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How should a candidate assess varicose veins in the MRCS clinical examination? A vascular viewpoint
1Leeds Vascular Institute, Leeds General Infirmary, Leeds, UK. neerajbhasin@hotmail.com
Insights
Traditional varicose vein tests are outdated. Clinical examination and hand-held Doppler (HHD) are now the accepted standard for assessing varicose veins in the MRCS clinical examination.
Area of Science:
- Vascular Surgery
- Medical Education
- Diagnostic Techniques
Background:
- Varicose veins are a common condition frequently assessed in surgical examinations.
- Traditional diagnostic tests for varicose veins are often considered inaccurate and obsolete.
- There is a need to clarify current best practices for varicose vein examination in clinical settings.
Purpose of the Study:
- To determine the preferred methods for examining primary varicose veins among vascular examiners.
- To assess the experience and proficiency of basic surgical trainees (BSTs) with hand-held Doppler (HHD) in varicose vein assessment.
- To update the examination protocols for varicose veins in the MRCS clinical examination.
Main Methods:
- A postal questionnaire was distributed to vascular examiners to gather opinions on examination techniques.
- An e-mail questionnaire was sent to BSTs to assess their experience with HHD for varicose veins.
- Response rates from examiners and BSTs were analyzed to identify trends and preferences.
Main Results:
- 93% of examiners favored clinical examination, with 86% and 79% supporting HHD of the SFJ and SPJ, respectively.
- Fewer examiners supported traditional tests: 50% for Trendelenburg and cough impulse, 57% for the tap test.
- 53% of BSTs felt competent using HHD, with 74% of those having prior vascular SHO experience.
Conclusions:
- Examiner opinions align with evidence suggesting HHD enhances diagnostic accuracy for varicose veins.
- Traditional tests like Trendelenburg, cough, and tap are considered outdated by many surgeons.
- HHD should be integrated into medical education and clinical practice, replacing outdated methods for varicose vein examination.
Introduction:
Varicose veins are a common problem and, therefore, regularly feature in the vascular bay of the MRCS clinical examination. Candidates are still being instructed to perform tests in the examination that are considered by many to be obsolete and inaccurate. Using the current cohort of vascular examiners, we aim to clarify which tests a candidate should be performing when assessing varicose veins. We also aim to assess basic surgical trainees' experience in the use of hand-held Doppler (HHD).
Materials And Methods:
Postal questionnaires were sent to all English College Court examiners with a declared vascular interest to gain their opinion on what tests should be used in the vascular bay to assess primary varicose veins. E-mail questionnaires were also sent to basic surgical trainees to assess their experience in the use of hand-held Doppler to assess varicose veins.
Results:
There was a 100% response rate from the examiners with 93%, 86% and 79% feeling that clinical examination, HHD examination of the SFJ and HHD examination of the SPJ, respectively, should form part of the examination of primary varicose veins in the vascular bay. Only 50% indicated the Trendelenburg test and cough impulse and 57% believed the tap test should form part of the examination of varicose veins. Of the BSTs, 53% believed they could examine varicose veins with HHD. Of the BSTs who could use HHD, 74% had held a vascular SHO post.
Discussion:
Published data and opinion show many consultant surgeons have totally abandoned the use of the Trendelenberg, cough, tap and Perthes tests and support the opinion that HHD increases the accuracy of the examination of varicose veins. This study shows the opinions of the examiners supports the evidence-based recommendations that, in the light of easily accessible HHD, the older tests are now outdated. The majority of BSTs who were able to use HHD had held a vascular SHO post (74%) but otherwise it was unlikely that the BST would be comfortable with this skill.
Conclusions:
The Brodie-Trendelenburg (tourniquet) test, cough impulse and tap test are outdated but candidates should be aware of the principles and failings behind them. In the MRCS clinical examination, candidates should examine varicose veins by means of clinical examination and HHD as this is now accepted standard practice. To aid candidate education, the HHD technique should replace traditional clinical tests which continue to be taught in medical school and remain within the classical surgical text books.
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