●
With these stations you must have an opinion as to whether the document is good or poor, and be able to defend your opinion. You must be able to give an overview of the documents, as well as addressing some details.
Clinical management of gynaecology or obstetric problems Here you may be faced with a scenario in either the clinic or the operating theatre and you must describe to the examiner what your management would be. You may be given examination findings or results that you may need to interpret.
Communication stations
Any scenario that may occur in your working day can be tested here. At these stations knowledge is often secondary and it is how you interact with the role-3
INTRODUCTION
player/patient that is important. If patients are angry, allow them to talk but keep control of the situation. Do not take that anger personally; they will have been told to act that way. If they are upset, let them talk, and act as though you have all the time in the world.
Structured oral examination/Viva
At these stations the examiner will ask set questions to which you need to provide the answers.
Summary
The marking of all the stations is structured and thereby objective. This means that whichever examiner you get, you should score the same mark. The examiners have practised the questions, by role-playing themselves as both the candidate and the examiner.
Global score:
0 = poor
1 = satisfactory
2 = average
3 = good
4 = excellent
Each station is currently marked out of 20, with four marks for a ‘global’ score. This takes into account your overall performance in the station and a logical approach is essential. There are no half marks. Marks will be awarded for all the tasks asked in the question.
The design of the OSCE ensures that, as far as possible, each candidate is exposed to the same examination. At the stations where there is a role-player and an examiner, do not interact with the examiner; he or she is merely an observer. To do well in the examination, all you need to do is to perform all your clinical activities as you would normally do them. It is a licensing examination and the RCOG needs to be sure you are competent.
4
Review Stations
Review station 1
Gynaecology history
Candidate’s instructions
The patient you are about to see has been referred to your gynaecology outpatient clinic by her general practitioner. A copy of the referral letter is given below. Read the letter and obtain a relevant history from the patient. You should discuss any relevant investigations and treatment options with the patient.
The Surgery
Large Pond Road
London SE16
Dear Gynaecologist
Please would you see Joan Dunn, aged 45 years. She is a female solicitor who has a 2-year history of painful heavy periods. She bleeds for 10 days every month and is in so much pain she is bedridden throughout her period. She is fed up and wants something done.
She is overweight with a BMI of 30 kg/m2 and on examination she has a large pelvic mass. An ultrasound scan has revealed this to be fibroids with an anterior fundal fibroid 12 × 8 × 6 cm and a submucosal fibroid 3 × 4 × 4 cm.
Thank you for your help.
Yours sincerely,
Dr W White MRCGP
MARKS WILL BE AWARDED FOR YOUR ABILITY TO TAKE A HISTORY
AND TO EXPLAIN THE APPROPRIATE INVESTIGATIONS AND TREATMENT PLAN TO THE PATIENT
6
GYNAECOLOGY HISTORY
Role-player’s instructions
You are Joan Dunn, a 45-year-old solicitor. Your attitude would be that of a friendly and calm patient who is generally interested to find out all the benefits and risks of the treatment of your problem. You may, however, turn combative if you are treated with discourtesy or belittled, or if you are generally dissatisfied with the doctor’s attitude. After all, you are a busy professional woman and do not want to be treated as though you are not very bright. You are worried that you may have cancer of the womb as your sister has that problem as well.
Let the doctor know if you do not understand any medical terms. Let him lead in the discussion and do not interrupt him unless you need some clarification. You may prompt him (see below) at the end if he asks if you have any questions.
Your symptoms
●
Your periods started when you were 13 years, and have been regular until recently, each period lasting about 3 days, and it comes every 28–30 days.
●
However, over the last 8 months, you have noticed that you have experienced bleeding in between your periods and they are irregular. This occurs irregularly when you are expected to be dry. You have to wear pads every day and are generally worried. You do not have bleeding after sexual intercourse.
●
You have seen a GP who gave you some iron tablets but these did not seem to stop your periods. No other medications were given to you.
●
Your last cervical smear was done 3 years ago and that was normal.
●
You have noticed that you have become more lethargic over the last 3
months, although you have not had any chest pain, shortness of breath, or palpitations.
●
You have not been pregnant before as you and your husband have been rather busy with your careers and you do not intend to get pregnant.
●
You have had diabetes for the last 5 years and have been very careful with your diet and the control has been good. Your yearly checks with your diabetes doctor have shown that your control has been good. You do not have any other symptoms.
●
You have no drug allergy.
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There is a family history of diabetes and cancer of the womb. Your mother suffers from diabetes controlled with medication. Your sister was 39 years old when she was diagnosed with early cancer of the womb. She had an operation to remove the womb and has been well since.
●
You occasionally drink alcohol and do not smoke.
Prompts
1.
What condition do I have?
2.
What needs to be done for me?
7
REVIEW STATIONS
Mark sheet
History
●
Symptoms – details of IMB
●
Previous menstrual history
●
Previous obstetric history
●
Family history (and patient anxiety)
●
Social history
0
1
2
3
4
5
6
Investigations
●
FBC
●
Blood glucose
●
Glycosylated haemoglobin
●
Cervical smear
●
Pelvic ultrasound scan (ovaries and endometrial thickness)
●
Pipelle biopsy of endometrium ± hysteroscopy
0
1
2
3
4
5
Further management dependent on findings
●
Hysteroscopy and resection of submucosal fibroid if pipelle normal
●
Hysterectomy if histology abnormal
●
Low risk of malignancy (reassure patient)
●
Non-hormonal treatments, tranexamic acid, mefenamic acid
●
Could take cyclical hormone tablets if no specific abnormality found
●
Even if nothing abnormal is found, patient encouraged to report further IMB
in future
●
Suggest ongoing active supervision of diabetes
0
1
2
3
4
5
Global score
0
1
2
3
4
Totaclass="underline"
/20
8
GYNAECOLOGY HISTORY
Discussion
What is the station testing?