Advanced Training Skills Modules August 2010 MRI / CT ... · Advanced Training Skills Modules August 2010 ... Advanced Training Skills Modules August 2010 ... Patient selection Counsel

Advanced Training Skills Modules August 2010

Advanced laparoscopic surgery for the excision of benign disease INTRODUCTION

This programme defines the training required to produce individuals with the skills required for the excisional treatment of benign gynaecological conditions using advanced laparoscopic surgical techniques. This is an advanced training program for a specified small group of clinicians to be trained to carry out high level laparoscopic surgery in this field. It is envisaged that people attaining these skills would serve as tertiary referral leads. This programme requires an average of two years intensive training and is separate from levels attained in the Benign Gynaecological Surgery: Laparoscopy ATSM. The trainee needs to assign at least 50% of their time for two years to be able to have the necessary skills at the end of training. Intermediate ultrasound training skills are required in gynaecology for this ATSM. (See Ultrasound training section).

Training in the module is competency-based, however, it is expected to take a least 18 months. Any trainee applying for training in this module will only be eligible if they have a minimum of 18 months of training remaining before their projected CCT date. Intermediate ultrasound training in the gynaecology

module will be undertaken as part of the ATSM. OUTLINE 1 Patient assessment and selection 2 Investigations 3 Non-surgical treatment modalities 4 Surgical treatments 5 Specialist urology 6 Specialist colorectal 7 Pain management 8 Generic competences (common to all advanced training skills modules)


1 General assessment 1.1 History Objective Understand the different facets of obtaining a history of the woman’s condition.

General history.

Pain, fertility, sexual function, menstrual history.

Standardised questionnaires.

Quality of life questionnaires.

1.2 Examination Objective Competent at examination and appropriate recording of findings.

General.

Pelvic.

Rectal.


2 Investigations

Objective To understand indications for and select correct tests, be able to interpret meaning of report and understand limitations for the following investigations:

Pelvic USS. Renal USS. MRI / CT. Contrast studies of the gastro-intestinal tract. Contrast studies of the upper and lower urinary tract. Endoscopy. Relevant blood tests. Relevant fertility tests Potential screening tests. Abdominal X-ray. DMSA scans 3 Non-surgical treatment modalities Objective To understand the indications, limitations and complications of the following treatment options Combined oral contraceptive pill. Progestagens. GnRH Analogues. Aromatase inhibitors. Analgesics and other pain management options. Immune modulators. Complementary therapies. Assisted reproductive techniques including IVF. Counselling


4 Surgical procedures 4.1 Generic Objective To be able to perform and understand the place of the following

Appropriate laparoscopic entry techniques o Veress. o Hassan. o Palmer’s point. o Non-standard placement of ports.

Port site closure.

Safe use of appropriate energy source.

Suturing.

Knot tying o Intra-corporeal. o Extra-corporeal.

Specimen retrieval o Use of mocellator. o Posterior colpotomy. o Bags.

Tests for bladder and bowel integrity.

Recognise and initially manage complications o Urinary tract. o Gastrointestinal tract. o Haemorrhage. o Late complications.

4.2 Specific procedures Objective Understand indications for and be able to carry out the procedure Be able to counsel a woman appropriately Understand potential complications and be able to deal with them

Division of dense adhesions involving bowel.

Pelvic side-wall dissection.

Recto-vaginal dissection.

Utero-vesical dissection.


Excision of endometriosis.

Repair of bladder.

Repair of sero-muscular layer of bowel.

Total laparoscopic hysterectomy.

Laparoscopic myomectomy.

Interruption of neural pathways where indicated

Laparoscopic pre-sacral neurectomy

Laparoscopic uterine nerve ablation / excision 5 Specialist urology Objective Understand indications for and be able to perform

Ureteric stenting (including double J).

Cystoscopy. Objective To have an understanding of and be able to counsel appropriately for

Ureteric anastamosis.

Ureteric re-implantation.

