educational forum in obstetrics gynaecology of ranzcog/fnu cmnhs educational forum in obstetrics and...

College of Medicine, Nursing and Health Sciences

The Royal Australian and New ZealandCollege of Obstetricians and Gynaecologists

24-29 June 2012 | Lautoka, Fiji

FNU and RANZCOG are pleased to acknowledge the support and involvement from the following bodies:

final report

College of Medicine, Nursing and Health Sciences

educational forum in obstetrics gynaecology

The Royal Australian and New ZealandCollege of Obstetricians and Gynaecologists

Report of RANZCOG/FNU CMNHS Educational Forum in Obstetrics

and Gynaecology, Lautoka Fiji, 23-29 June 2012

1

CONTENTS

Page

Acknowledgements

Message from the Chairman, Organising Committee

2

4

Seminar ‘Evidence Based Updates in Clinical Obstetrics and

Gynaecology Practice’

5

Inaugural meeting of the Fiji Obstetrics and Gynaecology Society (FOGS)

10

Educational Forum Dinner

11

RANZCOG/PSRH Emergency Obstetrics and Neonatal Care Workshop

12

RANZCOG/ASCCP Colposcopy Workshop

16

RANZOG/PSRH Pacific Obstetrics and Gynaecology Ultrasound Workshop

19

RANZCOG/FOFH Laparoscopy Training workshop

21



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Acknowledgements

On behalf of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists

(RANZCOG) and the Fiji National University College of Medicine, Nursing and Health Sciences (FNU

CMNHS) we have pleasure in presenting the Report of the inaugural RANZCOG/FNU CMNHS Educational

Forum in Obstetrics and Gynaecology, held in Lautoka Fiji, 23-29 June 2012.

The forum comprised a seminar and clinical workshop program bringing together, for the first time, local

and international specialists in obstetrics and gynaecology, for an interesting, innovative and interactive

learning experience for O&G postgraduate trainees, specialist obstetrician gynaecologists, and other

reproductive health workers from Fiji and other PICs.

Simultaneously, the forum was a unique opportunity designed to initiate networking and develop closer

liaisons in the region, and a number of suggestions were forthcoming about ways that the Pacific can

interact more with Asian, Australian and New Zealand colleagues through the network of Obstetrics and

Gynaecology societies in the Oceania region.

A necessary element to hosting a meeting of this size is significant funding to enable the event to

proceed. RANZCOG and FNU CMNHS would therefore like to express their sincere appreciation to the

following bodies:

• AusAID, through the Strengthening Specialist Clinical Services in the Pacific project

• UNFPA

• Asia Oceania Federation of Obstetrics and Gynaecology (AOFOG)

• Australian Society for Colposcopy and Cervical Pathology (ASCCP)

• Friends of Fiji Health (FOFH)

• Pacific Society for Reproductive Health (PSRH)



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The other equally important element in hosting the 2012 Educational Forum in O&G was the personal

commitment to delivery of a high quality educational program, with associated social and logistical

aspects, provided by the organising committee, facilitators, lecturers and staff manning the various

facilities used during the week-long forum.

Special acknowledgement is made of:

Educational Forum – Seminar and Workshop Organisers

Professor Rajat Gyaneshwar Chief Local Organiser FNU CMNHS

Dr Amanda Noovao-Hill Second in Charge FNU CMNHS

Ms Carmel Walker Senior Coordinator RANZCOG

Ms Vinau Savu Project Officer FNU CMNHS

Dr Miriam O’Connor Emergency Obstetrics Workshop Leader

Matron Emma Deloi Emergency Obstetrics Workshop Local Organiser

Dr Jeffrey Tan Colposcopy Workshop Leader

Dr Virisila Sema Colposcopy Workshop Local Organiser

Professor Peter Stone Pacific O&G Ultrasound Workshop Leader

Dr Amanda Noovao-Hill Pacific O&G Ultrasound Workshop Local organiser

Dr Sunil Pillay Laparoscopic Surgery Workshop Leader

Dr Jimi Taria Laparoscopic Surgery Workshop Local Organiser

Dr Luisa Cikamatana-Rauto Medical Superintendent Lautoka Hospital

We are confident that the joint inaugural RANZCOG/FNU CMNHS Educational Forum in Obstetrics and

Gynaecology in Lautoka has been a significant step forward in partnerships between Fiji, the Pacific and

regional bodies concerned with maternal and child health.

We hope the momentum generated by the event will continue with fervour.

