Core Curriculum - Obstetrics and Gynaecology

Section 1 – Introduction UK training in Obstetrics and Gynaecology comprises a minimum of 7 years specialist training in O & G. The programme is divided into three components: basic, intermediate and advanced training. Successful completion of the programme will lead to the award of a Certificate of Completion of Training (CCT) or a Certificate of Eligibility for Specialist Registration (CESR). The content and structure of the training programmes is determined by the Royal College of Obstetricians and Gynaecologists and approved by the Postgraduate Medical Education and Training Board (PMETB). The delivery of the programme is overseen by Postgraduate Deans in conjunction with the Deanery Specialty Training Committees.

Specialty Training & Education Programme Full registration

Foundation

1

2

Basic Training

1

2

Intermediate Training

3

4

5

Advanced Training Modules

6

7

CCT Specialist Register Independent Practice

Core Log Book RITA

Women's Health Module

NTN

Subspecialty 2-3yr

PART 1 MRCOG

PART 2 MRCOG

Feb 2007

How to use the Postgraduate Training manual The Postgraduate Training manual will provide a comprehensive record of your training and will document your progression through training. You should commence your logbook at the start of your ST1 year. Attainment of competences to a defined level is required for progression from basic to intermediate training (ST2 to ST3) and from intermediate to advanced training (ST5 to ST6). Successful completion of the logbook is a prerequisite for the award of the CCT/CESR. The stages at which different competences need to be obtained are indicated in the logbook and are colour coded: a different colour for each training level. All basic competences must be signed off before progressing from ST2 to ST3, all intermediate competences to be completed prior to moving from year ST5 to ST6 and the advanced competences to be completed prior to your final assessment for the CCT, the RITA G award.

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The Logbook The logbook comprises 19 modules and each module needs to be signed off by your educational supervisors. As you acquire new competences you should ask your clinical trainer to SIGN and DATE the relevant section in the logbook. Unless the competency is signed and dated and a record of the signature of the trainer recorded in the logbook the completion of the module will not be accepted by the Specialist Training Committee. Signatures should also be obtained to confirm successful completion of the relevant course. There is a section at the end of each module for each of your clinical trainers to print and sign their names. These clinical trainers may be consultants in obstetrics and gynaecology but some skills will be taught by senior trainees in the discipline or by specialists in other disciplines, not all of whom will be doctors. The logbook is divided into modules for ease of reference but it is not intended that modules should be completed in isolation. You will acquire skills at different times depending upon the opportunities provided by each clinical post. By the end of intermediate training (ST5), however, you must have completed and have signed off all of the intermediate skills targets to the level indicated in the logbook. Failure to complete the logbook will delay progression into advanced training years 6&7. How will my training be assessed? The logbook makes use of a simple system for recording the acquisition of clinical skills. Each module has specific training targets and the final level of competence is reached in stages, ranging from observation through direct supervision to independent practice. Observation Prior to undertaking any clinical skill under direct supervision you must have observed the procedure on a number of occasions, have a thorough understanding of the principles of the procedure, the indication for the procedure and the complications. Once these skills have been obtained, the relevant competency box should be signed and dated and you can then move on to performing the procedure under direct supervision. Direct Supervision The time taken to acquire the necessary skills under direct supervision will depend on the complexity of the procedure and your aptitude for it. There is therefore no limit to the number of times the procedure needs to be supervised and there is no advantage in having a module signed up until you and your clinical supervisor can be certain that you can safely perform this procedure in a number of different clinical situations and levels of complexity. It is also important to be certain that when you are performing a procedure independently that you are able to deal with any unexpected complications and who to call on for help. Independent Practice The progression to independent practice will be the most difficult for you. Once you have been signed off for direct supervision you should start the process of performing

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procedures with less and less supervision as agreed by your trainer. You should only be signed off for independent practice when you and your trainer are confident that you can perform the procedure in situations when your trainer is out of the hospital. Once this competency has been attained you must keep a record of the numbers of the procedures you subsequently perform and any complications. You will need this information for revalidation and the necessary forms can be found in section eight of the Postgraduate Training Manual. Training Courses The RCOG approved Basic Surgical Skills Course (see RCOG website for course availability) is mandatory and must be undertaken by the completion of year 2. Evidence of completion will be sought at the RITA year 2 and will be a prerequisite for entry to ST3. All other courses, which are required for core training, and mentioned in the curriculum training and logbook will be provided within your Deanery. A certificate confirming attendance and, where relevant, documented confirmation of satisfactory completion of the course is required before the module can be completed and should be filed in section three of your Postgraduate Training Manual.

Section 2 – Regulations for the Certificate of Completion of Training (CCT) or the Certificate of Eligibility for Specialist Registration (CESR) Section two contains the regulations for the Certificate of Completion of Training/Certificate of Eligibility for Specialist Registration. You will find this a useful document should you have a query concerning your CCT/CESR. If you need further advice you should speak to your College Tutor or email the Secretary to the Specialist Training Committee at the RCOG.

Section 3 – Training History Section three contains a summary of your training history and information about any prolonged periods of leave. At the start of each new post you should record the region and unit you are working in and the name of your Educational Supervisor (ES). There are also areas for you to record details of any overseas or supplementary training you may have received and a further form for you to record details of all the courses and regional training days you have attended. Please file any certificates you have received from courses attended in this section. Some trainees are able to count time in research or out of programme OOPE towards training for the CCT/CESR. Prospective approval must be obtained from the Postgraduate Dean and the Chair of the Deanery Specialist Training Committee. Having obtained approval from the regional training committee, an application must be made to Specialist Training Committee at the RCOG. The STC at the RCOG will require to see your timetable and details of out of hours work before approving this time for CCT/CESR training. Generally a maximum of a year will be approved but there are exceptions. The appropriate forms for applying for approval can be found at the back of this section. Details of any such approval should be kept in this section.

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Section 4 – Induction and Appraisal You should meet with your Educational Supervisor (ES) within two weeks of starting your new post. Prior to this first meeting you MUST complete the front section of the induction/appraisal form. At this induction interview you should look together at your logbook to review your current competences and set achievable goals for further progress. Additional educational objectives, such as audit projects and study leave, should be identified with a time scale for achieving them. A record of this meeting must be made on the induction/appraisal form. You should meet with your ES on at least two further occasions at four and eight months to ensure you are making satisfactory progress and that you are on track to achieve your educational objectives. The dates of these appraisal interviews and a record of the discussion should be recorded on the induction/appraisal form and stored in your Postgraduate Training Manual (PTM) in section four. A Summary entitled “Assessment and Training – what to do and when” provides an overview of the assessment process and can be found in section four. Team Observations (TO1 & TO2) Trainees need feedback from a range of healthcare professionals and the TO1 form is to be used for this purpose. This multi source feedback tool will form part of your assessment and will inform the RITA process. The TO1 form is based on “Good Medical Practice” as defined by the GMC. You and your educational supervisor should agree on at least 10 observers. You are responsible for ensuring that these forms are distributed and returned to you in time for your Educational Sperviser to collate the report prior to the assessemt interview. Your ES may also send out additional TO1 forms as and when required. TO1 forms should be completed prior to your four and eight month meeting with your ES and the meeting you have with your ES before your RITA. The completed TO1 forms should be returned to your ES who will collate the forms onto the TO2 form. If problems are identified, then your ES working with the College Tutor will talk these over with you and implement an agreed action plan. You do have a right to view the TO1 forms and you MUST look on the comments as constructive. Observations are made by your assessors from the impressions you create, and may be at variance with your perception of yourself. The purpose of the TO1 forms is to try and close the gap. It is suggested that you include in your list of assessors at least three senior medical colleagues(consultant or senior SpR), a senior midwife on delivery suite and from the antenatal clinic, a senior nurse from the gynaecology ward and a member of the theatre team. Other appropriate staff includes midwives from other areas, staff from the specialist clinics you have been working in, anaesthetic and paediatric colleagues. Generally it is felt not appropriate to ask clerical and support staff to complete TO1 forms, although in certain situations your ES may request TO1 forms from non clinical colleagues.

Section 5 - Record of In Training Assessment (RITA) At the end of each year of training a more formal assessment of your training will be made to determine whether you can progress to the next year. This is the responsibility of the Postgraduate Dean in conjunction with the Deanery Specialist 4

Training Committee. A Record of In-Training Assessment (RITA)form will be issued after every assessment and copies must be kept in this section of your manual and a further copy forwarded to the Specialist Advisory Committee (SAC) at the RCOG. In preparation for your RITA you must meet with your ES and together complete the RITA review form detailing your educational achievements and logbook modules completed for the year. Your educational supervisor will also complete the structured reference section of this form and the TO2 form. You must complete the National Trainee Assessment Questionnaire and take it with you to the RITA. If the evidence provided at your RITA is satisfactory you will be awarded a RITA C indicating successful transition to the next training year. Deficiencies in your training or poor performance will usually result in you being awarded a RITA D, which is a recommendation for targeted training, which if successfully completed will not delay your progression to CCT/CESR. A failure to acquire the educational objectives as laid out in the RITA D will lead to the award of a RITA E. At this point, your training clock stops while you undergo a period of repeat experience with clearly defined educational objectives. Failure to achieve these objectives within the indicated time frame will lead to you being removed from the training programme. You do have a right of appeal at every stage of this process. Within six months of your anticipated CCT/CESR date you will be called up for your final RITA. At this review the entirety of your training will be reviewed and, subject to satisfactory completion, you will be issued with a RITA G form. You need to submit your signed RITA G form to the Postgraduate Training Department at the RCOG and the Secretary to the Specialty Advisory Committee will contact you directly with the relevant forms for you to complete. The RCOG will then make a recommendation to PMETB that you have completed the relevant training and are eligible for specialist registration.