Urinary fistulae.


6 Specialist colorectal Objective Understand indications for and be able to perform

Proctoscopy.

Sigmoidoscopy. Objective To have an understanding of and be able to counsel appropriately for:

Full thickness bowel repair.

Bowel resection.

Ileostomy.

Colostomy.

Ileostomy reversal.

Colostomy reversal.

Bowel fistulae. 7 Pain management Objective Understand principles of pain management

Psychology.

Drug treatment.

Other o Nerve blocks. o TENS. o Complementary therapy.


8 Generic Generic skills Objective To be highly proficient with

Communication skills.

Maintaining good medical practice.

Maintaining trust.

Professional behaviour.

Ethics and legal issues.

Patient education and disease prevention.

Team working and leadership skills.

Clinical governance/risk management Research, audit and epidemiology

Objective To be able to understand and demonstrate appropriate skills and attitudes in relation to research

Review evidence.

Critically evaluate scientific studies and multicentre trials/systematic reviews. Objective To be able to understand and demonstrate appropriate skills and attitudes in relation to clinical audit

Define standard, prepare project, collate data.

Re-audit and close audit loop.

Formulate policy as a result of the audit. Objective To have an understanding of

Clinical Governance.

Risk management: evidence.

Audit.

Guidelines.

Structure of the NHS and ‘Principles of Management’.

Information use and management.


1: Assessment of woman and selection process

Assessment of woman The trainee should be able to perform a thorough assessment of women with benign gynaecological conditions that pertain to excisional laparoscopic surgery. This includes: 1.1. History Learning outcomes: Understand the different facets of obtaining a history of the woman’s condition.

To be able to obtain a general history

To be able obtain a pelvic pain / menstrual / fertility/ bowel function history.

To be able to use standardised questionnaires

To be able to use quality of life questionnaires

Knowledge criteria Clinical competency

Professional skills and attitudes

Training support Assessment / Evidence

Understand symptoms that women may complain of. Able to break down of the history into its various components, such as dysmenorrhoea, dyspareunia, dyschezia, pelvic pain, lower backache. Understand that other associated gastrointestinal and urological symptoms should also be assessed. Able to ascertain fertility history and if the woman is trying for pregnancy. Knowledge including past investigations and treatment Relationship with other

Take an appropriate history Be able to present relevant history. Arrange for use of appropriate standardised QUOL questionnaires:

Ability to take an appropriate history Ability to use appropriate QUOL questionnaires and analyse them. The use of such scoring systems to assess severity and to monitor response to treatment. Importance of differential diagnosis such as urological or gastrointestinal disease.

Tailored clinical experience

Observation of cases, assisting and discussing cases with senior medical staff

Personal study Appropriate postgraduate education courses

Mini CEX Case based discussion Discussion groups Log of experience and competence


Knowledge criteria Clinical competency

Professional skills and attitudes


medical conditions and psychosexual health. Understand how standardised questionnaires are devised Understand the significance of quality of life questionnaires Understanding of how questionnaires are validated.


1.2. Examination Learning outcomes: Be able to carry out a competent examination

To be able to do a general examination

To be able to do a pelvic examination including standardised methods of assessment

To be able to do a relevant basic colorectal examination

Knowledge criteria Clinical competency Professional skills and attitudes Training support Assessment / Evidence

Understand the anatomy and innervation of the genital tract and the impact of disease on the organs. Examine findings relevant to benign gynaecological conditions including assessment of the posterior cul de sac.

Carry out an appropriate general, pelvic and rectal examination. Able to map areas of pain or abnormal masses in relation to underlying anatomical structures.

Ability to:

Carry out an appropriate general examination.

Carry out an appropriate abdominal and pelvic examination including new assessments methods as they are introduced into clinical practice.

Carry out an appropriate rectal examination especially with regard to rectovaginal endometriosis.


