Solve ◽  
The Right ◽  
Initial Reading

This task assesses the following clinical skills: … ● Patient safety ● Communication with colleagues ● Applied clinical knowledge … Mrs. Ahmed is a 48- year- old lady undergoing total abdominal hysterectomy and bilateral salpingo-oophorectomy for heavy menstrual bleeding with a 20 week size fibroid. She is generally well and has undergone a left hip replacement five years ago. Your consultant has asked you to commence the surgery by opening the abdomen with a vertical subumbilical incision. She will shortly join you for the surgery. The Foundation Year 1 doctor will be assisting you in the interim. You will be presented with scenarios in the theatre. Your task is to problem solve and answer the queries of the F1 doctor. You have 10 minutes for this task (+ 2mins initial reading time). There is no role player for this scenario. This scenario checks the understanding of Monopolar diathermy and the ability to problem solve. It also assesses the understanding of safety issues surrounding electrocautery. First tell the candidate: The Theatre Assistant Practitioner (ODP) is newly qualified and normally works in the ENT theatres. You start the incision using a finger switch diathermy but it is not working What will you do? The candidate should first check if the machine is on Tell them that is was not on, but has now been switched on As soon as the machine is switched on, the machine starts beeping What should the ODP do next? If the candidate asks if there are any indications on the machine, say the sign of the returning electrodes is highlighted The candidate should check if the returning electrodes (pads) have been applied. They had not been. The ODP asks where he should apply the returning electrodes. The candidates should ask the electrode to be placed on the right buttock. The ODP asks if it is OK to put the returning electrode on the left buttock as the scrub nurse and trolley are on the right and it is convenient to apply on the left. The candidate should explain that as Mrs. Ahmed has had a hip replacement on the left, it is important to avoid applying the returning electrode near the metal implant and the scarring around it, for safety. The ODP asks that he has never seen a split returning electrode. Why is it split?

Gynaecological oncology

2017 ◽  
Keyword(s):  
Social Life ◽  
Clinical Skills ◽  
After School ◽  
Cervical Smear ◽  
Safety Communication ◽  
Part Time ◽  
Level 3 ◽  
Early Cervical Cancer ◽  
The Moment ◽  
Initial Reading

This task assesses the following clinical skills: … ● Patient safety ● Communication with patients and their relatives ● Information gathering ● Applied clinical knowledge … Your consultant has asked you to speak to Agnieska Polanski aged 38 whose smear result has shown ‘severe dyskaryosis’, HPV positive. Your task is to: … ● break the news to Agnieska about the abnormal smear ● discuss the next stage of management (i.e. colposcopy and biopsy) ● answer any questions … You do not need to take a history. You have 10 minutes for this task (+ 2mins initial reading time). Please read the instructions for candidates and actors. This station is designed to test the candidate’s ability to break bad news in a sensitive and professional way. This case involves a patient who has a severely abnormal cervical smear result (with the possibility of early cervical cancer). The candidate explains the implications of such a smear and discusses the next step in management. Record your overall clinical impression of the candidate for each domain (e.g. should this performance be pass, borderline, or a fail. You are Agnieska Polanski, aged 38 years, and you have come to an outpatient gynaecology clinic (called a colposcopy clinic) to discuss your recent cervical smear result. You have a feeling that the smear might be abnormal because the secretary refused to discuss it with you on the phone and you received a very prompt appointment to see the doctor. You love children and work part time in a local nursery and after school club whilst you are studying for a NVQ level 3 childcare qualification. Your social life is great at the moment— you live with a very supportive and loving partner Lee and are planning to get married next year. Your partner and you have planned to have children and you will probably come off the pill just before your wedding (because at your age you don’t want to leave it too long but you don’t want to look huge in your wedding dress).