Section 6 - Assessment Tools Objective Structured Assessment of Technical Skill (OSATS) There are a small number of procedures, which are so fundamental to the practice of obstetrics and gynaecology that an objective assessment tool has been developed to aid the assessment process. The OSATS is a validated assessment tool to assess your technical competency in a particular technique. The curriculum indicates those skills, which need to be assessed with OSATS, and the forms are included within the relevant module in the logbook. The OSATS should be used to help you and your trainer to assess when you are ready to move on to independent practice for a procedure and when you are ready to be signed off for independent practice. The same OSATS may be used to assess increasing levels of complexity for any particular procedure. Ten OSATS have been developed to assess those procedures that are fundamental to the practice in obstetrics and gynaecology. They are: •

Fetal blood sampling

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• • • • • • • • •

Diagnostic hysteroscopy Diagnostic laparoscopy Opening and closing the abdomen Uterine evacuation Perineal repair Caesarean section Operative vaginal delivery Operative laparoscopy Manual removal of placenta

Before the competences can be signed off in the logbook each OSATS must have been successfully completed (i.e. every box ticked for independent practice) on at least five separate occasions. When you feel ready to undertake the relevant OSATS, you will meet with your clinical supervisor who will assess the procedure and complete the OSATS form. A total of five OSATS will need to be successfully completed for the competency to be signed off in your logbook. A record of the date that each OSATS is signed off should be entered in the relevant section of the logbook module. You will need to involve at least two different assessors for this process. You must not use the same assessor for all five OSATS assessments, and a consultant must do at least one assessment. Once you have been signed up for independent practice it is recommended that in order to demonstrate continued competency in this area you have an annual OSATS assessment. Prior to undertaking an OSATS assessment you must be able to perform the procedure competently under direct supervision, and you will be required to demonstrate this on several occasions, prior to the first OSATS assessment. It is not envisaged that you will successfully complete the assessment at the first attempt and this should not be seen as failure. The department will nominate an assessor for you and in some situations will give you discretion to choose your own assessor. Taking consent for the procedure is not part of the assessment; however the taking of consent must be assessed separately using a mini-CEX. You MUST retain all OSATS assessment forms whether satisfactorily completed or otherwise. Review of these forms allows your assessor to see the progress you are making. There are two parts to the OSATS form. The first is a checklist, which breaks down the procedure into steps, all of which must be successfully completed. The second is a generic technical skills assessment. The generic technical skills, not all of which will be relevant to every OSATS, will form an important part of the assessment process. It is anticipated that to pass the OSATS you will have the majority of competences ringed in the middle or right of the generic skills assessment list. However, in order to be signed off for independent practice you must have the generic skill “fully understands areas of weakness” within the generic skill of insight/attitude consistently ringed. Trainees will proceed at different rates and the competency levels are the minimum that must be achieved prior to moving to the next stage of training.

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The OSATS form may be used to assess technical skills at differing levels of complexity e.g. the caesarean section OSATS may be used for assessing competency for a simple caesarean section or a complex caesarean section. The level of complexity should be indicated on the assessment form. Mini-Clinical Evaluation (Mini-CEX) This tool tests many different and varied competences and is a generic tool. Indicated in the curriculum are the competencies that can be tested using this tool. Copies of the relevant forms can be found in your PTM for you to reproduce as and when indicated. This tool enables your trainer to directly observe and assess you in the process of history taking, clinical examination, formulating management plans and communicating with your patient. It also allows your trainer to assess your professional and interpersonal skills. The mini-CEX is designed to take about 20 minutes to perform and the results should be fed back to you and discussed immediately after the assessment. It is suggested that a minimum of 10 mini CEX, with a variety of different trainers, are satisfactorily completed for each clinical encounter before the competency is signed off. The competencies required to be assessed in this way and the forms are in the relevant modules for completion. Case Based Discussions (CBD) This generic tool formalises case discussion with your trainer. Indicated in the curriculum are the competencies that can be tested using this tool. Copies of the relevant forms can be found in your PTM for you to reproduce as and when indicated. Trainees use CBD to document objective assessments of discussion about cases. They can be used to assess clinical decision-making, knowledge and application of that knowledge. Each case based discussion should involve slightly different clinical situations in the competency area to be tested. The discussion will focus on the information given to the patient and recorded in the notes. A minimum of 6 successfully completed CBDs will be required to have a competency signed up.

Section 7 – Reflective Practice Learning to reflect on and learn from difficult clinical situations that you have been directly involved in is a vital part of being a good doctor. Reflective practice can only occur after you have been involved in a difficult situation which will usually be clinical but could also include difficult situations occurring with colleagues. Inevitably there will have been a poor outcome and the purpose of reflection is to allow you to identify potential learning opportunities and develop your clinical practice by learning from them. For this to be a meaningful process you will need to examine previously and often firmly held beliefs about your practice and also learn to accept that you may have been wrong. Only by continuously evaluating previously held beliefs and assumptions will you be able to learn and move forward. This section of your logbook is designed to assist you in this process. If you are involved in a difficult situation record the event and your thoughts about it on the reflective practice form. You should aim to discuss these forms either with your ES or the consultant directly involved with the case. If the case has been particularly distressing for you please seek help and support quickly. 7

Section 8 - Log of Experience Once you enter advanced training you will need to keep a log of operative experience to confirm that you have been able to maintain your newly acquired skills. You should also record any complications from the procedures you have undertaken. You will need to continue to collect this information after you become a consultant for revalidation purposes.

Section 9 – Audit, Research, Publications and Formal Presentations Involvement in audit is a crucial part of the learning process. Evidence of a successfully completed audit will be expected at each of your RITA panel assessments. Failure to complete an audit may hold up progress to the next year of training. The audit may be something you have planned and undertaken on your own but may also include departmental audits that you have participated in. To be acceptable the audit must be complete and have been presented at a departmental meeting or discussed in detail with the audit supervisor. The recommendations from the audit must be also clearly recorded. In this section you need to retain copies of all presentations and audit projects with their recommendations. If you undertake any periods of research details should also be kept in this section. Case reports and peer review papers should also be stored here. You will also find a form for summarising details of publications in peer-reviewed journals.

Section 10 – Advanced Training Skills Modules In the final two years of the training programme trainees will be expected to develop professional interests commensurate with their skills and interest and future health service needs. In addition to the advanced competences as set out in the logbook, trainees will be expected to complete a number of advanced training skills modules (ATSMs) during years six and seven. Trainees will spend the majority of their working week completing the core curriculum but an absolute minimum of two half days, eight hours, per week should be ring fenced for ATSMs. Nineteen modules have been developed and trainees will choose from the mandatory list and optional list in order to gain sufficient credits prior to the award of the CCT. The trainee should discuss within their deanery which modules they are considering in years four and five to allow for local planning and educational programmes and workforce numbers. In some instances modules may be oversubscribed in which case trainees will be ‘selected’ competitively eg. following structured interviews. For the full list of ATSMs and corresponding credits please refer to the Education and Training section of the RCOG website. The completed ATSM modules should then be filed in section ten of the postgraduate training manual. The ATSM section of the website will be developed to include full details concerning the registration aspects of the new modules and the corresponding credit system. Please check the website when you are planning the ATSMs in year 6 and 7 of your training.

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In Summary It is hoped that you have been provided with all the information you require in order to commence your training programme. If you have any queries which cannot be resolved locally please refer these to the secretary to the Specialist Advisory Committee: [email protected]

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Glossary of Terms ALSO

Advanced Life Support in Obstetrics

CbD

Case based Discussion

CCT

Certificate of Completion of Training

CESR

Certificate of Registration

CEX

Clinical Evaluation Exercise

Clinical Trainer (CLT)

The Consultant assigned to a trainee who provides training during episodes of ‘direct clinical care’.

College Tutor (CT)

A consultant with at least two years’ experience as educational supervisor, accepted jointly by the Deanery Specialist Training Committee (DSTC) and the RCOG.

Eligibility

of

Specialist

Responsible for the delivery of the training programme within the unit/hospital/trust. Deanery College Adviser (DCA)

Deanery Specialist Committee (DSTC)

Elected by Fellows and Members within the region to represent their views at College meetings.

