Prophylactic antibiotics in 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?”

• Clean-contaminated because the vagina is entered under controlled conditions.
• Skin flora plus polymicrobial genital tract flora matter.
• Anaerobes are relevant, so choose procedure-specific coverage.

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

• Clarify allergy: nausea is intolerance, not immediate beta-lactam hypersensitivity.
• Cefazolin 2 g IV at induction, completed within 60 minutes before incision.
• Add metronidazole 500 mg IV when required by the current local hysterectomy protocol.
• Document agent, dose and administration time at sign-in/time-out.

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

• Assign anaesthesia/theatre ownership of the re-dose clock.
• Re-dose cefazolin after the locally specified prolonged-surgery interval.
• Re-dose after major blood loss or fluid shift where policy directs.
• Stop prophylaxis after the perioperative window unless infection or contamination creates a treatment indication.

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

• Assess ABCDE, sepsis physiology, wound, vaginal cuff, abdomen and urinary symptoms.
• Differentiate superficial SSI, pelvic abscess, UTI, haematoma and bowel/urinary injury.
• Obtain cultures before treatment when safe and relevant blood tests.
• Image suspected deep collection and give therapeutic antibiotics plus source control; do not repeat prophylaxis.

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]