Get Through MRCOG Part 3

Clinical Assessment, Second Edition

T. Justin Clark, Arri Coomarasamy, Justin Chu, Paul Smith

• Publisher: CRC Press
• Year: 2018
• Print ISBN: 9781138498464
• eBook ISBN: 9781351016216
• Edition: 2
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

This study guide offers a systematic, comprehensive and focused approach to preparation for the MRCOG Part 3 Clinical Assessment exam. After an initial introduction, the text divides by OSCE station, beginning with an analysis of what the station is testing and what approaches and preparation are required, supported by tips and examples; this is followed by thoroughly worked practice questions based upon the exam format, with an analysis of how these are likely to be marked. Practice exam 'circuits' with fully worked questions and answers conclude the book.

SECTION III

OSCE PRACTICE CIRCUITS

CHAPTER 10
PRACTICE CIRCUIT 1

• ● Duration – 2 hours 48 minutes.
• ● Structure – 14 stations × 12 minutes, which includes 2 minutes of initial reading time
• ● Additional information – At the start of each station, you will have 2 minutes to read the instructions for the task and any additional material.
• ● In addition to the questions, the mark sheets and revision notes are provided.

MODULE 1: TEACHING

Candidate instructions

This station is with a simulated trainee and will assess the following domains:

• ● Communication with colleagues
• ● Information gathering
• ● Applied clinical knowledge
• ● Patient safety

A junior trainee has come to the department and would like to know more about the third stage of labour.

You have 10 minutes to explain the third stage of labour including:

1. The components of active and passive management.
2. How to diagnose a prolonged third stage of labour.
3. The techniques and medications that are used in active management of third stage.

Simulated trainee instructions

You are a first-year specialist trainee in O&G beginning your placement on the labour ward department. You know that the third stage of labour is the delivery of the placenta but do not know how long is left before a diagnosis of prolonged third stage is made. You are unsure about what constitutes active and passive management of the third stage. You have heard about gentle cord traction but do not know how to perform it. You remember seeing someone given syntometrine during the third stage when you were on placement.

You are receptive to advice but ask for clarification if the candidate sounds unsure.

If not covered by the candidate, questions that you could ask include:

• ● What is the difference between active and passive management of third stage?
• ● How do you perform gentle cord traction?
• ● What drugs are used in active third stage?
• ● Can syntometrine be used for active third stage?

Marking

Communication with colleagues

• ● Appropriate introduction.
• ● There should be a clear structure to the delivery of the teaching.
• ● Encourages learning, discussion and questions with appropriate verbal and non-verbal communication.

Information gathering

• ● Checks the existing knowledge of the candidate.
• ● Confirms understanding at appropriate intervals during teaching.

Applied clinical knowledge

• ● Understands the correct definitions of the third stage of labour and knows what is defined as prolonged third stage.
• ● Correctly identifies which elements belong to the active and passive third stage of management packages.
• ● Gives appropriate feedback and develops a learning plan using knowledge of the curriculum and assessment tools.

Safety

• ● The candidate teaches the importance of counter traction during controlled cord traction of the umbilical cord.
• ● The candidate should advise that syntometrine should not be given to women suffering from hypertensive disorders due to the risk of further increasing the blood pressure.

Examiner notes

• ● ‘The third stage of labour is the time from the birth of the baby to the expulsion of the placenta and membranes’. (NICE intrapartum guideline)
• ● Diagnosis of a prolonged third stage of labour is made if expulsion of the placenta and membranes does not occur within 30 minutes of the birth with active management or within 60 minutes of the birth with physiological management.
• ● Active management of the third stage involves the following components:
  • ● Use of uterotonic drugs such as 10 IU of oxytocin by intramuscular injection immediately after the birth of the baby.
  • ● Delayed cord clamping and cutting.
  • ● After signs of separation of the placenta (cord lengthening, gush of blood, uterus becomes smaller and firmer) controlled cord traction is applied (by one hand provides traction and another supports the uterus with suprapubic pressure).
• ● Physiological management of the third stage involves the following components:
  • ● Uterotonic drugs are not used routinely.
  • ● The cord is not clamped until pulsations have stopped.
  • ● The placenta is delivered by maternal effort.
• ● For delayed cord clamping, do not clamp the cord earlier than 1 minute from the birth of the baby unless there is concern about the integrity of the cord or the baby has a heart rate below 60 beats/minute that is not getting faster.
• ● For active management, oxytocin alone is preferred as it is associated with fewer side effects than oxytocin plus ergometrine.

Further reading: NICE intrapartum guideline

MODULE 2: CORE SURGICAL SKILLS

Candidate instructions

This station is a structured viva and will assess your knowledge of instruments used in operative vaginal delivery. It will assess the following domains:

• ● Communication with colleagues
• ● Applied clinical knowledge
• ● Patient safety

The examiner has different pairs of obstetric forceps and will ask you questions regarding forceps delivery. You will be assessed on your ability in answering the questions and the amount of prompting that you require.

Examiner instructions

This is a structured viva of practical skills. The candidate has 12 minutes to answer questions related to operat...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication Page
• Table of Contents
• Preface
• Abbreviations
• Introduction
• Section I Preparation for the MRCOG Part 3
• Section II Techniques for specific OSCE stations
• Section III OSCE practice circuits
• Index