Download GMP - RCOG

Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Core Module 1: Clinical Skills
Learning outcomes:



To understand and demonstrate the appropriate knowledge, skills and attitudes to perform assessment of women by means of clinical history taking and physical
examination.
To manage problems effectively, and to communicate well with women, relatives and colleagues in a variety of clinical situations.
To demonstrate effective time management.
Knowledge criteria
GMP
Clinical competency
Define the patterns of symptoms and
identify risks factors in women presenting
with obstetric and gynaecological
problems
1
Take and analyse an obstetric and gynaecological
history in a succinct and logical manner
Recognise that the woman’s wishes and
beliefs and their history should inform
examination, investigation and
management
1
Comprehend that effective history taking in nonurgent cases may require several discussions with
the woman over time
Comprehend the different elements of
history taking
Recognise that patients do not present
their history in a structured fashion
Professional skills and attitudes
HISTORY TAKING
Evidence/assessment
Show empathy and develop rapport
1,3,4
Mini CEX
Acknowledge and respect cultural
diversity
1,3,4
StratOG.net.
Communication skills
e-tutorial. Available
online

Manage alternative and conflicting views from
family, carers, friends and members of the
multidisciplinary team.

Assimilate history from the information available
from women and other sources including
members of the multidisciplinary team
1,3,4
GMC Good Clinical
Care guidelines.
Available on GMC
website
Demonstrate an awareness of the
interaction of social factors with the
woman’s condition
Manage difficulties of language, physical,
educational and mental impairment, with carers
and family members as appropriate
Use interpreters and health advocates
appropriately. Maintain focus and recognise that
relatives may be affecting decisions made by a
woman
CbD
MSF (TO1 and TO2)



Training support
Acknowledge the significance of
psychological factors of a woman and
her relatives
Supplement history with standardised instruments
or questionnaires when relevant


GMP
GMP
3
Demonstrate an awareness of the
impact of health problems on the ability
of a woman to function at work and at
home
MRCOG Part One
MRCOG Part Two
MRCOG Part Three
1,3
Manages time and draw consultation to a close
appropriately
1
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Knowledge criteria
GMP
Clinical competency
GMP
Professional skills and attitudes
NOTE KEEPING
GMP
Training support
Evidence/assessment
Understand the importance and
conventions of accurate clinical note
keeping
1
Record and communicate concisely, accurately,
confidentially and legibly, the results of the history,
examination, investigations, differential diagnosis
and management plan
1
Appreciate the importance of timely
dictation, cost-effective use of medical
secretaries and increasing use of
electronic communication
2
MSF (TO1 & 2 forms)
1,2,4
Understand the limitations and
problems of electronic communication
2
Caldicott Committee
Report on the review
of patient identifiable
information (DH;
1997). Available on
DH website.
Know the relevance of data protection
(see Module 3)
1
Mark each note entry with date, signature, name
and status including appropriate use of electronic
clinical record systems
1
Communicate promptly and accurately
with primary care and other agencies
Demonstrate courtesy towards
secretaries, clerical and other staff
1,2,3
Mini CEX
CbD
GMC. Management
for Doctors. 2006.
Available on GMC
website.
1,3
TIME MANAGEMENT AND DECISION MAKING
Understand clinical priorities according to
urgency and importance
1
Understand that effective organisation,
prioritisation and delegation is key to time
management
Understand the importance of prompt
investigation, diagnosis and treatment in
disease and illness management
Identify clinical and clerical tasks and prioritise
tasks to maintain focus on individual patient needs
whilst balancing multiple, competing pressures
Anticipate future clinical events and plan
appropriately
1
Have realistic expectations of tasks to
be completed, and timeframe for tasks
1
Have the ability to prioritise workload
GMC. Management
for Doctors. 2006.
Available on GMC
website.
Appreciate the internal signs of one’s
own stress and ask for help. Be willing
to consult, and work as part of a team
Resilience training;
Step-up (or
equivalent)
MSF (TO1 & 2 forms)
Reflective practice
Mini CEX
Estimate time required for essential tasks and
plan accordingly
Group together tasks and recognise the most
urgent/important tasks and ensures that they are
managed expediently
Regularly review and reprioritise personal and
team workload and organise and manage
workload effectively and flexibly
Recognise when self or others are
falling behind and take steps to rectify
the situation and communicate
changes in priority to others
Be receptive to feedback on
performance and work flexibly,
effectively and efficiently. Be willing to
take advice, and change in the light of
new information
Make appropriate use of other healthcare
professionals and support workers
Remain calm in high pressure
situations and adopt a timely, rational
approach
Work with increasing efficiency as clinical skills
develop but know when to get help
Clinical skills essential for:
o
Common clinical skills-delivery of twins
fetal bradycardia and ventouse delivery,
malposition at full dilatation
CbD
1,3
1,3
Appropriately recognise and handle
uncertainty within a consultation
Confident in stepping up from ST2 to
ST3
2
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Knowledge criteria
GMP
Clinical competency
GMP
Professional skills and attitudes
GMP
Training support
Evidence/assessment
Increase responsibility and promote
patient safety
Non-clinical skills essential for:
o
Understanding of senior
midwife coordinator
expectations of an ST3 on
delivery suite
o
Best practice in telephone
consultations and referral
o
Coping and dealing with
serious untoward incidents
including debriefing and
feedback.
o
Improving resilience –looking
after yourself
TEAM WORK
Understand the roles, competencies and
capabilities of other professionals and
support workers
1,2,3,4
Prepare patient lists with clarification of problems
and ongoing care plan
1,2,3,4
Give detailed hand over between shifts and areas
of care and provide good continuity of care
Understand that some factors adversely
affect team performance. Have
knowledge of methods to rectify issues.
Recognise limits of own professional
competency and only practices within
these limits
3,4
MSF (TO1 & 2 forms)
Mini CEX
Recognise and respects the request
for a second opinion
CbD
Participate in multidisciplinary team meetings
Reflective practice
Recognise the importance of induction
for new members of a team
Understand the components of effective
collaboration and team working
Provide appropriate supervision to less
experienced colleagues
Understand the roles and responsibilities
of members of the healthcare team
Recognise and respond to the manifestations of a
patient’s deterioration or lack of improvement
(symptoms, signs, observations, and laboratory
results) and support other members of the team to
act similarly
MRCOG Part Three
Recognise the importance of prompt
and accurate information sharing with
Primary Care team following hospital
discharge
COMMUNICATION AND SUPPORT
Understand the components of effective
verbal and non-verbal communication
1,2,3,4
Demonstrate listening skills
3,4
Use open questions where possible
Respect patients’ views
Respect the skills and contributions of
colleagues
Structure a consultation appropriately
Avoid using jargon
Importance of the woman’s background,
culture, education and preconceptions
Communicate clearly both verbally and in writing
Be committed to good communication
whilst also inspiring confidence and
3,4
RCOG patient
information website
section
MSF (TO1 and 2)
StratOG.net: The
Obstetrician and
Gynaecologist as a
CbD
Mini CEX
Reflective practice
3
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Knowledge criteria
GMP
Clinical competency
GMP
(beliefs, ideas, concerns, expectations) to
the process
to women, including those whose first language
may not be English
Outline the impact of healthcare beliefs,
culture and ethnicity in presentations of
physical and psychological conditions.
Utilise open and closed questioning appropriately
and listen actively
Professional skills and attitudes
trust
Outline health needs of particular
populations; e.g. the elderly, ethnic
minorities
Evidence/assessment
Acknowledge and respect diversity
3,4
Realise when it is appropriate to ask women or
carers to summarise back to check their
understanding
Training support
Teacher and
ResearcherCommunication skills
e-tutorial
Offer choices
Question sensitively to guide the woman. Be
prepared to handle difficult questions and to
qualify treatment recommendations
GMP
Use appropriate non verbal
communication
SANDS (stillbirth and
neonatal death
charity) guidance for
professionals website
3,4
Identify and manage communication barriers,
tailoring language to the individual woman and
carer (where relevant), using interpreters when
indicated. Avoid using medical jargon
GMC. Valuing
diversity guide:
Effective
communications.
Available on GMC
website.
Give clear information and feedback, establish
rapport and share communication with the woman
and her relatives or carers
Deliver information compassionately, being alert
to and managing the woman and own emotional
responses e.g. anxiety, antipathy etc.
Provide information resources, ensuring that
these can be obtained in different formats to
enable access for all – Braille, large print,
translations, spoken word etc.
Check a woman and any carer’s understanding of
information given, ensuring that all their
concerns/questions have been covered
1,3
Human Rights Act
1998. Available
online.
1,3
Disability
Discrimination Act
1995. Available
online.
1,2
Make accurate contemporaneous records of the
discussion
Manage ‘follow-up’ effectively and safely utilising
a variety of methods e.g. telephone calls, emails,
letters etc.
4
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Knowledge criteria
GMP
Clinical competency
GMP
Professional skills and attitudes
GMP
Training support
Evidence/assessment
3,4
Local and regional
courses in breaking
bad news
Mini CEX
StratOG.net: Early
pregnancy loss:
Breaking bad news
e-tutorial.
Reflective practice
Indicate when the consultation is nearing its end
and conclude with a summary and appropriate
action plan and ensure that the appropriate
referral and communications with other healthcare
professionals resulting from the consultation are
made accurately and timely
BREAKING BAD NEWS
Be aware that the way in which bad news
is delivered to a patient can affect them
for the rest of their life in terms of
emotions, perception of the condition and
their ability to cope. It also irretrievably
affects the subsequent relationship with
the patient
3,4
Aware that every patient may require
different levels of explanation and have
different responses and way of coping
with bad news
Demonstrates to others good practice in ‘breaking’
bad news
Involve patients and carers (where relevant) in
decisions regarding their future management
comprehends the impact of the bad news on the
patient, carer (where relevant), supporters, staff
members and self
Aware that ‘breaking’ bad news can be
extremely stressful for the professional
involved
Aware of the steps to take in preparing to break
bad news:

Set aside sufficient uninterrupted time

Choose an appropriate private
environment and ensure that there will
be no unplanned disturbances

Have sufficient information regarding
prognosis and treatment

Ensure the individual has appropriate
support if desired

Structure the interview

Be honest, factual, realistic and
empathic

Be aware of relevant guidance
documents
Aware that, as with all clinical
encounters, the interview at which bad
news is given will be an educational
opportunity
Awareness of how to structure and conduct the
interview:

Set the scene

Establish understanding
Aware that bad news is confidential but
the patient may wish to be accompanied
Aware that once the news is given,
patients are unlikely to take anything
subsequent in, so a further appointment
should be made for soon afterwards
3,4
Take leadership in ‘breaking’ bad news
Respect the different ways people
react to bad news
Ensure appropriate recognition and
management that the impact of
‘breaking’ bad news has on the doctor
CbD
Logbook
Roleplay
MRCOG Part Three
The Miscarriage
Association.
Guidance on
breaking bad news.
Guidance available
on Miscarriage
Association website.
Multisource feedback (TO1
and TO2)
GMC Guidance:
Treatment and care
towards the end of
life: good practice in
decision making.
Available on GMC
website
5
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Knowledge criteria
GMP
Clinical competency

Know that bad news may be expected or
unexpected and it cannot always be
predicted


Know that sensitive communication of
bad news is an essential part of
professional practice

Know that bad news has different
connotations depending on the context,
individual, employment, social and
cultural circumstances
GMP
Professional skills and attitudes
GMP
Training support
Evidence/assessment
3,4
GMC. Maintaining
boundaries- including
intimate examination.
Guidance for doctors.
Logbook
Discuss; diagnosis(es), implications,
treatment, prognosis and subsequent
care
Encourage questions and ensure
comprehension
Respond to verbal and visual cues from
patients and carers and relatives (where
relevant)
Act with empathy, honesty and
sensitivity avoiding undue optimism or
pessimism
CLINICAL EXAMINATION AND INVESTIGATION
Understand the need for a targeted and
relevant clinical examination
1,2,3,4
Understand the pathophysiological basis
of physical signs, both positive and
negative
Understand the indications, risks,
benefits and effectiveness of
investigations
Comprehend constraints to performing
physical examination and strategies that
may be used to overcome them
Comprehend the limitations of physical
examination and the need for adjunctive
forms of assessment to confirm diagnosis
Recognise that use of a chaperone in
obstetrics and gynaecology is always
recommended
Perform valid, targeted and time efficient
examinations relevant to the presentation and risk
factors




1,2,3,4
Respect patients’ dignity and
confidentiality
Acknowledge and respect cultural
diversity and religious boundaries
Breast examination
Abdominal examination
Non-pregnant
Pregnant
Vaginal examination*
Vulval examination
Bimanual
Cusco’s, Sims’ speculum
Microbiology swabs*
Throat, vagina, cervix, urethra,
rectum, cervical smear*
Involve relatives appropriately
Be aware of Fraser competence issues
Mini CEX
RCOG guidance.
Maintaining Good
Medical Practice.
Available on RCOG
website.
Appreciate the need for a chaperone
Appreciate the need for a patient to
seek a female attendant
Provide explanations to patients in
language they can understand
Perform investigations competently where
relevant
Interpret the results of investigations and actively
elicits important findings
Insight into one’s ability and the need
to ask for help
Reflective practice
CbD
Log of experiences
MRCOG Part Three
Gynaecological
Examinations:
Guidelines for
Specialist Practice.
RCOG. Available on
RCOG website.
*Use of low fidelity
pelvic mannequins to
enhance speculum
and bimanual skills
Liaise and discuss investigations with colleagues
Recognise the possibility of deliberate harm (both
self harm and harm by others) in vulnerable
patients and report to appropriate agencies
GMC guidelines. 018 years: Public
interest. GMC
website.
6
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Knowledge criteria
GMP
GMP
Clinical competency
Professional skills and attitudes
CLINICAL REASONING: DIAGNOSTIC AND THERAPEUTIC PLANS
GMP
Training support
Evidence/assessment
Define the steps of diagnostic reasoning
1,2
Interpret history and clinical signs
1,3,4
Research articles
relating to
psychology of
disease and illness.
Mini CEX
1,2,3
Conceptualise the clinical problem in a
clinical and social context
Recognise critical illness and responds with due
urgency
Recognise how to use expert advice,
clinical guidelines and algorithms
Interpret clinical features and their reliability and
relevance to clinical scenarios, including the
recognition of the breadth of presentation of
common disorders
Recognise the difficulties in predicting
occurrence of future events
1,2,3
CbD
Reflective diary
Be aware of and maintain an up to date
knowledge of research evidence
regarding the most important
determinants of health
Know how to access and use local health
data
Know how to access resources for
community action and advocacy (e.g.
resources, legislation, policy documents).
Support patient self-management
Respond to questions honestly and
seek advice if unable to answer
Incorporate an understanding of the psychological
and social elements of clinical scenarios into
decision making through a robust process of
clinical reasoning
1
Willingness to facilitate patient choice
1,2
Generate hypothesis within context of clinical
likelihood
Roleplay
Log of experiences
RCOG Recovering
Well Series. RCOG
website.
Recognise the duty of the healthcare
professional to act as a patient
advocate
Gives adequate time for patients and carers
(where relevant) to express their beliefs, ideas,
concerns and expectations
1,2
RCOG Patient
information. RCOG
website.
MRCOG Part Three
1,2
Willingness to discuss intelligibly with a
patient the notion and difficulties of
prediction of future events, and the
benefit/risk balance of therapeutic
intervention
Action plans and post procedural
rehabilitation and re-integration guidance
Develop problem lists and action plans
Recognise and appropriately respond to
sources of information accessed by
patients
Develop a self-management plan with the patient
1,3,4
1,3,4

Define the concepts of the natural history
of disease and assessment of risk

Awareness of evidence based guidance
on return to work times
Understand the medical, psychological
and social impacts of FGM. Awareness of
the classification system, methods and
appropriate timing of de-infibulation



Support patients and carers (where
relevant) to comply with self-management
plans
Encourage patients to voice preferences
and personal choices about their care
Consider the potential impact of work on
the progress and recovery of a health
condition
Develop and agree a management plan
with the patient and carers (where
relevant), ensuring awareness of
alternatives to maximise self care within
patients care pathway
Provide relevant evidenced-based
information and where appropriate,
effective patient education in the
Willingness to adapt and adjust
approaches according to the beliefs
and preferences of the patient and/or
carers (where relevant)
Construct an appropriate management
plan in conjunction with the patient,
carers (where relevant) and other
members of the clinical team and
communicates this effectively to the
patient and carers (where relevant)
Recognise that return to work is one of
the key indicators of a successful
clinical outcome
Demonstrate ability to identify one’s
own biases and inconsistencies in
clinical reasoning
GMC. Supporting
Self care.GMC Good
Medical Practice.
Available on GMC
website.
RCOG Patient
Information. Available
on RCOG website.
RCOG Recovering
Well Patient Advice.
RCOG website.
http://www.elfh.org.uk/programme
s/female-genitalmutilation
7
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Knowledge criteria
GMP
Clinical competency
GMP
appropriate medium to enable choice, with
support of the multidisciplinary team
Professional skills and attitudes
GMP
Training support
Evidence/assessment
Show willingness to facilitate access to
the appropriate training and skills in
order to develop the patient's
confidence and competence to self
care and adapt appropriately as those
needs change over time
Able to identify issues in assessing fitness for
work and to discuss a range of measures which
might facilitate a patient’s return to work
Encourage recognition of the benefits
of health and wellbeing, and the
negative effects of no work and
inappropriate working
Recognise that individuals do not need
to be 100% to return to work
Longer term conditions