Training The Committee is formulated by the postgraduate dean in order to manage and deliver training. It is chaired by a deanery appointee, acceptable to the RCOG.

DFFP

Diploma of the Faculty of Family Planning

DISQ

Doctor’s Interpersonal Skills Questionnaire

Educational Supervisor (ES)

Consultant assigned by the College Tutor to supervise a trainee’s period of training. The superviser is responsible for the process of appraisal.

MMC

Modernising Medical Careers

MOET

Managing Obstetric Emergencies and Trauma

NICE

National Institute for Clinical Excellence

OSATS

Objective Structured Assessment of Technical Skills

PMETB

Postgraduate Medical Education and Training Board

RCOG Specialty Committee

Advisory This College committee is responsible for all aspects of the specialist training programme and makes recommendations and approves applications for the Certificate of Completion of Training.

RITA (Record of In-training Assessment carried out by the Deanery Specialist Training Committee at the end of each period of Assessment) training. SANDS

Stillbirth and Neonatal Death Society

SIGN

Scottish Intercollegiate Guidelines Network

TO

Team Observation

Training Programme Director This is an executive post appointed by the Deanery STC to organise and manage the (TPD) delivery and training within that deanery. USS

Ultrasound Scanning

JMedit/16-11-2006

The Postgraduate Training Manual Module 1 Module 2 Module 3 Module 4 Module 5 Module 6 Module 7 Module 8 Module 9 Module 10 Module 11 Module 12 Module 13 Module 14 Module 15 Module 16 Module 17 Module 18 Module 19

Basic Clinical Skills Teaching Appraisal and Assessment Information Technology, Clinical Governance and Research Ethics and Legal Issues Core Surgical Skills Postoperative Care Surgical Procedures Antenatal Care Maternal Medicine Management of Labour Management of Delivery Postpartum Problems (The Puerperium) Gynaecological Problems Subfertility Women’s Sexual and Reproductive Health Early Pregnancy Care Gynaecological Oncology Urogynaecology and Pelvic Floor Problems Professional Development

JMedit/16-11-2006

Curriculum Module 1: Basic Clinical Skills Learning outcomes: • • •

To understand and demonstrate the appropriate knowledge, skills and attitudes to perform specialist assessment of patients by means of clinical history taking and physical examination. To manage problems effectively and to communicate well with patients, relatives and colleagues in a variety of clinical situations. To demonstrate effective time management.

History taking Knowledge criteria

Clinical competency

Professional skills and attitudes

Training support

Evidence/assessment

¾ Define the patterns of symptoms in women presenting with obstetric and gynaecological problems

¾ Take and analyse an obstetric and gynaecological history in a succinct and logical manner

¾ Show empathy and develop rapport with patients

¾

¾ Mini CEX

¾ Manage difficulties of language, physical, educational and mental impairment ¾ Use interpreters and health advocates appropriately

¾ Acknowledge and respect cultural diversity ¾ Appreciate the importance of psychological factors for patients and their relatives ¾ Demonstrate an awareness of the interaction of social factors with the patient’s illness ¾ Demonstrate an awareness of the impact of health problems on the ability to function at work and at home

¾ MRCOG Part 2 ¾ MSF (TO1 and TO2)

JMedit/16-11-2006 Internal clinical examination and investigation: Knowledge criteria

Clinical competency


Training support

Evidence/assessment

¾ Understand the pathophysiological basis of physical signs

¾ Perform a reliable and appropriate examination, including:

¾ Respect patients’ dignity and confidentiality

¾ GMC Good Medical Practice

¾ Logbook

¾ Acknowledge and respect cultural diversity

¾ Maintaining Good Medical Practice in Obstetrics and Gynaecology: the Role of the RCOG (RCOG, February 1999; ISBN 1-900364-22-0)

¾ Understand the indications, risks, benefits and effectiveness of investigations

•

Breast examination Abdominal examination Nonpregnant Pregnant • Vaginal examination Bimanual Cusco’s, Sims’ speculum • Microbiology swabs Throat, vagina, cervix, urethra, rectum Cervical smear •

¾ Perform investigations competently where relevant ¾ Interpret the results of investigations ¾ Liaise and discuss investigations with colleagues

¾ Involve relatives appropriately ¾ Be aware of Fraser competence issues ¾ Appreciate the need for a chaperone ¾ Appreciate the need for a patient to seek a female attendant ¾ Provide explanations to patients in language they can understand ¾ Insight into ones ability and the need to ask for help

¾ Gynaecological Examinations: Guidelines for Specialist Practice (RCOG, July 2002, 1900364-77-8) ¾

¾ Reflective diary

JMedit/16-11-2006 Note keeping: Knowledge criteria

Clinical competency


Training support

Evidence/assessment

¾ Understand the importance and conventions of accurate clinical note keeping

¾ Record and communicate concisely, accurately, confidentially and legibly the results of the history, examination, investigations, differential diagnosis and management plan

¾ Appreciate the importance of timely dictation, cost effective use of medical secretaries and increasing use of electronic communication

¾ Caldicott Committee Report on the review of patient identifiable information (DH, 1997)

¾ TO1 and 2 forms

¾ Know the relevance of data protection pertaining to patient confidentiality

¾ Mark each note entry with date, signature, name and status

¾ Understand the limitations and problems of electronic communication ¾ Communicate promptly and accurately with primary care and other agencies ¾ Demonstrate courtesy towards secretaries, clerical and other staff

¾

JMedit/16-11-2006 Time management and decision making: Knowledge criteria

Clinical competency

¾

¾ Prioritise tasks

Understand clinical priorities


¾ Have realistic expectations of tasks to be completed and ¾ Work with increasing efficiency timeframe for tasks as clinical skills develop ¾ Have the ability to prioritise ¾ Know when to get help workload ¾ Anticipate future clinical events ¾ Appreciate the internal signs of and plan appropriately one’s own stress and ask for help ¾ Be willing to consult and work as part of a team ¾ Be receptive to feedback on performance ¾ Learn to be flexible and be willing to take advice and change in the light of new information

Training support

Evidence/assessment

¾

¾ TO1 and 2 ¾ MRCOG part 2

JMedit/16-11-2006 Communication: Knowledge criteria

Clinical competency


Training support

Evidence/assessment

¾ Understand the components of effective verbal and nonverbal communication

¾ Demonstrate listening skills

¾ Demonstrate an ability to:

¾ Local and regional courses in ‘breaking bad news’

¾ TO1 and 2

¾ Use open questions where possible ¾ Avoid jargon ¾ Communicate clearly both verbally and in writing to patients, including those whose first language may not be English ¾ Give clear information and feedback and share communication with patients and relatives ¾ Break bad news sensitively

• • • • •

Involve patients in decision making Offer choices Acknowledge and respect diversity Respect patients’ views Use appropriate non-verbal communication

¾ RCOG patient information (www.rcog.org.uk) ¾ StratOG.net: The Obstetrician and Gynaecologist as a Teacher and Researcher. Communication skills e-tutorial ¾ SANDS guidance for professionals

¾ MRCOG Part 2 ¾ Mini CEX ¾ MSF

JMedit/16-11-2006 MODULE 1

TOPIC: Basic clinical skills Competence level: Basic training

Skills

History taking Take and analyse an obstetric history Take and analyse a gynaecological history Appropriate use of interpreters Clinical examination and investigation Breast examination Abdominal examination: Nonpregnant Pregnant Speculum examination: Cusco’s Sims’ Take microbiology swabs: Vagina Cervix Urethra

Intermediate training

Advanced training

Observation

Direct supervision

Independent practice

Date

Dates

Dates

Signature

Signature

Signature

JMedit/16-11-2006 Perform cervical cytology screening

Training courses or sessions Title Breaking bad news

Signature of educational supervisor

Authorisation of signatures – please print your name and sign Name (please print)

Signature

Completion of Module 1 I confirm that all components of the module have been successfully completed: Date Name of Educational Superviser Signature of Educational Superviser

Date

JMedit/16-11-2006

Curriculum Module 2: Teaching, Appraisal and Assessment Learning outcomes: • •

To understand and demonstrate the knowledge, skills and attitudes to provide appropriate teaching, learning opportunities, appraisal, assessment and mentorship. To acquire the knowledge and skills to cope with and to understand the ethical and legal issues which occur during the management of obstetric and gynaecological patients.

