Gynaecological surgical training in the operating room: an exploratory study.

OBJECTIVE: One of the challenging goals of gynaecological education is preparing trainees for independent practice of surgery. Research, however, on how to acquire surgical skills in the operating room safely, effectively and efficiently is scarce. We performed this study to explore trainers' and trainees' mutual expectations concerning operative training, to identify key aspects for improving learning and teaching in the operating theatre. STUDY DESIGN: We conducted a focus group study in different teaching hospitals in The Netherlands. Three focus groups were composed of gynaecology consultants representing over half of the training hospitals in The Netherlands. Four groups were composed of gynaecology trainees at different stages of training, from university and non-university hospitals and of both sexes. The interviews were recorded, transcribed verbatim and entered into qualitative data analysis software and two researchers performed a thematic analysis. RESULTS: Teaching and learning in the operating theatre are complicated by the dynamics of trainer-trainee interaction, which are fraught with potentially conflicting interests. Trainer and trainee have to consider each other's interests, while their primary concern must be patient safety. Trainers want to feel in control and trainees want to be given a free hand within a safe atmosphere. Structuring of the teaching and learning process appears to hold the key to creating positive dynamics between trainer, trainee and their responsibility towards the patient. Structuring can be achieved before, during and after an operation. Before the operation both trainer and trainee can take the initiative to talk about learning objectives, plan of action, and task allocation. During the operation, the trainee can verbalise actions before actually performing them. This makes trainee actions predictable, enhances trainer confidence and thus may increase the trainee's chance of actually performing (a portion of) a procedure. After the operation, both trainer and trainee can initiate an evaluation the trainee's performance. CONCLUSION: Interaction between trainer and trainee is complicated by their shared responsibility towards the patient. Structured interactions before, during and after operations appear to offer opportunities for improving learning and teaching in the operating theatre.

Transient early preeclampsia in twin pregnancy with a triploid fetus: a case report.

INTRODUCTION: Triploid pregnancies have an increased risk of early preeclampsia. Twin pregnancies consisting of one healthy fetus and one complete or partial molar, with or without a triploid fetus, are rare and management is complex. CASE PRESENTATION: A 33-year-old Caucasian woman presented with a dichorionic diamniotic twin pregnancy. One fetus showed early growth restriction resulting in fetal death at 20 weeks. The placenta was enlarged with some cysts. Chorionic villus biopsy confirmed triploidy. At 21 weeks, the patient developed preeclampsia with a blood pressure of 154/98 mmHg and proteinuria (24 hour protein excretion of 2.5 g/L), for which she was hospitalized. Without pharmacological interventions, the blood pressure normalized and proteinuria disappeared. At 35 weeks, she again developed preeclampsia. A cesarean section was performed at 38 weeks and a healthy child was born. CONCLUSIONS: Survival of the healthy fetus is possible in a twin pregnancy with a triploid fetus complicated by early preeclampsia. The pregnancy should not be terminated if the triploid twin has died and as long as conservative management is safe.

Feasibility of central co-ordinated EMA/CO for gestational trophoblastic disease in the Netherlands.

OBJECTIVE: In the Netherlands, high risk gestational trophoblastic disease (GTD) patients are treated in different referral hospitals with a national working party on trophoblastic tumours having a co-ordinating function. Our purpose was to evaluate whether this policy is a satisfactory alternative to complete centralisation. DESIGN: A retrospective study of all etoposide, methotrexate, actomycin D, cyclophosphamide and vincristine (EMA/CO)-treated women in the Netherlands between 1986 and 1997. Data regarding risk factors, treatment results and toxicity were collected. SETTING: Ten hospitals; 2 general, 6 academical and 2 oncology centres. POPULATION: Fifty EMA/CO-treated women registered by the central registration unit of the Dutch Working Party on Trophoblastic Disease. METHODS: Patients files and quarterly reports of the Dutch Working Party. MAIN OUTCOME MEASURES: Cure rate and consistency of treatment in different hospitals. RESULTS: EMA/CO treatment was administered in 10 different hospitals. All patients were discussed during the meetings of the Dutch Working Party and overall, 86% of patients were cured. Consistency in treatment was good. CONCLUSIONS: Cure rates were comparable with results of single institution series. We conclude that treatment of high risk GTD patients in different referral hospitals with concentration of expertise in a working party is a good alternative to centralisation of treatment in GTD specialised hospitals.