Able to define the role of
rehabilitation and the role of support
services and the multidisciplinary
team to facilitate long-term care
Outline the concept of quality of life
and how this can be measured whilst
understanding the limitations of such
measures for individual patients
Outline the concept of patient self
care and the role of the expert
patient
Understand and be able to compare
and contrast the medical and social
models of disability
Know about the key provisions of
disability discrimination legislation
Understand the relationship between
local health, educational and social
service provision, including the
voluntary sector
1,2,3,4
Comprehend the need to determine the best value
and most effective treatment both for the
individual patient and for a patient cohort
Encourage the healthcare team to respect the
philosophy of patient focussed care
Develop and sustain supportive relationships with
patients and carers (where relevant) with whom
care will be prolonged and potentially life
long
Confident and positive in own values
1,3,4
Show willing and support for the
patient in their own advocacy, and
taking into account the best interests of
the wider community
Promote and encourage involvement
of patients in appropriate support
networks, both to receive support and
to give support to others
Recognise the potential impact of longterm conditions on the patient,
relatives and friends
Accept that diagnostic label does not
always reflect functional capacity
Show willingness to maintain a close
working relationship with other
members of the multidisciplinary team
and primary and community care
Understand different methods of ethical
reasoning to come to a balanced
decision where complex and conflicting
issues are involved
Recognise and respect the role of
family, friends and carers (where
relevant) in the management of the
patient with a long-term condition
8
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Knowledge criteria
GMP
Clinical competency
Be aware of the indications, contraindications, adverse effects, drug
interactions and dosage of commonly
used drugs in obstetrics and gynaecology
practice
1,2
Prescribe appropriately in pregnancy, and during
breast feeding
Minimise the number of medications
taken by a patient to a level compatible
with best care
GMP
Training support
Evidence/assessment
1,2
eLfH Safe prescribing
e-learning modules
CbD
Reflective learning
GMC. Good practice
in prescribing
medicines- guidance
for doctors. GMC
website.
Remain up to date with therapeutic
alerts, and responds appropriately
3
Advise women and carers (where relevant) about
important interactions and adverse drug effects.
Anticipate and avoid defined drug interactions,
including complimentary medicines
Be aware of the potentially adverse
effects of medication on performance and
safety at work
Know the range of drugs requiring
therapeutic drug monitoring and interpret
results
Understand the roles of regulatory
agencies involved in drug use, monitoring
and licensing e.g. NICE, Committee on
Safety of Medicines, Medications and
Healthcare Products Regulatory Agency
(MHRA) and hospital formulary
committees
1,2
Provide comprehensible explanations to the
patient, and carers (where relevant), for the use of
medicines
Have a familiarity of the range of adverse
drug reactions to commonly used drugs,
including complementary medicines
Define the effects of age, body size,
organ dysfunction and concurrent illness
on drug distribution and metabolism
relevant to the trainee’s clinical practice
GMP
Professional skills and attitudes
THERAPEUTICS AND SAFE PRESCRIBING
1
1,2
Review the continuing need for, effect of and
adverse effects of long-term medications relevant
to own clinical practice
1,2
Make appropriate dose adjustments following
therapeutic drug monitoring, or physiological
change e.g. deteriorating renal function
Ensure prescribing information is
shared promptly and accurately
between a patient’s healthcare
providers, including between primary
and secondary care
1
Appreciate the role of non-medical
prescribers
1,2
Participate in adverse drug event
reporting mechanisms
Use IT prescribing tools where available to
improve safety
1,2
Understand the importance of nonmedication based therapeutic
interventions including the legitimate role
of placebos
Remain open to advice from other
healthcare professionals on medication
issues
Employ validated methods to improve patient
concordance with prescribed medication
Ensures safe systems for monitoring, review and
authorisation where involved in “repeat
prescribing”
Ensure that if the patient works in
partnership with the doctor and fully
understands the need for, and how
medication works, it will result in
increased patient concordance
Understand the principles of concordance in
ensuring that drug regimes are followed
Recognise the importance of resources when
prescribing, including the role of a Drug Formulary
and electronic prescribing systems
Recognise the importance of resources when
prescribing, including the role of a Drug Formulary
and electronic prescribing systems
Roleplay
Log of experiences
MRCOG Part Three
3
1,2,3
National Institute for
Clinical Evidence
(NICE) website.
Committee on Safety
of Medicines website
Medications and
Healthcare Products
Regulatory Agency
website
British National
Formulary website
9
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Competence level
Basic level
Intermediate level
Advanced level
Not required
Core Module 1 Logbook
Level 1
Date
Level 2
Signature
Date
Signature
Level 3
Date
Signature
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:
Non-pregnant
Pregnant
Speculum examination:
Cusco’s
Sims’
Take microbiology swabs:
10
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Competence level
Basic level
Intermediate level
Advanced level
Not required
Core Module 1 Logbook
Level 1
Date
Level 2
Signature
Date
Signature
Level 3
Date
Signature
Vagina
Cervix
Urethra
Perform cervical cytology screening
Training Courses or sessions
Date
Title
Signature of educational supervisor
Breaking bad news
http://www.e-lfh.org.uk/programmes/female-genitalmutilation
Resilience training; Step-up course or equivalent
11
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Authorisation of signatures (to be completed by the clinical trainers)
Name of clinical trainer (please print)
Signature of clinical trainer
COMPLETION OF MODULE 1
I confirm that all components of the module have been successfully completed:
Date
Name of educational supervisor
Signature of educational supervisor
12
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Core 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 understand the ethical and legal issues which occur during the management of obstetric and gynaecological patients.
Knowledge criteria
GMP
Clinical competency
Understand the principles of adult
learning
1
Facilitate the learning process
Professional skills and attitudes
MEDICAL EDUCATION
GMP
1
Understand the skills and practices of a
competent teacher
Use varied teaching strategies appropriate to
audience and context (including one-to-one, small
and large groups, formal lectures)
Understand the principles of giving
feedback
Demonstrate the application of education
literature relevant to teaching
Understand the principles of evaluation
Use appropriate and current curricula to inform
teaching practice
Identify teaching strategies appropriate to
adult learning
Use of audiovisual aids effectively
Demonstrate willingness to teach
trainees and other healthcare workers
in a variety of settings to maximise
effective communication and practical
skills and to improve patient care
Prepare teaching session
Demonstrate knowledge of literature
relevant to current developments in
medical education and other sectors
Identify, plans and deliver learning activities in the
workplace
Outline the appropriate local course of
action to assist a trainee experiencing
difficulty in making progress within their
training programme
Recognise the importance of the role
of the doctor as an educator within the
multidisciplinary team and use medical
education to enhance the care of
patients
Balance the needs of service delivery
with education
Identification learning theories, principles,
needs and styles relevant to medical
education
Define the roles of the various bodies
involved in medical education and other
sectors
In discharging educational duties, act
to maintain the dignity and safety of
patients at all times
Provide timely and effective feedback
Teach in small (<10) and large groups (>20) and
at the bedside
Teach some practical procedures (including
ultrasound)
Contribute towards staff development and
training, including mentoring, supervision,
appraisal and workplace-based assessment
Demonstrate consideration for learners
including their emotional, physical and
psychological well being with their
development needs.
Act to ensure equality of opportunity
for trainees, staff and professional
colleagues
Encourage discussions with
colleagues in clinical settings to share
knowledge and understanding
Allow learners to make contributions to clinical
practice of increasing value and importance
commensurate with their competence
GMP
Training support
Evidence/assessment
1,3
Local and regional
Courses in
presentation skills
Logbook
StratOG.net: The
Obstetrician and
Gynaecologist as a
Teacher and
Researcher.
Teaching e-tutorial
MSF (TO1 and TO2)
Reflective diary
Log of experiences
CbD
Personal development
planning
Observation of and
discussion with
senior medical staff
MRCOG Part Two
MRCOG Part Three
Appropriate
postgraduate courses
Medical Education
England website
Deanery websites
GMC education and
training website
RCOG Tips for
trainers and tips for
Trainees
The Obstetrician and
Gynaecologist journal
13
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Knowledge criteria
GMP
Clinical competency
GMP
Provide appropriate career support, or refer
trainee to an alternative effective source of career
information
Professional skills and attitudes
Maintains honesty and objectivity
during appraisal and assessment
Acts as a leader, mentor, educator and
role model
Participate in strategies aimed at improving
patient education e.g. talking at support group
meetings
Able to lead departmental teaching programmes
including journal clubs
Recognise the trainee in difficulty and take
appropriate action including, where relevant,
referral to other services
Contribute to educational research or projects e.g.
through the development of research ideas of
data/information gathering
Able to manage personal time and resources
effectively to the benefit of the educational faculty
and the need of the learners
Gain insight in to educational policy and
development at local or national levels
GMP
Training support
Evidence/assessment
RCOG careers
service and mentoring
support
documentation.
RCOG website.
Show willingness to take up formal
training as a trainer and responds to
feedback obtained after teaching
sessions
Demonstrate willingness to become
involved in wider medical education
activities and foster an enthusiasm for
medical education activity in others
Recognise the importance of personal
development as a role model to guide
trainees in aspects of good
professional behaviour
Demonstrate willing to advance own
educational capability through
continuous learning
Demonstrate the ability to set objectives and
structure of educational session
Act to enhance and improve education
provision through evaluation of own
practice
Demonstrate the ability to present a teaching
session with audience participation
Demonstrate the skills to evaluate a training event
and act upon feedback
Demonstrate the ability to achieve
rapport and to be willing to supervise
less experienced colleagues
Demonstrate the ability to communicate
professionally and motivate learners
Participate in the organisation of a programme of
postgraduate education e.g. short course or
multidisciplinary meeting
14
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Knowledge criteria
GMP
Clinical competency
GMP
Professional skills and attitudes
GMP
Training support
Evidence/assessment
Acknowledge and respect cultural
diversity
3
Logbook
Demonstrate the ability to deal with
conflict
1,3
Have the ability to deal with a trainee
in difficulty and a difficult trainee
1,3
StratOG.net: The
Obstetrician and
Gynaecologist as a
Professional.
Appraisal, Mentoring
and Reflective
Practice e-tutorials
StratOG.net: The
Obstetrician and
Gynaecologist as a
Teacher and
Researcher.
Assessment e-tutorial
CbD
APPRAISAL
Understand the difference between
appraisal, assessment and performance
review
1
Perform effective appraisal
1,3,4
Assess objectivity in appraisal and use of a
methodical, structured approach
Understand the importance of an
appraisal and the qualities of a good
appraiser
Analyse information relating to performance from a
range of sources
Know the advantages and disadvantages
of different study methodologies
(quantitative and qualitative) for different
types of questions at appraisal
Take action early on to improve performance
Act as mentor
Take responsibility for tackling difficult issues
Build learning from experience in to future
development plans
Know the principles of appraisal and the
structure of the appraisal interview
Understand the principles of mentoring
Local educational
session
Understand levels of evidence and
quality of evidence
Appraisal and
assessment
Reflective diary
MSF (TO1 and TO2)
Log of experiences
Personal development
planning
Equal opportunity
training
ASSESSMENT
Understand the difference between
appraisal and assessment
1
Perform appropriate assessments
1,3
Have the ability to assess performance
honestly and objectively
1,3,4
Training the Trainers
Course
Use appropriate assessment methods
Reflective diary
Understand the reasons for assessment
Know different assessment methods and
when to use them appropriately
Be aware of the differences between
formative and summative assessment
Logbook
Acquire the necessary skills to give
constructive and effective feedback
Take responsibility for own workplace-based
assessment and
Conduct thorough, constructive workplace-based
assessments for junior colleagues
Take a responsibility in collecting suitable
evidence to the meet the requirements of
recertification and revalidation
Local educational
session
StratOG.net: The
Obstetrician and
Gynaecologist as a
Teacher and
Researcher.
Assessment etutorial.
MSF (TO1 and TO2)
Log of experiences
CbD
Personal development
planning
15
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Knowledge criteria
GMP
Clinical competency
Outline the role of workplace-based
assessments, the assessment tools in
use, their relationship to course learning
outcomes, the factors that influence their
selection and the need for monitoring
evaluation
GMP
Professional skills and attitudes
Show willingness to participate in
workplace-based assessments and
demonstrates a clear understanding of
their purpose
GMP
Training support
Evidence/assessment
RCOG best practice
videos
Understand the purpose of each
assessment used within the MRCOG
examination
Understand the difference between a
reliable and a valid assessment
Understand the purpose of recertification
revalidation
16
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Competence level
Basic level
Intermediate level
Advanced level
Not required
Core Module 2 Logbook
Level 1
Date
Level 2
Signature
Date
Signature
Level 3
Date
Signature
Teaching
Small group teaching
Large group teaching
Formal presentation or lecture
One-to-one teaching at the bedside
Teaching practical procedures
Organisation of teaching
Run obstetric emergency drill
Appraisal
Observe effective appraisal
Assessment
Perform appropriate assessments
17
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Training Courses or sessions
Date
Title
Signature of educational supervisor
Appraisal and assessment
Presentation skills
Teaching skills
Authorisation of signatures (to be completed by the clinical trainers)
Name of clinical trainer (please print)
Signature of clinical trainer
18
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
COMPLETION OF MODULE 2
I confirm that all components of the module have been successfully completed:
Date
Name of educational supervisor
Signature of educational supervisor
19
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Core Module 3:
Information Technology, Clinical Governance and Research
Learning outcomes:



To understand and demonstrate the 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.
Knowledge criteria
GMP
Clinical competency
Understand the principles of storage,
retrieval, analysis and presentation of
data
1,2,
Retrieve and use data recorded in clinical systems
1
Search medical literature including use of
PubMed, Medline, Cochrane Reviews and the
internet
Understand the effective use of
computing systems including ePortfolios
to support training
Demonstrate the ability to apply IT
solutions in the management of
patients
GMP
Training support
Evidence/assessment
1
Local IT training
courses
Use of ePortfolio
MRCOG Part One
StratOG.net: The
obstetrician and
gynaecologist as a
Teacher and
Researcher: Data
handling. Research
and Assessing
evidence e-tutorials
Adopt a proactive and enquiring
attitude to new technology
Demonstrate appropriate use of IT for patient care
and for personal development
Understand the range of uses of clinical
data and its effective interpretation
Be aware of the confidentiality issues
GMP
Professional skills and attitudes
USE OF INFORMATION TECHNOLOGY
1,2,4
Demonstrate competent use of databases, word
processing techniques, statistics programmes and
electronic mail
MRCOG Part Two
MRCOG Part Three
Mini CEX
NHS Connecting for
Health website
Undertake searches, and access web sites, and
health-related databases
Present data in an understandable manner
Engage with ePortfolios as required
CLINICAL GOVERNANCE: AUDIT
Understand the audit cycle
1
Understand clinical effectiveness:

Principles of evidence-based
practice

Types of clinical trial/evidence
classification

Grades of recommendation
Understand guidelines and integrated
care pathways. Know how to formulate
these and be aware of the advantages
and disadvantages
Perform




an audit project:
Define standard
Prepare project
Collate data
Formulate policy
Repeat audit cycle; perform clinical audit
 Define standard based on evidence
 Prepare project and collate data
 Re-audit and close audit loop
 Formulate policy
2
Show how the use of audit can
improve clinical practice
Listen to and reflect on the views of
patients and carers, dealing with
complaints in a sensitive and
cooperative manner
Recognise the need for audit in clinical
practice to promote standard setting
and quality assurance
2
RCOG.
Understanding Audit
RCOG website.
National Institute for
Clinical Excellence
(NICE). Principles for
best practice in audit
Ability to perform a
clinical audit
Audit project
Presentation at audit
meeting
Logbook
Reflective diary
MRCOG Part Three
20
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Knowledge criteria
GMP
Understand the different methods of
obtaining data for audit including patient
feedback questionnaires, hospital
sources and national reference data
Clinical competency
GMP
Professional skills and attitudes
GMP
Develop and implement a clinical guideline
 Purpose and scope
 Identify and classify evidence
 Formulate recommendations
 Identify auditable standards
Understand the role of audit i.e.
improving patient care and services, risk
management etc
Training support
Evidence/assessment
StratOG.net: The
Obstetrician and
Gynaecologist as a
Professional. Clinical
governance e-tutorial.
Contribute to the construction, review and
updating of local (and national) guidelines of good
practice using the principles of evidence based
medicine
Understand the steps involved in
completing the audit cycle
Contributes to local and national audit projects as
appropriate e.g. NCEPOD, SASM
Describe the working uses of national
and local databases used for audit such
as specialty data collection systems,
cancer registries etc, and for reporting
and learning from clinical incidents and
near misses in the UK
Support audits being undertaken by junior medical
trainees and within the multidisciplinary team
CLINICAL GOVERNANCE: CLINICAL STANDARDS
Understand the definitions and relevance
of levels of evidence
1
Review evidence
1,3
Understand the development and
implementation of clinical guidelines,
integrated care pathways and protocols
1,2
Understand the organisational framework
for clinical governance at local, regional
and national levels
2
Understand standards e.g. NSF, NICE,
RCOG guidelines
2
Apply conclusions from critical appraisal to
clinical care
Understand quality improvement
methodologies and a range of methods
2
Analyse feedback and comments and integrate
them into the service
Evaluate guidelines
Prepare a protocol
Have the skills to be able to discuss
the relevance of evidence in the
clinical situation
1,3
Recognises knowledge gaps and
keeps a logbook of clinical questions
Critically evaluate a care pathway
Logbook
Reflective diary
StratOG.net: The
Obstetrician and
Gynaecologist as a
Professional. Clinical
governance etutorial.
Aims for the best clinical practice
(clinical effectiveness) at all times, as
informed by evidence-based medicine
Critically appraise publications and evaluate
multicentre trials to address a clinical question
RCOG. Searching for
Evidence guideline.
Presentation to colleagues
Log of experiences
Reflective diary
MSF (TO1 and TO2)
Keeps up to date with national reviews,
key new research and guidelines of
practice e.g. NICE and SIGN
Recognise the common need to practice outside
clinical guidelines
Act as an advocate for the service
Acknowledge and show regard for
individual patient needs when using
guidelines
1
Be aware of advantages and
disadvantages of guidelines and
protocols, and use them appropriately.
1
Accept responsibility
21
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Knowledge criteria
GMP
Clinical competency
Know the principles of risk management
and their relationship to clinical
governance
1,2
Report and review critical incidents
Understand the basic measures of risk
and uncertainty
Be aware of particular issues pertinent to
the specialty and to trainees specifically
Understand potential sources of risk and
risk management tools, techniques and
protocols
Understand best practice, transparency
and consistency
Outline the features of a safe working
environment
Outline the hazards of clinical equipment
in common use
GMP
Professional skills and attitudes
CLINICAL GOVERNANCE: RISK MANAGEMENT
3,4
Use a reflective approach to practice with an
ability to learn from previous experience
Recall the components of safe working
practice in the personal, clinical and
organisational settings
Be able to access advice on occupational hazards
from a range of sources
Display eagerness to use evidence in
support of patient care when
evaluating risk
Assess and analyse situations, services and
facilities in order to minimise risk to patients, the
public and colleagues
Communicate risk information, and risk
benefit trade-offs, in ways appropriate
for individual patients
1,4
RCOG. Clinical Risk
Management for
Obstetricians and
Gynaecologists.
RCOG website.
Logbook
2
GMC Management
for Doctors. GMC
website.
Reflective diary
Presentation at risk
management meetings
MRCOG Part Three
MSF (TO1 and TO2)
Monitor the quality of equipment and safety of
environment relevant to the specialty
1,4
Adopt strategies to reduce risk
Discuss risks with patients
1,2,3
Investigate a critical incident