Teaching: Knowledge criteria

Clinical competency


Training support

Evidence/assessment

¾ Understand the principles of adult learning

¾ Facilitate the learning process

¾ Demonstrate the ability to set objectives and structure of educational session

¾ Local and regional Courses in presentation skills

¾ Logbook

¾ Demonstrate the ability to present a teaching session with audience participation

¾ StratOG.net: The Obstetrician and Gynaecologist as a Teacher and Researcher. Teaching e-tutorial

¾ Understand the skills and practices of a competent teacher ¾ Identify learner needs and learning styles ¾ Understand the principles of giving feedback

¾ Use varied teaching strategies appropriate to audience and context (including one-to-one, small and large groups, formal lectures) ¾ Use of audiovisual aids effectively

¾ Demonstrate the ability to achieve rapport

¾ Prepare teaching session

¾ Demonstrate the skills to evaluate a training event and act upon feedback

¾ Identify teaching strategies appropriate to adult learning

¾ Teach in small (< 10) and large groups (> 20) and ‘at the bedside’

¾ ¾ Identify of learning principles, needs and styles

¾ Teach some practical procedures (including ultrasound)

¾ Understand the principles of evaluation

¾ Demonstrate the ability to communicate effectively ¾ Demonstrate the ability to teach on various topic(s) using appropriate teaching resources ¾ Participate in the organisation of a programme of postgraduate education, e.g. short course or multidisciplinary meeting

¾ Observation of and discussion with senior medical staff ¾ Appropriate postgraduate courses

¾ Reflective diary ¾ Feedback summaries ¾ MSF

JMedit/16-11-2006 Appraisal: Knowledge criteria

Clinical competency


Training support

Evidence/assessment

¾ Understand the difference between appraisal and assessment

¾ Perform effective appraisal

¾ Acknowledge and respect cultural diversity

¾ StratOG.net: The Obstetrician and Gynaecologist as a Professional. Appraisal, Mentoring and Reflective practice e-tutorials

¾ Logbook

¾ Understand the importance of appraisal and the qualities of a good appraiser ¾ Know the principles of appraisal and the structure of the appraisal interview ¾ Understand the principles of mentoring

¾ Assess objectivity in appraisal and use of methodical, structured approach

¾ Demonstrate the ability to deal with conflict ¾ Have the ability to deal with a trainee in difficulty and the difficult trainee ¾ Be prepared to act as a mentor (for RCOG definition see www.rcog.org.uk)

¾ StratOG.net: The Obstetrician and Gynaecologist as a Teacher and Researcher. Assessment e-tutorial ¾ Local educational session ¾ Appraisal and assessment ¾ Equal opportunity training

Assessment

¾ Reflective diary

JMedit/16-11-2006 Knowledge criteria

Clinical competency


Training support

Evidence/assessment

¾ Understand the difference between assessment and appraisal

¾ Perform appropriate assessments

¾ Have the ability to assess performance honestly and objectively

¾ Training the Trainers Course

¾ Logbook

¾ Understand the reasons for assessment

¾ Use appropriate assessment methods

¾ Know different assessment methods and when to use them appropriately

¾ Acquire the necessary skills to give constructive and effective feedback

¾ Be aware of the differences between formative and summative assessment

MODULE 2

Competence level: Basic training

Date D

Large group teaching Formal lecture One-to-one teaching at the bedside Teaching practical procedures Organisation of teaching

¾ StratOG.net: The Obstetrician and Gynaecologist as a Teacher and Researcher. Assessment e-tutorial

TOPIC: Teaching, appraisal and assessment

Skill

Teaching Small group teaching

¾ Reflective diary

¾ Local educational session

Intermediate training

Observation

Direct supervision

Signature

Date

Signature

Advanced training Independent practice Date

Signature

JMedit/16-11-2006 Appraisal Perform effective appraisal Assessment Perform appropriate assessments

Training courses or sessions Title Appraisal and assessment Presentation skills Teaching skills


Date

JMedit/16-11-2006 Authorisation of signatures – please print your name and sign Name (please print)

Signature


JMedit/16-11-2006

Curriculum Module 3: Information Technology, Clinical Governance and Research Learning outcomes: • • •

To understand and demonstrate appropriate knowledge, skills and attitudes in the use and management of health information. To have an understanding of the context, meaning and implementation of clinical standards and governance. To know and understand the audit cycle and to have knowledge of research methodology.

Use of information technology: Knowledge criteria

Clinical competency


Training support

¾ Understand the principles of storage, retrieval, analysis and presentation of data

¾ Retrieve and use data recorded in clinical systems

¾ Demonstrate the ability to apply IT solutions in the management of patients

¾ IT courses

¾ Understand the effective use of computing systems ¾ Understand the range of uses of clinical data and its effective interpretation ¾ Be aware of the confidentiality issues

¾ Demonstrate appropriate use of IT for patient care and for personal development ¾ Demonstrate competent use of databases, word processing techniques, statistics programmes and electronic mail ¾ Undertake searches and access web sites, and healthrelated databases ¾ Present data in an understandable manner

¾ Adopt a proactive and enquiring attitude to new technology

¾ StratOG.net: The Obstetrician and Gynaecologist as a Teacher and Researcher. Data handling, Research and Assessing evidence e-tutorials

Evidence/assessment

JMedit/16-11-2006 Clinical governance: audit: Knowledge criteria

Clinical competency


Training support

Evidence/assessment

¾ Understand the audit cycle

¾ Perform an audit exercise:

¾ Show how the use of audit can improve clinical practice

¾ Understanding Audit (RCOG; October 2003)

¾ Presentation at audit meeting

¾ Principles for best practice in audit (NICE)

¾ Logbook

¾ Understand clinical effectiveness: • • •

Principles of evidencebased practice Types of clinical trial and evidence classification Grades of recommendation

¾ Understand guidelines and integrated care pathways: • Formulation • Advantages and disadvantages

• • • •

Define standard Prepare project Collate data Formulate policy

¾ Repeat audit cycle; perform clinical audit: • • • •

Define standard based on evidence Prepare project and collate data Re-audit and close audit loop Formulate policy

¾ Develop and implement a clinical guideline: • • • •

Purpose and scope Identify and classify evidence Formulate recommendations Identify auditable standards

¾ Ability to perform a clinical audit ¾ Ability to develop and implement a clinical guideline ¾ StratOG.net: The Obstetrician and Gynaecologist as a Professional. Clinical governance e-tutorial

¾ Reflective diary ¾ Part 2 MRCOG ¾ RITA

JMedit/16-11-2006 Clinical governance: clinical standards: Knowledge criteria

Clinical competency


Training support

Evidence/assessment

¾ Understand the definitions and relevance of levels of evidence

¾ Review evidence

¾ Searching for Evidence (RCOG, October 2001)

¾ Logbook

¾ Prepare a protocol

¾ Have the skills to be able to discuss the relevance of evidence in the clinical situation

¾ Critically appraise publications and evaluate multicentre trials

¾ Acknowledge and show regard for individual patient needs when using guidelines

¾ Critically evaluate a care pathway

¾ Be aware of advantages and disadvantages of guidelines and protocols, and use them appropriately

¾ Understand the development and application of clinical guidelines, integrated care pathways and protocols ¾ Understand the organisational framework for clinical governance at local, SHA and national levels ¾ Understand standards, e.g. NSF, NICE, RCOG guideline

¾ Evaluate guidelines

¾ Ability to practice evidencebased medicine ¾ StratOG.net: The Obstetrician and Gynaecologist as a Professional. Clinical governance e-tutorial

¾ Reflective diary ¾ MRCOG Part 2 ¾ Presentation to colleagues ¾ RITA

JMedit/16-11-2006 Clinical governance: risk management: Knowledge criteria

Clinical competency


Training support

Evidence/assessment

¾ Know the principles of risk management and their relationship to clinical governance

¾ Report and review critical incidents

¾ Demonstrate respect and accept patients’ views and choices

¾ Logbook

¾ Discuss risks with patients

¾ Display eagerness to use evidence in support of patient care when evaluating risk

¾ Clinical Risk Management for Obstetricians and Gynaecologists (RCOG, January 2001) ¾ GMC: Good Medical Practice

¾ Presentation at risk management meetings

¾ Understand complaints procedures and risk management: • • •

incidents/near miss reporting complaints management litigation and claims management

¾ Patient/user involvement

¾ Document adverse incidents ¾ Prepare a report relating to an adverse incident ¾ Participate in risk management ¾ Investigate a critical incident: • • •

Assess risk Formulate recommendations Debrief staff

¾ Show probity by being truthful and be able to admit error to patients, relatives and colleagues

¾ Clinical Governance Bulletin series (DH funded) www.clinicalgovernance.com

¾ Demonstrate the ability to act constructively when a complaint is made

¾ StratOG.net: The Obstetrician and Gynaecologist as a Professional. Clinical governance e-tutorial

¾ Reflective diary ¾ MRCOG Part 2

JMedit/16-11-2006 Research: Knowledge criteria

Clinical competency


Training support

Evidence/assessment

¾ Understand the difference between audit and research

¾ Appraise a scientific paper

¾ Have the ability to be receptive to innovations resulting from research publications

¾ GMC Duties of a Doctor (www.gmc-uk.org)

¾ Logbook

¾ Understand how to plan and analyse a research project ¾ Understand statistical methods

¾ Evaluate a multicentre trial ¾ Understand the principles of critical reading and undertake critical review of scientific literature

¾ Know the principles of research ethics and conflicts of interest

¾ Acquire skills to put research findings into practice ¾ Be aware of the issues underlying plagiarism and how this relates to the duties of a doctor