Professor Ian Rouse Dr Rupert Sherwood

Dean, College of Medicine Nursing and President, The Royal Australian and

Health Sciences, Fiji National University New Zealand College of Obstetricians and

Gynaecologists

July 2012



4

Message from the Chairman, Organising Committee

For the first time in 2012, RANZCOG and FNU CMNHS joined together to provide an Educational Forum

in Obstetrics and Gynaecology, over the period 23 June to 29 June. The forum comprised a one-day

Seminar, held at the Tanoa Waterfront Hotel, followed by four concurrent workshops held at Lautoka

Hospital over the following week.

The timing of the Educational Forum was planned to coincide with a visit by a significant number of

internationally renowned specialist obstetricians and gynaecologists, visiting Lautoka for the 2012

Council meeting of the Asia & Oceania Federation of Obstetrics and Gynaecology (AOFOG). This

provided the opportunity for a number of visiting AOFOG representatives to join with RANZCOG and

FNU CMNHS lecturers as speakers and facilitators for the seminar and workshop program the following

week. The report of the various components of the forum is contained in this report.

On behalf of the Organising Committee, may I express our sincere appreciation to all who contributed to

the success of the Seminar and Workshop program - as participants, facilitators, organisers, supporters,

donors, hospital staff and friends.

We were thrilled at the enthusiasm and goodwill amongst colleagues, as we work towards our common

goal in the provision of quality care for women and their families in the Pacific.

Professor Rajat Gyaneshwar

Chief Local Organiser

Professor of Obstetrics and Gynaecology, FNU CMNHS



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Seminar ‘Evidence Based Updates in Clinical Obstetrics and Gynaecology Practice’

1. Seminar Organisers

Professor Rajat Gyaneshwar Chief Local Organiser FNU CMNHS

Dr Amanda Noovao-Hill Second in Charge FNU CMNHS

Ms Carmel Walker Senior Coordinator RANZCOG

Ms Vinau Savu Project Officer FNU CMNHS

2. Report of the Seminar Organiser, Professor Rajat Gyaneshwar

The seminar ‘Evidence Based Updates in Clinical Obstetrics and Gynaecology Practice’ was a

central feature of the educational form. This was the event at which all participants came

together for a lecture program delivered by local and international speakers, on a range of key

areas relevant to O&G practice. The seminar was attended by approximately 100 participants,

comprising O&G trainees and specialists from Fiji and surrounding Pacific island countries (PICs),

and O&G specialists representing AOFOG, the Pacific Society for Reproductive Health (PSRH) and

the Australian Society for Colposcopy and Cervical Pathology (ASCCP) as well as RANZCOG and

FNU CMNHS.

Contributors to the seminar program were as follows:

Professor Yu-Shih Yang President AOFOG Taiwan

Professor Ian Rouse Dean, FNU CMNHS

Suva Fiji

Dr Alec Ekeroma President, PSRH

New Zealand

Dr Wame Baravilala Adviser in Reproductive Health

UNFPA Pacific Sub-Regional Office

Suva Fiji

Dr James Fong Head of O&G, CWMH Suva Fiji

Dr Kenneth Clark Chairman, RANZCOG Asia Pacific

Committee

New Zealand

Dr Rupert Sherwood President, RANZCOG Australia

Dr Shanti Raman Senior Research Fellow and

Community Paediatrician/ Human

Resources for Health Knowledge

Hub @ UNSW

Australia

Dr Swaran Naidu Specialist Obstetrician/

Gynaecologist

Lautoka Fiji



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Dr Rekha Joseph Specialist Obstetrician

Gynaecologist

Chennai India

Dr Jaydeep Tank Chairman Reproductive

Endocrinology Committee AOFOG

Mumbai India

Professor PC Ho Immediate Past President, AOFOG Hong Kong

Dr Rohana Haththotuwa Deputy Secretary-General, AOFOG Sri Lanka

Dr Sunil Pillay Specialist Obstetrician

Gynaecologist

New Zealand

Dr Pushpa Nusair Specialist Obstetrician

Gynaecologist

Suva Fiji

Professor Walfrido Sumpaico Secretary-General, AOFOG Philippines

Dr P.K Shah Council Member (India) Mumbai India

Dr Amanda Noovao-Hill Specialist Obstetrician

Gynaecologist

Lautoka Fiji

Dr Rajendra Kumar Specialist Obstetrician

Gynaecologist

New Zealand

Dr Kurian Joseph President-Elect, AOFOG

Chennai India

Dr Jeffrey Tan Specialist Obstetrician

Gynaecologist

Australia

Dr Digby Ngan Kee Specialist Obstetrician

Gynaecologist

New Zealand

Dr Ravi Chandran Treasurer, AOFOG Malaysia

The target audience for the program was the postgraduates in O&G and current O&G specialists

in Fiji and those who had completed their MMed in Fiji and returned to their own Pacific Island

countries (PICs). These participants were given central seating in the seminar so that it was

clear to them that they were the target group for the lectures.

