การใช้สมุดบันทึกการปฏิบัติงานทางคลินิกเพื่อประเมินการเรียนรู้ทางสูติศาสตร์นรีเวชวิทยา ( Assessment of student’s clinical skill in Obstetrics and Gynecology: logbook versus Objective Structure Clinical Examination.)

     While the training of clinical skills is a requirement for medical study, it is necessary to evaluate whether a student receives enough learning experience. Besides a standard test, the objective structure clinical examination (OSCE), another way to assess the clinical experience of student is the evaluation of the number of patients whom the medical student has take care, which is recorded in a logbook. In this study, the Department of Obstetrics and Gynecology , Faculty of Medicine, Srinakharinwirot University aimed to examine the relationship between the number of studied cases as shown in the student’s logbook and the score that the student got from OSCE. The data of number of patients were collected from 106 logbooks of 4th year medical students that were handed in the department after the 8-week training session in 2008. It was shown that the average number of cases of low risk pregnancy and high risk pregnancy that were taken care per a student were 9.0±3.4 and 5.7±3.7, respectively. The average number of labor cases that were attended by a student was 10.4±3.0. The average number of operative obstetric cases that were attended by a student was 16.7±4.3. The average number of obstetric cases that were attended by a student in obstetric operative room was 5.9±2.3. The average number of obstetric inpatient cases that were taken care per a student was 8.9±2.7. The average number of gynecologic outpatient cases that were taken care per a student was 11.8±11.5. The average number of obstetric cases that were attended by a student in gynecologic operative room was 5.5±2.4. The average number of gynecologic inpatient cases that were taken care per a student was 5.8±1.9. The average number of frequency of evening on-duty was 8.5±0.9. These data revealed that the students should practice the clinical skills from enough number of patients. However, the average score of total students from OSCE was only 53.4±9.7 percent. The statistical tests also showed that there was no relation between the numbers of studies cases and the scores taken by OSCE. Therefore, the criteria for checking the student’s logbook should be evaluated and adjusted for better assessment of clinical training in the department.

Clinicopathologic analysis of women with synchronous primary carcinomas of the endometrium and ovary: 10- year experience from Chiang Mai University Hospital.

The aim of this study was to analyze the clinicopathologic features and survival outcomes of women with synchronous primary carcinomas of the endometrium and ovary that were treated at Chiang Mai University Hospital between January 1995 and December 2004. During the study period, 43 women with such tumors were identified. These carcinomas accounted for 0.58% (95%CI=0.42-0.79%) of all gynecologic malignancies. Median age at diagnosis was 49 years (range: 34-60 years). Median body mass index (BMI) was 21.6 kg/m2(range: 15.5-27.7 kg/m(2)). The majority of women (65%) were premenopausal. The most common presenting symptom was abnormal uterine bleeding (42%), followed by a pelvic mass (30%). Twenty-seven (62.8%, 95%CI= 46.7-77.0%) women had concordant endometrioid carcinomas of the endometrium and ovary. Five (11.6%) women experienced tumor recurrence with median follow up 39 months (range: 1-85 months). The overall 5-year survival was 85.2%. There was no significant difference in survival outcomes among the women who had endometrioid/endometrioid histology and those who had other histological subtypes (P=0.674). In conclusion, synchronous primary carcinomas of the endometrium and ovary, although uncommon, should be considered in differential diagnosis in premenopausal women presenting with abnormal uterine bleeding and ovarian tumors. The prognosis of patients with these tumors appears excellent.

Prevalence and risk factors for residual cervical neoplasia in subsequent hysterectomy following LEEP or conization.

OBJECTIVES: The purposes of the present study were to determine the prevalence of residual disease in the hysterectomy specimens following cold knife conization (CKC) or loop electrosurgical excision procedure (LEEP) and to evaluate the predictive factors for residual disease. DESIGN: Descriptive study SETTING: Department of Obstetrics and Gynecology, Faculty of Medicine, Siriraj Hospital. SUBJECTS: A total of 120 patients who underwent hysterectomy after either LEEP or CKC. MATERIAL AND METHOD: The medical records of 120 women were reviewed to estimate the prevalence of residual disease.. The patients' characteristic and pathologic parameters were analyzed for the risk factors of residual disease. Chi square test and Student t test were used for statistical analysis. RESULTS: Of the 120 patients, 46 cases had residual disease in their hysterectomy specimens so the prevalence was 38.3% (95% CI 29.5, 47.2). Invasive cervical cancer was found in the hysterectomy specimens in 4 cases (8.7%). Only ectocervical margin was the predictive factor of residual disease in the hysterectomy specimen (p = 0.002). Age, conization pathologic findings, glandular involvement, endocervical margin status, stromal invasion, and endocervical curettage results were not predictive factors for residual disease in the hystectomy specimens. CONCLUSION: Residual disease was found in 38.3% of hysterectomy specimens after conization. Also undiagnosed invasive cervical cancer was found. Careful examination for residual disease in hysterectomy specimens should be performed, especially among those with positive cone margin.