¾ Local and RCOG courses ¾ StratOG.net: The Obstetrician and Gynaecologist as a Teacher and Researcher etutorials ¾ Introduction to Research Methodology, 2nd edition (RCOG Press, 2006)

¾ Reflective diary ¾ MRCOG Part 2 ¾ Presentations at journal club meetings ¾ Publications ¾ RITA

Patient Public Involvement Knowledge criteria

Clinical competency


Training support

Evidence/assessment

¾ Understand the principles of Patient Public Involvement

¾ Undertake a project on Patient Public Involvement

¾ Practice patient-centred care at all times

¾ Local courses

¾ Observation of clinical practice

¾ Involve patient and carers in decision making ¾ Demonstrate skill in information giving

¾


TOPIC: Information technology, clinical governance and research Competence Level: Basic Training


Advanced Training

Skill Observation Date Audit Perform an audit Clinical governance Prepare or revise a guideline or care pathway Deal effectively with complaint Appraisal Participate in NHS appraisal Risk management Present at risk management meeting Research Critically appraise a scientific paper

Signature

Direct supervision

Independent practice

Date

Date

Signature

Signature

JMedit/16-11-2006


Signature

Completion of Module 3 I confirm that all components of the module have been successfully completed Date Name of Educational Superviser Signature of Educational Superviser

JMedit/16-11-2006 Consent: Knowledge criteria

Clinical competency


Training support

¾ Understand the principles and legal issues surrounding informed consent

¾ Use written material correctly and accurately

¾ Demonstrate the ability to give appropriate information in a manner that patients and relatives understand and assess their comprehension

¾ StratOG.net: The Obstetrician and Gynaecologist as a Professional. Ethical and legal issues e-tutorial

¾ Understand specific legal issues about consent in under 16-year-olds and vulnerable adults ¾ Understand the implications of the Sexual Offences Act 2003 ¾ Be aware of diversity ¾ Be aware of the implications of the legal status of the unborn child ¾ Understand appropriateness of consent to postmortem examination

¾ Gain valid consent from patients and know when to ask for a second opinion ¾ Discuss clinical risk ¾ Know when to involve social services and police and how to do so

¾ Show an awareness of the patient’s needs as an individual ¾ Respect diversity

¾ Informed consent and minimum standards of communication ¾ DH guidance on consent (www.dh.gov.uk) ¾ Obtaining Valid Consent (RCOG, October 2004) ¾ RCOG Consent Advice Series (www.rcog.org.uk) ¾ RCOG Ethics Guideline No. 1: Law and Ethics in Relation to Court-authorised Obstetric Intervention (RCOG, October 2006) ¾ www.homeoffice.gov.uk/justi ce/sentencing/sexualoffencesb ill

Evidence/assessment

JMedit/16-11-2006 Confidentiality: Knowledge criteria

Clinical competency


Training support

Evidence/assessment

¾ Be aware of relevant strategies to ensure confidentiality

¾ Use and share information appropriately

¾ Respect the right to confidentiality

¾ Confidentiality and Disclosure of Health Information: RCOG Ethics Committee comments on BMA document October 2000

¾

¾ Be aware when confidentiality might be broken ¾ Understand the principles of data protection including electronic and administrative systems ¾ Understand the role of interpreters and patient advocates

¾ Be aware of the requirements of children, adolescents and patients with special needs

¾ Caldicott Committee Report on the Review of Patient Identifiable Information (DH; 1997) ¾ GMC Good Medical Practice ¾ StratOG.net: The Obstetrician and Gynaecologist as a Professional. Ethical and legal issues e-tutorial

JMedit/16-11-2006 Legal issues relating to medical certification: Knowledge criteria

Clinical competency


Training support

¾ Know the legal responsibilities of completing maternity, birth, sickness and death certificates

¾ Complete relevant medical certification

¾ Have the ability to know how to obtain suitable evidence and whom to consult

¾ Local courses

¾ Understand abortion certificates HSA 1 and HSA 4 and be aware of exemptions for those who will not participate in abortion services for moral or religious reasons ¾ Know the types of deaths that should be referred to the Coroner/Procurator Fiscal ¾ Understand the principles of advance directives and living wills ¾ Be aware of the indications for section under the Mental Health Act

¾ Act with compassion at all times

¾ Registration of Stillbirths and Certification for Pregnancy Loss before 24 Weeks of Gestation (RCOG, January 2005) ¾ StratOG.net: The Obstetrician and Gynaecologist as a Professional. Ethical and legal issues

Evidence/assessment


TOPIC: Ethics and legal issues Competence level: Basic Training Observation Date

Signature


Advanced Training

Direct Supervision Dates

Signature

Independent Practice Dates

Signature

Consent: Obtain valid consent* Ability to discuss clinical risk Consent for neonatal post mortem examination Legal: Attend CNST meeting or equivalent for Scotland and Wales *Trainees may only obtain consent for those procedures with which they are familiar and performing either under direct supervision of independently. While trainees may observe obtaining consent for a postmortem examination after a maternal death or a death of a gynaecological patient, there is no expectation that they will start to obtain consent until after completion of core training.

JMedit/16-11-2006

Authorisation of signatures – please print your name and sign below Name (please print)

Signature

*Trainees may only obtain consent for those procedures with which they are familiar and performing either under direct supervision of independently. While trainees may observe obtaining consent for a post mortem after a maternal death or a death of a gynaecological patient there is no expectation that they will start to obtain consent until after completion of core training


JMedit/16-11-2006

Curriculum Module 5: Core Surgical Skills Learning outcomes: •

To understand and demonstrate appropriate knowledge, skills and attitudes in relation to basic surgical skills.

Knowledge criteria

Clinical competency


Training support

Evidence/assessment

¾ Legal issues around consent to surgical procedures, including consent of children, adults with incapacity and adults and children in emergency situations

¾ Interpret preoperative investigations

¾ Recognise the need for and initiate collaboration with other disciplines, before, during and after surgery

¾ Basic Surgical Skills Course

¾ Logbook

¾ Obtaining Valid Consent (RCOG, October 2004)

¾ Audit project

¾ Name and mode of use of common surgical instruments and sutures

¾ Obtain valid consent

¾ Complications of surgery

¾ Advise patient on postoperative course

¾ Regional anatomy and histology ¾ Commonly encountered infections, including an understanding of the principles of infection control ¾ Principles of nutrition, water, electrolyte and acid base balance and cell biology ¾ Appropriate use of blood and blood products ¾ General pathological principles

¾ Arrange preoperative management ¾ Recognise potential comorbidity ¾ Explain procedures to patient

¾ Within agreed level of competency for the procedure you may: • • • • •

Choose appropriate operation Exhibit technical competence Make intraoperative decisions Manage intraoperative problems Communicate with colleagues and relatives

¾ Demonstrate the ability to select the operative procedure with due regard to degree of urgency, likely pathology and anticipated prognosis ¾ Have an awareness of the need to meet national targets ¾ Develop the ability to work under pressure and recognise own limitations ¾ Show the need to appreciate and recognise that decision making is a collaborative process between doctor and patient

¾ RCOG Consent Advice series ¾ DH website ¾ Local courses ¾ StratOG.net: The Obstetrician and Gynaecologist as a Professional. Ethical and legal issues

¾ MRCOG Parts 1 and 2 ¾ OSATS: opening and closing abdomen

JMedit/16-11-2006

Appendix to Curriculum Module 5: Details of Knowledge Criteria ¾ Legal issues around consent to surgical procedures, including consent of minors (and Fraser competency), adults with incapacity and adults and children in emergency situations. ¾ Name and mode of use of common surgical instruments. ¾ Knowledge of sutures and their appropriate use. ¾ Prevention and complications of surgery including: • • •

venous thromboembolism infection (wound, urinary tract, respiratory, intra-abdominal and pelvic) primary and secondary haemorrhage (intraoperative and postoperative).

¾ Relevant clinical anatomy. ¾ Relevant bones, joints, muscles, blood vessels, lymphatics, nerve supply and histology. ¾ Characteristics, recognition, prevention, eradication and pathological effects of all commonly encountered bacteria, viruses, Rickettsia, fungi, protozoa, parasites and toxins, including an understanding of the principles of infection control. ¾ Principles of nutrition, water, electrolyte and acid base balance and cell biology. ¾ Knowledge and awareness of anaesthesia: general anaesthetic, conscious sedation, regional and local. ¾ General pathological principles, including general, tissue and cellular responses to trauma, infection, inflammation, therapeutic intervention (especially by the use of irradiation, cytotoxic drugs and hormones), disturbances in blood flow, loss of body fluids, hyperplasia and neoplasia. ¾ Knowledge and awareness of use in complications of diathermy and other energy sources.