Observation of, assisting and discussion with senior medical staff Personal study Appropriate postgraduate education courses

Mini CEX Team observation Log of experience and competence


1.3 Patient selection


Patient selection for laparoscopic excisional surgery should demonstrate a thorough knowledge of the following:

1. Suitability of woman for laparoscopic procedure:

ASA score / fitness.

Assessment of suitability of condition for laparoscopic surgery.

Knowledge of appropriate preoperative investigations

Knowledge of appropriate alternative options.

Effect of previous surgery.

Impact of body mass

Knowledge of necessary laparoscopic equipment

3. Thorough counselling / consent of woman:

Alternatives

Risks

Benefits

Understand importance of appropriate selection of woman Have an understanding of how history, investigations and careful counselling impact on patient selection

Able to exhibit knowledge of selection criteria Able to apply knowledge of patient selection criteria to clinical situation.


Observation of, assisting and discussion with senior medical staff Personal study Appropriate postgraduate education courses

Case based discussion Team observation Log of experience and competence


1 – Patient assessment and selection

Competence level

Level 1 Level 2 Level 3

Date Signature Date Signature Date Signature

History

Full menstrual history

Interpret quality of life questionnaires

Examination

Appropriate abdominal examination

Appropriate pelvic examination

Assessment of pelvic nodules

Perform a rectal examination

Patient selection

Counsel with regards different option

Counsel with regards to suitability for surgery

Carries out ASA score

(Grey out = not required)


2: Investigations Objectives For the following investigations: 1.To understand indications and contraindications. 2 To select appropriate investigation. 3 To interpret the results. 4 To understand the limitations of the investigation. Pelvic USS. Abdominal USS. MRI / CT Scan. Plain x-ray of chest and abdomen. Contrast studies of the gastro-intestinal and urinary tracts. Colonoscopy. Cystoscopy. Blood tests including hormones to assess ovarian reserve and ovulation. Relevant fertility tests including semen analysis and tubal patency tests.

Knowledge criteria Clinical competency Professional skills and attitudes


Indications for Imaging

Ultrasound

MRI

CT

Plain X-Ray

Contrast Studies of renal tracts

Contrast studies of gastro-intestinal tract

DMSA scans Indications for endoscopy

Sigmoidoscopy

Colonoscopy

Cystoscopy

Interpret images in consultation with imaging specialist Perform transvaginal ultrasound Perform sigmoidoscopy and cystoscopy Understand colonoscopy reports Order and interpret appropriate tests

Ability to explain findings and their significance Competently perform procedure Carry out the procedure Explanation of findings Correct interpretation and significance of results


Observation of, assisting and discussion with senior medical staff


Satisfactory completion of the Intermediate Ultrasound module in gynaecological scanning OSATS in cystoscopy Case based discussion Team observation Log of experience and competence




Blood Tests Understand physiological and pathological processes affecting the following blood tests:

Haematological indices

Renal function Liver function Sex steroids CA125 Future markers Fertility tests

Understand indications and referral for tubal patency test, semen analysis for the partner


Competence level


2 – Investigations Date Signature Date Signature Date Signature

Interpret MRI pelvis

Report CXR

Report AXR

Report Contrast studies renal tract

Report contrast studies GI tract

Cystoscopy

Sigmoidoscopy

Colonoscopy

Interpret blood results



3: Non-surgical treatment modalities

Objective: To understand the role of non-surgical modalities in the treatment of benign gynaecological conditions. Hormonal Treatments

COC Pill Progestagens GnRH analogues Aromatase Inhibitors

Non-Hormonal Treatments

Non-steroidal anti-inflammatories Tranexamic Acid Immune Modulators

Analgesics and other pain management options Haematinics Complementary therapies Assisted conception techniques Counselling



Have a thorough understanding of

The principles of pharmacology.

The pharmacology of chemical substances that act upon benign gynaecological conditions.

The pharmacology and side-effects of analgesic drugs.

