Educational impact of mini-CEX using clinical encounter card system among obstetrics and gynecology residents in a tertiary care hospital

Objective: to assess the educational impact of implementing mini-CEX clinical encounter card system to the residents in obstetrics and gynecology

Study Design: quasi-experimental study

Place and Duration of Study: gynecology Unit 1, Jinnah Hospital, Allama Iqbal Medical College, Lahore, from April 2016 to March 2017

Methodology: in this prospective study, a total of 64 encounters were assessed in eight residents by three assessors using mini-CEX Clinical Encounter Card System [CEC]. Scores were awarded and entered on the card. Cronbach's alpha was calculated to check reliability of the mini-CEX items

Results: in the first encounter, three [37.5%] residents had unsatisfactory overall skills, while five [62.5%] had satisfactory and none had superior skills. However, at the eighth assessment, none of the resident had unsatisfactory skills, six [75%] had satisfactory skills, while two [25%] had superior skills. Cronbach's alpha was calculated as 0.894, which shows high reliability. Statistically significant differences [p <0.05] were observed in medical interviewing skills [MIS], physical examination skills [PES] and organizational efficiency [OE]

Conclusion: mini-CEX is an acceptable and practical tool for assessment of residents during training. The study showed marked improvement in the overall skills of the residents. It was found to be feasible within the daily working in OPD and Indoor wards. Both faculty and residents have accepted it very well

Pattern of gynaecological malignancies in tertiary hospital

To analyze the pattern of genital tract tumour in terms of their age, mode and stage of presentation, histological subtypes and treatment modalities. Gynae Unit-1 Jinnah Hospital/Allama Iqbal Medical College, Lahore from Oct 2007 to Oct 2009. All cases of genital tract malignancy admitted through OPD, emergency or referred to the unit were included in the study. A proforma was designed for each type of genital tract cancer and its details entered through history, examination and investigations. The staging and grading systems as designed by FIGO[7] were used. The data was collected and analysed through SPSS version 10. During the two years, 63 cases of genital tract malignancies were recorded. The most frequent cancer was ovarian seen in 35 [55.6%] with mean age 48 years. Among them two third of cases were with stage 3 and 4 disease. Epithelial ovarian cancer was seen in 26[41.3%] and abdominal hysterectomy and bilateral salpingoophrectomy and nodal dissection was carried out in 16 patients. Fertility preserving surgery was done in young patients with germ cell tumors and were given chemotherapy post-operatively. Cervix cancer was seen in 14 [22.2%], with mean age of 45 years. Among them five patients [35.7%] presented with stage 2 were given radio chemotherapy. Endometrium cancer was seen in 12[19%], with mean age of 50 years. Among them nine patients [75%] presented with stage 1 and 2, and were treated by radical surgery followed by radiotherapy and three patients [25%], in stage 3 and 4 were treated with radiotherapy. One patient [1.6%] of vulval carcinoma was 55 years of age with stage 2 squamous cell carcinoma. She was given radiotherapy. One patient [1.6%] of choriocarcinoma was 40 years of age and was given chemotherapy. Ovarian cancer was the most frequent gynaecological malignancy, which presented at an advanced stage due to late referral. A strong referral system should be developed between primary, secondary and tertiary health centres for screening of general population and high risk group and treatment of affected cases. Awareness about modification of risk factors, and management guidelines also need to be adopted

Multiple pregnancies-maternal and fetal outcome

This study was carried-out on all patients with multiple gestation, who delivered in Unit - I, Lady Willingdon Hospital, from October 2000 to March 2003. A total of 10391 women delivered during this 21/2 years period, out of these 179 had multiple births -176 had twin delivery and three gave births to triplets. The aim of the study was to find out frequency of multiple births and maternal and neonatal outcome in these cases. The prevalence of multiple births was 1.72% with 1.69% of twins and 0.029% triplets. Women with multiple pregnancy were found to be at high risk of pre-term delivery and about 34% of babies were between 1-2 Kg. The rate of caesarean section was also significantly high in these women

Frequency, presentation and management of fibroid uterus

The study was carried-out in Unit - I, Department of Obstetrics and Gynaecology Lady Willingdon Hospital, Lahore from January 2001 to December 2002. A total of 164 women with fibroid uterus were managed during this period. The objective of this study is to find out frequency and presentation of fibroids and to evaluate surgical treatment of women with fibroid uterus. Out of 164 cases, 47 had diagnostic D and C and were managed medically. Out of the rest 117 patients, 23 patients underwent myomectomy after diagnostic D and C. Ninety-three patients had abdominal hysterectomy while only one had vaginal hysterectomy. During operation, haemorrhage was the only complication which occurred in nine cases of myomectomy and intra-operative blood transfusion was done. Patients were followed- up for a period of six weeks to six months. There was no delayed complication or mortality in our study

Uterovaginal prolapse

This cross-sectional study included 160 patients with uterovaginal prolapse managed in Unit - I, Lady Willingdon Hospital, Lahore from January 2001 to December, 2002. Vaginal hysterectomy was done in 103 patients, Manchester repair operation in 18, anterior and posterior repair in 10 patients, posterior repair in 6 patients, ring pessary insertion in 3 patients and sling operation in 2 patients. One nulliparous girl who had Manchester repair and 1 elderly woman who had sling operation for post-hystrectomy vault prolapse had recurrence. These patients became asymptomatic after second operation. There was no mortality

Instrumental vaginal deliveries

The objective of this study was to describe trends in instrumental delivery and to find out frequency of maternal and neonatal complications in a large maternity hospital. All 123 patients undergoing instrumental vaginal delivery in Unit-1 were included. The operative vaginal delivery was 1.17% of total births and 1.648% of vaginal deliveries. Of these 68 women had vaccum extractions while, 55 had forceps delivery. Seventy-one patients were primigravida and the commonest indication for instrumental delivery was fetal distress followed by prolonged second stage. Apgar score at 5 min. was more than 5 in 79.6% of babies. There was one still birth in the vaccum extraction group and five neonatal deaths [all due to birth asphyxia]. There were few maternal complications including only one third degree perineal tear

study of caesarean sections

This study was carried out on 248 patients delivered by caesarean at Zulfi General Hospital, Riyadh over a period of four years. During this period, there were total of 5394 deliveries. Overall caesarean section rate of 4.6% was significantly lower than other reports from Saudi Arabia and abroad. Perinatal mortality during the same period was 16.7/1000 live births. Common indications for caesarean section included CPD, failure to progress, malpresentation and fetal distress. Fetal weights, maternal age parity and were found to be appreciably related to the caesarean section rates. From this experience, we conclude that a lower caesarean section rate can be maintained without compromising perinatal mortality