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Obstetrics and Gynaecology

OBSTETRICS AND GYNAECOLOGY

O&G is an 8-week placement of which 6 weeks are spent at hospital and 2 weeks at the GP.

How you will spend your time

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The hospital part of the placement is divided into one week of gynae-oncology, one week of urogynaecology, a week of reproductive medicine and one week of fetal and maternal medicine. There is a set number of clinics and theatre lists you need to attend, which leave a comfortable amount of time for revision. You will also spend two weeks at a regional hospital where you can consolidate all subspecialties. This is also the chance to see as much obstetrics as you like and perhaps the easiest opportunity to tick off your pelvic examination list. The exact schedule depends on the local hospital.

During the GP placement, similar to that of the paediatrics placement, it is again a bit hit and miss how many gynae cases you will see. Hopefully your GP will organise a few special sessions for you, for example with a nurse specialising in contraception or with a midwife. The GP placement can also provide additional opportunities to perform pelvic examinations on patients that are not pre-op, something that I didn't manage to do much during my time in hospital.

How to fit in pathology

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O&G is a good placement to get lots of pathology done while still getting enough exposure to the specialty. I’d recommend not only working through the pathology associated with the O&G, but to also study other topics that don’t match any other specialty throughout the year. My O&G placement was last, and I was able to work through chemical pathology in the first two weeks and holidays, then finish off microbiology and start revising.

Which books to use

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Impey&Child is the standard book, and useful to obtain sufficient detail about the most important topics such as incontinence, surgical procedures, antenatal bleeding, contraception etc. For revision, I found Obstetrics and Gynaecology at a Glance more useful, as it is so well laid out that it saves you making notes. As I mentioned in the paediatrics section, the Oxford Handbook of Clinical Specialties is useful for the wards. For GP, I’d definitely recommend the Oxford Handbook of General Practise to read about Domestic Violence and related topics for the community case.

How to use the resources on medportal

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There aren’t many resources for O&G, and I didn’t even work with few O&G path podcasts there are. I did not regret this, but others found the podcasts useful, so it's worth taking a look if you have enough time.

Assignments

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You need to reflect on two cases, which is comparatively less work than the critical appraisal and ethical case during the paediatrics placement. There is no need to start with these excessively early, even with exams approaching, just keep them in mind during your placement so you can take detailed notes once you come across  appropriate case.

You also need to perform your five pelvic examinations and get them signed off. It’s easiest to do this during theatre days at Addie’s or at your regional hospital. Many people manage to get them all done in a day.

What came up in the exam

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The O&G exam is a single OSCE held at the end of the academic year. It usually has 8 stations of 13 minutes, mostly made up of 1 minute reading time, 9 minutes to do the task and three minutes for a viva. There is usually a break station as well. Similar to the paediatrics page, I’ve summarised what has come up in previous years by type of station, excluding the year 2012. If you have information about this year, please e-mail me and I’ll add it to the list:

Examination stations – usually 2 each year, some combined with practical skills

* Examination of the pregnant abdomen (2013, 2011, 2010, 2009, 2008) – often followed by a viva about what other routine things are tested during antenatal appointments and/or questions about pre-eclampsia and urinalysis.

* Pelvic examination and/or smears/swabs (2013, 2011, 2010, 2009) – in various combinations, always ask if a bimanual is required, viva can be on procedure after cervical smear, finding a lump during bimanual, swab etc.

Communication skills - up to 4 Hx each year

* Incontinence (2013, 2011, 2010, 2009) - questions about treatment

* Antenatal bleeding (2011, 2010, 2008, 2007) - questions about causes and treatment

* Post-section/post-natal complications (2013, 2009, 2008) - in our case this was a history of a woman with pyrexia in a hospital bed followed by questions on how to investigate and manage her

* Abdominal mass (2010) - questions about investigation of ovarian cancer

* Contraception (2013, 2008) - in our year, this felt like a mixed Hx and explanation and planning station to decide which mode of contraception was best for the patient

* Post-menopausal bleeding (2011, 2009)

* Subfertility (2011, 2009)

* Amenorrhoea (2010)

* Menorrhagia (2008)

Explanation and Planning Station - usually 1 station with time to prepare before the exam

* Fibroids (2013, 2011, 2010, 2009)

* Concern about Down's syndrome (2007)

Case-based learning / Community case - usually 1 per year

This station has five minutes of reading time, followed by a viva. Usually, there is a combination of medical, psychological, social issues and ethical issues that you need to discuss, covering the entire O&G objectives: ectopic pregnancy, recurrent miscarriage, previous abortion, smoking, alcohol abuse, promiscuity, underage sex, domestic abuse, etc.

Data interpretation station - 0-1 per year

* Interpretation of tests relating to fertility (2013)

* Interpretation of partogram (2008, 2007)

How to prepare for the exam

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It's a bit easier to predict what comes up in O&G than in paeds. Just work through background on the mandatory teaching sessions and clinics you have to attend and be sure you are comfortable talking about investigation and management of the most common conditions.

Just like for paediatrics, the BMA offers an Essential O&G course that is quite useful for introduction or revision. I found the O&G course slightly less useful than the paediatrics one, but still worth it. Perhaps it’s better not to book them both on the same week-end, so you can still take in some info on the 2nd day.

 

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