Assess risk

Formulate recommendations

Debrief staff
Recognise limits of own professional competence
and only practices within these
Understand significant event analysis
Recognise when a patient is not responding to
treatment, reassess the situation, and encourages
others to do so
Outline local procedures and protocols
for optimal practice including early
warning systems
Ensure the correct and safe use of clinical
equipment, ensuring that faulty equipment is
reported appropriately
Understand root cause analysis
Improve patients’ and colleagues’ understanding
of the side effects and contraindications of
therapeutic intervention
Department of
Health. Clinical
Governance Bulletin
series
Willingness to take responsibility for
clinical governance activities, risk
management and audit in order to
improve the quality of the service
Show probity by being truthful and be
able to admit error to patients, relatives
and colleagues
Demonstrate the ability to act
constructively when a complaint is
made and use assessment, appraisal
and reflection as insight to understand
ones’ own development needs
Understand root cause analysis
Understand significant event analysis
Evidence/assessment
Participate in risk management
Prepare a report relating to an adverse incident
Outline human factors theory and
understand its impact on safety
Training support
Seek advice/assistance when
concerned about patient safety
Document adverse incidents
Recall side effects and contraindications
of prescribed medications
Demonstrate respect and accept
patients’ views and choices
GMP
Awareness of equity in healthcare
access and delivery
StratOG.net: The
Obstetrician and
Gynaecologist as a
professional. Clinical
governance e-tutorial
1,4
1,4
Attend a perinatal
morbidity and
mortality
multidisciplinary
meeting
Clinical Negligence
Scheme for Trusts
website.
Maintain a high level of safety
awareness and consciousness at all
times
Encourage feedback from all members
of the team on safety issues and
encourages discussion amongst
colleagues on evidence-based practice
22
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Knowledge criteria
GMP
Understand processes for dealing with
and learning from clinical errors, including
the management of complaints
procedures risk management incidents/
near miss reporting complaints
management litigation and claims
management
Clinical competency
GMP
Sensitively counsel a colleague following a
significant untoward event, or near incident, to
encourage improvement in the practice of
individuals and the unit
Professional skills and attitudes
GMP
Training support
Evidence/assessment
Show willingness to take action when
concerns are raised about
performance of members of the
healthcare team, and act appropriately
when these concerns are voiced to you
by others
Continue to be aware of own
limitations, and operates within them
competently
Keep abreast of national patient safety
initiatives including NPSA. NCEPOCD
reports, NICE guidelines
Be aware of how healthcare governance
influences patient care, research and
educational activities at a local, regional
and national level
Ensure patient/ user involvement
Maintain a portfolio of information and
evidence, drawn from own clinical
practice
National Patient
Safety Agency
website
Engage with an open no blame culture
The National
Confidential Enquiry
into Patient Outcome
and Death
(NCEPOD) website
Respond positively to outcomes of
audit and quality improvement
Outline methods and associated
problems of quantifying risk e.g. cohort
studies
Construct concise and applicable problem lists
using available information
Co-operate with changes necessary to
improve service, quality and safety
Apply quantitative data of risks and benefits of
therapeutic intervention to an individual patient
Outline the concepts and drawbacks of
quantitative assessment of risk or benefit
e.g. numbers needed to treat
Search and comprehend medical literature to
guide reasoning
Describe commonly used statistical
methodology
Know how relative and absolute risks are
derived and the meaning of the terms:
predictive value, sensitivity and
specificity, in relation to diagnostic tests
RESEARCH
Understand the difference between audit
and research
1
Appraise a scientific paper
1
Be receptive to innovations resulting
from research publications
1
GMC Duties of a
Doctor
Logbook
Acquire skills to put research into
practice
1
Local courses and
RCOG courses
Presentations at Journal
Club meetings
4
StratOG.net: The
Evaluate a multicentre trial
Know how to apply statistics in scientific
and medical practice
Understand how to plan and analyse a
Understand the principles of critical reading, and
undertake critical review of scientific literature
Compare and benchmark healthcare services
1,2
Understand issues and potential
solutions before acting
MRCOG Part Three
23
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Knowledge criteria
GMP
Clinical competency
GMP
Professional skills and attitudes
research project
Understand statistical methods
Be aware of the issues underlying
plagiarism and how this relates to the
duties of a doctor
Use critical appraisal skills and applies these
when reading literature
Know the principles of research ethics
and conflicts of interest
GMP
Training support
Evidence/assessment
Obstetrician and
Gynaecologist as a
Teacher and
Researcher etutorials
Reflective diary
Presentations of research
Log of experiences
Demonstrate the ability to write a scientific paper
Outline the GMC guidance on good
practice in research
Apply for appropriate ethical research approval
Know about local and national research
guidelines
Demonstrate the use of literature databases
Follows guidelines on ethical conduct
in research and consent for research
Understand the difference between populationbased assessment and unit-based studies and is
able to evaluate outcomes for epidemiological
work
Know the principles of research
governance. Describe how clinical
guidelines are produced
Demonstrate a knowledge of research
principles
Shows willing to encourage and take
part in research
Introduction to
Research
Methodology RCOG
book
Be aware of situations where patient
consent, where desirable, is not
required for disclosure e.g. serious
communicable diseases, public
interest
Outline the principles of formulating a
research question and designing a
project
Comprehend principal qualitative,
quantitative, biostatistical and
epidemiological research methods
3
Demonstrate good verbal and written
presentations skills
Have knowledge of research methods
and how to evaluate scientific
publications including the limitations of
different methodologies for collecting
data
Define the role of the Caldicott Guardian
and Information Governance lead within
an institution, and outline the process of
attaining Caldicott approval for audit or
research
24
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Knowledge criteria
GMP
Clinical competency
GMP
Professional skills and attitudes
PATIENT PUBLIC INVOLVEMENT
Understand the principles of patient and
public involvement
1,2
Undertake a project on patient and public
involvement
1,2
Aim to practice patient-centred care at
all times
GMP
Training support
Evidence/assessment
3,4
Local courses
Observation of clinical
practice
NHS Direct website
Involve patients in decision making
Know about quality improvement
methodologies including a range of
methods for obtaining feedback from
patients and the public
With respect to management and leadership,
consider the involvement of the public and
patients in decision-making
Involve patient/carers in decision
making at all times
Demonstrate skill in information giving
at a level the patient will understand
Patient surveys
Project on patient
involvement
25
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Competence level
Basic level
Intermediate level
Advanced level
Not required
Core Module 3 Logbook
Level 1
Date
Level 2
Signature
Date
Signature
Level 3
Date
Signature
Audit
Perform an audit
Clinical governance
Prepare or revise a guideline or care pathway
Adopts a structured approach to managing complaints OM
Appraisal
Participate in NHS appraisal
Risk management
Present at risk management meeting
Research
Critically appraise a scientific paper
26
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Training Courses or sessions
Date
Title
Signature of educational supervisor
Authorisation of signatures (to be completed by the clinical trainers)
Name of clinical trainer (please print)
Signature of clinical trainer
27
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
COMPLETION OF MODULE 3
I confirm that all components of the module have been successfully completed:
Date
Name of educational supervisor
Signature of educational supervisor
28
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
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
Give appropriate information and
conduct a consultation to obtain
consent in a suitable setting and at a
suitable time
1,3,4
Department of Health
Guidance on consent
Mini CEX
CONSENT
Understand the principles and legal
issues surrounding informed consent
1
Outline the guidance given by the GMC
on consent, in particular:
Understand that consent is a process that
may culminate in, but is not limited to, the
completion of a consent form
Understand the particular importance of
considering the patient's level of
understanding and mental state (and also
that of the relatives/carers where
relevant) and how this may impair their
capacity for informed consent
Understand specific legal issues about
consent in under 16 -yr olds, and
vulnerable adults
Understand the implications of the Sexual
Offences Act 2003
Use written material correctly and accurately
1
Recognise the problems posed by disclosure in
the public interest, without patient’s consent
1,3,4
Gain valid consent from patients, and know when
to ask for a second opinion
Discuss clinical risk
Obtain consent in a manner that
patients and relatives understand and
assess their comprehension
2,3,4
Know when to involve social services/police, and
how to do so
1,2,3
Be aware of the patient’s needs as an
individual
Shows willingness to seek advance directives
Knowledge of ethical and legal issues
related to female genital mutilation
(FGM)
Show willing to obtain a second opinion, senior
opinion, and legal advice in difficult situations of
consent or capacity
Respect diversity
Inform a patient and seek alternative care where
personal, moral or religious belief prevents usual
professional action
Adopt a patient-focused approach to
decisions that acknowledge the rights,
values and strengths of the public
Be aware of diversity
Respect a patient’s rights of autonomy
even in situations where their decision
might put them at risk of harm
Be aware of the implications of the legal
status of the unborn child
Keep within the scope of authority
given by a competent patient
Understand appropriateness of consent
to post mortem examination
Provide all information relevant to
proposed care or treatment in a
competent patient
Outline the procedures for seeking a
patient’s consent for disclosure of
identifiable information
CbD
RCOG guidance on
Obtaining Valid
Consent. RCOG
website.
Reflective learning
MRCOG Part Two
MRCOG Part Three
RCOG Consent
Advice Series
RCOG guideline. Law
and Ethics in relation
to Court-authorised
Obstetric
Intervention. RCOG
website.
StratOG.net: The
Obstetrician and
Gynaecologist as a
professional. Ethical
and legal issues etutorial
GMC. Consent
guidance on patients
and doctors making
decisions together.
GMC website.
Only obtain consent for procedures
where competence has been attained
to perform the procedure, in
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Knowledge criteria
GMP
Clinical competency
GMP
Knowledge of ethical and legal issues
related to Female Genital Mutilation
(FGM)
Professional skills and attitudes
GMP
accordance with the appropriate GMC
standards
Training support
Evidence/assessment
Access Female
Genital Mutilation
training video
www.fgmnationalgrou
p.org
(Password access
detailed in e portfolio)
http://www.elfh.org.uk/programme
s/female-genitalmutilation
Understanding the ethical and legal
issues of organ donation
Access UK
Transplant website at
www.uktransplant.org
.uk
CONFIDENTIALITY
Be aware of relevant strategies to ensure
confidentiality
1,2
Use and share information properly
3,4
Respect the right to confidentiality
Be aware of the requirements of
children, adolescents and patients with
special needs
Outline and follow the guidance given by
the GMC on confidentiality
Be aware when confidentiality might be
broken
4
Confidentiality and
Disclosure of Health
Information: RCOG
Ethics Committee
comments on BMA
document. RCOG
website.
Mini CEX
Reflective Practice
CbD
Reflective learning
Caldicott Committee
Report on the review
of patient identifiable
information (DH;
1997). Department of
Health website.
Understand the principles of data
protection including electronic and
administrative systems
Understand that interpreters and patient
advocates must be aware of
confidentiality issues
StratOG.net: The
Obstetrician and
Gynaecologist as a
professional. Ethical
and legal issues etutorial.
Recall the obligations for confidentiality
following a patient’s death
Data Protection Act
1998.
GMC. Confidentiality
30
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Knowledge criteria
GMP
Clinical competency
GMP
Professional skills and attitudes
GMP
Training support
Evidence/assessment
guidance handbook.
GMC website.
LEGAL FRAMEWORK FOR PRACTICE
Know that all decisions and actions must
be in the best interests of the patient
1
Understand the legislative framework
within which healthcare is provided in the
UK and/or devolved administrations, in
particular:











death certification and the role of the
Coroner/Procurator Fiscal;
child protection legislation;
mental health legislation (including
powers to detain a patient and giving
emergency treatment against a
patient’s will under common law);
withdrawing and withholding
treatment;
decisions regarding resuscitation of
patients;
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 local
authorities
Cooperate with other agencies with regard to legal
requirements, including reporting to the
Coroner’s/Procurator Officer, the Police or the
proper officer of the local authority in relevant
circumstances
1,3,4
Show willingness to seek advice from
the employer, appropriate legal bodies
(including defence societies), and the
GMC on medico-legal matters
Promote informed reflection on legal
issues by members of the team
Prepare appropriate medical legal statements for
submission to the Coroner’s Court, Procurator
Fiscal, Fatal Accident Inquiry and other legal
proceedings and be prepared to present such
material in court
Incorporate legal principles in to day-to-day
practice
Demonstrates that all decisions and
actions must be in the best interest of
the patient
Understand the role of the medical
practitioner in relation to personal
health, the health of colleagues, and
concerns of substance misuse and
substance abuse
Practice and promote accurate documentation
within clinical practice for legal purposes
1,3,4
GMC Ethical
Guidance. End of life
care: Certification,
post-mortems and
referral to a coroner
or procurator fiscal.
GMC website.
CbD
Reflective learning
eLfH Child Protection
theory modules
GMC 0-18 years
guidance. Child
protection. GMC
website.
GMC guidance.
Mental Health Act.
GMC website.
eLfH Child Protection
theory modules. eLfH
website.
Data Protection Act
1998. Available
online
Freedom of
Information Act 2000.
Available online.
Understand that there are differences
between health related legislation in the
four countries of the UK and know the
legislation as it relates to the country in
which you practice
GMC. Medical
Defence
Organisations.
Available on the
GMC website.
Understand sources of medical legal
information
Understand disciplinary processes in
relation to medical malpractice
31
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Knowledge criteria
GMP
Clinical competency
GMP
Professional skills and attitudes
GMP
Training support
Evidence/assessment
Have the ability to know how to obtain
suitable evidence, and whom to
consult
1,2,3
Local courses
CbD
Mini CEX
Act with compassion at all times
4
RCOG guideline.
Registration of
Stillbirths and
Certification for
Pregnancy Loss
before 24 weeks of
Gestation. RCOG
website.
Understand the procedure to be followed
when personal health and substance
abuse is suspected
Value, ethics and the law
Ensure that all decisions and actions are
in the best interests of the patient and the
public good
Be familiar with and uphold the rights of
children and vulnerable adults
Be familiar with and uphold the rights of
disabled people to participate in healthy
and rewarding employment
Practise in accordance with an
appropriate knowledge of contemporary
legislation
Act with appropriate professional and
ethical conduct in challenging situations.
LEGAL ISSUES RELATING TO MEDICAL CERTIFICATION
Know the legal responsibilities of
completing maternity, birth, sickness and
death certificates
1
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
Complete relevant medical certification
Use and share information with the highest
regard for confidentiality, and encourages such
behaviour in other members of the healthcare
team
1
Know the types of deaths that should be
referred to the Coroner/Procurator Fiscal
Reflective learning
StratOG.net: The
Obstetrician and
Gynaecologist as a
Professional. Ethical
and legal issues etutorial
Understand the principles of advance
directives and living wills
Be aware of the indications for section
under the Mental Health Act (1983)
32
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Knowledge criteria
GMP
Clinical competency
GMP
Professional skills and attitudes
GMP
Training support
Evidence/assessment
1,3,4
StratOG.net: The
Obstetrician and
Gynaecologist as a
Professional. Ethical
and legal issues etutorial
TO1 and TO2
Outline the principles of the Mental
Capacity Act
INTEGRITY
Demonstrate knowledge of the
professional, legal and ethical codes of
the GMC, e.g. Fitness to Practice and
any other codes pertaining to obstetrics
and gynaecology
1,4
Be aware of prejudice and preferences
within self, others, society and cultures
Beware of the define the standards of
practice defined by the GMC when
deciding to withhold or withdraw lifeprolonging treatment
Recognise, analyse and know how to deal with
unprofessional behaviours in clinical practice,
taking into account local and national regulations
Create open and non-discriminatory professional
working relationships with colleagues’ awareness
of the need to prevent bullying and harassment
Recognise the factors influencing ethical decision
making, including religion, personal and moral
beliefs, cultural practices
Use and promote strategies to ensure
confidentiality is maintained e.g. anonymisation
Outline the main methods of ethical
reasoning: case based reasoning, the
justification of decision and moral
judgment
Counsel patients on the need for information
distribution within members of the immediate
healthcare team
Know the overall approach of valuebased practice and how this relates to
ethics, law and decision-making
Counsel patients, relatives, carers and advocates
(where relevant) tactfully and effectively when
making decisions about resuscitation status, and
withholding or withdrawing treatment
1,4
Accept professional regulation
Promote professional attitudes and
values
Demonstrate probity and the
willingness to be truthful and to admit
to errors
Encourage informed ethical reflection
in others
Show willingness to seek advice of
peers, local clinical ethics committees,
legal bodies, and the GMC in the event
of ethical dilemmas over disclosure
and confidentiality
Respect patient’s requests for
information not to be shared, unless
this puts the patient, or others, at risk
of harm
CbD
Reflective learning
GMC fitness to
practice panels
online information.
GMC website.
GMC guidance on
withholding and
withdrawing
treatment. GMC
website.
GMC guidance on
patient confidentiality.
GMC website.
Show willingness to share information
about the patients care with the
patient, unless they have expressed a
wish not to receive such information
Show willingness to seek the opinion
of others when making decisions about
resuscitation status, and withholding or
withdrawing treatment
33
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Competence level
Basic level
Intermediate level
Advanced level
Not required
Core Module 4 Logbook
Level 1
Date
Level 2
Signature
Date
Signature
Level 3
Date
Signature
Consent and legal/ethical issues
Understand the ethical and legal issues of consent
Understand the ethical and legal issues of patient safety
Understand the ethical and legal issues of consent for
neonatal post-mortem examination
Knowledge of ethical and legal issues related to Female
Genital Mutilation
Legal and ethical issues
Participate in Critical Incident Review
*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 they
will start to obtain consent until after completion of core training.
Training Courses or sessions
Date
Title
Signature of educational supervisor
34
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
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
35
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Core Module 5: Core Surgical Skills
Learning outcomes:

To understand and demonstrate appropriate knowledge, skills and attitudes in relation to basic surgical skills
Knowledge criteria
GMP
Clinical competency
GMP
Professional skills and attitudes
GMP
Training support
Evidence/assessment
Legal issues around consent to surgical
procedures, including consent of children,
adults with incapacity and adults and
children in emergency situations
1,2
Interpret pre-operative investigations
1
Recognise the need for and initiate
collaboration with other disciplines,
before, during and after surgery
3
Basic Practical skills
course (RCOG
approved)
Logbook
Demonstrate the ability to select the
operative procedure with due regard
to degree of urgency, likely pathology
and anticipated prognosis
1
RCOG Obtaining
Valid Consent
Guideline. RCOG
website.
MRCOG
Have an awareness of the need to
meet targets
1
RCOG Consent
Advice series
Mini CEX
Develop the ability to work under
pressure and recognise limitations
2
Department of Health
website
Reflective learning
Show the need to appreciate and
recognise that decision making is a
collaborative process between the
surgical team members
3
Local courses
MRCOG Part One
StratOG.net: The
Obstetrician and
Gynaecologist as a
Professional. Ethical
and legal issues etutorial
MRCOG Part Two
Arrange pre-operative management
Recognise potential co morbidity
Name and mode of use of common
surgical instruments and sutures
Obtain valid consent
1,3,4
Complications of surgery
Explain procedures to patient
3
Regional anatomy and histology
Advise patient on postoperative course
Commonly encountered infections,
including an understanding of the
principles of infection control
Within agreed level of competency for the
procedure:

Choose appropriate operation

Exhibit technical competence

Make intraoperative decisions

Manage intra-operative problems
Audit project
OSATS – opening and
closing abdomen
CbD
Knowledge of the NHS Improvement
Programme Enhanced Recovery
principles to enhance patient safety and
optimise pre, intra and postoperative care
Principles of nutrition, water; electrolyte
and acid base balance and cell biology.
1,3,4
Clinical skills essential for:
o
Common clinical skills-delivery of twins
fetal bradycardia and ventouse delivery,
malposition at full dilatation
Confident in stepping up from ST2 to
ST3
Increase responsibility and promote
patient safety
Appropriate use of blood and blood
products
Non-clinical skills essential for:
o
Understanding of senior
midwife coordinator
expectations of an ST3 on
delivery suite
o
Best practice in telephone
consultations and referral
o
Coping and dealing with
serious untoward incidents
including debriefing and
feedback.
o
Improving resilience –looking
after yourself
General pathological principles
MRCOG Part Three
Assessment in
Laparoscopic Simulation
with OSATS
The Obstetrician and
Gynaecologist journal
Learning resources
available at NHS
Improvement
Programme website
– Enhanced
Recovery
(Gynaecology)
http://www.improvem
ent.nhs.uk/enhancedr
ecovery2/Gynaecolo
gy.aspx
36
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Knowledge criteria
GMP
Clinical competency
GMP
Professional skills and attitudes
GMP
Training support
Evidence/assessment
Resilience training;
Step-up course or
equivalent
37
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Appendix to Module 5: Details of Knowledge Criteria:

Knowledge of the NHS Improvement Programme Enhanced Recovery principles to enhance patient safety and ensure:

patients are in the optimal condition for treatment

patients have different care during their operation

patients experience optimal post-operative rehabilitation

Legal issues around consent to surgical procedures, including consent of minors (and Fraser competency), adults with incapacity and adults and children in emergency situations.

Name and mode of use of common surgical instruments.

Knowledge of sutures and their appropriate use.

Prevention and complications of surgery including:



Venous thromboembolism
Infection (wound, urinary tract, respiratory, intra-abdominal and pelvic)
Primary and secondary haemorrhage (intraoperative and postoperative).

Relevant clinical anatomy.

Relevant bones, joints, muscles, blood vessels, lymphatics, nerve supply and histology.

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.

Principles of nutrition, water, electrolyte and acid base balance and cell biology.

Knowledge and awareness of anaesthesia: general anaesthetic, conscious sedation, regional and local.

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.