The program was developed as four sessions:

• Session 1: Professional Development

• Session 2: Reproductive Endocrinology



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• Session 3: Intrapartum Care

• Session 4: Gynaecology

After an overview of challenges in maternal and reproductive health in the Pacific by leading

local obstetrician gynaecologist, Dr James Fong, the first session utilised the expertise of

RANZCOG experts and what Australian and New Zealand Colleges can do to support

professionalism in the Pacific.

Sessions 2-4 focussed on clinical areas, with the lecture topics chosen to complement the FNU

CMNHS O&G curriculum, providing updates on key areas relevant to clinical O&G practice, and

utilising the expertise of a number of leading international speakers on these topics.

At the conclusion of each session was a panel discussion with experts who had provided the

lectures, to answer questions or raise queries about local issues relevant to the lectures.

An electronic responder system was used during several of the presentations, to encourage

participation from all students, in a de-identified way, and this was successful. It was felt that

the electronic responder system facility could be further explored by faculty at the medical

school, as a useful tool for teachers to identify areas to focus on in situations where students

may be shy in revealing what areas they need further help with, or in fact unable to identify

gaps in knowledge.

The powerpoint presentations from each speaker were made available on the RANZCOG

website for seminar participants to download.



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2. Evaluation of the seminar

Evaluation forms were completed by 38 Fijian and Pacific O&G trainees and specialists.

Level of satisfaction

Respondents reported the following level of satisfaction regarding the seminar and its content:

Registration process Satisfied 52% Very satisfied 48%

Training materials Satisfied 48% Very satisfied 52%

Speakers/presenters Satisfied 29% Very satisfied 61%

Training facilities Satisfied 65% Very satisfied 34%

Appropriate and informative training sessions Agree 50% Strongly agree 50%

Well organised training Agree 48% Strongly agree 52%

Satisfactory training location Agree 50% Strongly agree 50%

Supportive and helpful training staff Agree 68% Strongly agree 32%

Additional comments

Alternative venue:

Suva or Nadi as possible alternate venue

Topics suggested for future seminars:

A wide range of topics were suggested for future seminars and these will be noted by the

organising committee.

Areas most enjoyed by participants:

The areas that participants liked the most were particular topics, the mix of speakers from

different backgrounds, and the fact that the presentations were evidence-based.

Areas least enjoyed by participants:

A variety of comments included absence of midwifery participation and lack of time after each

speaker for questions and comments.

Improvements for next seminar:

A range of suggestions were made including more frequent seminars of this type, more use of

the responder system, more case scenarios and better food.

Relevancy of the seminar to practice:

100% of respondents reported Yes to the following questions.

Will the seminar assist current clinical practice?

Was training relevant?

Would you recommend this seminar?

Rating of the seminar to other training of this type previously attended:

Very good 55% Excellent 45%



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In addition to feedback from Fijian and Pacific participants, comments on the seminar were

sought from the perspective of the visiting specialists from the Asian region (AOFOG

representatives). These comments commended the efforts of the local organisers and venue. It

was felt that the topics were appropriately selected with good response and interactions by

delegates. It was suggested that future seminars be needs based with more time for interaction

at the end of each talk. The use of the responder system was commended and it was felt that

more seminars of this type should be conducted using local faculty and faculty from adjacent

countries. The presentation ‘Challenges in Maternal Health in the Pacific’ was of interest to

visiting O&G specialists from the Asian region.

Dr James Fong, Head of O&G at Colonial War Memorial Hospital, Suva, present on ‘Challenges in Maternal Health in the Pacfific’



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Inaugural meeting of the Fiji Obstetrics and Gynaecology Society (FOGS)

Immediately following the seminar, the inaugural meeting of the Fiji O&G Society (FOGS) was held at the

Tanoa Waterfront Hotel, taking advantage of the number of interested persons present who would be

potential members for FOGS. At the FOGS meeting the FOGS Constitution was adopted, with the

following office bearers declared elected:

President Dr Swaran Naidu

Vice President Dr James Fong

Secretary/Treasurer Dr Amanda Noovao-Hill

General Members Dr Kelera Sakumeli

Dr Vasitia Cati

At the Seminar Dinner the official launch of FOGS was delivered by the President of Fiji. Dr Naidu then

addressed the dinner gathering and introduced the member of the FOGS Executive.