Indication for Hormonal Treatments

COC Pill Progestagens GnRH analogues Aromatase Inhibitors

Non-Hormonal Treatments Non-steroidal anti-

inflammatories Tranexamic Acid Immune Modulators

Analgesics Haematinics Complementary therapies Indication for assisted conception techniques

Appropriate knowledge Choose appropriate treatment Counsel woman accordingly

Refer and counsel appropriately Ability to choose appropriate treatment Develop knowledge base Ability to counsel woman

Able to exhibit knowledge of treatment selection

Counsel appropriately






3– Conservative treatments

Competence level



Discussion of medical options

Give a subcutaneous injection

Give an intra-muscular injection


4 Surgical procedures 4.1 Generic Objectives: To be able to perform and understand the place of the following

Appropriate laparoscopic entry techniques Veress Hassan Direct visual entry Palmer’s point Non standard placement of ports Port site closure


Knowledge of relevant anatomy and pathopysiology. Detailed knowledge and understanding of the current controversies and theories of aetiology about all benign gynaecological diseases that pertain to laparoscopic excisional surgery.

Understand the advantages and pitfalls of Veress needle entry Hassan technique Direct visual entry Palmer’s point entry Understand the principles of port site closure and the need to avoid port site hernia or damaged underlying structures

Proficiency in Veress needle, Hassan and Palmer’s point entry techniques Knowledge of techniques Ability to safely close port sites using appropriate needles

Complete understanding and ability to apply principles to surgery Ability to perform procedures Understand the principles underlying these techniques Ability to close port sites

Appropriate reading and courses Tailored clinical experience and practice

Team observation Log of experience and competence OSATS for Palmers point and Hassan


Safe use of appropriate energy source

Knowledge criteria Clinical competency Professional skills and attitudes Training support Assessment/evidence

Understand the principles of electrosurgery, laser modalities, beam coagulators, ultrasound and other future energy sources.

Be able to demonstrate ability to use one modality effectively and have an understanding of the principles underlying all the others

Ability to safely perform these procedures and a thorough understanding of the safety checks required before activating the energy source Trouble shooting

Tailored clinical experience and appropriate theoretical training

Case based discussion

Suturing


Ability to competently suture pedicles and hollow viscii using laparoscopic needle holders Ability to undertake intracorporeal and extracorporeal knot tying

Proficiency in competently suturing and tying the appropriate surgical knots

Ability to perform these procedures Tailored clinical experience and practice

OSATS knot tying

Specimen retrieval


Understand the use of tissue morcellation techniques, posterior colpotomy and tissue retrieval bag

Proficiency in the use of morcellator, undertaking posterior colpotomy and trans abdominal and trans vaginal removal of tissue using tissue retrieval bags



Tests for bladder and bowel integrity

Knowledge criteria Clinical competency Professional skills and attitdues Training support Assessment / Evidence

Ability to inspect bladder, ureter, small and large bowel for perforation or damage, recognition of this and undertake appropriate special tests such as air insufflation and use of dyes

Ability to carry out visual inspection of bowel, carry out air insufflation and dye tests. Ability to check integrity of bladder using visual inspection and dye tests. Ability to visually check the ureter through its pelvic course and pass the appropriate ureteric catheter.


OSATS

Initial management of intraoperative complications


Recognition of bowel and bladder complications. Assessment of these and ability if appropriate to perform primary repair. Understand the principles of more complex repairs such as segmental bowel resection and ureteric anastamosis and reimplantation. Recognise and be able to control haemorrhage.

