Breaking bad news: a clinical skill for postgraduate exams.

Breaking bad news is a challenging station in postgraduate exams. Candidates can struggle if they have not practised delivering sensitive information in a professional and empathetic way. Limited experience of using this clinical skill as a junior doctor often compounds candidates' uncertainty in exams. A clear structure is essential for examination success. The most commonly used is the SPIKES framework, the elements of which are Setting, Perception, Invitation, Knowledge, Emotions and Strategy. This is a stepwise approach that allows candidates to break bad news in a structured way. This is beneficial in clinical practice, but is also invaluable in postgraduate exams, which often have prescriptive marking schemes. This article highlights the key topics and pitfalls that candidates may encounter and suggests tips for success in exams.

The non-operative management of primary osteoarthritis.

Osteoarthritis is a syndrome characterised by joint pain, resulting in functional limitation and a decreased quality of life. This chronic condition is one of the major public health problems facing society today and is likely to become more prevalent. The expected increase is because of the primary causative factors, advancing age and obesity, becoming increasingly prevalent in society. The diagnosis of osteoarthritis can be made clinically when activity related joint pain is present, alongside morning joint stiffness that lasts for less than 30 minutes. However, a radiological diagnosis can also be made. This article examines the current management strategies, as outlined by the National Institute for Health and Care Excellence guidelines for osteoarthritis. Although numerous surgical options are available, this article focuses on the non-operative strategies currently used. The emphasis in this article is on general principles of treatment rather than treatment options for specific joints.

Adherence to European Polypectomy Guidelines: Retrospective Experience from a Tertiary Irish Hospital.

BACKGROUND AND STUDY AIM: The European guidelines for colorectal cancer screening state that snare resection should remove any polyps ≥5 mm. This study aimed to investigate if these new guidelines are adhered to in clinical practice. PATIENTS AND METHODS: This study consists of patients who underwent colonoscopies in Tallaght Hospital, Dublin (AMNCH), between 2012 and 2015. The size of the polyp, the method of removal, and the subspecialty and grade of the endoscopists were all recorded. RESULTS: 6,000 colonoscopies were reviewed and 687 (12.5%) of these patients were found to have polyps. In 655 (95%) colonoscopies, the caecum was positively identified. In all, 371 (54%) of the polyps detected were < 5 mm; resection via forceps was carried out in n405 cases (59%). Overall, 16% (n = 45) of the polyps > 5 mm underwent resection with forceps, showing that the new European guidelines are not being tightly adhered to. CONCLUSIONS: This study found an 84% compliance with polypectomy resection guidelines which is an improvement on previous studies. However, endoscopist grade significantly affected compliance and may reflect overall competency, highlighting the need for specific training in snare polypectomy techniques.