Dr Rey de los Reyes, (President Philippine Society of O&G), Dr Kelera Sakumeli, Dr Alec Ekeroma (Presdient PSRH), Dr James Fong, Dr Rupert

Sherwood (President RANZCOG), Dr Swaran Naidu (President FOGS), the Honourable Ratu Epeli Nailatikau President of Fiji, Dr Vasitia Cati,

Dr Amanda Noovao-Hill, Dr Kenneth Clark, Dr Yu-Shih Yang (President AOFOG), Dr PK Shah.



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Educational Forum Dinner

A Dinner was held on Sunday 24 June, hosted by FNU CMNHS and RANZCOG, attended by 130 guests. Dr

Wame Baravilala presided as Master of Ceremony for the event.

The special guest at the dinner was His Excellency the President of Fiji, Ratu Epeli Nailatikau, who

delivered an impressive address demonstrating his commitment to the women of Fiji, and the

involvement of men in supporting their wife’s pregnancy and childbirth and their ongoing role in

education and raising of their children. The President of Fiji then officially launched FOGS. It is noted

that the President has agreed to be the Patron of FOGS and this level of support is encouraging and

exciting for the Society’s Board and its members.

An address was given by the newly elected President FOGs, Dr Swaran Naidu, reporting the intention of

the new society to build a cohesive and progressive entity to support O&G and reproductive health

workers. Dr Naidu thanked partner organisations for their current and future support and interest in

FOGS and she introduced the members of the Executive Committee.

Dr Alec Ekeroma, President of PSRH, confirmed the ongoing interest of PSRH in all matters concerning

the O&G and reproductive workforce with the common aim of improving reproductive, neonatal and

perinatal health in the Pacific through the Pacific workforce.

The speech by the RANZCOG President, Dr Rupert Sherwood, encapsulated RANZCOG’s commitment to

Fiji and the Pacific, and its intention to build on current partnerships across the region and expand

existing programs of educational support and opportunity in collaboration with these partners in a

multidisciplinary approach to addressing maternal health and MDG4 and 5 targets.

An impressive address was provided by the Dean of the FNU CMNHS, Professor Ian Rouse, concerning

the potential for further development of positive partnerships in the region with existing and new

partners. At the same time, Professor Rouse commended the O&G and reproductive health workforce

currently serving Fiji, with commitment and dedication to the women and their families which comprise

the fabric of Fijian society. Dean Rouse then formally announced the appointment of Dr Sunil Pillay as

Adjunct Associate Professor of Obstetrics and Gynaecology to the FNU CMNHS.

In the address by the AOFOG President, Professor Yu-Shih Yang thanked the hosts for the educational

forum, RANZCOG and FNU CMNHS. On behalf of AOFOG member societies, he announced a number of

new initiatives from AOFOG member societies to support professional development and networking for

Pacific O&G specialists from Fiji and other PICs. These interactions will be explored and discussed

further over coming months.

MC, Dr Baravailala, opens the dinner The President of Fiji addresses the Dinner Prof Rouse, Dr Pillay, Prof Gyaneshwar



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RANZCOG/PSRH Emergency Obstetrics and Neonatal Care Workshop, 25-27 June 2012

1. Workshop Faculty

Dr Miriam O’Connor Course Director

Dr Shyam Desai Chairman, Maternal and Perinatal Health Care Committee AOFOG

Dr Alec Ekeroma President PSRH, Consultant Obstetrician Gynaecologist Auckland

Sr Aliote Galuvakadua CWMH (Educator/facilitator with Fiji EmONC training course)

Sr Sera Witherow Nauqe CWMH (Educator/facilitator with Fiji EmONC training course)

Sr Kathy Gapirongo Midwifery educator, Honiara, Solomon Islands

Organisers:

Sr Emma Diloi

Dr Amanda Noovao-Hill

Prof Rajat Gyaneshwar

Ms Vinau Savu

Ms Carmel Walker

Local Host Organiser (Matron, Labour Ward, Lautoka Hospital)

O&G Specialist Lautoka


FNU CMNHS

RANZCOG

2. Report of the Course Director, Dr Miriam O’Connor

The evaluation of the Emergency Obstetrics and Neonatal Care (EONC) workshop reveals, on the

whole, that the course was well-received by all, and some very reasonable suggestions have

been made. There was no pre- and post- participant assessment given the time constraints (we

normally include options for pre-quiz and post-quiz + assessment at 2 Skills Stations in the PNG

PEmOC course for hospital staff.....but there is no evidence that this sort-term evaluation of

improvement in knowledge and hands-on skills translates into improved services at the facility

level unless the class-room based learning is tied to clinical attachments for several weeks to

address individual Learning Objectives). However, program managers always love pre-and post-

tests....and they do have value to the facilitators in terms of pinpointing what has been well

taught and learned and where they might focus efforts to improve delivery/translation.