Ability to undertake primary bladder closure. Understand principles of ureteric anastamosis. Ability to undertake with supervision primary small or large bowel perforation repair laparoscopically. Knowledge of the principles and techniques of segmental bowel resection and ureteric reimplantation. Ability to control major haemorrhage until appropriate help available and understand the principles underlying the repair of major vessels

Ability to perform these procedures Understand the principles underlying these procedures Ability to apply the appropriate vascular clamps and understand the principles underlying the repair of major vessels

Tailored clinical experience and practice



Management of late complications


Recognition of delayed onset complications such as peritonitis, ileus, faecal contamination or urinary leakage. The ability to start appropriate initial management and understand the principles of subsequent management

Recognition of the signs and symptoms of intra-abdominal trauma and the use of appropriate investigations. The ability to seek appropriate support e.g General Surgeon, Urologist, Intensive Care Specialist

Ability to recognise and deal with intra-abdominal trauma

Tutorials, lectures and training


4.2. Specific procedures

Objective Understand indications for and be able to carry out procedures outlined below Be able to counsel a woman appropriately Understand potential complications and be able to deal with them

Division of dense adhesions involving bowel

Repair of sero-muscular layer of bowel



Ability to undertake adhesiolysis using appropriate instruments or energy source, the ability to check for bowel integrity and appropriate suture of sero-muscular tears. Ability to explain to the risks and benefits of the procedure to be undertaken. Recognise and deal with complications such as bowel perforation, ischaemic damage or haemorrhage

Proficiency in adhesiolysis and appropriate suture repair of sero-muscular tears Appropriate counselling skills. Ability to recognise and deal with complications

Ability to undertake adhesiolysis and appropriate repair techniques Ability to counsel women appropriately Prompt response and proficiency

Tailored clinical experience and practice Tutorials, lectures Tutorials, lectures and tailored clinical experience

OSATS

Utero-vesical dissection

Repair of bladder



Ability to undertake dissection of the utero-vesical fold of peritoneum and reflection of the bladder Ability to excise the peritoneum overlying the bladder and fibrotic lesions such as infiltrating endometriotic deposits Recognition and suturing of bladder defects Recognition of urinary leakage post operatively

Proficiency in dissection of the bladder. Ability to excise fibrotic lesions of the dome of the bladder Ability to suture bladder defects Ability to recognise the signs and symptoms of urinary peritonitis or fistula formation

Ability to perform these procedures Appropriate post operative management

Tailored clinical experience and practice Lectures and tutorials

Excision of endometriosis

Pelvic sidewall dissection


Ability to excise superficial and deep endometriosis overlying pelvic structures, bowel and the pelvic sidewall using the appropriate instruments and energy sources Ability to dissect the pelvic sidewall to demonstrate the course of the pelvic ureter, the great vessels, uterine arteries and the root of the sigmoid colon

Proficiency in excision of superficial and deep endometriosis using the appropriate technology Proficiency in the dissection of the pelvic sidewall

Ability to excise superficial and deep endometriosis Ability to dissect the pelvic sidewall

Tailored clinical experience and practice Tutorials and lectures

OSATS OSATS



Recognition of immediate and late post operative complications

Ability to recognise and undertake immediate management of complications, summoning appropriate specialist help as necessary

Appropriate clinical skills


Rectovaginal dissection


Ability to recognise and excise infiltrating and nodular endometriosis of the rectovaginal septum and uterosacral ligaments. Recognition of the degree of obliteration of the posterior cul de sac and involvement of the rectum Ability to appropriately repair sero-muscular lesions of the intraperitoneal and extraperitoneal rectum and vaginal epithelium of the posterior vaginal fornix Understand risks of ischaemic damage and wound breakdown leading to fistula formation or faecal peritonitis

Proficiency in excisional techniques to allow a complete dissection of the rectovaginal space by identification of the appropriate anatomical landmarks such as the uterine arteries, uterosacral ligaments and ureters. The ability to recognise both partial and full thickness involvement of the rectum. The ability to undertake disc resection of the rectum with supervision and to appropriately assess the need for segmental resection Proficiency in suturing sero-muscular lesions of the intraperitoneal and extraperitoneal rectum and the ability to suture vaginal lesions laparoscopically or transvaginally Ability to recognise and undertake immediate management of complications, summoning appropriate specialist help as necessary

