Enhanced recovery after gynaecological surgery — structured oral station (12 minutes)

Opening — “Summarise your approach.”

• Define the clinical objective and distinguish routine prevention/recovery from treatment of a complication.
• State patient risk, procedure risk and the first safe prescription or pathway step.
• Name who owns timing, review and escalation. ^[1]

Probe 1 — “What history and examination change your plan?”

• Counsel on functional milestones, analgesia, feeding, mobilisation and discharge criteria.
• Optimise anaemia, diabetes, nutrition, smoking, medicines and VTE risk.
• Follow local fasting policy; consider selected carbohydrate loading only after aspiration-risk review.
• Avoid routine mechanical bowel preparation unless the planned procedure requires it.

Probe 2 — “Give me the exact perioperative orders.”

• Minimally invasive access if oncologically appropriate; antibiotic and VTE prophylaxis.
• Maintain normothermia and individualised euvolaemia; avoid salt-water overload.
• Multimodal opioid-sparing analgesia with paracetamol, NSAID if safe and local/regional technique.
• Multimodal PONV prophylaxis using different classes plus baseline-risk reduction.

Probe 3 — “What happens after surgery and at discharge?”

• Scheduled non-opioid analgesia; limited opioid rescue and pain-on-movement review.
• Early oral fluids and food as tolerated; stop IV fluid when oral intake and haemodynamics are adequate.
• Sit out and walk with assistance using explicit goals.
• Remove urinary catheter early with a documented trial-of-void plan; review every drain daily.
• Continue indicated VTE prophylaxis; set criteria-led discharge and safety net.

Probe 4 — “The patient deteriorates. What now?”

• Haemorrhage, sepsis, respiratory compromise or suspected visceral injury: ABCDE and targeted escalation.
• Persistent vomiting/distension, ileus/obstruction, retention or physiological instability: pause the relevant element and investigate.

Communication probe

Say: “I will explain the purpose, benefits and harms in plain language, check understanding and preferences, and tell you which symptoms need urgent review. If the plan changes, I will explain why and when we will reassess.” ^[1][2]

Evidence probe

• Name the ANZ local guideline as the operational source and use the verified international evidence in this station.
• Acknowledge uncertainty rather than inventing a version, threshold or PMID. ^[1][2][3][4]