Knowledge and awareness of use in complications of Diathermy and other energy sources Curriculum Module 6: Postoperative Care
38
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Competence level
Basic level
Intermediate level
Advanced level
Not required
Core Module 5 Logbook
Level 1
Date
Level 2
Signature
Date
Signature
Level 3
Date
Signature
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
Training Courses or sessions
Date
Title
Signature of educational supervisor
Obtaining consent
Basic Practical Skills in Obstetrics and Gynaecology course
(RCOG approved)
39
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Resilience training; Step-up course (or equivalent)
Authorisation of signatures (to be completed by the clinical trainers)
Name of clinical trainer (please print)
Signature of clinical trainer
Each OSATS should be successfully completed for Independent Practice on 3 occasions before the module can be signed off
OSATS
Opening and closing the abdomen
Date
Date
Date
Signature
Signature
Signature
40
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
COMPLETION OF MODULE 5
I confirm that all components of the module have been successfully completed:
Date
Name of educational supervisor
Signature of educational supervisor
41
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Core Module 6: Postoperative Care
Learning outcomes:

To understand and demonstrate appropriate knowledge, skills and attitudes in relation to postoperative care
Knowledge criteria
GMP
Knowledge of the NHS Improvement
Programme Enhanced Recovery
principles to enhance patient safety and
ensure patients experience optimal postoperative rehabilitation
Clinical competency
Professional skills and attitudes
POSTOPERATIVE CARE
GMP
GMP
1
Postoperative complications related to
obstetric, gynaecological and nongynaecological procedures
1
Fluid/electrolyte balance
1
Wound healing
1
Late postoperative complications,
including secondary haemorrhage
1
Evidence/assessment
Learning resources
available at NHS
Improvement
Programme website
– Enhanced
Recovery
(Gynaecology)
http://www.improvem
ent.nhs.uk/enhancedr
ecovery2/Gynaecolo
gy.aspx
Use Enhanced Recovery principles to ensure
optimal post-operative rehabilitation
General pathological principles of post
operative care
Training support
Make appropriate postoperative plans of
management
1
Conduct appropriate review of:

fluid/electrolyte balance

catheter

surgical drainage

sutures
1
Recognise and initiate collaboration
with other disciplines.
Demonstrate the need for effective
communication with other healthcare
professionals.
Demonstrate the need for effective
communication with patients and
relatives.
Manage complications including wound,
thromboembolism, and infection.
1,2
1,2
Deal competently with the unexpected
complication e.g. bladder or ureteric injury.
Psychological support for patients and relatives
Initiate management for primary and secondary
haemorrhage
3
1,2,3
Basic Practical skills
course (RCOG
approved)
3
RCOG guidelines on
thromboembolism
Attend morbidity and
mortality meetings
Audit project
3
Document the surgical procedure with
appropriate notes
MRCOG Part One
StratOG.net: Surgical
Procedures and
Postoperative Care etutorial
MRCOG Part Two
MRCOG Part Three
Mini CEX
Construct an appropriate discharge
letter
1,3
Recognise limits and refer
appropriately
2,4
National Patient
Safety Agency.
Surgical Safety
Checklists. Available
online.
CbD
Reflective diary
ARCP
The Obstetrician and
Gynaecologist journal
1
42
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Competence level
Basic level
Intermediate level
Advanced level
Not required
Core Module 6 Logbook
Level 1
Date
Level 2
Signature
Date
Signature
Level 3
Date
Signature
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
43
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Competence level
Basic level
Intermediate level
Advanced level
Not required
Core Module 6 Logbook
Level 1
Date
Level 2
Signature
Date
Signature
Level 3
Date
Signature
Manage postoperative complications, collaborating with others where appropriate:
Gynaecological
Non-gynaecological
Late complications
Training Courses or sessions
Date
Title
Signature of educational supervisor
Authorisation of signatures (to be completed by the clinical trainers)
Name of clinical trainer (please print)
Signature of clinical trainer
44
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Authorisation of signatures (to be completed by the clinical trainers)
Name of clinical trainer (please print)
Signature of clinical trainer
COMPLETION OF MODULE 6
I confirm that all components of the module have been successfully completed:
Date
Name of educational supervisor
Signature of educational supervisor
45
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Core Module 7: Surgical Procedures
Learning outcomes:

To understand and demonstrate appropriate knowledge, skills and attitudes in relation to surgical procedures
Knowledge criteria
GMP
Knowledge of the NHS Improvement
Programme Enhanced Recovery
principles to enhance patient safety and
ensure:

patients are in the optimal
condition for treatment

patients have different care
during their operation

patients experience optimal
post-operative rehabilitation
Clinical competency
Professional skills and attitudes
SURGICAL PROCEDURES
GMP
Training support
Evidence/assessment
Have the knowledge to choose
appropriate instruments, sutures,
drains and catheters
1,2
Observation of,
assisting and
discussion with
Senior Medical Staff
OSATS Diagnostic
laparoscopy
Know own limitations and when to
seek help
2
2
First trimester surgical termination (unless
conscientious objection)
Demonstrate the use of diathermy,
endoscopic and other equipment
safely and efficiently
Diagnostic hysteroscopy (inc endometrial
polypectomy)**
Show evidence of thinking ahead
during procedure
Minor cervical procedures (inc polypectomy)
Amend surgical procedure
appropriately when necessary
following consultation
Management of Bartholin's Abscess/Cyst
GMP
1
Evacuation of uterus
Diagnostic laparoscopy**
Sterilisation**
Relevant basic sciences
1
3
Knowledge of instruments and sutures
Excision of vulval lesions
Laparotomy for ectopic pregnancy
Ovarian cystectomy for benign disease
Demonstrate the ability to work
effectively with other members of the
theatre team, showing leadership
where appropriate
Elective peritoneal adhesiolysis
Myomectomy
3
OSATS Operative
laparoscopy
RCOG Basic
Practical Skills
course
OSATS Diagnostic
hysteroscopy
Learning resources
available at NHS
Improvement
Programme website
– Enhanced
Recovery
(Gynaecology)
http://www.improvem
ent.nhs.uk/enhancedr
ecovery2/Gynaecolo
gy.aspx
OSATS Uterine
evacuation
**Use of low fidelity
[box] trainers or
virtual reality (VR)
simulation to
enhance
psychomotor skills
MRCOG Part One
Successful patient
outcomes
Logbook
Reflective diary
ARCP
MRCOG Part Two
MRCOG Part Three
National Institute for
Clinical Excellence
(NICE) Balloon
catheter insertion for
Bartholin's cyst or
abscess
StratOG.net: Surgical
Procedures and
Postoperative Care e46
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Knowledge criteria
GMP
Clinical competency
GMP
Professional skills and attitudes
GMP
Training support
Evidence/assessment
tutorials
The Obstetrician and
Gynaecologist journal
47
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Competence level
Basic level
Intermediate level
Advanced level
Not required
Core Module 7 Logbook
Level 1
Date
Level 2
Signature
Date
Signature
Level 3
Date
Signature
Evacuation of uterus
Management of Bartholin's Abscess/Cyst
Laparotomy for ectopic pregnancy
Excision biopsy of benign vulval lesion (LA or GA)
Vulval biopsy under local anaesthesia
Abdominal hysterectomy ± bilateral salpingo-oophorectomy
Vaginal hysterectomy
Oophorectomy
Ovarian cystectomy
Adhesiolysis
Transabdominal myomectomy
Diagnostic laparoscopy
Management of pelvic abscess
(a) Non-surgical management of pelvic abscess OM
(i.e. conservative, interventional radiology/needle
48
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Competence level
Basic level
Intermediate level
Advanced level
Not required
Core Module 7 Logbook
Level 1
Date
Level 2
Signature
Date
Signature
Level 3
Date
Signature
drainage)
(b) Surgical management of pelvic abscess
Laparoscopic sterilisation
Diagnostic hysteroscopy
Hysteroscopy and polypectomy
Minor cervical procedures
Minor perineal revision surgery OM
Training Courses or sessions
Date
Title
Signature of educational supervisor
49
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Authorisation of signatures (to be completed by the clinical trainers)
Name of clinical trainer (please print)
Signature of clinical trainer
Each OSATS should be successfully completed for Independent Practice on 3 occasions before the module can be signed off
OSATS
Diagnostic laparoscopy
Operative laparoscopy
Date
Date
Date
Signature
Signature
Signature
Date
Date
Date
Signature
Signature
Signature
Date
Date
Date
Signature
Signature
Signature
Diagnostic hysteroscopy
Each OSATS should be successfully completed for Independent Practice on 3 occasions before the module can be signed off
OSATS
50
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Laparoscopy management of
ectopic pregnancy
Date
Date
Date
Signature
Signature
Signature
COMPLETION OF MODULE 7
I confirm that all components of the module have been successfully completed:
Date
Name of educational supervisor
Signature of educational supervisor
51
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Core Module 8:
Antenatal care
Learning outcomes:

To understand and demonstrate appropriate knowledge, skills and attitudes in relation to antenatal care
Knowledge criteria
GMP
Clinical competency
GMP
Professional skills and attitudes
ANTENATAL CARE
Preconception care
1
Undertake pregnant and non-pregnant abdominal
examination
Purposes and practice of antenatal care
Take obstetric history and make relevant referral
as a result of domestic violence
Recognition of signs of domestic violence
Problems of teenage pregnancy
1,3
Awareness of drug and alcohol misuse
Conduct booking visit and arrange appropriate
investigations. Understand the positive and
negative effects of screening on the individual
1,3
Management of normal pregnancy, birth
and puerperium
Conduct follow-up visits
Manage:






Placental abnormalities and diseases
Genetic modes of inheritance, common
genetic conditions the importance of
screening and the diagnosis thereof.
Epidemiology, aetiology, pathogenesis,
diagnosis, prevention, management,
delivery, complications of:
 Pregnancy-induced hypertension
 haemorrhage
 preterm premature rupture of
membranes
 multiple pregnancy:
 malpresentation
 fetal growth retardation:
 fetal haemolysis:
 prolonged pregnancy:
 congenital malformation
 Social and cultural factors:



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
Assess fetal wellbeing by interpretation of CTG
Observe:
 External cephalic version (ECV)
 cervical cerclage
Immunology and immunological disorders
affecting pregnancy
1,2
Counsel about:
 Screening for Down syndrome
 genetic disease
 fetal abnormality
 haemolytic disease
 infection
 mode of delivery
 defibulation in cases of female genital
mutilation
1,2
Have the skills to liaise with midwives
and other health professionals to
optimise care of the woman
Demonstrate the skills to empower and
inform women to make appropriate
choices for themselves and their
families in pregnancy and childbirth
Show awareness of the need to
identify and deal appropriately with
domestic violence and have a working
knowledge of child protection issues as
they relate to the practice of obstetrics
and gynaecology
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, cytomegalovirus,
parvovirus and
toxoplasmosis
GMP
Training support
Evidence/assessment
3,4
Appropriate
postgraduate
education courses
including CTG
interpretation courses
MRCOG Part2
Perinatal morbidity
and mortality
meetings
Case reports
Risk assessment
meetings
Certificate of completion
of CTG training package
(e.g. K2)
Logbook
Local meetings attended
Audit project
StratOG Antenatal
Care e-tutorials
MSF (TO1/TO2)
National Institute for
Clinical Excellence.
CbD
Mini CEX
Scottish
Intercollegiate
Guidelines Network
website
Log of experience
Reflective learning
Scottish Health on
the Web website
Roleplay
MRCOG Part One
The Obstetrician and
Gynaecologist journal
Access female
genital mutilation
training video.
www.fgmnationalgrou
p.org (password
detailed within e
portfolio)
MRCOG Part Two
MRCOG Part Three
52
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Appendix to Module 8 – details of knowledge criteria:
Preconception care:
Immunology:









Sources of detailed information accessed by patients
Effect of pregnancy upon disease
Effect of disease upon pregnancy
Principles of inheritance of disease
Teratogenesis
Drugs and pregnancy
Purposes and practice of antenatal care:







Arrangements for and conduct of booking visit
Arrangements for and conduct of follow-up visits
Use of imaging techniques
Screening for abnormality
Health education
Liaison between health professionals
Recognition of domestic violence
Physiology and management of normal:




Pregnancy
Childbirth, including delivery outside specialist unit
Puerperium, including lactation
Neonate, including feeding
Placental:








Abnormalities (shape, size, implantation)
Chorioamnionitis
Infarcation
Chorioangioma
Multiple pregnancy
Intrauterine growth retardation
Cord abnormalities
Trophoblastic disease
Preterm premature rupture of membranes:




Fetal pulmonary maturity
Therapy (steroids, antibiotics, tocolytics)
Infection (risks, management)
Delivery (induction of labour, timing, mode)
Haemorrhage:





Placental abruption
Placenta praevia
Vasa praevia
Placenta accreta
Trauma
Multiple pregnancy:








Zygosity
Impact of assisted reproduction techniques
Placentation
Diagnosis
Management (antenatal, intrapartum, postnatal)
Special procedures (prenatal diagnosis, monitoring)
Feeding
Higher order multiple pregnancies (counselling, community care)
Malpresentation:




Fetal growth restriction:




Immunological pregnancy tests
Rhesus and other isoimmunisation
Auto-immune diseases
Types (breech, brow, face, shoulder, variable lie)
Diagnosis
Management (antenatal, intrapartum)
Mode of delivery
Hypotensive disorders:
Aetiology (maternal, placental, fetal)
Diagnosis (clinical, imaging, biochemical, genetic)
Monitoring (ultrasound, cardiotocography)
Delivery (timing, method)




Hypovolaemia
Sepsis
Neurogenic shock
Cardiogenic shock
53
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies

Prognosis (fetal, neonatal)
Genetic:



Modes of inheritance (Mendelian, multifactorial)
Cytogenetics
Phenotypes of common aneuploidies (Down syndrome, Edward syndrome, Patau syndrome,
Turner syndrome, Klinefelter syndrome, triple X, multiple Y)
Translocation
Miscarriage
Molecular genetics (DNA transcription, DNA translation, DNA blotting techniques, gene
amplification techniques, principles of gene tracking)
Counselling (history taking, pedigree analysis)
Population screening (genetic disease, congenital malformations)
Antenatal diagnosis (chromosomal defects, inborn errors of metabolism, neural tube defects,
other major structural abnormalities)
Management [referral to specialist team, antenatal intervention, delivery, neonatal investigation,
neonatal care (medical, surgical)]












Fetal haemolysis:








Relevant antigen-antibody systems
Prevention
Fetal pathology
Diagnosis
Assessment of severity
Intrauterine transfusion (indications, techniques, referral)
Delivery (timing, method)
Counselling
Prolonged pregnancy:



Epidemiology, aetiology, pathogenesis, diagnosis, prevention, management, delivery,
complications, prognosis with regard to the following:
Anaphylaxis
Trauma
Amniotic fluid embolism
Thromboembolism
Uterine inversion
Risks
Fetal monitoring
Delivery (indications, methods)
Pregnancy induced hypertension:








Definitions
Aetiological theories
Prophylaxis
Assessment of severity
Consultation
Therapy
Delivery (timing, method)
Complications (eclampsia, renal, haemorrhagic, hepatic, fetal)
Congenital malformation:










Screening
Amniotic fluid volume (polyhydramnios, oligohydramnios)
Management: diagnosis, consultation, viability, delivery (time, place, method), counselling
Specific abnormalities:
Head (anencephaly, microcephaly, encephalocele, hydrocephalus, hydranencephaly,
holoprosencephaly)
Skeleton (spina bifida, phocomelia, chondrodysplasia, intrauterine amputation)
Heart (major defects, other defects)
Lungs (pulmonary hypoplasia)
Urinary (renal agenesis, polycystic kidneys, urinary tract obstruction)
Genital (intersex, genital tract abnormalities, ovarian cyst)
54
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies







Gastro-intestinal (abdominal wall defects, oesophageal atresia, duodenal atresia,
diaphragmatic hernia, bowel obstruction)
Other (cystic hygroma)
Other fetal disorders:
Non-haemolytic hydrops fetalis
Tumours
Pleural effusion
Fetal bleeding
Social and cultural factors:






Effect upon pregnancy outcome
Single parenthood
Teenage motherhood
Parent-baby relationships (factors promoting, factors interfering)
Bereavement counselling
Counsel women appropriately about defibulation
Techniques of fetal anomaly scanning and non-invasive fetal diagnosis:

Use of nuchal translucency measurements to identify fetuses at high risk of Down’s syndrome

Combination of ultrasound and other risk markers to create an individualised risk profile for
each patient
Invasive procedures:

Amniocentesis

Chorionic villus sampling

Placentesis

Cordocentesis
55
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Competence level
Basic level
Intermediate level
Advanced level
Not required
Core Module 8 Logbook
Level 1
Date
Level 2
Signature
Date
Signature
Level 3
Date
Signature
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
56
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Competence level
Basic level
Intermediate level
Advanced level
Not required
Core Module 8 Logbook
Level 1
Date
Level 2
Signature
Date
Signature
Level 3
Date
Signature
Care of woman diagnosed with a stillbirth
Prolonged pregnancy
Drug and alcohol problems in pregnancy
Common infections in pregnancy (UTI, parvovirus,
varicella)
Rarer infections (e.g. HIV, CMV)
Preterm premature rupture of the membranes
Antepartum haemorrhage
External cephalic version
Insertion of cervical cerclage OM
Counsel about:
Screening for Down syndrome
Screening for other fetal abnormalities
Able to discuss risks of stillbirth
57
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Competence level
Basic level
Intermediate level
Advanced level
Not required
Core Module 8 Logbook
Level 1
Date
Level 2
Signature
Date
Signature
Level 3
Date
Signature
Haemolytic disease of the newborn
Mode of delivery after caesarean section
Cervical cerclage
Defibulation as appropriate in cases of
female genital mutilation
OM
Training Courses or sessions
Date
Title
Signature of educational supervisor
CTG Interpretation
Basic obstetric ultrasound theoretical course
Authorisation of signatures (to be completed by the clinical trainers)
Name of clinical trainer (please print)
Signature of clinical trainer
58
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Authorisation of signatures (to be completed by the clinical trainers)
Name of clinical trainer (please print)
Signature of clinical trainer
COMPLETION OF MODULE 8
I confirm that all components of the module have been successfully completed:
Date
Name of educational supervisor
Signature of educational supervisor
59
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Core Module 9: Maternal Medicine
Learning outcomes:

To understand and demonstrate appropriate knowledge, skills and attitudes in relation to maternal medicine
Knowledge criteria
GMP
Clinical competency
GMP
Professional skills and attitudes
GMP
Training support
Evidence/assessment
Understand the epidemiology, aetiology,
pathophysiology, clinical characteristics,
prognostic features and management of
the prevalence and risks associated with
the conditions stated below:
1,2
Diagnose, investigate and manage, with direct
supervision:
1,2
Have the ability to recognise the
normal from abnormal
1,2,3
Local and regional
Courses
Logbook

















hypertension
kidney disease
heart disease
liver disease:
circulatory disorders
haemoglobinopathies
connective tissue diseases
disorders of carbohydrate
metabolism
endocrinopathies
gastrointestinal disorders
pulmonary diseases
connective tissue diseases
bone and joint disorders
perinatal mental health
infectious diseases
neurological diseases
neoplasia


















pregnancy-induced hypertension
thromboembolism
impaired glucose tolerance
insulin-dependent diabetes
essential hypertension
kidney disease
liver disease
maternal haemoglobinopathy
coagulation disorders
acute abdominal pain
asthma
inflammatory bowel disease
intercurrent infection
psychological disorders
infectious disease
epilepsy
endocrinopathies
neoplasia
Attendance at
medical disorders
antenatal clinic
Reflective diary
Have the skills to request the relevant
investigations to support the differential
diagnosis
StratOG.net Maternal
Medicine e-tutorials
Audit project
Competently demonstrate the skills to
formulate a management plan
National Institute for
Clinical Excellence.
Have the ability to implement a plan of
management and modify if necessary
Scottish
Intercollegiate
Guidelines Network
website
Develop the skills to competently
formulate list of differential diagnoses
Develop the skills to liaise effectively
with colleagues in other disciplines,
both clinical and non-clinical
Case reports
CbD
Mini CEX
MRCOG Part One
MRCOG Part Two
MRCOG Part Three
Scottish Health on
the Web website
British Maternal and
Fetal Medicine
Society website
Maternal complications due to pregnancy
RCOG Green Top
guideline 12:
Pregnancy and
breast cancer
Able to describe the natural history of
diseases and illnesses that run a chronic
course
The Obstetrician and
Gynaecologist journal
Have knowledge of long term
management plans for chronic conditions
https://stratog.rcog.or
g.uk/tutorial/perinatalmental-health
60
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Appendix to Module 9 – Details of Knowledge Criteria
Understand the epidemiology, aetiology, pathophysiology, clinical characteristics, prognostic features and management of the prevalence and
risks associated with the conditions stated below:
Heart disease:

Congenital

Rheumatic

Ischaemic

Cardiomyopathy

Heart failure
Hypertension:

Definitions

Aetiological theories

Organ involvement (mother, fetus)

Diagnosis

Drug therapy
Liver disease:

Cholestasis

Hepatitis

Acute fatty degeneration

Gall stones
Kidney disease:

Urinary tract infection

Pyelonephritis

Chronic renal disease

Renal stones

Transplantation

Acute renal failure
Circulatory disorders:

Coagulation defects

Thrombocytopenias

Thromboembolism

Transfusion

Replacement of blood constituents

Varicose veins (legs, vulva, haemorrhoids)
Pulmonary diseases:

Asthma

Infection

Embolism

Aspiration syndrome
Haemoglobinopathies

Anaemia

Sickle cell disease

Thalassaemias
Neurological disorders:
 Epilipesy
 Cerebrovascular disease
 Multiple sclerosis
 Migraine
 Neuropathies
 Myasthenia gravis
 Paraplegia
Connective tissue diseases:

Systemic lupus erythematosus

Rheumatoid arthritis

Immunosupressant drugs
Bone and joint disorders:

Backpain

Pelvic girdle dysfunction

Chronic arthritis
Perinatal mental health:

Perinatal mental health services and the referral process and an awareness of different
treatment modalities (e.g. counselling/support groups etc

Psychiatric assessment: history taking, mental state examination and risk assessment

Managing perinatal health emergencies
Disorders of carbohydrate metabolism:

Diagnosis

Gestational diabetes

Type 1 and Type 2 diabetes

Hazards (maternal, fetal, neonatal)

Ketoacidosis

Drugs (insulins, oral hypoglycaemic agents and pregnancy)
Endocrinopathies:

Thyroid (diagnosis, assessment, antibodies, therapy, fetal hazards)

Adrenal (Addison’s disease, acute adrenal failure, congenital adrenal hyperplasia,
61
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies






Depression in pregnancy, postnatal depression and the relevant treatments
Anxiety disorders including tokophobia and PTSD
Psychotic disorders: puerperal psychosis, bipolar disorder and schizophrenia
Eating disorders: anorexia nervosa, bulimia nervosa
Personality disorders
Use of medications in pregnancy: antenatal and postnatal and the benefits and risks
Gastrointestinal disorders:

Nausea

Vomiting

Hyperemesis

Gastric reflux

Abdominal pain

Appendicitis

Inflammatory bowel disease

Intestinal obstruction
Neoplasia

Principles of pregnancy management following malignancy including breast cancer

Principles of pregnancy management with new diagnosis of malignancy including breast
cancer

phaeochromacytoma)
Pituitary (prolactinoma, hypopituitarism, diabetes insipidus)
Infectious diseases:

Investigation of pyrexia

Serological tests

Principles (prevention, detection, isolation)

Therapy (prophylaxis, immunization, antibiotics, antiviral agents)

Maternal (preterm premature rupture of membranes, preterm labour, chorioamnionitis,
puerperal sepsis, mastitis, urinary tract infection, wound infections, septic shock, malaria,
other tropical infections and infestations)

Fetus and neonate (streptococcus, gonococcus, syphilis, toxoplasma, listeria, haemophilus,
chlamydia, mycoplasma, ureaplasma, herpes hominis, rubella, cytomegalovirus, varicella,
hepatitis A, hepatitis B, hepatitis C, parvovirus, influenza, human immunodeficiency virus,
neonatal sepsis)
Maternal complications due to pregnancy:

Antepartum haemorrhage

Amniotic fluid embolism

Sheehan’s syndrome
62
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Competence level
Basic level
Intermediate level
Advanced level
Not required
Core Module 9 Logbook
Level 1
Date
Level 2
Signature
Date
Signature
Level 3
Date
Signature
Diagnose, investigate and manage antenatally with appropriate consultation:
Chronic hypertension
Gestational hypertension
Pre eclampsia
Severe hypertension/pre-eclampsia
HELLP syndrome
OM
Eclampsia
OM
Acute pyelonephritis
Renal stones
Chronic renal disease
Renal disease – transplantation
OM
Cardiac disease – congenital heart disease
63
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Competence level
Basic level
Intermediate level
Advanced level
Not required
Core Module 9 Logbook
Level 1
Date
Cardiac disease – rheumatic heart disease
OM
Cardiac disease – ischaemic heart disease
OM
Level 2
Signature
Date
Signature
Level 3
Date
Signature
Cardiac disease – arrhythmia
Cardiac disease – peripartum cardiomyopathy
OM
Liver disease – obstetric cholestasis
Liver disease – acute fatty liver of pregnancy
OM
Respiratory disease – asthma
Respiratory disease – TB
OM
Respiratory disease – acute respiratory distress syndrome
Gastrointestinal disease – chronic inflammatory bowel
disease
Gastrointestinal disease – gallstones
Gastrointestinal disease – reflux oesophagitis
Gastrointestinal disease – hyperemesis gravidarum
64
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Competence level
Basic level
Intermediate level
Advanced level
Not required
Core Module 9 Logbook
Level 1
Date
Level 2
Signature
Date
Signature
Level 3
Date
Signature
Gestational diabetes
Insulin-dependent diabetes-use of sliding scale
Insulin-dependent diabetes- complications
Hypothyroidism
Hyperthyroidism
Microprolactinoma
OM
Neurological disease – epilepsy
Neurological disease – migraine
Neurological disease – multiple sclerosis
Neurological disease – Bell’s palsy
Neurological disease – carpel tunnel syndrome
Systemic lupus erythematosus
OM
Antiphospholipid syndrome (APLS)
65
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Competence level
Basic level
Intermediate level
Advanced level
Not required
Core Module 9 Logbook
Level 1
Date
Level 2
Signature
Date
Signature
Level 3
Date
Signature
Sickle cell disease & other haemoglobinopathies
Haemophilia & von Willebrand’s disease
Thrombocytopaenias
Previous deep vein thrombosis
Thrombophilias
Acute DVT
Pulmonary embolism
OM
Perinatal mental health: planning of antenatal/intrapartum
care including emergency
Perinatal mental health: planning of postnatal care
Perinatal mental health: appropriate MDT management of
acute events
Perinatal mental health: knowledge of relevant
pharmacology
Skin disease – eczema
Skin disease – polymorphic eruption of pregnancy
66
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Competence level
Basic level
Intermediate level
Advanced level
Not required
Core Module 9 Logbook
Level 1
Date
Non-gynaecological malignancy
Level 2
Signature
Date
Signature
Level 3
Date
Signature
OM
HIV
Training Courses or sessions
Date
Title
Signature of educational supervisor
Authorisation of signatures (to be completed by the clinical trainers)
Name of clinical trainer (please print)
Signature of clinical trainer
67
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Authorisation of signatures (to be completed by the clinical trainers)
Name of clinical trainer (please print)
Signature of clinical trainer
COMPLETION OF MODULE
I confirm that all components of the module have been successfully completed:
Date
Name of educational supervisor
Signature of educational supervisor
68
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Core Module 10:
Management of Labour
Learning outcomes:

To understand and demonstrate appropriate knowledge, skills and attitudes in relation to labour
Knowledge criteria
GMP
Clinical competency
GMP
Professional skills and attitudes
GMP
Training support
Evidence/assessment
Mechanisms of normal labour and
delivery
1,2
Manage:
1,2
Demonstrate the appropriate use of
protocols and guidelines
1,2
CTG training
Meetings attended
Eclampsia drill –
simulation**
Case reports






Induction and augmentation of labour
Drugs acting upon the myometrium
in-utero transfer
intrauterine fetal death (IUFD)
women who decline blood products
obstetric haemorrhage**
severe pre-eclampsia/eclampsia**
obstetric collapse**
Demonstrate the ability to prioritise
cases and have the skills to supervise
the workload on a labour ward
Structure and use of partograms
Prioritise labour ward problems
Audit project
Respect cultural/religious differences
in attitudes to childbirth
3,4
Practice effective liaison with
colleagues in other disciplines, clinical
and non-clinical
3
Demonstrate the ability to deal
sensitively with the issues regarding
intrauterine fetal death
3,4
Fluid balance in labour
Evaluate clinical risk
Blood products
Liaise with other staff
Regional anaesthesia, analgesia and
sedation
Interpret a CTG
Fetal wellbeing and compromise
Manage:
Prolonged labour
Emergency policies/maternal
collapse/haemorrhage
Pre-term labour/ premature rupture of
membranes




induction of labour
delay in labour
labour after a previous lower
segment caesarean section
preterm labour
Keep accurate contemporaneous
records
1,3
Ensure prompt post-incident report is
completed
1,4
Perform and interpret a fetal blood sample
Cervical cerclage
Advise on pain relief
Confident in stepping up from ST2 to
ST3
Multiple pregnancy in labour
Removal of cervical suture
Severe pre-eclampsia and eclampsia
In-utero fetal death (IUFD), including
legal issues
Increase responsibility and promote
patient safety
Counsel and consent for fetal post-mortem in
cases of intrauterine fetal death
Manage abdominal pain
Acute abdominal pain
Clinical skills essential for:
3,4
Non-clinical skills essential for:
o
Understanding of senior
midwife coordinator
expectations of an ST3 on
Annual Review
Logbook
Reflective diary
Communication in an
emergency – role
play/simulation
Recognise personal limitations and the
need to refer appropriately
Prescribe blood products appropriately
Drill for obstetrical
collapse and
obstetric
haemorrhage simulation/drills**
OSATS- Fetal blood
sampling
Breaking bad news
study session – role
play
MRCOG Part One
Labour ward team
drills (as used for
CNST training) which
include aspects of
team-working,
leadership and
situational judgment
awareness
MRCOG Part Three
MRCOG Part Two
Perinatal mortality
and morbidity
meetings
StratOG.net:
Management of
Labour and delivery
e-tutorials
69
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Knowledge criteria
GMP
Clinical competency
o
GMP
Common clinical skills-delivery of twins
fetal bradycardia and ventouse delivery,
malposition at full dilatation
Professional skills and attitudes
o
o
o
delivery suite
Best practice in telephone
consultations and referral
Coping and dealing with
serious untoward incidents
including debriefing and
feedback.
Improving resilience –looking
after yourself
GMP
Training support
Evidence/assessment
Resilience training;
Step-up course (or
equivalent)
Disposal of fetal parts
RCOG Good Practice
Guideline: Disposal
following pregnancy
loss before 24 weeks
of gestation. RCOG
website.
Courses such as
ALSO and MOET
The Obstetrician and
Gynaecologist journal
70
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Appendix to Module 10: Management of Labour

Mechanisms of normal and abnormal labour

Mechanism of spontaneous vaginal delivery

Methods of induction of labour; indications, contraindications and complications

Methods of augmentation of labour; indications, contra-indications and complications

Drugs acting upon the myometrium and cervix

Structure and use of partograms

Fluid balance in labour

Transfusion

Types and methods of action of regional anaesthesia including epidural (lumbar, caudal), spinal, pudendal nerve block; indications and contra-indications

Types and methods of action of analgesia and sedation including narcotics, hypnotics, psychotropics, non-steroidal anti-inflammatory drugs; indications, contra-indications

Complications of anaesthesia and analgesia including cardiac arrest, respiratory arrest, aspiration, drug reactions

Assessment of fetal wellbeing using fetal heart rate monitoring, acid/base balance, and fetal scalp blood sampling

Causes and management of fetal compromise including cord prolapse and intra-uterine fetal death

IUFD – legalities regarding registration and disposal of fetal tissue

Causes and management of prolonged labour

Causes and management of maternal collapse including massive haemorrhage, cardiac problems, pulmonary and amniotic embolism, drug reactions, trauma

Emergency guidelines and procedures

Ante andintra partum haemorrhage including, placenta praevia, vasa praevia, ruptured uterus, coagulation defects, iatrogenic causes

Causes, mechanisms of action and complications of pre-term labour/ premature rupture of membranes including fetal pulmonary maturity, infection risks

Preterm labour including therapy (antibiotics, steroids, tocolysis), consultation with neonatologists, in-utero transfer, methods of delivery (induction of labour, timing, mode), outcomes, risks

Role and types of cervical cerclage

Multiple pregnancy in labour

Severe pre-eclampsia and Eclampsia

Placental abruption
71
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Competence level
Basic level
Intermediate level
Advanced level
Not required
Core Module 10 Logbook
Level 1
Date
Level 2
Signature
Date
Signature
Level 3
Date
Signature
Induce labour
Manage delay in first labour
Manage delay in second stage of labour
Advise on pain relief
Interpret CTG
Perform fetal blood sampling
Manage fetal acidaemia
Manage preterm labour and delivery
Manage labour after previous caesarean section
Management of the breech in labour (excluding delivery)
Management of transverse lie in labour (excluding delivery)
OM
Cord prolapse
OM
Manage severe pre-eclampsia in labour
72
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Competence level
Basic level
Intermediate level
Advanced level
Not required
Core Module 10 Logbook
Level 1
Date
Manage eclampsia in labour
Manage HELLP in labour
Level 2
Signature
Date
Signature
Level 3
Date
Signature
OM
OM
Manage obstetric antepartum haemorrhage
Safe use of blood products
Manage obstetrical collapse
OM
Manage intrauterine infection
Prioritise labour ward problems
Evaluate clinical risk
Coordinate and run labour ward
Liaise with other staff
Manage in utero transfer
Manage in utero fetal death
73
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Competence level
Basic level
Intermediate level
Advanced level
Not required
Core Module 10 Logbook
Level 1
Date
Level 2
Signature
Date
Signature
Level 3
Date
Signature
Date
Title
Signature of educational supervisor
Eclampsia drill
Drill for obstetric collapse
ALSO/MOET or similar
Resilience training; Step-up course (or equivalent)
Authorisation of signatures (to be completed by the clinical trainers)
Name of clinical trainer (please print)
Signature of clinical trainer
74
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Authorisation of signatures (to be completed by the clinical trainers)
Name of clinical trainer (please print)
Signature of clinical trainer
Each OSATS should be successfully completed for Independent Practice on 3 occasions before the module can be signed off
OSATS
Fetal blood sampling
Date
Date
Date
Signature
Signature
Signature
COMPLETION OF MODULE 10
I confirm that all components of the module have been successfully completed:
Date
Name of educational supervisor
Signature of educational supervisor
75
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Core Module 11: Management of delivery
Learning outcomes:
 To understand and demonstrate appropriate knowledge, skills and attitudes in relation to management of delivery
Knowledge criteria
GMP
Clinical competency
GMP
Professional skills and attitudes
GMP
Training support
Evidence/assessment
Normal vaginal delivery
1,2
Normal delivery**
1
Make appropriate decisions in the
choice of delivery in partnership with
the mother and respect the views of
other healthcare workers (midwives)
2,3,4
Audit project
Be aware of emotional implications for
women, families and staff
3
Normal delivery,
vacuum extraction,
forceps delivery,
vaginal breech
delivery – low fidelity
simulation**
Operative vaginal delivery
Vacuum extraction without rotation**
Complex vaginal delivery
Forceps delivery without rotation**
Retained placenta
Shoulder dystocia**
Management of female genital mutilation
Retained placenta
Caesarean section
Recognition of mal-presentation
Acknowledge and respect cultural
diversity and the differences of others
Caesarean section with sterilization
General anaesthesia
Cord prolapse**
3,4
Uncomplicated caesarean section
The unconscious patient
Repeat caesarean section
Potential medico-legal implications of
operative vaginal birth
Acute emergency caesarean section
Demonstrate the ability to
communicate clearly and effectively at
times of stress**
2
Show ability to prioritise workload
1,2
Demonstrate team management and
show leadership according to year of
training**
2,3
Be realistic. Recognition of own
competence level and have self
awareness to call for help when
necessary
1,2,3,4
Demonstrate the use of appropriate
protocols and guidelines
1,2
Vaginal delivery of twins
Vaginal breech delivery
Perform the technique of defibulation safely and
appropriately
Delivery with fetal malpresentation
Previously undiagnosed breech
Caesarean section with placenta praevia
Uterine rupture
ALSO course
OSATS:
Operative vaginal
delivery
Caesarean section
Rotational assisted delivery
Strategies to reduce risk to both mother
and infant through safe operative birth
Shoulder dystocia
drill – low fidelity
simulation**
Cord prolapse Team-working
simulation/drills**
Respect confidentiality
Regional anaesthesia
Logbook
Log of experiences
Respect individual dignity and privacy
Sterilisation procedures
Annual Review
Provide training in the non-technical
skills necessary to achieve:
o
Decision making
o
Teamwork and
communication
Communication
issues – use role
play**
Manual removal of
placenta
Perinatal mortality
and morbidity
meetings
MRCOG Part One
StratOG.net:
Management of
Labour and Delivery
e-tutorials
MRCOG Part Three
MRCOG Part Two
MOET / ALSO
course
RoBUST course (or
equivalent)
Local protocols
National Institute for
Clinical Excellence.
76
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Knowledge criteria
GMP
Clinical competency
GMP
Professional skills and attitudes
o
o
Vaginal breech delivery including second twin
Learning and practice, using simulation, of the
technical skills necessary for safe, operative birth,
including:
o
Non-rotational vacuum
o
Non-rotational forceps
o
Rotational vacuum
o
Rotational forceps – OP and OT
o
Caesarean section at full dilatation
Situational awareness
Maintaining professional
relationships
GMP
Training support
Evidence/assessment
Scottish
Intercollegiate
Guidelines Network
website
Scottish Health on
the Web website
British Maternal and
Fetal Medicine
Society website
The Obstetrician and
Gynaecologist journal
Access female
genital mutilation
training video
www.fgmnationalg
roup.org
(password
detailed within e
portfolio)
77
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Appendix to Curriculum Module 11: details of knowledge criteria
Operative/complex vaginal delivery:
















Malpresentation (brow, face, shoulder, variable lie)
Malpositions
Manual rotation of the fetal head
Outlet forceps/ventouse
Mid-cavity forceps/ventouse
Rotational forceps/ventouse
Pelvic floor anatomy
Episiotomy
Perineal trauma and repair
Female genital Mutilation
Assisted breech delivery
Breech extraction
Twin delivery
High order multiple births
Shoulder dystocia
Caesarean section

Indications for and complications of caesarean section

Routine

Repeat

Acute emergency

Sterilisation procedures
Anaesthesia:

General anaesthesia

Regional anaesthesia

Induction agents

Inhalation agents

Prophylactic measures

Complications
The unconscious patient
Resuscitation
Intensive care
78
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Competence level
Basic level
Intermediate level
Advanced level
Not required
Core Module 11 Logbook
Level 1
Date
Level 2
Signature
Date
Signature
Level 3
Date
Signature
Normal delivery
Shoulder dystocia
OM
Ventouse extraction without rotation
Uncomplicated acute/elective caesarean section
Repeat caesarean section (two or more previous sections)
Retained placenta
Cord prolapse
OM
Forceps delivery without rotation
Caesarean section with sterilisation
Vaginal delivery of twins
Preterm (< 28 weeks) caesarean section
Rotational assisted ventouse delivery
Procedure of defibulation in cases of female genital
mutilation
OM
79
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Competence level
Basic level
Intermediate level
Advanced level
Not required
Core Module 11 Logbook
Level 1
Date
Level 2
Signature
Date
Signature
Level 3
Date
Signature
Complex emergency caesarean section
Caesarean section for placenta praevia
Caesarean section after failed instrumental delivery
Caesarean section at full dilation
Recognise undiagnosed breech
Vaginal breech delivery
OM – including breech at CS
and vaginal twin delivery)
Delivery with fetal malpresentation
(a) Delivery with face presentation OM
(b) Delivery with compound presentation
(c) Delivery with shoulder presentation/transverse lie OM
Uterine rupture
(a) Uncomplicated uterine scar dehiscence/rupture
OM
(b) Complicated uterine rupture OM
80
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Training Courses or simulation sessions
Date
Title
Signature of educational supervisor
Shoulder dystocia drill
RoBUST course (or equivalent)
Authorisation of signatures (to be completed by the clinical trainers)
Name of clinical trainer (please print)
Signature of clinical trainer
81
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
OSATS
Each OSATS should be successfully completed for Independent Practice on 3 occasions before the module can be signed off
Operative vaginal delivery (nonrotational forceps)
Date
Date
Date
Signature
Signature
Signature
Date
Date
Date
Signature
Signature
Signature
Date
Date
Date
Signature
Signature
Signature
Date
Date
Date
Signature
Signature
Signature
Date
Date
Date
Signature
Signature
Signature
Operative vaginal delivery
(non-rotational vacuum)
Operative vaginal delivery
(rotational vacuum)
Caesarean section
Manual removal of placenta
COMPLETION OF MODULE 11
I confirm that all components of the module have been successfully completed:
Date
Name of educational supervisor
Signature of educational supervisor
82
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Core Module 12: Postpartum Problems (the Puerperium)
Learning outcomes:


