b-ED-CORE-4

7/25/2019 b-ED-CORE-4

1/7

Key:Common competency framework competences Medical leadership framework competences Health inequality framework competences

29

GMC Good Medical Practice (GMP) Domains: Domain 1: Knowledge, skills and Performance Domain 2: Safety and quality Domain 3: Communication, Partnership and Teamwork. Domain 4: Maintaining Trust

Core Module 4: Ethics and Legal Issues

Learning outcomes: To understand and demonstrate the appropriate knowledge, skills and attitudes in the context of taking consent and confidentiality To have an understanding of the context, meaning and implementation of the legal framework for practice. To know and understand professional, legal and ethical codes of practice.

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

CONSENT

Understand the principles and legalissues surrounding informed consent

Outline the guidance given by the GMCon consent, in particular:

Understand that consent is a process thatmay culminate in, but is not limited to, thecompletion of a consent form

Understand the particular importance of

considering the patient's level ofunderstanding and mental state (and alsothat of the relatives/carers whererelevant) and how this may impair theircapacity for informed consent

Understand specific legal issues aboutconsent in under 16 -yr olds, andvulnerable adults

Understand the implications of the SexualOffences Act 2003

Be aware of diversity

Be aware of the implications of the legal

status of the unborn child

Understand appropriateness of consentto post mortem examination

Outline the procedures for seeking apatients consent for disclosure ofidentifiable information

1 Use written material correctly and accurately

Recognise the problems posed by disclosure inthe public interest, without patients consent

Gain valid consent from patients, and know whento ask for a second opinion

Discuss clinical risk

Know when to involve social services/police, and

how to do so

Shows willingness to seek advance directives

Show willing to obtain a second opinion, senioropinion, and legal advice in difficult situations ofconsent or capacity

Inform a patient and seek alternative care wherepersonal, moral or religious belief prevents usualprofessional action

1

1,3,4

2,3,4

1,2,3

Give appropriate information andconduct a consultation to obtainconsent in a suitable setting and at asuitable time

Obtain consent in a manner thatpatients and relatives understand andassess their comprehension

Be aware of the patients needs as anindividual

Respect diversity

Adopt a patient-focused approach todecisions that acknowledge the rights,values and strengths of the public

Respect a patients rights of autonomyeven in situations where their decisionmight put them at risk of harm

Keep within the scope of authoritygiven by a competent patient

Provide all information relevant toproposed care or treatment in a

competent patient

Only obtain consent for procedureswhere competence has been attainedto perform the procedure, inaccordance with the appropriate GMCstandards

1,3,4 Department of HealthGuidance on consent

RCOG guidance onObtaining ValidConsent. RCOGwebsite.

RCOG ConsentAdvice Series

RCOG guideline. Lawand Ethics in relationto Court-authorisedObstetricIntervention. RCOGwebsite.

StratOG.net: TheObstetrician andGynaecologist as aprofessional. Ethicaland legal issues e-tutorial

GMC. Consentguidance on patients

and doctors makingdecisions together.GMC website.

Mini CEX

CbD

Reflective learning

MRCOG Part Two

7/25/2019 b-ED-CORE-4

2/7


30



CONFIDENTIALITY

Be aware of relevant strategies to ensureconfidentiality

Outline and follow the guidance given by

the GMC on confidentiality

Be aware when confidentiality might bebroken

Understand the principles of dataprotection including electronic andadministrative systems

Understand that interpreters and patientadvocates must be aware ofconfidentiality issues

Recall the obligations for confidentialityfollowing a patients death

1,2 Use and share information properly 3,4 Respect the right to confidentiality

Be aware of the requirements ofchildren, adolescents and patients with

special needs

4 Confidentiality andDisclosure of HealthInformation: RCOGEthics Committee

comments on BMAdocument. RCOGwebsite.

Caldicott CommitteeReport on the reviewof patient identifiableinformation (DH;1997). Department ofHealth website.

StratOG.net: TheObstetrician andGynaecologist as aprofessional. Ethicaland legal issues e-

tutorial.

Data Protection Act1998.

GMC. Confidentialityguidance handbook.GMC website.

Mini CEX

Reflective Practice

CbD

Reflective learning

7/25/2019 b-ED-CORE-4

3/7


31


Knowledge criteria GMP Clinical competency GMP Professional skills and attitudes GMP Training support Evidence/assessmentLEGAL FRAMEWORK FOR PRACTICE

Know that all decisions and actions mustbe in the best interests of the patient

Understand the legislative framework

within which healthcare is provided in theUK and/or devolved administrations, inparticular:

death certification and the role of theCoroner/Procurator Fiscal;

child protection legislation; mental health legislation (including

powers to detain a patient and givingemergency treatment against apatients will under common law);

withdrawing and withholdingtreatment;

decisions regarding resuscitation ofpatients;

surrogate decision making;

organ donation and retention; communicable disease notification; medical risk and driving; Data Protection Act and Freedom of

Information Act; provision of continuing care and

community nursing care by a localauthorities

Understand that there are differencesbetween health related legislation in thefour countries of the UK and know thelegislation as it relates to the country inwhich you practice

Understand sources of medical legal

information

Understand disciplinary processes inrelation to medical malpractice

Understand the procedure to be followedwhen personal health and substanceabuse is suspected

1 Cooperate with other agencies with regard to legalrequirements, including reporting to theCoroners/Procurator Officer, the Police or theproper officer of the local authority in relevant

circumstances

Prepare appropriate medical legal statements forsubmission to the Coroners Court, ProcuratorFiscal, Fatal Accident Inquiry and other legalproceedings and be prepared to present suchmaterial in court

Incorporate legal principles in to day-to-daypractice

Practice and promote accurate documentationwithin clinical practice for legal purposes

1,3,4 Show willingness to seek advice fromthe employer, appropriate legal bodies(including defence societies), and theGMC on medico-legal matters

Promote informed reflection on legalissues by members of the team

Demonstrates that all decisions andactions must be in the best interest ofthe patient

Understand the role of the medicalpractitioner in relation to personalhealth, the health of colleagues, andconcerns of substance misuse andsubstance abuse

1,3,4 GMC EthicalGuidance. End of lifecare: Certification,post-mortems and

referral to a coroneror procurator fiscal.GMC website.