I suspect that learning objectives for the big hospital staff versus rural facility staff are

somewhat different and it would be preferable to provide ‘whole-of-site’ training for each

setting or at least, for staff from the same level of facility. The original intention had been to

provide a tertiary referral centre PEmOC for staff of Lautoka Hospital (all cadres working in

Labour Ward) but there were other courses being run for the Medical Officers and, of course,

someone had to do the clinical work!). Some of the demonstrations (eg how to successfully

perform an informative speculum and vaginal examination on the anxious patient) were perhaps

a bit boring for the hospital staff....but the rural workers seemed very glad to have had this

addressed. I know there were times when we elaborated on some ‘basics’ for the benefit of the

rural staff that must have seen repetitive to the hospital staff.......but they seemed to handle it

with good and patient grace!



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I sought informal feedback from Srs Aliote and Sera, co-facilitators from CWMH:

• I asked if there was anything that was at variance with what they have been teaching to

date and was reassured to hear that this is not the case

• They felt that the session on Epidemiology of Maternal Mortality and Morbidity was of value

and a good scene-setter

• They very much appreciated the inclusion of a variety of videos to break up the teaching

sessions and have requested copies (which I shall send to both Sr Aliote and Prof.

Gyaneshwar who might copy and distribute to those participants who were interested).

• They found the PPH ‘staging’ classification and Estimating Blood Loss session very valuable

and would like to incorporate it locally

• They agree that sessions on retained placenta with Skills Stations on AMTSL, physiological

management of the 3rd

stage and manual removal of the placenta (using ModelMed® uterus

and placenta being cognizant of the recommendations for care and use..... these

mannequins are NOT easy to maintain in a tropical environment and they require

supervised use at all times.....so easy to rupture the cervix or uterus.....just like the real

thing!)

They suggested that future PEmOC courses for the Fiji context might include:

• More drills for nurses and include a drill on eclampsia Completely agree it would have been

ideal to run more but the facilitators had not worked together before....which I think is

almost essential for a satisfactory learning experience for the participants.

• More partogram scenarios.....which seem to have been enjoyed and valuable to the

participants this time (we did 3-4). This should be part of Essential Obstetric Care course,

rather than Emergency Obstetrics Care.....perhaps the one course (Essential) should be a pre-

requisite for the other (Emergency).

• More time spent ‘getting the dates right’ and using the obstetric calendars in creative

scenarios....without recourse do ‘doing a scan’ (generally included and emphasised in an

Essential Obstetrics Care course but I always offer it in PEmOC as well as PEOC if they want

it).

• Some may want the opportunity to practice maternal BALS in a Skills Station (even tho’ it

has almost zero success in the obstetric patient) which was not included in this course in the

interests of time and it’s low value in PIC obstetrics

• The 4th

stage.....of value but they want more than just the Golden Hour, with emphasis on

prevention and early identification of potential problems

� maybe the first 6 hrs then

� the first 24 hrs

I accept this is much needed but have included it in an Essential Obstetrics Care course for

staff of the more rural facilities rather than one on Obstetric Emergencies.....form follows

function.

• they were keen to include more on Antenatal care and the Birth Plan/Delivery Planning +

Danger Signs (pre and post-natally for mother and newborn) Again, not usually a part of

EmOC, but rather EOC

• Suggested including a PPH or Eclampsia Puzzle as a Skills Station and run race between 4 or

5 groups (1 facilitator for each group) Sounds great fun to me and I shall correspond with

Aliote and Sera to hear more about this.



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• Add a pre-test and post-test....points for and against doing this in an abbreviated time

frame.

I have no doubt that each PIC will gradually establish their own versions of EmONC training (and

might consider EOC training as a pre-requisite for PEmOC training), picking and choosing various

aspects of the various courses available which can then be appropriately transcribed for local

context and need. Gaps will be detected and products developed to fill those gaps. I feel

confident that RANZCOG/PSRH would be pleased to have PEmOC used in such a way, and I am

sure the PNG RHTU will be content to share resources and ideas with colleagues and institutions

across the Pacific as it moves through a Phased development and implementation with a well-

resourced, strong and dynamic monitoring and evaluation framework so that we identify

opportunities for improved quality as we go.