Sexual and reproductive health

2017 ◽  
Keyword(s):  
Failure Rate ◽  
Clinical Skills ◽  
General Rule ◽  
Uterine Perforation ◽  
General Anaesthetic ◽  
Surgical Trauma ◽  
Safety Communication ◽  
Contraceptive Implant ◽  
Effective Contraception ◽  
Initial Reading

This task assesses the following clinical skills: … ● Patient safety ● Communication with patients and their relatives ● Information gathering ● Applied clinical knowledge … You are an ST4 doctor conducting a post operative ward round. Your next patient is Danielle Wilson, a 26- year- old mother of three who has undergone a left salpingectomy for ectopic pregnancy. Having explained the operation to her, she asks why you couldn’t have just sterilized her at the same time as she never wants to be pregnant again and is struggling with her health and her young children. Her notes show that she has had 2 previous terminations and takes carbamazepine and levetiracetam for epilepsy and fluoxetine for anxiety. There is nothing else of note. Explain to Danielle why she was not sterilized at the time of salpingectomy. Then make a safe and effective contraception plan which is acceptable to her. You have 10 minutes for this task (+ 2mins initial reading time). Ask the candidate and actor to read their instructions. Then ask the candidate to start their discussion with the patient. Allow the candidate to conduct the discussion undisturbed unless they are straying off the track of the question (in which case you can show them their instructions again). Rationale for not sterilising should cover… ● General inadvisability of performing procedure at a time of reproductive stress (e.g. delivery, termination of pregnancy [TOP], miscarriage, salpingectomy) ● Sterilization under age 30 associated with higher incidence of regret— this should be conveyed as a general rule of thumb rather than as a personal judgement ● Reversal not funded by NHS ● Higher failure rate when performed when pregnant ● Possible complications of sterilization— general anaesthetic, surgical trauma or if hysteroscopic day case procedure, uterine perforation, interval to confirmation of success, need for ongoing contraceptive method ● Lifetime failure rate of sterilisation 1:200 which is comparable to that of an IUS and higher than the failure rate of the contraceptive implant ● Vasectomy safer

Management of labour

2017 ◽  
Keyword(s):  
Type 1 Diabetes ◽  
Clinical Skills ◽  
Antenatal Clinic ◽  
Screening Tests ◽  
Medical Risk ◽  
Medical Risk Factors ◽  
Professional Person ◽  
Long Acting ◽  
Initial Reading

This task assesses the following clinical skills: … ● Patient safety ● Communication with patients and their relatives ● Information gathering ● Applied clinical knowledge … You are an ST5 doctor in the diabetic antenatal clinic. The clinic has been particularly busy today and is running 60 minutes late. There are several different clinics running simultaneously and no extra staff available to help in the diabetic clinic. You are asked to see Claire Potter, a 28- year- old lady with Type 1 diabetes who is 32 weeks in her first pregnancy. She has no other medical risk factors and her diabetes is well controlled with no complications. A recent HBA1c was 45. Ultrasound today shows normal liquor and normal symmetrical growth plotting on her established growth curve at 75th centile. Conduct a focused antenatal review and respond to her concerns. You have 10 minutes for this task (+ 2mins initial reading time). This task assesses the communication skills and application of knowledge regarding diabetes in pregnancy. Please do not interrupt or prompt. Record your overall clinical impression of the candidate for each domain (i.e. pass, borderline, or fail). There are marks for the actor to also assign at the end of the station You are Claire Potter, a 28- year- old solicitor, 32 weeks into your first pregnancy. You have Type 1 diabetes since you were 12 and are very confident in how best to control your diabetes. You are meticulous with checking your BM’s and adjusting your insulin accordingly and they are all within range (4– 6.5). You have no complications of diabetes and no other health problems. You take short and long acting insulin and have no allergies. You do not smoke or drink alcohol. You’re dating and anomaly ultrasound scans were normal and screening tests were low risk for Down’s syndrome. Your pregnancy has been uneventful with regular clinic reviews of your diabetes. Your last scan at 28/ 40 showed the baby was growing normally. Temperament: You are a very busy professional person and do not like to be kept waiting unnecessarily. You are annoyed the clinic is running late (yet again) but are not unreasonable provided you feel you are being listened to and your concerns addressed.

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