Ability to dissect the rectovaginal space and excise infiltrating and nodular endometriosis completely and safely. The ability to undertake rectal and vaginal repairs with appropriate supervision Ability to undertake repair of seromuscular defects in the bowel wall and complete vaginal repairs Appropriate clinical skills


Team observation Log of experience and competence OSATS Case based discussion


Laparoscopic myomectomy


Ability to assess the appropriateness of laparoscopic myomectomy, and to undertake the excision of subserous intramural and broad ligament fibroids. The ability to suture the defect using the appropriate intra and extra corporeal techniques. The ability to deal with haemorrhage from the uterine serosa and myometrium. The ability to remove the extirpated fibromyomata using the appropriate morcellation, posterior colpotomy or tissue retrieval bags Recognition of potential complications such as haemorrhage, disseminated intravascular coagulation and late uterine dehiscence

Proficiency in the assessment and removal of subserous, intramural and broad ligament fibroids. Proficiency in suturing uterine defects and techniques for the control of haemorrhage. Proficiency in use of morcellators, posterior colpotomy and tissue extraction bags Ability to recognise and undertake immediate management of complications, summoning appropriate specialist help as necessary

Ability to excise myomata Ability to suture uterine defects using intracorporeal and extracorporeal suturing techniques. Ability to use appropriate techniques for tissue extraction Appropriate clinical skills


Case based discussion OSATS


Total laparoscopic hysterectomy


Appropriate assessment of suitability of woman for total laparoscopic hysterectomy and the ability to undertake a total laparoscopic hysterectomy using a recognised technique and an understanding of suitable alternatives. Recognition of initial and late complications such as haemorrhage or damage to adjacent viscera

Proficiency in undertaking total laparoscopic hysterectomy. Ability to manage haemorrhage and initial treatment of damage to adjacent viscera. Recognition of late complications. Initiation of immediate treatment and summoning the appropriate help.

Ability to undertake a total laparoscopic hysterectomy using a recognised technique Appropriate clinical skills


Case based discussions OSATS

Interruption of Neural Pathways


Understand the indications for and techniques of uterosacral nerve ablation, excision of uterosacral ligaments and pre-sacral neurectomy. Recognition of early and late complications such as haemorrhage, urinary retention, constipation

Proficiency in undertaking these procedures Ability to manage retroperitoneal haemorrhage, urinary retention and constipation

Ability to undertake these procedures Appropriate clinical skills




4 Surgical Procedures

Competence level



Hassan terchnique

Palmer’s point entry

Use of tissue morcellator

Suture ovary closed

Ureteric dissection

Rectovaginal space dissection

Close bowel disc resection

Total laparoscopic hysterectomy



5: Specialist urology Learning outcomes: 1. Have an understanding, knowledge of and be able to carry out

Cystoscopy

Inserion of urteric stents

2. Have an understanding of

Ureteric anastomosis Ureteric re-implantation Fistula management



Understand the indications for cystoscopy Have a knowledge of the surgical principles for the treatment of ureteric injury. Understand the investigation, and diagnostic criteria for fistulae. Understand the surgical principles of the repair and complications that may occur. Understanding of the correct investigations and treatments for ureteric obstruction and ureteric injury. Knowledge of when and how

Able to perform cystoscopy Determine correct indications for referral and have an understanding of the procedures and how to counsel women. Ability to diagnose fistulae and order appropriate investigations. Able to counsel women appropriately. Theoretical knowledge of management of ureteric problems. Ability to insert appropriate

Cystoscopy Assessment of women and appropriate counselling. Management of ureteric injury and obstruction.








to insert ureteric stents., Knowledge of the surgical principles of ureteric re-anastomoses and re-implantation techniques. Understands risks and management of voiding dysfunction post=operatively

ureteric stents. Correct counselling of a woman Able to advise on catheter management