I think there may be value in developing a Knowledge Bank/Clearing House of a variety Sexual

and Reproductive Health training materials and references, including EmONC training materials

(such as will be done by the PNG Reproductive Health Training Unit, RHTU....a public-private

partnership between PNG’s National Department of Health, AusAID and the Oil Search Health

Foundation) in order to catalogue and make available for dissemination S&RH training materials

of interest to and appropriate for Pacific use. I feel confident that the PNG RHTU would be

happy to make some of these things available using a ‘cloud’ vehicle such as dropbox

(www.dropbox.com ) or via our website which is currently in development even though putting

it all on an open website has some limitations that should be recognised and acknowledged.

These might include:

1. Books

1.1. hard copy or at least, information re source agencies and costs

1.2. e-resource books

1.2.1. free (provide copies or at least website addresses where they can be downloaded)

1.2.2. for purchase

2. e-journals

3. List of website links relevant to S&RH training eg the WHO Reproductive Health Library at

www.who.int/rhl; JPHIEGO; K4Health; Guttmacher Institute and ....many others

4. Interactive training CR-roms

5. Miscellaneous video presentations available online or through a variety of agencies, and

some that will be developed for specific settings by UN agencies, NGOs, training institutions,

private media organizations etc

6. Banks of assessment questions and ‘perfect’ answers

7. Banks of Skills Stations scenarios that might be adapted/varied for local use

There will be more good ideas in due course. I hope people will share their good ideas with the

folks at PSRH and RANZCOG’s APC who can act to disseminate ideas for development by those

who are willing to take up the mantle.



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3. Evaluation of the workshop

Evaluation forms were completed by 18 participants who attended the workshop.


Respondents reported the following level of satisfaction regarding the workshop and its

content:



Speakers/presenters Dissatisfied 6%* Satisfied 33% Very satisfied 67%

Training facilities Dissatisfied 6%* Satisfied 33% Very satisfied 61%


Well organised training Disagree 7%* Agree 55% Strongly agree 38%

Satisfactory training location Disagree 7%* Agree 50% Strongly agree 50%


*This respondent indicated they would prefer local facilitators and venue

Additional comments


The areas that participants liked the most were refreshing/updating basic knowledge,

interactivity of participants, and both the presentations and practical sessions.


Some responders felt that the room was too small and the practical sessions too short.

Improvements for next seminar:

A range of suggestions were made including extending the workshop to cover more topics.










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RANZCOG/ASCCP Colposcopy Workshop, 25-27 June 2012

1. Workshop Faculty

Dr Jeffrey Tan Course Director, Gynaecologist , Melbourne

Dr Ai Ling Tan Gynaecologist, New Zealand

Dr Kerryn Ireland-Jenkins Pathologist, Melbourne

Organisers

Dr Virisila Sema



Ms Vinau Savu

Ms Carmel Walker

Local Host Organiser, O&G Diplomate Lautoka Hospital

O&G Specialist Lautoka


FNU CMNHS

RANZCOG

2. Report of the Course Director, Dr Jeffrey Tan

Preparation:

The RANZCOG/ASCCP Colposcopy Workshop was funded by a donation from ASCCP and this was

well acknowledged by RANZCOG and the FNU CMNHS.

Prior to the event, a significant amount of effort went into organising the workshop and

equipment required. It would be worthwhile to have a standard operating protocol so all

aspects of the organisation of the workshop can be methodically checked to ensure minimum

glitches.

Workshop:

Setting: Video facilities from the colposcope are vital for the workshop. A list of equipment,

instruments, spare ‘parts’ , for example bulbs, disposables and supplies should be prepared to

avoid last-minute frantic maintenance prior to the workshop. The ideal setting would be two

separate rooms with video outlets. This would provide for privacy for patients and one-on-one

teaching in one room, and discussion and instruction by a second facilitator with other students

in the other room. There would still need to be some form of communication link between the

examining colposcopist and the instructor.

Faculty:

Two gynaecologists and a pathologist for a 3-day workshop is the ideal situation.

Attendees:

Six O&G trainees were designated for the intensive training, however others were keen to have

hands-on practice, so the intensive training did not eventuate. Future workshop will need firm

direction as to whether the facilitators are directed to train up to three people intensively or



17

whether more candidates get experience with hands-on colposcopy. A course can have

unlimited numbers but a workshop will need to be restricted in numbers of attendees.