To understand and demonstrate appropriate knowledge, skills and attitudes in relation to postpartum problems
To understand and demonstrate appropriate knowledge, skills and attitudes in relation to neonatal problems
Knowledge criteria
GMP
Clinical competency
GMP
Professional skills and attitudes
GMP
Training support
Evidence/assessment
Normal and abnormal postpartum period
1,2
Demonstrate skills in acute resuscitation**
1,2
Demonstrate the ability to counsel
women about management and
implications of anal sphincter trauma**
1,3
Role Play for
counselling issues**
Meetings attended
Techniques for the control of postpartum
haemorrhage
The normal puerperium, including contraception
Breast problems
Appropriate use of blood and blood
products
Perineal surgery
Perineal and vaginal tears**
Understand the roles of other
healthcare professionals (e.g. social
workers, psychiatrists,
physiotherapists)
Case reports
3,4
Damage to rectum and anal sphincters**
1
Postpartum sepsis**
Retained placenta
Primary, secondary and other postpartum
haemorrhage**
Normal and abnormal postpartum period
Acute maternal collapse**
Display empathy with women and their
families where puerperal problems
arise
Reflective diary
Audit project
Be aware of Breast feeding initiative
Postpartum and postoperative
complications
Acute resuscitation –
low-fidelity
simulation**
3,4
Postpartum sepsis,
massive
haemorrhage and
acute collapse –
simulation using
labour ward team
drills**
Problems after
childbirth
Infant feeding
Annual review
OSATS: Perineal repair
OSATS: Manual removal
of placenta
MRCOG Part One
MRCOG Part Two
Counselling after
perinatal loss – role
play**
Perinatal mental health (also see module
9)
MRCOG Part Three
Perineal trauma
course - low-fidelity
simulation**
Perinatal mortality
and morbidity
meetings
StratOG.net:
Postpartum and
Neonatal Problems
e-tutorials
National Institute for
83
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Knowledge criteria
GMP
Clinical competency
GMP
Professional skills and attitudes
GMP
Training support
Evidence/assessment
Clinical Excellence.
Scottish
Intercollegiate
Guidelines Network
website
Scottish Health on
the Web website
https://stratog.rcog.or
g.uk/tutorial/perinatalmental-health
NEONATAL PROBLEMS
Sequelae of obstetric complications:
Appropriately manage immediate resuscitation
of the neonate**
1,2
Liaise with paediatricians and the
neonatal team
Recognition of normality
3
StratOG.net:
Postpartum and
Neonatal problems etutorials
Logbook
Neonatal resuscitation
drill
Resuscitation of the newborn
Basic neonatal
resuscitation – lowfidelity simulation**
Common neonatal problems
Feeding
GMC guidance. End
of life care: neonates
and infants. GMC
website.
The Obstetrician and
Gynaecologist journal
Perinatal morbidity
and mortality
meetings
84
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Appendix to Module 12: details of knowledge criteria
Epidemiology, aetiology, pathogenesis, recognition, diagnosis, prevention, management, complication, prognosis regarding:











uterine involution
bleeding including placenta accreta, atonic uterus,
retained placenta, retained products of conception
pyrexia
infections
maternal collapse including massive haemorrhage, cardiac problems, pulmonary and amniotic embolism, drug reactions, trauma
thromboembolism
lactation (inadequate, suppression)
medical disorders (diabetes mellitus, renal disease, cardiac disease)
postnatal review
contraception
Techniques for the control of haemorrhage:










manual removal of placenta
bimanual compression of uterus
exploration of genital tract
cervical laceration (identification and repair)
drug management
balloon tamponade of uterus
laparotomy including B Lynch stitch
radiological embolisation
ligation of internal iliac arteries
caesarean hysterectomy
Perineal surgery:

Repair of episiotomy, second- third- fourth- degree laceration
Postpartum complications, including pathophysiology, diagnosis, management and prognosis in puerperal psychological disorders (blues, depression), mood disorders, reactions to
pregnancy loss
Puerperal sepsis, mastisis, urinary tract infection
Breast cancer
Sequelae of obstetric events:


antenatal
intrapartum
85
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Recognition of normality:


postnatal management
clinical evaluation
Resuscitation of newborn:










collapse
primary apnoea
secondary apnoea
ventilation
effect of maternal drugs
cardiac massage
umbilical catheterisation
volume replacement
temperature control
acid/base status
Common problems (aetiology, management sequelae):














respiratory distress
hyperbilirubinaemia
infection
seizures
hypoglycaemia
hypothermia
heart disease
intracranial haemorrhage
necrotizing enterocolitis
the preterm infant
the growth restricted infant
congenital anomalies
syndromes
cerebral palsy
Feeding:


breast (advantages, promotion, techniques)
artificial (formulae, techniques)
86
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Competence level
Basic level
Intermediate level
Advanced level
Not required
Core Module 12 Logbook
Level 1
Date
Level 2
Signature
Date
Signature
Level 3
Date
Signature
Conduct a postnatal consultation
Bladder dysfunction
Bowel dysfunction
Primary postpartum haemorrhage
Secondary postpartum haemorrhage
Intra-abdominal haemorrhage
(a) Obstetric (eg broad ligament
haematoma, post CS)
(b) Non-obstetric (e.g. liver capsule rupture,
splenic artery aneurysm)
OM
OM
Management of Massive Obstetric Haemorrhage
Acute maternal collapse
OM
Perineal and vaginal tears
Damage to rectum and to anal sphincters
(a) Repair 3rd degree tears
(b) Repair 4th degree tears
Immediate resuscitation of neonate
OM
OM
87
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Competence level
Basic level
Intermediate level
Advanced level
Not required
Core Module 12 Logbook
Level 1
Date
Level 2
Signature
Date
Signature
Level 3
Date
Signature
Puerperal sepsis
Perinatal mental health in postpartum period
Contraceptive advice
Breast problems
Management of mastitis
Management of thromboembolic problems
Training Courses or simulation sessions
Date
Title
Signature of educational supervisor
Basic neonatal resuscitation
Massive obstetric haemorrhage
Perineal trauma course
Authorisation of signatures (to be completed by the clinical trainers)
88
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Name of clinical trainer (please print)
Signature of clinical trainer
Each OSATS should be successfully completed for Independent Practice on 3 occasions before the module can be signed off
OSATS
Perineal repair
Date
Date
Date
Signature
Signature
Signature
COMPLETION OF MODULE 12
I confirm that all components of the module have been successfully completed:
Date
Name of educational supervisor
Signature of educational supervisor
89
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Core Module 13:
Gynaecological Problems
Learning outcomes:


To understand and demonstrate appropriate knowledge, skills and attitudes in relation to common gynaecological disorders
To understand paediatric and adolescent gynaecological disorders.
Knowledge criteria
GMP
Clinical competency
GMP
Professional skills and attitudes
GMP
Training support
Evidence/assessment
To understand the epidemiology,
aetiology, biological behaviour, pathophysiology, clinical characteristics,
prognostic features and management of:
1,2
Diagnose, investigate and manage common
gynaecological disorders
1,2
Demonstrate the ability to
communicate prognosis and counsel
patients sensitively about the options
available
3
StratOG.net:
Gynaecological
Problems and Early
Pregnancy Loss etutorials
Logbook
Have the necessary skills to explain
the nature, complications and adverse
effects of medical and surgical
treatments
3
**Use of low fidelity
(box) trainers or
virtual reality (VR)
simulation to
enhance
psychomotor skills
MRCOG Part One










Menstrual disorders
Benign conditions of the
genital tract
Endocrine disorders
Problems of the climacteric
Pelvic pain
Vaginal discharge
Emergency gynaecology
Congenital abnormalities of
the genital tract
Paediatric gynaecology
Puberty
Endometrial assessment**
Diagnostic hysteroscopy**
Diagnostic laparoscopy: staging of endometriosis
See Module 7 for other surgical competencies
Demonstrate the ability to formulate
and implement a plan of management
and have the ability to modify this as
necessary
Recognise the need for appropriate referral for
more complex or detailed evaluation with
ultrasound or other imagine techniques
See ultrasound modules for other ultrasound
competencies
Recognise the need for appropriate
referral for more complex or detailed
evaluation with ultrasound or other
imaging techniques
Able to describe the natural history of
diseases and illnesses that run a chronic
course
Have the skills to liaise with colleagues
in other disciplines where required
Have knowledge of long term
management plans for chronic conditions
(see Module 2)
3
Demonstrate and understanding of the
use of appropriate referral pathways
and local protocols if abnormal findings
suspected
Reflective diary
Log of experiences
MRCOG Part Two
MRCOG Part Three
Audit project
Supervised clinical
sessions
MSF (TO1 and TO2)
Specific courses and
academic meetings
OSATS: Diagnostic
Laparoscopy
Local and regional
courses in paediatric
gynaecological
problems and
problems of puberty
National Institute for
Clinical Excellence.
Scottish
Intercollegiate
Guidelines Network
website
Scottish Health on
the Web website
The Obstetrician and
Gynaecologist journal
90
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Knowledge criteria
GMP
Able to describe the anatomy and
physiology of the vulva, and its variation
between prepubertal, reproductive and
post-menopausal state
Clinical competency
GMP
Professional skills and attitudes
Take a vulval history
GMP
Training support
Evidence/assessment
Local and regional
courses in
assessment and
management of
vulval disorders
Counsel patient on the use of topical
steroids/emollients on the vulva
Interpret histopathological reports and ask a
histopathologist if needed
British Society for the
Study of Vulval
Disease website
http://www.bssvd.org/
RCOG Greentop
Guideline No 58 –
Management of
vulval skin disorders
(2011)
91
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Appendix to Module 13: details of knowledge criteria
Benign conditions of the lower genital tract:
Menstrual Disorders:

Menstrual irregularity

Excessive menstrual loss

Investigation of menstrual disorders

Medical and surgical management of menstrual disorders
Fibroids
Non menstrual bleeding (intermenstrual, postcoital)
Premenstrual syndrome
Problems of the climacteric:

Abnormal bleeding

Postmenopausal bleeding

Hormone replacement therapy

Non hormonal therapy

Osteopenia and osteoporosis

Breast cancer in relation to the climacteric
Amenorrhoea and endocrine disorders:

Investigation and interpretation

Hypothalamic/pituitary disorders

Hyperprolactinaemia

Premature ovarian failure

Polycystic ovaries and polycystic ovarian syndrome

Other causes of hyperandrogenism

Thyroid / adrenal disorders

Autoimmune endocrine disease
Vulva







Pruritus vulvae
Non-neoplastic cysts
Vulvodynia
Vulval pain
Lichens (sclerosus, simplex, chronicus and planus)
Contact dermatitis
Psoriasis
Vagina

Vaginal discharge (non sexually transmitted causes)
Pelvic pain:

Dysmenorrhoea

Dyspareunia

Endometriosis (staging, treatment)

Pelvic inflammatory disease

Non-gynaecological disorders
Ovary:


Benign ovarian neoplasms
Functional ovarian cysts
Emergency gynaecology:

Pelvic inflammatory disease

Bartholin's and vulval abscess

Ovarian cyst accidents

Acute vaginal bleeding outwith pregnancy

Miscarriage and ectopic pregnancy
Congenital abnormalities of genital tract:

Ambiguous genitalia

Imperforate hymen

Vaginal septae

Uterine anomalies

Mullerian duct development

Gonadal dysgenesis
Puberty:




Physiology and chronology
Precocious puberty
Delayed puberty
Excessive menstrual loss
92
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Competence level
Basic level
Intermediate level
Advanced level
Not required
Core Module 13 Logbook
Level 1
Date
Level 2
Signature
Date
Signature
Level 3
Date
Signature
Diagnose, investigate and manage the following clinical problems:
Menstrual disorders:
Menstrual irregularity
Excessive menstrual loss
Premenstrual syndrome
Amenorrhoea/oligomenorrhoea
Dysmenorrhoea
Pelvic pain:
Dyspareunia
Endometriosis (medical management)
Endometriosis (surgical management)
Pelvic inflammatory disease
Non-gynaecological disorders
93
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Competence level
Basic level
Intermediate level
Advanced level
Not required
Core Module 13 Logbook
Level 1
Date
Level 2
Signature
Date
Signature
Level 3
Date
Signature
Problems of the climacteric:
Postmenopausal bleeding
Hormone replacement therapy
Others:
Benign ovarian cysts
Vaginal discharge
Fibroids
Hirsutism
Pruritus vulvae
Vulval pain
Training Courses or sessions
Date
Title
Signature of educational supervisor
Problems of puberty
94
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Rape/ forensic gynaecology
Paediatric gynaecological problems
Authorisation of signatures (to be completed by the clinical trainers)
Name of clinical trainer (please print)
OSATS
Diagnostic laparoscopy
Signature of clinical trainer
Each OSATS should be successfully completed for Independent Practice on 3 occasions before the module can be signed off
Date
Date
Date
Signature
Signature
Signature
95
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
COMPLETION OF MODULE 13
I confirm that all components of the module have been successfully completed:
Date
Name of educational supervisor
Signature of educational supervisor
96
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Core Module 14: Subfertility
Learning outcomes:

To understand the issues and demonstrate appropriate knowledge, skills and attitudes in relation to subfertility
Knowledge criteria
GMP
Clinical competency
GMP
Professional skills and attitudes
GMP
Training support
Evidence/assessment
Epidemiology, aetiology, pathogenesis,
clinical features, treatment and prognosis
of male and female subfertility
1,2
Take history and examine a couple presenting
with subfertility
1,2
Show an appreciation of the
importance of psychological factors for
women and their partners
4
Logbook
Demonstrates respect for a woman’s
dignity and confidentiality
3,4
**Use of low fidelity
[box] trainers or
virtual reality (VR)
simulation to
enhance
psychomotor skills
Has an understanding of the issues
relating to NHS funding and rationing
of treatment
1
Demonstrates the ability to deal
sensitively with issues relating to the
welfare of the child
1,3,4
Arrange basic investigations
Indications, limitations and interpretation
of investigations:

endocrine measurements
(male and female)

semen analysis

ultrasound

other imaging techniques

genetic analysis

operative procedures
Counsel couples about diagnosis and
management options
Perform the following:

Diagnostic laparoscopy**

Staging of endometriosis**

Assessment of tubal patency**

Diagnostic hysteroscopy**
Indications, techniques, limitations and
complications of surgery in relation to:

male and female
subfertility

endometriosis

developmental disorders
3,4
Reflective diary
Log of experiences
Mini CEX
1,2
Appropriate
postgraduate
education courses
CbD
Case reports
Multi-disciplinary and
clinical team
meetings
Audit projects
OSATS:
Diagnostic laparoscopy
Has the ability to acknowledge cultural
issues and the issues relating to same
sex partnerships and single
parenthood
StratOG.net:
subfertility e-tutorials
Demonstrates the need to liaise
effectively with colleagues in other
disciplines, clinical and non-clinical
Assisted reproduction
sessions
MRCOG Part One
Subfertility clinics
MRCOG Part Two
Indications, limitations and complications
of assisted reproductive techniques:

Ovulation induction

IVF & ICSI

Gamete Donation
MRCOG Part Three
National Institute for
Clinical Excellence
website
Scottish
Intercollegiate
Guidelines Network
website
Legal and ethical issues
Able to describe the natural history of
conditions that run a chronic course
Scottish Health on
the Web website
Have knowledge of long term
management plans for chronic conditions
(see Module 2)
British Fertility
Society website
Human Fertilisation
97
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Knowledge criteria
GMP
Clinical competency
GMP
Professional skills and attitudes
GMP
Training support
Evidence/assessment
and Embryology Act
1991. Available
online
The Obstetrician and
Gynaecologist journal
98
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Appendix to Curriculum Module 14 – Details of Knowledge Criteria
Epidemiology, aetiology, pathogenesis, clinical features, treatment and prognosis of:
Male and female subfertility:





Female (ovulatory disorders, tubal disorders, endometriosis, cervical & uterine factors, genetic &
developmental disorders)
Male (structural, endocrine, pharmacological, infectious, lifestyle, genetic)
Unexplained infertility
Long term sequelae of cancer treatment
Sterilisation regret
Indications, limitations and interpretation of investigative techniques:
Operative investigative procedures


Diagnostic laparoscopy
Diagnostic hysteroscopy
Indications, limitations, techniques and complications of:






Ovulation induction (clomifene, gonadotropins, gonadotrophin-release hormone)
Other medical interventions (e.g. metformin, dopaminergic drugs)
Intrauterine insemnination
In vitro fertilisation
Intracytoplasmic sperm injection
Surgical sperm recovery


Semen analysis
Endocrine assessment (see also Module 13):
-
Assessment of ovulation
Assessment of the sub-fertile male
Amenorrhoea & oligomenorrhoea
Polycystic ovarian syndrome
Hyperprolacinaemia
Thyroid/adrenal function
Gonadal failure
Legal and ethical issues

Genetic analysis
Indications, limitations and complications of surgery in relation to male and female Infertility:
-
Chromosome analysis e.g. sex chromosome abnormalities
Genetic abnormities e.g. cystic fibrosis













Human Fertilisation and Embryology Act
Welfare of the child
Embryo storage
Gamete donation
Surrogacy
Reversal of sterilisation and vasectomy
Adhesiolysis
Salpingostomy
Surgical management of endometriosis
Ovarian diathermy
Myomectomy
Hysteroscopic surgery
Varicocoele
99
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Competence level
Basic level
Intermediate level
Advanced level
Not required
Core Module 14 Logbook
Level 1
Date
Level 2
Signature
Date
Signature
Level 3
Date
Signature
Take history from couple
Investigate female subfertility
Interpret semen analysis
Manage anovulation
Investigate tubal function
Counsel about management options
Training Courses or sessions
Date
Title
Signature of educational supervisor
Assisted reproduction
OSATS
Each OSATS should be successfully completed for Independent Practice on 3 occasions before the module can be signed off
100
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Diagnostic laparoscopy
Date
Date
Date
Signature
Signature
Signature
Authorisation of signatures (to be completed by the clinical trainers)
Name of clinical trainer (please print)
Signature of clinical trainer
COMPLETION OF MODULE 14
I confirm that all components of the module have been successfully completed:
Date
Name of educational supervisor
Signature of educational supervisor
101
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Core Module 15: Sexual and Reproductive Health
(Contraception, Termination of Pregnancy, Sexually Transmitted Infections and HIV, Sexual Problems)
Learning outcomes



To understand and demonstrate appropriate knowledge, skills and attitudes in relation to fertility control (contraception and termination of pregnancy), the diagnosis
and management of sexually transmitted infections including HIV and sexual dysfunction.
There may be conscientious objection to the acquisition of certain skills within the contraception and abortion components, this does not mean that meeting the
knowledge criteria is not required. Skills targets not attempted for these reasons should be clearly recorded in the logbook and signed off by a trainer.
Understand the need to respect women’s rights, dignity and confidentiality whilst providing appropriate information and advice.
Knowledge criteria
GMP
Clinical competency
GMP
Professional skills and attitudes
GMP
Training support
Evidence/assessment
Reversible, irreversible and emergency
contraception and termination of
pregnancy:
 mode of action and efficacy
 methods, indications,
contraindications and
complications
1,2
Take a history in relation to:

contraceptive and sexual health needs,
and risk assessment

unplanned Pregnancy
1,2,3,4
Demonstrates the ability to counsel
women sensitively about options
available, and associated sexual
health issues
3,4
StratOG.net: Sexual
and Reproductive
Health e-tutorials
Mini CEX
Displays tact, empathy and concern
3,4
eSRH e-Learning for
Healthcare (eLfH)
Modules (mandatory
completion by end
ST5) or DFSRH
completed and
recertified as

necessary

Certificate of completion
of eLfH eSRH modules
e-Learning for
Healthcare website
Reflective diary
The laws relating to termination of
pregnancy, sexually transmitted
infections, (STIs), consent, child
protection and the Sexual Offences Act
2003
Recognise and manage the sexual
healthcare needs of vulnerable groups,
e.g. young people, asylum seekers,
commercial sex workers, drug users, and
prisoners.
Counsel about:

contraceptive options (reversible and
irreversible)

unplanned pregnancy options
3,4
Demonstrates the ability to listen
actively and respect silences
Manage the following clinical situations:

Emergency Contraception

Hormonal

Insertion of IUD/IUS*

Medical Termination of Pregnancy
(early/late)
1,2
Is able to explain clearly and openly
treatments, complications and adverse
effects of drug treatment
Deliver all methods of reversible contraception
Demonstrates the ability to formulate
and implement a management plan
Surgical termination of early pregnancy
Network with other providers in multidisciplinary
team, for example:

counsellors

social workers

GUM specialists

contraception specialists

primary Care

voluntary sector/ self-help groups

police
3,4
Demonstrates effective liaison with
colleagues in other disciplines, clinical
and non-clinical
Understand the need to respect
cultural and religious beliefs as well as
sexual diversity
Aware of reproductive and sexual
health implications related to FGM
Log of experiences
DFSRH (optional)
CbD
MRCOG Part One
1,2
Female sterilisation**
Recall the effect of addictive and self
harming behaviours, especially
substance misuse and gambling, on
personal and community health and
poverty
Understand the ability to respect
women’s rights, dignity and
confidentiality
Logbook
1
3
*Use of low fidelity
pelvic mannequins to
enhance speculum
and bimanual skills
*Use of models to
facilitate IUD/IUS
insertion
MRCOG Part Two
MRCOG Part Three
Achievement of:

LoCIUT

LoCSdI
**Use of low fidelity
[box] trainers or
virtual reality (VR)
simulation to
enhance
psychomotor skills
102
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Knowledge criteria
GMP
Clinical competency
GMP
Sexually transmitted infections including
HIV/AIDS:
 transmission, clinical features,
management, transmission and
prevention
 National Chlamydia Screening
Programme and local
implementation
 Understand local care pathways
for multi-agency working and
cross referrals for individuals
with sexual health needs
Recognise and manage the following:

common clinical presentations of STIs in
the female patient e.g. dysuria, discharge,
genital ulcerations

clinical presentations of complications of
common STIs e.g. acute pelvic infection
Sexual problems:
Genital infections e.g. Bacterial Vaginosis, Genital
candidiasis


anatomy and physiology of the
human sexual response
epidemiology, aetiology,
pathogenesis, clinical features
and prognosis of psychosexual
/ sexual problems
Perform appropriate microbiological investigations to
investigate the common presentations of STIs
Professional skills and attitudes
Appreciate the importance of
psychological factors for women and
their partners
GMP
Training support
Evidence/assessment
http://www.elfh.org.uk/programme
s/female-genitalmutilation
Practical skills courses
1,2
Recognise and manage the clinical presentations of
non-STI genital infections e.g. bacterial vaginosis,
genital candidiasis
Has an understanding of the
psychosocial impact of STIs and living
with HIV and AIDS including the
support systems available for patients
Demonstrates the ability to promote
healthy lifestyles
Is aware of BMA/GMC Guidance for
Doctors with Conscientious Objections
to Abortion
Treat and arrange follow-up for patients with STIs as
per local protocols
Is aware of GMC Good Medical
Practice and Duties of a Doctor
publications and their implications for
doctors in practice
Explain the principles of partner notification and
epidemiological treatment for sexual contacts
Perform an HIV risk assessment and discuss HIV
transmission with patients.
Family Planning/
genitourinary
medicine sessions
Roleplay
Diploma of the
Faculty of Sexual and
Reproductive
Healthcare of the
RCOG (optional)
Faculty of Sexual and
Reproductive Health
Care Letter of
Competence in
Intrauterine
Techniques
(LoC IUT)
Faculty of Sexual and
Reproductive
Healthcare Letter of
Competence in
Subdermal Implants
(Loc SdI)
Give appropriate advice to an HIV positive woman
about interventions available to reduce vertical HIV
transmission in pregnancy
Perform an HIV pre-test discussion and provide
appropriate management for positive and negative
results
Faculty of Sexual and
Reproductive Health
website
Assess risk for Hepatitis A/B/C infections and arrange
HAV and HBV vaccination appropriately for at risk
groups according to local protocol
Sexually Transmitted
Infections Foundation
course
Liaise effectively with local GUM colleagues for
effective multi-agency working
Take a history from the couple – or individual - with a
sexual/ psychosexual problem
1,2,4
Recognise, counsel and plan initial management of
sexual/ psychosexual problems, and know when to
refer
Use of training
models
National Sexual
Health Strategy
documentation
103
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Knowledge criteria
GMP
Clinical competency
GMP
Professional skills and attitudes
GMP
Training support
Evidence/assessment
Recommended
standards for Sexual
health Services.
Department of Health
website
Department of Health
Chlamydia screening
programme website
SIGN guidelines.
Available online
National Institute for
Clinical Excellence
(NICE) guidelines
Medical Foundation
for Aids and Sexual
Health (MEDFASH)
The Obstetrician and
Gynaecologist journal
104
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Appendix to Curriculum Module 15 – Details of Knowledge Criteria
Fertility control methods




Termination of pregnancy
Natural family planning (physical, Persona®)
Barrier (condom: male and female), diaphragm, caps]
Chemical
Hormonal methods (including pharmacodynamics and metabolic effects) oral, transdermal,
subdermal, intramuscular, intrauterine
Male and female sterilisation
Intrauterine contraception, (copper-containing, progesterone-containing)
Reversal of sterilisation
Postcoital methods (progestogen, intrauterine contraceptive devices)
Advances in contraception (including male reversible)










Techniques



Unplanned/unwanted pregnancy
Pre-procedure consultation/assessment
Estimation of maturity
Method options/choice
STI screen and prophylaxis
Counselling and support
Methods (manual vacuum aspiration, suction evacuation of uterus, dilatation
and evacuation, medical termination)
Complications of procedures
Contraceptive supplies on discharge
Aftercare
Contraceptive failure






method
iatrogenic
User
Contraception
Sexual health
Counselling and support
Other issues
Non-use of contraception due to e.g.












social factors
cultural factors
sexual/ domestic abuse
poor service access/delivery
Socio-economic consequences


Cycle of deprivation
Population trends







Management options



Abortion
Adoption
Keep baby
Age
Consent
Confidentiality
Legality
Special needs and vulnerable groups
Service organisation
High risk groups for sexual poor health
‘Hard to reach’ groups (asylum seekers, homeless and rootless, commercial
sex worker, substance abusers, mental illness)
Adolescents
Vulnerable adults
Learning disability
Socio-economic deprivation
Negative psychosocial impact of STIs, in particular HIV/AIDS
Importance of networks and multi-agency working
Gender dysphoria
105
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Sexually Transmitted Infections including HIV/ AIDS


















Transmission
Clinical features
Detection
Prevention
Treatments
Test of cure
Contact tracing
Health advisors
Genitourinary medicine services
Screening programmes
Specific conditions
Chlamydia
HIV
Parasitic infections
Fungal infections
Bacterial infections
Protozoal infections
Viral infections
Sexual problems







The anatomy and physiology of human sexual response
The psychogenic aetiology and presentation of common sexual problems
such as loss of sexual interest and arousal, vaginismus, anorgasmia
The effect of age, cultural influences, illness and drugs on sexual behaviour
and performance
The principles of psychosexual counselling
Sexual problems in special needs groups such as physical and learning
disability
Covert presentations of psychosexual problems and childhood sexual abuse
Referral pathways to local expertise in the field of psychosexual medicine and
sexual dysfunction
106
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Competence level
Basic level
Intermediate level
Advanced level
Not required
Core Module 15 Logbook *
Level 1
Date
Level 2
Signature
Date
Signature
Level 3
Date
Signature
Identify, discuss and manage the following issues:
A sexual health risk assessment
A request for contraception:
Discuss and inform, regarding all options
Provide:
Reversible contraception
Emergency contraception: hormonal
Emergency contraception: intrauterine
Permanent (female only, surgical)
Unplanned pregnancy:
Outpatient consultation and referral
Please mark ‘CO’ (conscientious objection) alongside skills not acquired (see learning outcomes of module with regards to knowledge criteria)
Perform (to indicated level):
107
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Competence level
Basic level
Intermediate level
Advanced level
Not required
Core Module 15 Logbook *
Level 1
Date
Level 2
Signature
Date
Signature
Level 3
Date
Signature
Early medical termination of pregnancy
Late medical termination of pregnancy
Early surgical termination of pregnancy
Late surgical termination of pregnancy
OM
Post-procedure follow-up consultation
STIs including HIV/AIDS:
Diagnosis and management of the common STIs
Chlamydia screening and treatment
Explain the principles of partner notification
Perform an HIV risk assessment
Psychosexual problems
OM
Take a history from individual/couple
Plan initial management/know when to refer
Please mark ‘CO’ (conscientious objection) alongside skills not acquired (see learning outcomes of module with regards to knowledge criteria)
108
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Training Courses or sessions
Date
Title
Signature of educational supervisor
E-learning for Healthcare (eLfH) eSRH e-learning modules
(mandatory completion by end ST5) or DFSRH completed
and recertified as necessary
Authorisation of signatures (to be completed by the clinical trainers)
Name of clinical trainer (please print)
Signature of clinical trainer
109
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
COMPLETION OF MODULE 15
I confirm that all components of the module have been successfully completed:
Date
Name of educational supervisor
Signature of educational supervisor
110
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Core Module 16:
Early Pregnancy Care
Learning outcomes:

To understand and to demonstrate appropriate knowledge, skills and attitudes in relation to early pregnancy loss
Knowledge criteria
GMP
Clinical competency
GMP
Professional skills and attitudes
GMP
Training support
Evidence/assessment
Epidemiology, aetiology, pathogenesis
and clinical features of miscarriage
1,2
Clinical assessment of miscarriage and ectopic
pregnancy,
2,3
Demonstrates the ability to
communicate effectively with patients
and relatives
3,4
Basic Practical Skills
Course (RCOG
approved)
Meetings attended
Has the ability to break bad news and
appreciate and describe the possible
long term consequences for the
woman in a sensitive manner
3,4
StratOG.net:
Gynaecological
Problems and Early
Pregnancy Loss etutorials
Reflective diary
Has the desired skills necessary to
counsel patients in an acute and
outpatient environment
3,4
Management of Early
Pregnancy Loss
RCOG guideline.
RCOG website.
CbD
Trophoblastic disease and ectopic
pregnancy
Communication of findings
Medical management of ectopic
pregnancy
Indications and limitations of
Investigations:
 endocrine
 anatomical
 immmunological
 genetic
 radiological
 bacteriological
Case reports
Biochemical assessment of early pregnancy
Appropriate referral for more complex or detailed
evaluation with ultrasound or other imaging
techniques
Surgical, minimal access surgery and non-surgical
management of miscarriage and ectopic by
appropriate techniques
Exhibit technical competence surgically, and make
appropriate operative decisions
Demonstrates the ability to
communicate findings to patients and
other health care professionals using
appropriate terminology at the time of
pregnancy loss
Has the skills to work with other
healthcare professionals to achieve
better patient outcomes
Has the ability to recognise limits of
own competence and develop the
skills to refer appropriately
Mini CEX
MRCOG Part One
MRCOG Part Two
Understanding of management options
Prognosis after miscarriage(s) and
ectopic pregnancy
Audit project
2,3
The Obstetrician and
Gynaecologist journal
MRCOG Part Three
Association of Early
Pregnancy Units
website
OSATS Laparoscopic
management of ectopic
pregnancy
Recommended
terminology: surgical
management of
miscarriage (SMM) http://www.earlypreg
nancy.org.uk/Surgical
_Management_of_Mi
scarriage.asp
111
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Competence level
Basic level
Intermediate level
Advanced level
Not required
Core Module 16 Logbook
Level 1
Date
Level 2
Signature
Date
Signature
Level 3
Date
Signature
Miscarriage:
Miscarriage: clinical assessment
Medical management of miscarriage
Conservative management of miscarriage
Surgical management of miscarriage (SMM)
Counselling
Manage recurrent miscarriage
Ectopic pregnancy:
Diagnosis
Conservative management
Medical management
Laparoscopic management
Laparotomy for ectopic pregnancy
Other conditions:
112
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Early management of trophoblastic disease
Training Courses or sessions
Date
Title
Signature of educational supervisor
Authorisation of signatures (to be completed by the clinical trainers)
Name of clinical trainer (please print)
Signature of clinical trainer
113
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Each OSATS should be successfully completed for Independent Practice on 3 occasions before the module can be signed off
OSATS
Uterine evacuation
Date
Date
Date
Signature
Signature
Signature
COMPLETION OF MODULE 16
I confirm that all components of the module have been successfully completed:
Date
Name of educational supervisor
Signature of educational supervisor
114
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Core Module 17: Gynaecological Oncology
Learning outcomes

To understand and demonstrate appropriate knowledge, skills and attitudes in relation to Gynaecological Oncology
Knowledge criteria
GMP
Clinical competency
GMP
Professional skills and attitudes
GMP
Training support
Evidence/assessment
Epidemiology, aetiology, genetic
associations, diagnosis, prevention,
screening, management, prognosis,
complications, and anatomical
considerations of premalignant and
malignant conditions of:

vulva

vagina

uterus

cervix

fallopian tube

ovary
1,2
Counsel about cervical cytology reports and HPV
test information
1,2
Show empathy with patients
3
Logbook
Recognises the importance of
psychological factors for patients and
their families
3
Appropriate
postgraduate
education courses
Log of experiences
Demonstrates respect for the patient’s
dignity and confidentiality
3,4
Multidisciplinary and
clinical team
meetings
2,3,4
StratOG.net:
Gynaecological
Oncology e-tutorials
MRCOG Part Two
Explain clearly and openly treatments,
complications and side effects of drug
treatment, chemotherapy and
radiotherapy in language appropriate
for the patient
The Obstetrician and
Gynaecologist journal
Mini CEX
Observe cervical colposcopy
Recognise, counsel and plan initial management
of premalignant conditions of:
 cervix
 endometrium
 vulva
Recognise, counsel and plan initial management
of carcinoma of:

cervix

endometrium

ovary

vulva
FIGO classifications for gynaecological
Tumours (including 2009 versions)
Palliative and terminal care
Relief of symptoms
Community support roles
1,2,3
Indications and limitations in relation to
screening and investigative
techniques:

cytology and HPV testing

colposcopy

minor procedures
Awareness of genetic abnormalities in relation to
development of cancer
Demonstrates effectiveness in liaising
with colleagues in other disciplines,
clinical and non-clinical
Demonstrates and awareness of
cultural and religious issues, especially
with respect to death and burial
practices
MRCOG Part Three
Palliative Care
course or sessions
(including in hospice)
Audit projects
Meetings attended
Breaking bad news
course
Local education
session on the
cervical screening
programme
Attendance at
gynaecological cancer
MDT
Colposcopy sessions
Show willingness to engage with
expert patients and representatives of
charities or networks that focus on
specific conditions and comprehends
their role in supporting patients and
their families and carers
Diagnostic Imaging
Indications, techniques, complications,
and outcomes of:



MRCOG Part One
CbD
Deal sensitively with issues regarding
palliative care and death
Is aware of the ‘End of Life’ policy
Awareness of the role of multidisciplinary
meetings in determining gynaecological cancer
management
Reflective diary
oncological surgery
radiotherapy
chemotherapy
115
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Awareness of HPV vaccination
Knowledge of gynaecological
oncology multidisciplinary team
meeting
116
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Appendix to Module 17: details of knowledge criteria

Palliative and terminal care

Relief of symptoms

Pharmacological

Alternative Therapies

Community support roles:

General practitioner

District nurse

Family

Religion

Community services

Indications, techniques, complications, and outcomes of:

Cytology:

Cervical

Other (endometrial, vaginal, peritoneal)

Colposcopy:

Cervix

Vaginal

Vulva

Minor procedures:

Directed cervical biopsy

LLETZ

Endocervical curettage
Monitoring
Epidemiology, aetiology, genetic associations, diagnosis, prevention, screening, management,
prognosis, complications, and anatomical considerations of premalignant and malignant conditions of:

Vulva:
 Preclinical phase of invasive carcinoma
 Paget’s disease
 Basal cell carcinoma
 Squamous cell carcinoma
 Malignant melanoma
 Sarcoma

Cervix:
 Human pappilomavirus screening
 HPV vaccination programme
 Preclinical phase of invasive squamous cell carcinoma
 Adenocarcinoma in situ
 Squamous cell carcinoma
 Adenocarcinoma
 Sarcoma
 Metastatic tumours

Uterus:
 Intraendometrial adenocarcinoma
 Adenocarcinoma
 Adenosquamous carcinoma
 Sarcoma
 Leiomyosarcoma
 Haemangiopericytomata
 Trophoblastic disease. hydatiform mole (complete, partial, invasive)

Ovary:
 Epithelial Tumours
 Germ Cell Tumours
 Sex Chord Stromal Tumours
 Gonadoblastoma
 Mesonephroma
 Metatastic carcinoma

Diagnostic Imaging:



CT and PET-CT
Ultrasonography:
 Pelvis
 Abdomen
 Retroperitoneal masses
 Peripheral vascular thrombosis
Magnetic resonance imaging:
 Pelvis
 Abdomen
 Other
117
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Indications, techniques, complications and outcomes of:

Diagnostic biopsy
o
Hysteroscopy and endometrial curettage
o
Vulval biopsy
o
Needle biopsy – transabdominal, transvaginal, other
o
Nodal biopsy and FNA
o
Open biopsy


Oncology Surgery:
Gynaecological

Radical hysterectomy

Pelvic lymphadenectomy

Radical vulvectomy

Vaginal reconstruction

Pelvic exenteration

Feeding jejunostomy/gastrotomy

Urinary tract:

Ureteric surgery

Conduits (ileum, transverse colon, sigmoid colon)

Repair of vesico-vaginal fistulae

Gastrointestinal:

Resection

Reanastomosis

Colostomy


Radiotherapy:
Therapeutic methods:

Interstitial

Intracavity

External

Complications:

Gastrointestinal tract

Urinary tract

Skin

Bone marrow

Kidneys

Liver

Central nervous system

Chemotherapy

Drug Agents

Adverse effects

Monitoring
118
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Competence level
Basic level
Intermediate level
Advanced level
Not required
Core Module 17 Logbook
Level 1
Date
Level 2
Date
Level 3
Date
Cervical cytology:
Counsel about cytology reports
Observe and understand the need for basic colposcopy
Management cervical intraepithelial neoplasia
Manage premalignant conditions (including referral as appropriate) :
Cervical
Endometrial
Lower genital tract
Recognise, counsel and plan initial management of carcinoma of:
Cervix
Endometrium
Ovary
Vulva
Choriocarcinoma
OM
Rapid access clinic
119
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Training Courses or sessions
Date
Title
Signature of educational supervisor
Local education session on cervical screening programme
Attendance at gynaecological cancer MDT
Authorisation of signatures (to be completed by the clinical trainers)
Name of clinical trainer (please print)
Signature of clinical trainer
COMPLETION OF MODULE 17
I confirm that all components of the module have been successfully completed:
Date
Name of educational supervisor
Signature of educational supervisor
120
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
121
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Core Module 18:
Urogynaecology and Pelvic Floor Problems
Learning outcomes:

To understand and demonstrate appropriate knowledge, skills and attitudes in relation to Urogynaecology and Pelvic Floor Problems
Knowledge criteria
GMP
Clinical competency
GMP
Professional skills and attitudes
GMP
Training support
Evidence/assessment
Anatomy, physiology and
pathophysiology of:

pelvic Floor

urinary tract
1,2
Take a urogynaecological history
1,2
Show empathy with patients
4
Local and regional
courses
Logbook
Appreciate the importance of
psychological factors for patients
4
Demonstrates respect for patient’s
dignity and confidentiality
3,4
Explain clearly and openly treatments,
complications and side effects of drug
and surgical treatments
1,2
Epidemiology, aetiology, characteristics
and prognosis of:

urinary and faecal
incontinence

urogenital prolapse

urinary infection

lower urinary tract
disorders

urinary disorders
associated with other
conditions
Indications and limitations of
Investigations:

microbiological
examination of urine

quantification of urine loss

urodynamic investigations

videocystourethrography

urethrocystoscopy

imaging
Interpret investigations
Assessment and non-surgical management of
uterovaginal prolapse
Treatment of acute bladder voiding disorder
Counsel and plan initial management of
overactive bladder symptoms and stress urinary
incontinence
3,4
Under direct supervision:

