here is another valuable compilation of files

Here is another zip compilation of files my colleagues and i used for the exam
in this zip file contains a compilation off all the important rcog guidelines and tog guidelines so you dont have to download one by one . Also a compilation of all busy sprs osce, essays and notes.

sample osce:

Audit

Design an audit for the following protocol.
You are not expected to criticize the protocol.

Post dates protocol

Criteria for referral

Women seen in antenatal clinic at 40 weeks
Assessment in Day assessment unit from 41 weeks

All patients should be given a daily kick chart
If <10 movements between 9am to 9pm then patient should contact the Labour Ward to arrange CTG

Follow-up should then be arranged in the DAU

41-42 weeks
Twice weekly CTGs
Biophysical profile weekly
Check date for induction of labour at 42 weeks

>42 weeks
Admit
Record summary of findings, symptoms etc on a page(s) inserted in the antenatal in-patient part of the patient’s maternity notes booklet


The candidate needs to cover the following 5 areas of discussion and can be prompted by a specific question if he/she does not mention them spontaneously

Describe the key components of an audit
Which patients should have been managed by this protocol in the given time period
Would a x% sample be sufficient
Determine method of establishing whether each element in the protocol was followed for each patient
Ascertain the outcome
Analyse data including quantifying missing data
Consider sampling bias
See which items in the protocol had significant failures of compliance and try to assess why this occurred

Feed results back to departmental staff
Sensitively
Consider confidentiality
What reactions might be expected

Consider if organization changes are needed to facilitate/improve compliance
Resource implications
How to achieve consistent implementation

Consider if any elements of protocol require modification
Recent research data/College guidelines
Are pregnancy outcomes in line with national/regional norms
Has there been criticism of protocol by user groups

Decide when audit should be repeated
How long will it take for organizational/protocol changes to be implemented
If protocol is changed a second audit may not be comparable


Topic

Standard setting – literature search
RCOG/NICE guidelines
DOH guidelines
Previous audit (departmental/other hospital)
If no standard – may have to set own standard
(Mention recognized well-known standards if available e.g. National sentinel caesarean section audit)

Planning
Form audit team (stake-holders, user groups)
Involve audit department (especially to trace notes)
Decide whether retrospective or prospective
Design proforma
Data collection on structure, process, outcome?
Sample size (usually 50-100 cases)
Who to include?
Length (usually 3-6 months)
Audit team meeting to discuss proforma – any changes, improvement

Data collection
Who to collect?
Where to store? (Data protection act)
Use excel to store data

Data analysis
Results – whether standards achieved or not (are standards achieved in line with the standard set?)
If not achieved, what is the reasons

Analyse data including quantifying missing data
Consider sampling bias

Make recommendations if any, on:
Structure
Process
Outcome

Disseminate results
May need to be sensitive
May need to consider confidentiality
Audit meeting, departmental meeting, notice boards
Use power point
What reactions might be expected

Implement change
Barriers – resources (manpower, financial), individual “stubbornness”
Protocol revision/modification?
Any elements of the protocol
Any recent data/College guidelines
Any criticism of protocol by user groups/stake holders

Complete the audit cycle by reauditing
Allow some time for changes to take effect (? 6 months)
Is the audit proforma still applicable
If applicable - May need to change/review the audit protocol
If not applicable – need to do a new audit (i.e. especially after changing the protocol, a second audit (reaudit) may not be comparable)


Audit on a protocol
Given a protocol
How would you audit to see whether this protocol has been adhered to in your department? E.g. Protocol for management of 3rd and 4th degree perineal tear

Important : Then the standard is your protocol!!! You aspect it to be adhered 100%!
Audit to find out whether the staff is compliant to the protocol or are there any deficiencies.
If there are any deficiencies, then need to implement changes


Audit on e.g. excessive and unnecessary IOL in the department

Start by asking:
Is the rates really high?
Reasons if it is high
Who decides for IOL
Is the consultant involved in decision making
Who does the IOL

Compilation of important TOG and RCOG guidelines and busy spr osce,essay,notes