Workshop program:

It is appropriate to start with two hours of early morning lectures, but once the teacher and

trainee start seeing patients, the amount of time required per patient varies. There was a day

when we had 12 patients to see, and that took up the rest of the day, without opportunity for

late afternoon lectures and discussion. This last session of the day (at least 1 hour) is important

and serves as a de-brief as well.

Conclusion:

Overall, the attendees showed an average to good knowledge of colposcopy and management

of screened abnormalities. This is partly shown by their performance in ‘quiz’ sessions applying

the keypad polling system. The majority could do with more hands-on colposcopy training.

The range of equipment and accessories, eg biopsy forceps and disposables, is limited. There is

a need for support on pathways to sourcing equipment and supplies, including at times,

donated supplies, to ensure smooth function of colposcopy services.

Notwithstanding the above suggestions for organisational improvements for future workshops,

feedback during and following the conclusion of the course indicated that the workshop was

well received by the trainees, who were keen to receive further upskilling in their colposcopy

and pathology skills.

Comment:

The Pacific nations need an effective cervical cancer prevention program. There is a need to

document what efforts have been made from within and from outside assistance in this area

with a view to compiling a report looking at possible programs to assist the nations individually

and collectively in areas of screening, management of screened abnormalities and HPV

vaccination.


Evaluation forms were completed by 10 participants, specifically nominated for the course.


Respondents reported the following level of satisfaction regarding the workshop:







18





Additional comments


The areas that participants liked the most were the opportunity to do practical colposcopy one-

on-one with the trainer, the use of the TV screen set up for live teaching, and for those with

existing skills, the chance to build on those skills.


One participant queried the logistics of walking around from place to place, another felt the

afternoon sessions were a bit rushed, and one participant mentioned the delayed start of the

course due to equipment failure.






Overall comments

Respondents were very positive about the workshop overall. One respondent suggested

ongoing training support through the use of videoconferencing facilities between the experts

and the local Fijians for this and other workshops.





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RANZOG/PSRH Pacific Obstetrics and Gynaecology Ultrasound Workshop, 25-28 June 2012

1. Workshop Faculty

Prof Peter Stone Course Leader, Maternal-Fetal Medicine Subspecialist, Auckland

Dr Peter van Der Weijer Gynaecologist Auckland

Ms Cathy Sorensen Ultrasonographer, Auckland

Dr Kwok Yin Leung O&G Specialist, Hong Kong, visiting AOFOG facilitator

Organisers



Ms Vinau Savu

Ms Carmel Walker

Local Host Organiser (O&G Specialist Lautoka)


FNU CMNHS

RANZCOG

2. Report from Course Director, Professor Peter Stone

This was a highly successful, educational and enjoyable course. The organisers wish to sincerely

thank the local team both in Obstetrics and Gynaecology and Radiology for making available

facilities and arranging for women to come and have scans. The Fiji National University staff also

deserve thanks for much of the administrative organisation. It always is a pleasure to work with

friendly, enthusiastic Pacific people who are striving to learn and improve care.

The teachers are highly motivated to continue with such courses and include more one on one

teaching and retain the current format for those who are beginner scanners.

A particularly successful feature of the course was the clinical and ultrasound interactions with

combined lectures given by the clinicians and the sonographer. This showed the important

working relationship that develops between imaging and the outcome for the patient. The

concept of ultrasound as a tool for the clinician to use to enhance care is an important one as

ultrasound is expensive and is a technology which needs to be used wisely. Frequently, the

teachers were asking “what is the question?” or “how will ultrasound help?”.

The teachers would like the participants to work through the course book and DVD and to

obtain as much scanning experience as possible, not to hurry and really see in the image, what

ultrasound can offer when used appropriately.

As always the feedback was useful and the teachers are already working on different course

design to meet the needs of a wide range of people.



20


Evaluation forms were completed by 19 Fijian and Pacific O&G trainees and specialists.


Respondents reported the following level of satisfaction regarding the workshop and its

content:







Satisfactory training location Disagree 6% Agree 63% Strongly agree 31%


Additional comments:

Alternative venue:

One respondent felt that the location for the scanning was too crowded and the room too small.


The areas that participants liked the most covered both the lectures and the practical sessions.


Several respondents would have liked more time for scanning, and one commented on the

overcrowded room.

Improvements for next workshop:

One respondent suggested that materials be provided well before the workshop for pre-reading.

The other suggestions related to more time being allowed for practical scanning sessions. One

visiting PIC participant requested that other practitioners from other islands be included in

future workshops. It was requested that the next course be run for one week.






Other comments

Respondents felt that the workshop was generally well organised and relevant to practice.

Follow up workshops were requested.


