D.J. Cahill

Effect of progestogen therapy on follicular development, related hormone concentrations and fertilization in vitro in unstimulated cycles and unexplained and endometriosis-associated infertility

Evidence of pituitary-ovarian dysfunction in unexplained and endometriosis-associated infertility has been reported previously. Hormone-suppressive therapy is often used in an attempt to improve fertility, although benefits have not been proven. Our study examines the effect of progestogen (medroxyprogesterone acetate) treatment on women with endometriosis-associated and unexplained infertility, compared with women with tubal damage as functional controls. Pre-ovulatory follicular size and serum and follicular fluid hormone concentrations were measured, and oocyte collection and in-vitro fertilization were attempted, in natural cycles totally unperturbed by exogenous gonadotrophins, for two cycles before and two cycles following treatment with medroxyprogesterone acetate for 2 months. In the endometriosis and unexplained infertility groups, compared with the tubal group, the treatment led to significant reductions in the integrated luteinizing hormone (LH) values (483 versus 664, 559 versus 762 and 864 versus 820 notional IU/l respectively). There were no changes in serum oestradiol or follicular fluid oestradiol, progesterone, follicle stimulating hormone or LH concentrations after treatment. The results suggest that progestogen therapy has no beneficial effect on the pituitary-ovarian dysfunction which contributes to endometriosis-associated and unexplained infertility.

Does a high ranking mean success in the Situational Judgement Test

The selection of medical students to the foundation programme has undergone several changes since its introduction in 2005, with the latest being the introduction of the Situational Judgement Test (SJT) in 2013. The SJT, a 2–hour exam that uses a multiple‐choice format to assess an individuals judgement when presented with clinically related scenarios, now accounts for 50 per cent of the application process. The remaining 50 per cent is made up of the Educational Performance Measure (EPM) score, which includes the medical students performance at medical school, allocated by points attributed according to decile ranking. Coming out of its pilot year, there is little research into the results of the SJT. This project aims to discover whether there is a correlation between high‐performing students who succeeded at medical school (i.e. by decile ranking) and those who scored high in the SJT.

Evaluation of an online postgraduate education programme

Information technology supporting training in medicine is unstructured and critical evaluation of its use is lacking. The objective of the paper was the evaluation of an Internet-delivered postgraduate training course in medicine. The work took place in the Division of Obstetrics and Gynaecology and Institute for Learning and Research Technology, University of Bristol. Postgraduate trainees were invited to participate in an Internet delivered training programme over 5 months. Tutors and the participants were interviewed, inter-participant emails were collected and post-course evaluation of all trainees was undertaken at 2 and 6 months. Of 18 enrolled participants, 11 actively participated (mean: five each month). Participants were more likely to view other participants responses or tutor feedback than respond themselves. The Internet is a suitable medium for courses of this nature. Satisfaction levels with the content of the course and with the medium used were high. Constructive criticism was incorporated into future courses.

Hemizona Assay and Sperm Penetration Assay in the Prediction of IVF Outcome: A Systematic Review

The limited predictive value of semen analysis in achieving natural conception or in IVF outcome confirms the need for sperm function tests to determine optimal management. We reviewed HZA and SPA predictive power in IVF outcome, with statistical significance of diagnostic power of the assays. HZA was readily efficient in predicting IVF outcome, while evident inconsistency among the studies analysed framed the SPAs role in male fertility evaluation. Considerable variation was noted in the diagnostic accuracy values of SPA with wide sensitivity (52–100%), specificity (0–100%), and PPV (18–100%) and NPV (0–100%) together with fluctuation and notable differentiation in methodology and cutoff values employed by each group. HZA methodology was overall consistent with minor variation in cutoff values and oocyte source, while data analysis reported strong correlation between HZA results with IVF outcome, high sensitivity (75–100%), good specificity (57–100%), and high PPV (79–100%) and NPV (68–100%). HZA correlated well with IVF outcome and demonstrated better sensitivity/specificity and positive/negative predictive power. Males with normal or slightly abnormal semen profiles could benefit by this intervention and could be evaluated prior to referral to assisted reproduction. HZA should be used in a sequential fashion with semen analysis and potentially other bioassays in an IVF setting.

Implementation of teaching on LGBT health care

Lesbian, gay, bisexual and transgender (LGBT) patients represent an important proportion of the population. Despite the health inequalities and barriers to health care noted within this group, there is little evidence of LGBT‐focused education within medicine, dentistry or nursing. We introduced and evaluated the effect of a half‐day teaching session focused on LGBT health care, delivered to year‐2 students.

Medical student views on teaching about sexual dysfunction

Talking about sexual issues with patients can be difficult and requires training in good communication skills. Whilst most health care professionals think that medical staff should discuss psychosexual issues only a quarter actually do (Stead et al. 2001). Students should gain an understanding of how sexual behaviour has an impact on health, be able to broach the subject of their patient’s sex life and to be comfortable when discussing sexual practices and sexual orientation (BASHH 1999). To evaluate attitudes to the relevance of training in sexual dysfunction all medical students in our School were emailed background information and a request to participate in an online anonymous survey. We sought information on aspects of teaching in sexual dysfunction: the perceived need for delivery of teaching on sexual problems and intimate examinations; actual experience of patients with sexual problems and difficulties in talking about sex (both doctors and patients). More than 95% of students considered that genital examination, management of sexual dysfunction and communication about sex with patients should be included in teaching. Interestingly they considered the subjective response of the patient and the doctor to be less relevant which may explain in part the difficulty around acknowledging the anxiety evoked by this subject. Small group work, not large lectures, was considered the optimal way of delivering these topics. Over three quarters of respondents accepted the clinical significance of sexual dysfunction and wanted to know how and when to refer people with it. A major concern to us about the learning experience is that most (73%) reported that rarely actually encountering sexual problems during their training. We also noted that 2–3% of students across all years felt that sexual problems were of no concern or that there was no need for training in this area; this belief is likely to hold beyond graduation and this aspect of health will be ignored by a proportion of doctors. Overall it does seem that our students largely do understand and value the role of this aspect of their teaching. We need to continue to protect the need for high quality teaching in this matter, ensuring that the appropriate environment is available for it to be taught effectively. This must include small group teaching.