TOPIC: Core Surgical Skills Competence level: Basic Training


Advanced Training

Skills Observation Dates Interpret preoperative investigations Arrange preoperative management Obtain informed consent Choose appropriate operation Open and close the abdomen Exhibit technical competence Make appropriate operative decisions Manage intraoperative problems

Signature

Direct supervision Dates

Signature

Independent practice Dates

Signature

JMedit/16-11-2006 Training Courses or sessions Title Obtaining consent


Basic Surgical Skills (RCOG approved)


Signature

Date

JMedit/16-11-2006 OSAT

Each OSAT should be successfully completed for Independent Practice on 5 occasions before the module can be signed off

Opening and closing the abdomen

Date

Date

Date

Date

Date

Signat ure

Signature

Signature

Signature

Signature

Completion of Module 5 I confirm that all components of the module have been satisfactorily completed: Date Signature of Educational Superviser Name of Educational Superviser

JMedit/16-11-2006 OPENING AND CLOSING THE ABDOMEN Assessor Name:

Trainee Name:

Date:

Post:

Level of training: Grade/Year Clinical details of complexity/ difficulty of case

Performed Needs independently help PLEASE TICK RELEVANT BOX Item under observation: opening Appropriate preoperative preparation: bladder empty, prepare and drape abdomen Appropriate skin incision (e.g. length, position) with safe use of surgical knife Subcutaneous fascia opened with attention to haemostasis Rectus sheath incised either side of linea alba, extended with scissors and dissected off rectus muscle with attention to haemostasis Safe entry of peritoneal cavity by either sharp or blunt dissection Item under observation: closing Identification of peritoneal edge and closure (optional) using appropriate suture material, instruments and technique Ensure haemostasis of peritoneum and posterior surface of rectus sheath Secure closure of rectus sheath using appropriate suture material, instruments and technique for knot tying and placement of sutures Ensure haemostasis before skin closure Accurate skin closure using appropriate method, instruments and technique (trainees should demonstrate competence in the full range of closure methods) Appropriate and safe use of needle holder: needle loaded correctly, no touch technique, no inappropriate movements Comments (please state skin closure method)

Examples of minimum levels of complexity for each stage of training: ST1 Intermediate Training CCT

Patient with no previous lower transverse incision Patient with previous lower transverse incision but without suspicion of severe abdominal adhesions Patient with previous abdominal surgery and likely severe abdominal adhesions

Both sides of this form to be completed and signed

JMedit/16-11-2006

GENERIC TECHNICAL SKILLS ASSESSMENT Assessor, please ring the candidate’s performance for each of the following factors: Respect for tissue

Frequently used unnecessary force on tissue or caused damage by inappropriate use of instruments.

Careful handling of tissue but occasionally causes inadvertent damage.

Consistently handled tissues appropriately with minimal damage.

Time, motion and flow of operation and forward planning

Many unnecessary moves. Frequently stopped operating or needed to discuss next move.

Makes reasonable progress but some unnecessary moves. Sound knowledge of operation but slightly disjointed at times.

Economy of movement and maximum efficiency. Obviously planned course of operation with effortless flow from one move to the next.

Knowledge and handling of instruments

Lack of knowledge of instruments.

Competent use of instruments but occasionally awkward or tentative.

Obvious familiarity with instruments.

Suturing and knotting skills as appropriate for the procedure

Placed sutures inaccurately or tied knots insecurely and lacked attention to safety.

Knotting and suturing usually reliable but sometimes awkward.

Consistently placed sutures accurately with appropriate and secure knots and with proper attention to safety.

Technical use of assistants Relations with patient and the surgical team

Consistently placed assistants poorly or failed to use assistants. Communicated poorly or frequently showed lack of awareness of the needs of the patient and/or the professional team.

Appropriate use of assistant most of the time. Reasonable communication and awareness of the needs of the patient and/or of the professional team.

Strategically used assistants to the best advantage at all times. Consistently communicated and acted with awareness of the needs of the patient and/or of the professional team.

Insight/attitude

Poor understanding of areas of weakness.

Some understanding of areas of weakness.

Fully understands areas of weakness.

Documentation of procedures

Limited documentation, poorly written.

Adequate documentation but with some omissions or areas that need elaborating.

Comprehensive legible documentation, indicating findings, procedure and postoperative management.

Please complete the relevant box

Needs further help with: * *

Competent to perform the entire procedure without the need for supervision

Date

Date

Signed (trainer)

Signed

Signed (trainee)

Signed

JMedit/16-11-2006

Curriculum Module 6: Postoperative Care Learning outcomes: •

To understand and demonstrate appropriate knowledge, skills and attitudes in relation to postoperative care.

Knowledge criteria

Clinical competency


Training support

Evidence/assessment

¾ General pathological principles of postoperative care

¾ Make appropriate postoperative plans for management, including investigation

¾ Recognise the need and initiate collaboration with other disciplines

¾ Basic Surgical Skills course (RCOG approved)

¾ Morbidity and Mortality meetings attended

¾ Postoperative complications related to obstetric, gynaecological and nongynaecological procedures ¾ Fluid/electrolyte balance ¾ Wound healing ¾ Late postoperative complications, including secondary haemorrhage

¾ Conduct appropriate review of: • • • •

fluid/electrolyte balance catheter surgical drainage sutures

¾ Manage complications, including wound, thromboembolism and infection ¾ Deal competently with the unexpected complications, e.g. bladder or ureteric injury ¾ Offer psychological support for patients and relatives ¾ Initiate management for secondary haemorrhage

¾ Demonstrate the need for effective communication with other healthcare professionals ¾ Demonstrate the need for effective communication with patients and relatives ¾ Document the surgical procedure with appropriate notes ¾ Construct an appropriate discharge letter ¾ Recognise personal limitation and the need for appropriate referral

¾ RCOG guidelines on thromboembolism ¾ StratOG.net: Surgical Procedures and Postoperative Care e-tutorials

¾ Audit project ¾ MRCOG Part 2 ¾ Reflective diary


TOPIC: Postoperative care

Competence level: Basic Training


Advanced Training

Skill

Conduct appropriate review of: Fluid/electrolyte balance Catheter Surgical drainage Sutures Wound complications Communicate: With colleagues With relatives Explain procedure to patient Advise on postoperative progress Manage postoperative complications, collaborating with others where appropriate: Gynaecological Non-gynaecological

Observation

Direct Supervision

Independent Practice

Date

Date

Date

Signature

Signature

Signature

JMedit/16-11-2006 Late complications

Training courses or sessions Title



Signature

Completion of Module 6 I confirm that all components of the module have been satisfactorily completed: Date Signature of Educational Superviser

Name of Educational Superviser

Date

JMedit/16-11-2006

Curriculum Module 7: Surgical Procedures Learning outcomes: •

To understand and demonstrate appropriate knowledge, skills and attitudes in relation to surgical procedures.

Knowledge criteria

Clinical competency


Training support

Evidence/assessment

¾ Relevant basic sciences

¾ Marsupialisation of Bartholin’s abscess

¾ Have the knowledge to choose appropriate instruments, sutures, drains and catheters

¾ Observation of, assisting and discussion with senior medical staff

¾ OSATS Diagnostic laparoscopy

¾ Know own limitations and when to seek help

¾ Useful websites:

¾ Knowledge of instruments and sutures

¾ Evacuation of uterus ¾ Diagnostic laparoscopy ¾ Sterilisation ¾ Polypectomy ¾ First-trimester surgical termination (unless conscientious objection) ¾ Diagnostic hysteroscopy ¾ Minor cervical procedures ¾ Excision of vulval lesions ¾ Laparotomy for ectopic pregnancy ¾ Ovarian cystectomy for benign disease ¾ Elective perineal adhesiolysis ¾ Myomectomy

¾ Demonstrate the use of diathermy, endoscopic and other equipment safely and efficiently ¾ Show evidence of thinking ahead during procedure ¾ Have the ability to alter the surgical procedure appropriately when necessary following consultation ¾ Demonstrate the ability to work effectively with other members of the theatre team, taking a leadership role where appropriate ¾ ¾

• • •

www.rcog.org.uk www.nice.org.uk www.sign.ac.uk

¾ StratOG.net: Surgical Procedures and Postoperative Care e-tutorials

¾ OSATS Operative laparoscopy ¾ Successful Patient Outcomes ¾ Logbook ¾ Reflective diary ¾ RITA ¾ OSATS Diagnostic Hysteroscopy


TOPIC: Surgical procedures

Competence level: Basic Training


Advanced Training

Skills Observation Date Signature Evacuation of uterus Marsupialisation of Bartholin’s cyst Laparotomy for ectopic pregnancy Laparoscopy management ectopic pregnancy Excision of vulval lesions Abdominal hysterectomy ± bilateral salpingooophorectomy Oophorectomy Ovarian cystectomy Adhesiolysis Transabdominal myomectomy Diagnostic laparoscopy Management of pelvic abscess Laparoscopic sterilisation Diagnostic hysteroscopy

Direct Supervision Date Signature s

Independent Practice Dates Signature

JMedit/16-11-2006 Hysteroscopy and polypectomy Minor cervical procedures Elective perineal operations

Training courses or sessions Title


Surgical Skills course (RCOG approved)


Signature

Date

JMedit/16-11-2006 OSAT

Each OSAT should be successfully completed for Independent Practice on 5 occasions before the module can be signed off