Average 10%, Very good 25% Excellent 65%



21

RANZCOG/FOFH Laparoscopy Training workshop, 25-29 June 2012

1. Workshop Faculty

Dr Sunil Pillay Course Director, Gynaecologist Auckland

Dr Rajendra Kumar Gynaecologist Auckland

Dr Shiu Kumar Gynaecologist Auckland

Dr Kurian Joseph Gynaecologist, Chennai India (visiting AOFOG Councillor)

Dr Fong Yoke Fai Gynaecologist , Singapore (visiting AOFOG Councillor)

Dr Rekha Joseph Gynaecologist, Chennai India

Dr Nirupama Samaraweera Anaesthetist, Auckland New Zealand

Mr Brian Thomas Theatre Nurse, Auckland

Ms Vuki Nabete Theatre Nurse, Auckland

Ms Seruwaia Kolibagsoga Theatre Nurse, Auckland

Organisers

Dr Jimi Taria Local Host Organiser (Head of O&G Lautoka Hospital)

Dr Amanda Noovao-Hill O&G Specialist Lautoka

Prof Rajat Gyaneshwar Chief Local Organiser

Ms Vinau Savu FNU CMNHS

Ms Carmel Walker RANZCOG

2. Report from the Course Director – Dr Sunil Pillay

The joint RANZCOG/Friends of Fiji Health Laparoscopy/Endoscopy surgical workshop held as

part of the RANZCOG/FNU CMNHS educational forum is part of the introduction of laparoscopic

surgery to medical staff responsible for gynaecological surgery in Fiji, using a new laparoscopic

tower provided by Olympus. This training represents the introduction of minimally invasive

surgery. The program is being undertaken in a staged way by Friends of Fiji Health with a

number of supporting sponsors based in New Zealand: Johnson & Johnson, Olympus, Big Green

Surgical Co, 3M, REM Systems and Brightside Hospital.

For this course, expertise was provided by visiting senior laparoscopic surgeons representing the

Asia Oceania Federation of O&G (AOFOG). This level of experience and input was valued by the

‘regular’ faculty and participants.

The course comprised a one-day lecture and demonstration program focussing on safety and

care of the endoscopic equipment, held on Saturday 23 June, followed by practical sessions in

theatre during the week 25-29 June 2012. Attendance at the day program was compulsory for

those intending to attend the hands-on course. The lecture day was attended by 13

gynaecological surgeons, and approximately 14 theatre nurses. The program provided them

with a good understanding of care of the equipment and safety issues, electrosurgical principles,

entry techniques, anaesthetic considerations and selection of appropriate cases for endoscopic

surgery.



22

The hands-on course was attended by two general surgeons, eight gynaecologists practicing at

senior level, and three recently graduated gynaecologists. A number of other trainees,

gynaecologists and theatre nurses were invited to observe in theatre. The selection of doctors

for the hands-on training was based on the ‘train the trainer’ model, so that senior

gynaecologists were given the opportunity for this intensive training which they can then

introduce to their junior staff over time at Lautoka, Labasa and Colonial War Memorial

Hospitals.

Cases were selected by the Head of Obstetrics and Gynaecology, in consultation with the course

leader, Dr Pillay. Of the ten trainees identified for intensive training, all had at least three days

of training. Trainees took part in four operations per day such as diagnostic laparoscopy and

tubal sterilisation, and observed more complicated procedures.

Both during the surgery and during the break times, the trainees discussed issues with the

trainers and they appeared to increase in confidence as they undertook the procedures

themselves. Some surgeons will need additional experience and this will be continued with

future visits by members of FOFH over the coming year. The next training visit is organised for a

week in September when Dr Pillay will provide further training to the heads of O&G from

CWM, Labasa and Lautoka Hospitals.

3. Evaluation of the Workshop

Evaluation forms were completed by 7 participants.


Respondents reported the following level of satisfaction regarding the seminar and its content:









Additional comments


The areas that participants liked the most were the hands-on experience with experienced

surgeons. One respondent referred to applying the latest evidence based practice to different



23

clinical scenarios, and also the learning opportunity during the pre-op rounds with Dr Pillay

especially in regard to selection of cases for laparoscopic surgery.


One respondent felt that the intended training schedule had not been followed so some

trainees missed out.

Improvements for next workshop:

It was suggested that the training be more focussed with fewer participants.

Other comments

One respondent advised that a laparoscopy tower is needed in Labasa if they are to put into

practice what they learn in this training. All other comments were positive and appreciative.







Average 14% Very good14% Excellent 72%

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