Maintaining performance, learning, and teaching 📚
Descriptors and examples for the RCGP Trainee
Maintaining performance, learning, and teaching: This capability area is about maintaining the performance and effective continuing professional development (CPD) of oneself and others. The evidence for these activities should be shared in a timely manner within the e-portfolio.
💠Example Reflection
Suspected OHSS 🤰
Description
During my on-call night shift, I was referred a patient from A&E who had presented with lower abdominal pain and vomiting after recent egg collection for IVF. She had reported that she had been vomiting since the procedure 3 days ago, and had been unable to keep any food or fluid down for more than twenty-four hours.
I had a vague idea about ovarian hyper stimulation syndrome, but did not know what signs to look for, or investigations to order. The registrar on call was busy in theatres and unavailable for advice. I searched for the guidance on OHSS on the RCOG website and read the information prior to seeing the patient.
Although she was clearly dehydrated and had mild pain, her blood tests or examination were not suggestive of OHSS. I felt uneasy sending her home without an ultrasound scan, but at the same time, did not feel as though she needed an out-of-hours scan. I decided to admit her for IV fluids and anti-emetics, and arranged for her to have an urgent in-patient ultrasound the next morning.
Reflection: What will I improve, maintain, or stop?
Continue to reflect on clinical situations where there is uncertainty about diagnosis, and to feel more comfortable managing the patient’s (and my own) anxiety about this.
Learning needs identified from this event
Recognition and risk factors for OHSS.
Maintaining Performance, Learning, and Teaching
Trainee: I accessed RCOG OHSS guidelines and read them prior to seeing the patient in order to know exactly what questions I should be asking and what findings to look for on examination. This demonstrates that I am comfortable with accessing available literature and guidelines and use it to ensure good patient care. I can recognise immediate clinical learning needs, and respond to these effectively in a timely manner.Trainer: You clearly demonstrate your desire to be well informed and took the time to research the condition before you spoke to the patient.
Managing Medical Complexity
Trainee: I was not convinced that the patient had OHSS, however from what I had read, I was aware that patients with OHSS can initially have normal blood results, with little to no findings on examination, but could become unwell very quickly. The fact that she was clinically dehydrated made the decision to admit her easier for me as she needed IV rehydration and anti-emetics. I discussed the uncertainty with the patient, and explored her understanding and perception of OHSS. Having read the literature given to her by the fertility clinic, she was surprisingly well informed about OHSS, and agreed that an ultrasound scan would put our minds at ease.This demonstrates that I am able to manage uncertainty in complex situations, and use the patient’s understanding of the risk to formulate a plan.Trainer: Good communication of risk, you also discuss the uncertainty in the case and negotiate aa way to manage that with the patient.