Diagnostic laparoscopy

Date

Date

Date

Date

Date

Signature

Signature

Signature

Signature

Signature

Date

Date

Date

Date

Date

Signature

Signature

Signature

Signature

Signature

Date

Date

Date

Date

Signature

Signature

Signature

Signature

Operative laparoscopy

Diagnostic Date hysteroscopy Signature

Completion of Module 7 I confirm that all components of the module have been satisfactorily completed Date Signature of Educational Superviser

Name of Educational Superviser

JMedit/16-11-2006 DIAGNOSTIC LAPAROSCOPY Trainee Name: Level of training:

Assessor Name: Post:

Preparation of the patient

Date:

Performed independently

Needs help

Not applicable

PLEASE TICK RELEVANT BOX Ensures correct positioning of the patient Checked or observed catheterisation, pelvic examination and insertion of uterine manipulator where appropriate Establishing pneumoperitoneum Demonstrates knowledge of instruments and can trouble shoot problems Check patency and function of Veress (if used) Correct incision Controlled insertion of Veress (if used) Insufflation to at least 20 mmHg Controlled insertion of primary port Controlled insertion of secondary port under direct vision Operative procedure Maintains correct position of optics Clear inspection of pelvic and abdominal structures Movements: fluid and atraumatic Appropriate use of assistants (if applicable) Correct interpretation of operative findings Removal of ports under direct vision Deflation of pneumoperitoneum Appropriate skin closure


JMedit/16-11-2006 GENERIC TECHNICAL SKILLS ASSESSMENT Assessor, please ring the candidate’s performance for each of the following factors: Respect for tissue


Careful handling of tissue but occasionally causes inadvertent damage.




Makes reasonable progress but some unnecessary moves. Sound knowledge of operation but slightly disjointed at times.








Consistently placed assistants poorly or failed to use assistants. Communicated poorly or frequently showed lack of awareness of the needs of the patient and/or the professional team.





Fully understands areas of weakness




Suturing and knotting skills as Placed sutures inaccurately or appropriate for tied knots insecurely and the procedure lacked attention to safety. Technical use of assistants Relations with patient and the surgical team

Insight/attitude


Please complete the relevant box Needs further help with: * *

Competent to perform the entire procedure without the need for supervision.

Date

Date

Signed (trainer)

Signed (trainer)

Signed (trainee)

Signed (trainee)

JMedit/16-11-2006 OPERATIVE LAPAROSCOPY Trainee name: Level of training: Grade/Year

Assessor Name:

Date:

Post:

Clinical details of complexity/difficulty of case


Needs help

Not applicable

PLEASE TICK RELEVANT BOX Preparation of the patient: Ensures correct positioning of the patient, catheterisation and insertion of uterine manipulator Patient habitus Laparoscopic entry: Safe use of Veress needle (if used) Safe insertion primary port Appropriate position of and safe insertion of secondary ports Operative procedure: Maintains good view of operative field Uses appropriate instruments for the task Knowledge and safe use of energy modalities in laparoscopic surgery Identifies important anatomical structures (ureter, internal iliac artery/vein) Shows efficiency of movement and demonstrates good three dimensional spatial awareness Appropriate use of assistants (if applicable) Examples of minimum levels of complexity for each stage of training: ST1 Laparoscopic clip sterilisation Core Training Bipolar diathermy to endometriosis Aspiration of fluid form pouch of Douglas Aspiration of ovarian cyst Ectopic pregnancy CCT Salpingectomy Oophrectomy Both sides of this form to be completed and signed



Careful handling of tissue but occasionally caused inadvertent damage.




Made reasonable progress but some unnecessary moves. Sound knowledge of operation but slightly disjointed at times.









Consistently placed assistants poorly or failed to us assistants. Communicated poorly or frequently showed lack of awareness of the needs of the patient and/or the professional team.









Suturing and knotting skills as appropriate for the procedure Technical use of assistants Relations with patient and the surgical team

Insight/attitude




Competent to perform the entire procedure without the need for supervision Date

Date Signed (trainer) Signed (trainer) Signed (trainee) Signed (trainee)

JMedit/16-11-2006 DIAGNOSTIC HYSTEROSCOPY

Trainee name: Level of training:

Assessor name: Post:

Date:


Needs help

Not applicable

PLEASE TICK RELEVANT BOX Preparation of the patient: Supervises positioning of patient – correct as required Preps and drapes correctly Assembles equipment Chooses appropriate distension medium Demonstrates knowledge of equipment and can trouble shoot problems Operative procedure: Correct use of speculum and tenaculum Correct use of cervical dilators (if needed) Inserts hysteroscope into uterine cavity under direct vision Clear inspection of entire uterine cavity Correct interpretation of findings Correct technique to obtain endometrial biopsy if appropriate Careful removal of tenaculum




Careful handling of tissue but occasionally caused inadvertent damage.




Made reasonable progress but some unnecessary moves. Sound knowledge of operation but slightly disjointed at times.






Suturing and knotting skills as appropriate for the procedure




Technical use of assistants Relations with patient and the surgical team

Consistently placed assistants poorly or failed to us assistants. Communicated poorly or frequently showed lack of awareness of the needs of the patient and/or the professional team.



Insight/attitude









Competent to perform the entire procedure without the need for supervision Date

Date Signed (trainer) Signed (trainer) Signed (trainee) Signed (trainee)

JMedit/16-11-2006

Curriculum Module 8: Antenatal care Learning outcomes: •

To understand and demonstrate appropriate knowledge, skills and attitudes in relation to antenatal care.

Knowledge criteria

Clinical competency


Training support

Evidence/assessment

¾ Preconception care

¾ Undertake pregnant and nonpregnant abdominal examination

¾ Have the skills to liaise with midwives and other health professionals to optimise care of the woman

¾ Appropriate postgraduate educational courses, including CTG interpretation courses

¾ MRCOG Part2

¾ Purposes and practice of antenatal care ¾ Recognition of domestic violence ¾ Problems of teenage pregnancy ¾ Awareness of drug and alcohol misuse ¾ Management of normal pregnancy, birth and puerperium ¾ Placental abnormalities and diseases ¾ Genetic modes of inheritance, common genetic conditions and the diagnosis thereof ¾ Epidemiology, aetiology, pathogenesis, diagnosis, prevention, management, delivery, complications of: • • •

pregnancy-induced hypertension haemorrhage preterm prelabour

¾ Take obstetric history and make relevant referral in cases of domestic violence ¾ Conduct booking visit ¾ Conduct follow-up visits ¾ Arrange appropriate investigations ¾ Manage: • • • • • • • • •

growth restriction mode of delivery after caesarean section multiple pregnancy antepartum haemorrhage malpresentation preterm prelabour rupture of the fetal membranes reduced fetal movements prolonged pregnancy drug and alcohol abuse in pregnancy

¾ Demonstrate the skills to empower and inform woman to make appropriate choices for herself and her family in pregnancy and childbirth ¾ Demonstrate an ability to explain correctly and place in context for the woman: • •

•

•

detection rates and limitations of anomaly screening principles of screening for neural tube defects, Down syndrome and haemoglobinopathies genetic disorders and their inheritance, with examples such as Tay-Sachs disease, cystic fibrosis and thalassaemia effects upon fetus and neonate of infections during pregnancy, including HIV, measles, chickenpox, rubella,

¾ Perinatal morbidity and mortality meetings ¾ Risk assessment meetings ¾ StratOG.net: Antenatal Care e-tutorials ¾ Useful websites: • • • •

www.nice.org.uk www.rcog.org.uk www.sign.ac.uk www.show.scot.nhs.uk/sp cerh

¾ Logbook ¾ Local meetings attended, e.g. Perinatal in PDF ¾ Case reports ¾ Audit project ¾ Certificate of completion of CTG training package (e.g. K2) ¾ TO1/TO2

JMedit/16-11-2006 • • • • • • •

rupture of membranes multiple pregnancy malpresentation fetal growth restriction: fetal haemolysis prolonged pregnancy congenital malformation social and cultural factors

¾ Immunology and immunological disorders affecting pregnancy ¾

¾ Observe: • •

external cephalic version cervical cerclage

¾ Counsel about: • • • • • •

screening for Down syndrome genetic disease fetal abnormality haemolytic disease infection mode of delivery

cytomegalovirus, parvovirus and toxoplasmosis ¾ Show awareness of the need to identify and deal with domestic violence and have a working knowledge of child protection issues as they relate to the practice of obstetrics and gynaecology

¾ Basic fetal and placental anatomy to define fetal orientation ¾ Assessment of liquor volume

35

JMedit/16-11-2006 Ultrasound: Knowledge criteria

Clinical competency


Training support

Evidence/assessment

¾ Role and use of ultrasound in antenatal care (refer to Module 16 for principles of ultrasound examination)

¾ Assess fetal wellbeing by interpretation of CTG and ultrasound

¾ Demonstrate the use of appropriate referral pathways and local protocols if abnormal ultrasound findings are suspected