Use of ureteric stents. Use of bladder ultrasound to assess bladder volume


5- Specialist urology

Competence level



Cystoscopy

Ureteric stenting

Ureteric re-implantation

Ureteric re-anastomoses



6: Specialist colorectal Learning outcomes: Understand the indications for and be able to perform

Proctoscopy

Sigmoidoscopy Learning outcomes: Have an understanding of the indications for and methods of performing

Full thickness bowel repair

Bowel resection

Ileostomy (and reversal)

Colostomy (and reversal)

Bowel fistulae



Understand the indications for and limitations of visual inspection of the lumen of the lower gastro-intestinal tract. Understand the principles of bowel resection, stoma formation and bowel anastamosis. Understand the principles and practice of post-operative care for women who have had bowel surgery.

Ability to perform proctoscopy and sigmoidoscopy. Be able to recognise normal mucosa and bowel stenosis. Knowledge of when to refer to a coloproctologist. Ability to communicate with women about the need for bowel surgery. Be able to explain the procedures which may be required, need for stoma, and reversal. Able to provide post-operative care for women who have had bowel surgery.

Proctoscopy and sigmoidiscopy. Communication skills. Post-operative care following bowel surgery






6 – Specialist colorectal

Competence level



Proctoscopy

Sigmoidoscopy

Full thickness bowel repair

Ileostomy and reversal

Colostomy and reversal



7: Pain management Learning outcomes: Have an understanding of the mechanisms of perception of and methods to treat pain.

Recording and mapping pain

Psychology

Drug treatment

Nerve blocks

TENS

Complimentary therapy

Knowledge criteria Clinical competency Professional and attitudes


Understand theories of pain causation and perception. Understand the principles of pain mapping. Understand woman’s responses to and strategies for dealing with pain. Understand the pharmacological principles of analgesic drugs. Understand indications for and principles of the use of nerve blocks and TENS for analgesia.

Ability to accurately document woman’s descriptions of pain. Ability to prescribe effective and safe analgesia. Have observed nerve blocks and TENS use in a Pain Clinic. Knowledge of multidisciplinary pain management teams

Consultation skills Knowledge of pain management






Knowledge criteria Clinical competency Professional and attitudes


Understand the contribution of complementary therapies for analgesia. When to refer to pain management teams

7- Pain management

Competence level



Counselling for different treatments

Tens machine

Nerve blocks



8 Generic skills

Communication, team working and leadership skills Objectives: Demonstrate effective communication with women and colleagues

Demonstrate good working relationships with colleagues Demonstrate the ability to work in clinical teams and have the necessary leadership skills

Knowledge criteria Clinical competency Professional skills and attitudes Training support

Evidence / Assessment

Communication

- how to structure an interview with a woman to identify: concerns & priorities expectations understanding & acceptance

- breaking bad news

- bereavement process and behavior Team working

- roles and responsibilities of team members

- factors that influence & inhibit team development

- ways of improving team working incl.

objective setting & planning

motivation and demotivation

organization

respect

- contribution of mentoring and supervision

Leadership

- qualities and behaviors

- styles

- implementing change / change management (see 7.5)

Be able to communicate both verbally and in writing with women and their relatives including;

breaking bad news

appropriate use of interpreters Be able to communicate both verbally and in writing with colleagues

Ability to communicate effectively with:

colleagues

women and relatives Ability to break bad news appropriately and support distress Ability to:

work effectively within a subspecialty team

lead a clinical team

respect other’s opinions

deal with difficult colleagues

Observation of and discussion with senior medical staff

Team observation Log of experience and competence Mini CEX Case based discussion


Good Medical Practice and maintaining trust

Objectives: To inculcate the habit of life long learning and continued professional development To ensure trainee has the knowledge, skills and attitudes to act in a professional manner at all times

Knowledge criteria Clinical competency Professional skills and attitudes Training support Evidence / Assessment

Continuing professional development Doctor-patient relationship Personal health Understand relevance of:

RCOG

GMC, Defence Unions, BMA

Specialist societies

STC & postgraduate dean Ethical principles

respect for autonomy

beneficence & non maleficence

justice Informed consent Confidentiality Legal issues

death certification

mental illness

advance directives, living wills

Be able to recognize and use learning opportunities Be able to gain informed consent for:

patient care and procedures

research

Ability to recognize and use learning opportunities Ability to:

learn from:

- colleagues

- experience

work independently but seek advice appropriately

deal appropriately with challenging behaviour

Understand:

ethical issues relevant to subspecialty

legal responsibilities Recognize; own limitations when personal health takes

priority over work pressure Ability to gain informed consent

Observation of and discussion with senior medical staff

Team observation Log of experience and competence Mini CEX Case based discussion)


Teaching Objectives: Understand and demonstrate appropriate skills and attitudes in relation to teaching


Teaching strategies appropriate to adult learning RCOG core and advanced training relevant to subspecialty Identification of learning principles, needs and styles Principles of evaluation

Prepare and deliver a teaching session

small group (<10)

large group (>20)

at the bedside Teach practical procedures (incl. ultrasound)

Ability to communicate effectively Ability to teach postgraduates on topic(s) relevant to subspecialty using appropriate teaching resources Ability to organize a programme of postgraduate education e.g. short course or multidisciplinary meeting

Observation of and discussion with senior medical staff Appropriate postgraduate courses

Log of experience and competence

Clinical governance (CG) and risk management Objectives: Understand and demonstrate appropriate knowledge and skills in relation to CG and risk management


Clinical Governance

- organizational framework at local, SHA and national levels

- standards e.g. NSF, NICE, RCOG guidelines

- clinical effectiveness

principles of evidence based practice

types of clinical trial/evidence classification

Perform clinical audit

define standard based on evidence

prepare project & collate data

re-audit and close audit loop

formulate policy Develop and implement a clinical guideline

purpose and scope

identify and classify evidence

Ability to practice evidence based medicine Ability to perform a clinical audit relevant to subspecialty Ability to develop and implement a clinical guideline relevant to subspecialty Ability to report and investigate a

Observation of and discussion with senior medical staff and clinical governance team. Attendance at risk management meetings DH, RCOG and




grades of recommendation

- guidelines and integrated care pathways

formulation

advantages and disadvantages

- clinical audit

- patient / user involvement Risk management

- incidents/near miss reporting

- complaints management

- litigation and claims management Appraisal and revalidation

- principles

- process

formulate recommendations

identify auditable standards Participate in risk management

investigate a critical incident

assess risk

formulate recommendations

debrief staff Perform appraisal

critical incident Ability to respond to a complaint in a focused and constructive manner. Ability to perform appraisal

Trust publications

Administration and service management Objectives: Display knowledge of the structure and organization of the NHS nationally and locally

Understand and demonstrate appropriate skills and attitudes in relation to administration and management


Organization of NHS services

Directorate, Trust

PCT, SHA Managed clinical network for subspecialty service Health and safety Management

strategy development

Develop and implement organizational change

development of strategy

formulate a business plan

manage project Be able to participate in recruitment

job specification

interview and selection

Ability to develop and implement organizational change Ability to collaborate with:

other professions

other agencies Develop interviewing techniques and those required for performance review

Observation of and discussion with senior medical and management staff Attendance at Directorate management meetings / interviews Management




business planning

project management Financial resource management Human resources

team building

appointments procedures

disciplinary procedures Scrutiny of organization

Healthcare Commission

PMETB / educational inspection visits

course

Information use and management Objective Demonstrate competence in the use and management of health information


Input, retrieval and utilization of data recorded on clinical systems relevant to subspecialty Main local and national projects and initiatives in IT and its applications

NPfIT and Connecting for Health Confidentiality of data

principles and implementation

role of Caldicott guardian

Be able to use relevant

software

databases

web sites

digital recording media

Ability to apply principles of confidentiality in context of IT

Observation and discussion with senior medical staff World wide web

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