After a long and fruitful first day, the KSUOG trainers very kindly took the whole team as well as our friends from NCMCH out for dinner at a local Korean restaurant prior to Prof Jun’s return to Seoul. Thank you KSUOG and Prof Jun for a delicious and wonderful evening! What a great way to start what is shaping up to be a truly inspiring outreach course.
Tuesday and Wednesday saw the ISUOG trainees continuing to advance through lectures and hands-on training, and the trainers continue to be very happy with the progress made.
Today was a day full of particularly interesting cases that demonstrated almost word-for-word what had been taught in the classroom.
Dr Jeanty tells us more about today’s truly exciting developments:
Wow, this is a good one !
1) we are teaching you ultrasound during this course, but do not forget that you are first and foremost clinicians.
2) although we are teaching you ultrasound in Ob-Gyn, remember that, if needed you can look at other things too with ultrasound, and it is good to have a little knowledge of non-ob-gyn ultrasound too.
Workshop in the afternoon: (Translated from Mongolian for the reader’s comfort :))
“What is the history of the patient you are going to scan?”
“Why is her doctor asking for a scan?”
“Want to learn where her placenta is”
“What should you think in a patient that had previous C-section?”
… more prodding…
“OK, C-section and placenta previa… what should you be looking for?”
… more silence… more prodding…
“Great, now you can scan!”
First image on the lower uterine segment (37 weeks): textbook accreta-increta!!
Wow, the students were really eager to ask about the clinical history and indications for the next patients, and for sure they will forever remember this case!
Two patients later…
“Pelvic pain, normal physical exam”
First image on the screen: a gigantic cystic collection (15 by 12 by 7cm). Normal uterus, adnexa not seen.
We bet: Bladder or Cystadenoma?
“How would you find out?”
“Let her pee…”
… rescan after peeing…
No more cyst, it was her bladder. (Where else in the world do women have such a full bladder and do not bitterly complain about it?)
“Anything abnormal in her pelvis? Any masses?”
… long search: nothing…
“What else can cause pain ?”
…long list of differential (this was a left-lower-quadrant pain, after more questions to the patient)
“How would you find?”
“Look at her kidney for hydronephrosis…”
… we look at her kidneys and she has an anomaly of migration of her left kidney, that is resting mid-distance between the renal fossa and the promontory…
“How can you know this is the source of her pain?”
“Gently press on her kidney and you will see…” and this was clearly what was causing the patient’s pain.
So the lessons, were, if you don’t find the answer to the clinical question, try more, look elsewhere. The scanning protocols are wonderful, but remain clinicians first.
The students are all very eager to learn, despite the language barrier, they show great interest and it is such a pleasure for me to see each one of them conquer one milestone after another. A very great bunch of young people who will very much benefit from their training and go on to be useful to their respective regions (some travelled 1000-1500 km to attend). One area still to work on: they seem convinced that if you “paint” the whole patient with gel first, the exam will be easier 🙂 and another issue, learn to rest their arm or wrist on the patient instead of putting the whole weight of their arm on the transducer. Nothing that descendants of Genghis Khan cannot conquer!