GMC 0-18 yearsguidance. Childprotection. GMCwebsite.

GMC guidance.Mental Health Act.GMC website.

eLfH Child Protectiontheory modules. eLfHwebsite.

Data Protection Act1998. Availableonline

Freedom ofInformation Act 2000.Available online.

GMC. MedicalDefenceOrganisations.Available on theGMC website.

CbD

Reflective learning

eLfH Child Protectiontheory modules

7/25/2019 b-ED-CORE-4

4/7


32



Value, ethics and the law

Ensure that all decisions and actions arein the best interests of the patient and thepublic good

Be familiar with and uphold the rights ofchildren and vulnerable adults

Be familiar with and uphold the rights ofdisabled people to participate in healthyand rewarding employment

Practise in accordance with anappropriate knowledge of contemporarylegislation

Act with appropriate professional andethical conduct in challenging situations.

LEGAL ISSUES RELATING TO MEDICAL CERTIFICATION

Know the legal responsibilities ofcompleting maternity, birth, sickness anddeath certificates

Understand abortion certificates HSA 1and HSA 4, and be aware of exemptionsfor those who will not participate inabortion services for moral or religiousreasons

Know the types of deaths that should bereferred to the Coroner/Procurator Fiscal

Understand the principles of advancedirectives and living wills

Be aware of the indications for sectionunder the Mental Health Act (1983)

Outline the principles of the MentalCapacity Act

1 Complete relevant medical certification

Use and share information with the highestregard for confidentiality, and encourages suchbehaviour in other members of the healthcareteam

1 Have the ability to know how to obtainsuitable evidence, and whom toconsult

Act with compassion at all times

1,2,3

4

Local courses

RCOG guideline.Registration ofStillbirths andCertification forPregnancy Lossbefore 24 weeks ofGestation. RCOGwebsite.

StratOG.net: TheObstetrician andGynaecologist as aProfessional. Ethical

and legal issues e-tutorial

CbD

Mini CEX

Reflective learning

7/25/2019 b-ED-CORE-4

5/7


33



INTEGRITY

Demonstrate knowledge of theprofessional, legal and ethical codes ofthe GMC, e.g. Fitness to Practice andany other codes pertaining to obstetrics

and gynaecology

Be aware of prejudice and preferenceswithin self, others, society and cultures

Be ware of the define the standards ofpractice defined by the GMC whendeciding to withhold or withdraw life-prolonging treatment

Outline the main methods of ethicalreasoning: case based reasoning, thejustification of decision and moraljudgment

Know the overall approach of value-based practice and how this relates toethics, law and decision-making

1,4 Recognise, analyse and know how to deal withunprofessional behaviours in clinical practice,taking into account local and national regulations

Create open and non-discriminatory professionalworking relationships with colleagues awarenessof the need to prevent bullying and harassment

Recognise the factors influencing ethical decisionmaking, including religion, personal and moralbeliefs, cultural practices

Use and promote strategies to ensureconfidentiality is maintained e.g. anonymisation

Counsel patients on the need for informationdistribution within members of the immediatehealthcare team

Counsel patients, relatives, carers and advocates(where relevant) tactfully and effectively whenmaking decisions about resuscitation status, andwithholding or withdrawing treatment

1,4 Accept professional regulation

Promote professional attitudes andvalues

Demonstrate probity and thewillingness to be truthful and to admitto errors

Encourage informed ethical reflectionin others

Show willingness to seek advice ofpeers, local clinical ethics committees,legal bodies, and the GMC in the eventof ethical dilemmas over disclosureand confidentiality

Respect patients requests forinformation not to be shared, unlessthis puts the patient, or others, at riskof harm

Show willingness to share informationabout the patients care with thepatient, unless they have expressed awish not to receive such information

Show willingness to seek the opinionof others when making decisions aboutresuscitation status, and withholding orwithdrawing treatment

1,3,4 StratOG.net: TheObstetrician andGynaecologist as aProfessional. Ethical

and legal issues e-tutorial

GMC fitness topractice panelsonline information.GMC website.

GMC guidance onwithholding andwithdrawingtreatment. GMCwebsite.

GMC guidance onpatient confidentiality.GMC website.

TO1 and TO2

CbD

Reflective learning

7/25/2019 b-ED-CORE-4

6/7


34


Core Module 4 Logbook

Competence level Basic level Intermediate level Advanced level Not required

Level 1 Level 2 Level 3

Date Signature Date Signature Date 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 post-mortem examination after a maternal death or a death of a gynaecological patient, there is no expectation that theywill start to obtain consent until after completion of core training.

Training Courses or sessions

Title Signature of educational supervisor

Date

OM

7/25/2019 b-ED-CORE-4

7/7


35


Authorisation of signatures (to be completed by the clinical trainers)

Name of clinical trainer (please print) Signature of clinical trainer

COMPLETION OF MODULE 4

I confirm that all components of the module have been successfully completed:

Date Name of educational supervisor Signature of educational supervisor

Documents

b-ED-CORE-4