AGSM Brochures

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    TWENTH ANNUAL GENERAL AND SCIENTIFIC MEETING
    (Ghana College of Physicians and Surgeons, 2023-12-03) Ghana College of Physicians and Surgeons
    The Pursuit of Excellence in Postgraduate Medical Training in Ghana – Challenges of the Next Twenty Years The Ghana College of Physicians and Surgeons has, over the past twenty years of its existence, largely achieved the objectives for which it was set up. This success can engender a sense of complacency which could be detrimental to its existence. It is in this regard therefore that the College is called upon to pursue excellence if it is to continue to achieve greater successes. A selected number of areas of operation are considered in the short discourse of this lecture. The College must be commended for the efforts made to equip its trainers with some skills in teaching and learning, however, a lot more could be done. The establishment of a Health Professions Education Unit in the College is advocated to prosecute an agenda of furthering scholarship in teaching and learning especially at the postgraduate level. The College runs various workshops to equip trainees with skills in conducting research which culminate in the submission of a dissertation as part of the requirements for fellowship graduation. Trainees should also be equipped with skills for seeking funding to support their research. Engaging in research should be considered a cultural imperative for the College’s graduands, irrespective of areas or institutions of practice. The College has been impressive in incorporating technology into its administration and educational functions. With the world moving fast in technological advancements, the College needs to move along to ensure effective use of Artificial Intelligence not only in its teaching and learning activities but also in equipping its trainees to effectively use this technology in their clinical practice and continuous professional development. Starting with only the Korle Bu and Komfo Anokye Teaching Hospitals, the College has over time accredited other health institutions for postgraduate medical training. Considering the numbers of doctors currently in postgraduate medical training, it is suggested that steps be taken to upgrade the regional hospitals, in terms of human and material resources, to enable them function effectively as training institutions to absorb the anticipated increase in numbers of applicants for postgraduate training. The need for high-fidelity simulation facilities to aid training is paramount. The resurgence of brain drain of doctors from the country poses an existential threat to the College if the trend continues. The main driving factor, among others, is the increasingly difficult economic conditions in the country which the College, unfortunately, is not in a position to do much about. A general tribute is paid to individuals and institutions that have contributed to the establishment and growth of the College in the past twenty years of its existence. Optimism is expressed over the College’s ability to withstand the challenges and march on to achieve excellence in postgraduate medical training in Ghana.
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    TWENTY-FIRST ANNUAL GENERAL & SCIENTIFIC MEETING
    (Ghana College of Physicians and Surgeons, 2024-11-27) Ghana College of Physicians and Surgeons
    Introduction The rate of caesarean deliveries (CD) has increased globally in recent years. CD accounts for more than 1 in 5 births; this is predicted to rise to about a third by 2030. When indicated, CD preserves the lives of mother and baby; however, it has associated complications. Vaginal birth after CD (VBAC) has gained traction in recent years because of its high success rate, but identifying which women are likely to have a successful VBAC remains challenging. Methods Myometrial lower uterine segment thickness (mLUS) and full lower uterine segment thickness (fLUS) were measured with transvaginal ultrasound (TVUS). The women were managed according to local protocols with the clinicians blinded to the ultrasound measurements. The LUS was measured intraoperatively for comparison with ultrasound measurements. Results 311 pregnant women with one previous CD were enrolled; 147 underwent elective CD and 164 underwent a TOLAC. 96(58.5%) women had a successful vaginal birth. The mLUS was comparable to the intraoperative measurement in the elective CD group with LUS thickness <5mm(bias of 0.01, 95% CI-0.10 to 0.12mm); fLUS overestimated LUS<5mm( bias of 0.93, 95% CI 0.80-1.06mm). Successful vaginal birth rate correlated with higher mLUS values (OR 1.30, 95% CI 1.03 1.64). LUS measurement ≤2.0 mm was associated with an increased risk of uterine defects with a sensitivity of 91.7% (95% CI 61.5–99.8%) and specificity of 81.8% (95% CI75.8–86.8%). Discussion Our findings revealed that mLUS values compared favourably with intraoperative measurements. The rate of successful VBAC increased with increasing mLUS measurements with a 71/105 (67.6%) success in mLUS ≥3.0 mm, 25/48 (52.1%) success in measurements between 2.1 and 2.9 mm and no successful VBAC with mLUS ≤2 mm (0/11). Conclusion Accurate TVUS measurement of the LUS is feasible in a resource-limited setting. This could help in making safer decisions on mode of birth in limited-resource settings.