¾ Mandatory education and training sessions

¾ Certificate of course attendance

¾ Theoretical accredited course (local or RCOG)

¾ MRCOG Part 2

¾ Determine fetal viability by transabdominal ultrasound, if less than 14 weeks refer for transvaginal scanning to confirm absent fetal heart beat ¾ Perform a transabdominal scan after 14 weeks of gestation

¾ Supervised structured clinical learning sessions ¾ Observation by attendance at sessions in an obstetric ultrasound department, including anomaly and fetal assessment scans

¾ Identify features of the head, chest, abdomen ¾ Determine fetal lie and presentation ¾ Determine placental site ¾ Assess liquor volume by deepest pool

36

JMedit/16-11-2006

Appendix to Curriculum Module 8: details of knowledge criteria Preconception care: ¾ Sources of detailed information accessed by patients ¾ Effect of pregnancy upon disease ¾ Effect of disease upon pregnancy ¾ Principles of inheritance of disease ¾ Teratogenesis ¾ Drugs and pregnancy Purposes and practice of antenatal care: ¾ Arrangements for and conduct of booking visit ¾ Arrangements for and conduct of follow-up visits ¾ Use of imaging techniques ¾ Screening for abnormality ¾ Health education ¾ Liaison between health professionals ¾ Recognition of domestic violence Physiology and management of normal: ¾ Pregnancy ¾ Childbirth, including delivery outside specialist unit ¾ Puerperium, including lactation ¾ Neonate, including feeding Placental: ¾ Abnormalities (shape, size, implantation) ¾ Chorioamnionitis ¾ Infarcation ¾ Chorioangioma ¾ Multiple pregnancy ¾ Intrauterine growth retardation ¾ Cord abnormalities ¾ Trophoblastic disease

Immunology: ¾ Immunological pregnancy tests ¾ Rhesus and other isoimmunisation ¾ Autoimmune diseases Preterm prelabour rupture of membranes: ¾ Fetal pulmonary maturity ¾ Therapy (steroids, antibiotics, tocolytics) ¾ Infection (risks, management) ¾ Delivery (induction of labour, timing, mode) Haemorrhage: ¾ Placental abruption ¾ Placenta praevia ¾ Vasa praevia ¾ Placenta accreta ¾ Trauma Multiple pregnancy: ¾ Zygosity ¾ Impact of assisted reproduction techniques ¾ Placentation ¾ Diagnosis ¾ Management (antenatal, intrapartum, postnatal) ¾ Special procedures (prenatal diagnosis, monitoring) ¾ Feeding ¾ Higher order multiple pregnancies (counselling, community care)

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Malpresentation: ¾ Types (breech, brow, face, shoulder, variable lie) ¾ Diagnosis ¾ Management (antenatal, intrapartum) ¾ Mode of delivery ¾ ¾ ¾ ¾ ¾

Fetal growth restriction: Aetiology (maternal, placental, fetal) Diagnosis (clinical, imaging, biochemical, genetic) Monitoring (ultrasound, cardiotocography) Delivery (timing, method) Prognosis (fetal, neonatal)

Genetic: ¾ Modes of inheritance (Mendelian, multifactorial) ¾ Cytogenetics ¾ Phenotypes of common aneuploidies (Down syndrome, Edward syndrome, Patau syndrome, Turner syndrome, Klinefelter syndrome, triple X, multiple Y) ¾ Translocation ¾ Miscarriage ¾ Molecular genetics (DNA transcription, DNA translation, DNA blotting techniques, gene amplification techniques, principles of gene tracking) ¾ Counselling (history taking, pedigree analysis) ¾ Population screening (genetic disease, congenital malformations) ¾ Antenatal diagnosis (chromosomal defects, inborn errors of metabolism, neural tube defects, other major structural abnormalities) ¾ Management: referral to specialist team, antenatal intervention, delivery, neonatal investigation, neonatal care (medical, surgical)

Epidemiology, aetiology, pathogenesis, diagnosis, prevention, management, delivery, complications, prognosis with regard to the following: Pregnancy-induced hypertension: ¾ Definitions ¾ Aetiological theories ¾ Prophylaxis ¾ Assessment of severity ¾ Consultation ¾ Therapy ¾ Delivery (timing, method) ¾ Complications (eclampsia, renal, haemorrhagic, hepatic, fetal) Hypotensive disorders: ¾ Hypovolaemia ¾ Sepsis ¾ Neurogenic shock ¾ Cardiogenic shock ¾ Anaphylaxis ¾ Trauma ¾ Amniotic fluid embolism ¾ Thromboembolism ¾ Uterine inversion Fetal haemolysis: ¾ Relevant antigen–antibody systems ¾ Prevention ¾ Fetal pathology ¾ Diagnosis ¾ Assessment of severity ¾ Intrauterine transfusion (indications, techniques, referral) ¾ Delivery (timing, method) ¾ Counselling Prolonged pregnancy: ¾ Risks ¾ Fetal monitoring ¾ Delivery (indications, methods)

JMedit/16-11-2006 Congenital malformation: ¾ Screening ¾ Amniotic fluid volume (polyhydramnios, oligohydramnios) ¾ Management: diagnosis, consultation, viability, delivery (time, place, method), counselling ¾ Specific abnormalities: o head (anencephaly, microcephaly, encephalocele, hydrocephalus, hydranencephaly, holoprosencephaly) o skeleton (spina bifida, phocomelia, chondrodysplasia, intrauterine amputation) o heart (major defects, other defects) o lungs (pulmonary hypoplasia) o urinary (renal agenesis, polycystic kidneys, urinary tract obstruction) o genital (intersex, genital tract abnormalities, ovarian cyst) o gastrointestinal (abdominal wall defects, oesophageal atresia, duodenal atresia, diaphragmatic hernia, bowel obstruction) o other (cystic hygroma) ¾ Other fetal disorders: o non-haemolytic hydrops fetalis o tumours o pleural effusion o fetal bleeding Social and cultural factors: ¾ Effect upon pregnancy outcome ¾ Single parenthood ¾ Teenage motherhood ¾ Parent–baby relationships (factors promoting, factors interfering) ¾ Bereavement counselling

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JMedit/16-11-2006 Principles of ultrasound: ¾ Basic physics ¾ Safety ¾ Relationship between two dimensional screen image and three dimensional object Ultrasound assessment of fetal wellbeing: ¾ Fetal biometry (pregnancy dating, gestational age, fetal growth) ¾ Biophysical profile ¾ Use of Doppler to assess blood flow (fetus, uterus) ¾ Indications and limitations of scanning in late pregnancy ¾ Ultrasound surveillance in twin pregnancy Techniques of fetal anomaly scanning and non-invasive fetal diagnosis: ¾ Use of nuchal translucency measurements to identify fetuses at high risk of Down syndrome ¾ Combination of ultrasound and other risk markers to create an individual risk profile for each woman Invasive procedures: ¾ Amniocentesis ¾ Chorionic villus sampling ¾ Placentesis ¾ Cordocentesis

Orientate ultrasound findings in the second and third trimesters and orientate the fetus correctly in the uterus: ¾ Determine lie and position of fetus ¾ Identify features of the head ¾ Identify features of the chest ¾ Identify features of the abdomen ¾ Locate best position to measure abdominal circumference ¾ Identify the spine ¾ Identify the limbs ¾ Perform basic fetal measurements (e.g. those of biparietal diameter, head circumference, abdominal circumference, femur length, estimation of fetal weight) Localise the placenta in the third trimester: ¾ Find the placenta ¾ Describe its features: o texture o echolucent areas o chorionic plate o echogenicity ¾ Define its upper and lower borders ¾ Relate it to other features such as bladder and cervix

Identify fetal position and fetal heart in later pregnancy and to create a three-dimensional image of the fetus in the mind: ¾ Identify the fetus ¾ Determine the lie of the fetus ¾ Be familiar with maneuvers to identify position of fetal heart ¾ Identify fetal heart pulsations (use of transvaginal ultrasound at less than 14 weeks) ¾ Demonstrate fetal heart pulsations to mother

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MODULE 8

TOPIC: Antenatal care Competence level: Basic Training


Advanced Training

Skill Date Conduct a booking visit Conduct a follow up visit Arrange appropriate investigations Assess fetal wellbeing by interpretation of: Maternal history CTG Ultrasound assessment Manage: Oligohydramnios/polyhydramnios Growth restriction Multiple pregnancy Malpresentation Reduced fetal movements Prolonged pregnancy Drug and alcohol problems in pregnancy Infections in pregnancy

Observation

Direct Supervision

Signature

Date

Signature

Independent Practice Date

Signature

JMedit/16-11-2006 Preterm premature rupture of the membranes Antepartum haemorrhage External cephalic version Insertion of cervical cerclage Counsel about: Screening for Down syndrome Screening for other fetal abnormalities Haemolytic disease Mode of delivery after caesarean section Cervical cerclage Basic obstetric ultrasound: Identify features head, chest, abdomen Transvaginal confirmation viability