Primary repair of anterior and
posterior prolapse

vaginal Hysterectomy
1,2
Deal sensitively with issues regarding
incontinence
Reflective diary
Multidisciplinary and
clinical team
meetings
Annual Review
StratOG.net:
Urogynaecology and
Pelvic Floor
Problems e-tutorials
CbD
Mini CEX
The Obstetrician and
Gynaecologist journal
Case Reports
Meetings attended
Liaise effectively with colleagues in
other disciplines, clinical and nonclinical
3
Urodynamic sessions
Observe procedure:

Minimally invasive slings
Audit projects
Log of experiences
MRCOG Part One
MRCOG Part Two
MRCOG Part Three
Indications, techniques, limitations and
complications of treatment:

non-surgical

drug

surgical
122
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Appendix to Curriculum Module 18 – Details of Knowledge Criteria
Indications, techniques, limitations and complications of treatment:
Epidemiology, aetiology, characteristics and prognosis of:

Urinary and faecal incontinence:

Urodynamic Stress incontinence

Detrusor over activity

Voiding disorders and urinary retention

Urinary frequency and urgency

Lower urinary tract disorders:

Urethral disorders

Pain

Fistulae

Effects of radical pelvic surgery

Effects of irradiation

Urinary disorders associated with other conditions:

Pregnancy

Gynaecological pathology

Elderly patients

Neurological conditions
Indications and limitations of Investigations:


Urodynamic investigations

Voiding charts

Ambulatory monitoring

Urodynamic equipment

Uroflowmetry

Standard subtracted cystometry
Imaging

Upper urinary tract

Lower urinary tract

Pelvic floor

Non-surgical
 Pads and garments
 Bladder retraining
 Pelvic floor exercises
 Self-catheterisation
 Long-term indwelling catheterisation
 Community care

Drug






Anticholinergics
Anti-muscarinic
Alpha blockers
Antidepressants
Oestrogens
Surgical

Urethral dilatation

Urethrocystoscopy

Suprapubic catheterisation

Peri-urethral injectables

Anterior repair

Vaginal hysterectomy

Vaginal repair of genital tract prolapse

Sling procedures

Colposuspension

Repair of recurrent prolapse

Fistula repair

Urinary diversion

Injectables
123
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Competence level
Basic level
Intermediate level
Advanced level
Not required
Core Module 18 Logbook
Level 1
Date
Level 2
Signature
Date
Signature
Level 3
Date
Signature
Take urogynaecological history
Cystoscopy
Interpret:
Urinary frequency volume charts
Uroflowmetry profiles
Cystometric investigations
Residual volume measurement
Manage non-surgically:
Bladder voiding disorders
Urgency of micturition
Uterovaginal prolapse:
Assess
Manage non-surgically
124
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Competence level
Basic level
Intermediate level
Advanced level
Not required
Core Module 18 Logbook
Level 1
Date
Level 2
Signature
Date
Signature
Level 3
Date
Signature
Repair of anterior prolapse
Repair of posterior prolapse
Vaginal hysterectomy
Stress urinary problems:
Minimally invasive slings/bladder neck procedures
Training Courses or sessions
Date
Title
Signature of educational supervisor
Authorisation of signatures (to be completed by the clinical trainers)
Name of clinical trainer (please print)
Signature of clinical trainer
125
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Authorisation of signatures (to be completed by the clinical trainers)
Name of clinical trainer (please print)
Signature of clinical trainer
COMPLETION OF MODULE 18
I confirm that all components of the module have been successfully completed:
Date
Name of educational supervisor
Signature of educational supervisor
126
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Core Module 19: Developing Professionalism
Learning outcomes:
 To understand the skills and qualities required to be become a consultant
 To develop the communication, team working and team leadership skills required
 To experience challenging situations where negotiating, influencing and diplomacy are required
 To gain a thorough knowledge of administration processes with a vested interest in contributing towards the development of the service
Knowledge criteria
GMP
Clinical competency
GMP
Professional skills and attitudes
GMP
Training support
Evidence/assessment
3,4
RCOG. The Future
Role of the
Consultant. RCOG
website.
MSF (TO1 and TO2)
BECOMING A CONSULTANT
Roles and responsibilities of team
members involved in delivering care
1,3
Define the concept of modern medical
professionalism
1,3
Show awareness of and sensitivity to the way in
which cultural and religious beliefs affect
approaches and decisions, and to respond
respectfully
Demonstrate the ability to communicate
effectively with:
 colleagues
 patients and relatives
Be able to break bad news
How a team works effectively and ways
of improving team working
dynamics and function
objective setting and planning
motivation and organization
respect
Use interpreters appropriately
Ability to work in a clinical team
Be aware of team structures and the
structures, roles and responsibilities of
the multidisciplinary teams within the
broader health context relevant to
obstetrics and gynaecology
Respect the opinions of others and enable
individuals, groups and agencies to implement
plans and decisions
Be able to communicate both verbally and in
writing with colleagues
Ability to manage time, prioritise and
delegate safely as necessary
Be able to work effectively within a specialty team
Recognise personal health as an
important issue
Understand the contribution that
mentoring and supervision make to
professional and personal development
Maintain and routinely practice critical selfawareness, including the ability to discuss
strengths and weaknesses with supervisor,
recognising external influences and changing
behaviour accordingly
Theories of motivation and demotivation
Facilitate, chair and contribute to meetings
Mini CEX
CbD
Demonstrates the ability to break bad
news appropriately and support
distress of patients, the families of
patients and colleagues
Know the relevance of the relevant
professional bodies; e.g. Royal Colleges,
GMC, PMETB




Be able to communicate both verbally and in
writing with patients and relatives
Recognise good advice and
continuously promote value-based
non-prejudicial practice
Lord Darzi’s Next
Stage Review. High
Quality Care for All.
Department of Health
website
Logbook
Reflective learning
Log of experiences
GMC Good Medical
Practice
Observation of and
discussion with
senior medical staff
MRCOG Part Two
MRCOG Part Three
Experiential learning
in the workplace
Leadership course
Use authority appropriately and
assertively; particularly with reference
to the resolution of conflict and
disagreement
Deal with problems and difficult colleagues by rebuilding rapport and articulating own views
Recognise the importance of active
participation in multi-disciplinary
meetings
Career guidance
StratOG.net: The
Obstetrician and
Gynaecologist as a
Teacher and
Researcher
127
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Knowledge criteria
GMP
Clinical competency
GMP
Professional skills and attitudes
GMP
Training support
Evidence/assessment
Leadership skills
Factors that influence and inhibit team
development including different
leadership and working styles
Conflict resolution methods
Know how to obtain and deal with
feedback professionally
Be aware of tools and techniques for
managing stress
Be aware of the limitations of selfprofessional competence
Understand the section in Good Medical
Practice on Working with Colleagues, in
particular:

The roles played by all members of
a multidisciplinary team

The features of good team
dynamics

The principles of effective interprofessional collaboration to
optimise patient or population care
Understand the principles of
confidentiality that provide boundaries to
communicate
Encourage staff to develop and exercise their own
leadership skills
Communicates accurately, clearly, promptly and
comprehensively with relevant colleagues by
means appropriate to the urgency of a situation
(e.g. telephone, email, letter etc), especially where
responsibility for a patient's care is transferred e.g.
at handover
Utilises the expertise of the whole multidisciplinary
team as appropriate, ensuring when delegating
responsibility that appropriate supervision is
maintained
Participates in, and co-ordinates, an effective
hospital at night or hospital out of hours team
where relevant; or participates in General Practice
out of hours effectively
Communicates effectively with administrative
bodies and support organisations
StratOG.net: The
Obstetrician and
Gynaecologist as a
Professional etutorials
Fosters a supportive and respectful
environment where there is open and
transparent communication between
all team members
e-Learning for
Healthcare (e-LfH)
Medical Leadership etutorials. e-LfH
website.
Ensures appropriate confidentiality is
maintained during communication with
any member of the team
Recognises the need for a healthy
work/life balance for the whole team.
only takes any leave after giving
appropriate notice to ensure that cover
is in place
GMC guidance.
Working in Teams.
GMC website.
GMC document:
Management for
doctors. GMC
website,
Accepts additional duties in situations
of unavoidable and unpredictable
absence of colleagues ensuring that
the best interests of the patient are
paramount
Employs behavioural management skills with
colleagues to prevent and resolve conflict, and
enhance collaboration
Demonstrate leadership and management in the
following areas:

Know techniques to manage anger and
aggression in self and colleagues

Know responsibility of the doctor in the
management of physical and/or mental ill
health in self and colleagues
Shows awareness of the importance
of, and takes part in, multidisciplinary
teamwork, including adopting a
leadership role when appropriate but
also recognising where others are
better equipped to lead


education and training of junior
colleagues and other members of the
healthcare team
deteriorating performance of colleagues
e.g. stress, fatigue
high quality care
effective handover of care between
shifts and teams
Encourage an open environment to foster and
explore concerns and issues about the functioning
and safety of team- working
NEOTIATING AND INFLUENCING SKILLS
128
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
GMP
Clinical competency
GMP
Professional skills and attitudes
GMP
Training support
Evidence/assessment
1,3
1,3
Has the ability to be able to assess
competence of StRs in formal
negotiations and informal situations
that require assertive responses
3,4
Management course
MSF (TO1 and TO2)
Characteristics and phase of negotiation
Identify and improve skills to prepare effectively
for negotiations and discussions that require
ability to influence colleagues
CbD
Tips and tactics for influencing others and
arriving at win-win situation
Understand different styles and make the most of
difficulties
Techniques in assertion and persuasion
Choose the right job
Understanding yourself, how conflict
arises and the principles for resolution
Application interview process
StratOG.net: The
Obstetrician and
Gynaecologist as a
Teacher and
Researcher and The
Obstetrician and
Gynaecologist as a
Professional etutorials
Observation of and
discussion with
senior medical staff
MSF (TO1 and TO2)
Demonstrate the ability to work
towards independent practice, but
seek advice appropriately
Management course
Mini CEX
NHS appraisal
CbD
Show competence in gaining informed
consent for:

patient care and procedures

research
StratOG.net: The
Obstetrician and
Gynaecologist as a
Teacher and
Researcher and The
Obstetrician and
Gynaecologist as a
Professional etutorials
Reflective Diary
Knowledge criteria
Principles of effective negotiation
Had skills to ensure effective
interaction with professionals in other
disciplines and agencies
Has developed the skills to access and
give appropriate career guidance
Roleplay
Reflective learning
Log of experiences
Professional role of a consultant
Self-awareness. Know how individual
behaviours impact others; personality
types, group dynamics, learning styles,
leadership styles
Takes on different and complimentary roles within
different communities within work
Becoming a consultant
Support the bringing together of different
professionals, disciplines and other agencies, to
provide high quality healthcare
Understands job planning and
negotiating a contract
Respects the skills and contributions of
colleagues
MANAGING SELF AND OTHERS
Continuing professional development
1,2,3
Doctor-patient relationship
4
Personal health
Understand the role and responsibility of
occupation health and other support
networks
Understand relevance of:

RCOG

GMC, Defence Unions, BMA

specialist societies

STC & postgraduate dean

Defence unions

Ethical principles

respect for autonomy

beneficence & non maleficence

justice
Informed consent
Be able to recognise and use learning
opportunities
1
3,4
Be able to deal appropriately with challenging
behaviour
Be able to recognise manifestations of stress on
self and know where and when to look for support
Recognise own limitations
2
Balance personal and professional roles and
responsibilities. Prioritise tasks, have realistic
expectations of what can be completed by self
and others
1,3
Ability to learn from:

colleagues

experience
Be committed to continuing
professional development. Seek
training and self-development
opportunities, learn from colleagues
and accept constructive criticism
Recognise when personal health takes priority
over work pressure
1,2,3,4
Logbook
Management course
certificate
Log of experiences
Reflective diary
Be able to gain informed consent
Understand ethical issues relevant to obstetrics
and gynaecology
Ability to develop and implement
organizational change, being aware of
Observation of and
discussion with
129
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Knowledge criteria
GMP
Clinical competency
GMP
Confidentiality
Professional skills and attitudes
GMP
Training support
the effects on systems and people
1,
senior medical and
management staff
Ability to collaborate with:

other professions

other agencies
3
Confidentiality and
Disclosure of Health
Information: RCOG
Ethics Committee
comments on BMA
document. RCOG
website.
3,4
Data Protection Act
1998.
Understand legal responsibilities
Legal issues

death certification

mental illness

advance directives, living wills
1,2,3
Organization of NHS services, financing,
operation and constituent organisations:

Directorate, Trust

PCT, SHA

Commission for Health
Improvement

Educational inspection visits
Role of Medical Director, Clinical
Director, Chief Executive
Management

strategy development

business planning

project management
Health and safety
Resource management
 Efficient use of clinical resources
in order to provide care
 Commissioning, funding and
contracting arrangements
relevant to the specialty
 Contribution to the management
of financial pressures
experienced by the specialty,
department and organisation
Be familiar with relevant legislation (e.g.
Equality and Diversity, Employment Law)
and local Human Resources policies
Develop and implement organizational change

development of strategy

formulate a business plan

manage a project
Know the human resources structure:

team building

appointments
procedures

disciplinary procedures
Be able to participate in recruitment

job specification

interview and selection
Practises with professionalism including:

integrity

compassion

altruism

continuous improvement

aspiration to excellence

respect of cultural and ethnic diversity

regard to the principles of equity
1,3,4
Works in partnership with patients and members
of the wider healthcare team
3
Liaises with colleagues to plan and implement
work rotas
3
Promotes awareness of the doctor’s role in
utilising healthcare resources optimally and within
defined resource constraints
1
Recognises and responds appropriately to
unprofessional behaviour in other
Respect the ethical and equality
aspects relating to management and
leadership, e.g. approaches to use of
resources/rationing; approaches to
involving the public and patients in
decision-making
Provides specialist support to hospital and
community based services if appropriate and
permitted
Handles enquiries from the press and other media
effectively
GMC. Confidentiality
guidance handbook.
GMC website.
1
StratOG.net: The
Obstetrician and
Gynaecologist as a
professional. Ethical
and legal issues etutorial.
4
Attendance at
Directorate
management
meetings
Be committed to the proper use of
public money. Takes action when
resources are not used efficiently or
effectively
Be aware that in addition to patientspecific clinical records, clinical staff
also have a responsibility for other
records (e.g. research)
Recognises personal beliefs and
biases and understands their impact
on the delivery of healthcare services
Appropriately refers patients where
own personal beliefs and biases could
impact upon professional practice
Uses all healthcare resources
prudently and appropriately
Evidence/assessment
Management course
4
Equal opportunity
course
Health and Safety
course
Resource
management course
Improves clinical leadership and
management skills
Know the duties, rights and
responsibilities of an employer and coworker (e.g. looking after occupational
Develop interviewing techniques and those
required for performance review
Recognises situations where it is
appropriate to involve professional and
regulatory bodies
130
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Knowledge criteria
GMP
safety of fellow staff). Understand how
occupation health and safety is organised
in the UK.
Clinical competency
GMP
Awareness of how to prepare rotas, delegate and
organise a team and run a unit relevant to the
specialty
Professional skills and attitudes
GMP
Training support
Evidence/assessment
3,4
Observation of and
discussion with
senior medical staff
MSF (TO1 and TO2)
Deals with inappropriate patient and
family behaviour
Write a simple business case
Respects the rights of children, elderly,
people with physical, mental, learning
or communication difficulties
Contribute towards staff development and
training, including mentoring, supervision and
appraisal
Adopts an approach to eliminate
discrimination against patients from
diverse backgrounds including age,
gender, race, culture, disability,
spirituality and sexuality
Use clinical audit to highlight resources required
Manage time and resources effectively to ensure
service delivery
Places needs of patients above own
convenience
Behaves with honesty and probity
Acts with honesty and sensitivity in a
non-confrontational manner
Accepts mentoring as a positive
contribution to promote personal
professional development
Participates in professional regulation
and professional development
Takes part in 360 degree feedback as
part of appraisal
Promotes the right for equity of access
to healthcare
Demonstrates reliability and
accessibility throughout the healthcare
team
MAINTAINING TRUST
Roles and responsibilities of team
members involved in delivering care
1,3,4
Be able to communicate both verbally and in
writing with patients and relatives
3,4
Demonstrate the ability to
communicate effectively with:
 colleagues
Mini CEX
131
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Knowledge criteria
GMP
Define the concept of modern medical
professionalism
Know the relevance of the relevant
professional bodies; e.g. Royal Colleges,
GMC, PMETB
How a team works effectively and ways
of improving team working

dynamics and function

objective setting and
planning

motivation and
organization

respect
Be aware of team structures and the
structures, roles and responsibilities of
the multidisciplinary teams within the
broader health context relevant to the
specialty, including other agencies
Understand the contribution that
mentoring and supervision make to
professional and personal development
Theories of motivation and demotivation
Factors that influence and inhibit team
development including different
leadership and working styles
Conflict resolution methods
Leadership skills
Know how to obtain and deal with
feedback professionally
Be aware of tools and techniques for
managing stress
Be aware of the limitations of selfprofessional competence
Clinical competency
GMP

Show awareness of and sensitivity to the way in
which cultural and religious beliefs affect
approaches and decisions, and to respond
respectfully
Be able to break bad news
Professional skills and attitudes
3,4
Demonstrates the ability to break bad
news appropriately and support
distress of patients, the families of
patients and colleagues
Ability to work in a clinical team
Be able to communicate both verbally and in
writing with colleagues
Ability to manage time, prioritise and
delegate safely as necessary
Be able to work effectively within a specialty team
Recognise personal health as an
important issue
3
Deal with problems and difficult colleagues by rebuilding rapport and articulating own views
Encourage staff to develop and exercise their own
leadership skills
Case-based discussion
Reflective Diary
1
StratOG.net: The
Obstetrician and
Gynaecologist as a
Teacher and
Researcher and The
Obstetrician and
Gynaecologist as a
Professional etutorials
GMC. Valuing
diversity: effective
communications.
GMC website.
Recognise the importance of active
participation in multi-disciplinary
meetings
Shows awareness of the importance
of, and takes part in, multidisciplinary
teamwork, including adopting a
leadership role when appropriate but
also recognising where others are
better equipped to lead
Communicates accurately, clearly, promptly and
comprehensively with relevant colleagues by
means appropriate to the urgency of a situation
(e.g. telephone, email, letter etc), especially where
responsibility for a patient's care is transferred e.g.
at handover
Experiential learning
in the workplace
Logbook
Use authority appropriately and
assertively; particularly with reference
to the resolution of conflict and
disagreement
Facilitate, chair and contribute to meetings
Evidence/assessment
Leadership course
Recognise good advice and
continuously promote value-based
non-prejudicial practice
Maintain and routinely practice critical selfawareness, including the ability to discuss
strengths and weaknesses with supervisor,
recognising external influences and changing
behaviour accordingly
Training support
patients and relatives
Use interpreters appropriately
Respect the opinions of others and enable
individuals, groups and agencies to implement
plans and decisions
GMP
3
3
Utilise the expertise of the whole multidisciplinary
team as appropriate,
ensuring when delegating responsibility that
appropriate supervision is
maintained
3
Fosters a supportive and respectful
environment where there is open and
transparent communication between
all team members
4
132
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Knowledge criteria
GMP
Understand the section in Good Medical
Practice on Working with Colleagues, in
particular:



Clinical competency
GMP
Participate in, and co-ordinates, an effective
hospital at night or hospital
out of hours team where relevant; or participates
in General Practice out
of hours effectively
The roles played by all members of
a multidisciplinary team
The features of good team
dynamics
The principles of effective interprofessional collaboration to
optimise patient or population care
GMP
Training support
Evidence/assessment
Ability to develop and implement
organizational change, being aware of
the effects on systems and people
1,2,3
Observation of and
discussion with
senior medical and
management staff
Management course
Demonstrate compliance with national
guidelines that influence healthcare
provision
3
Ensure appropriate confidentiality is
maintained during communication with
any member of the team
Recognises the need for a healthy
work/life balance for the whole team.
Communicate effectively with administrative
bodies and support
organisations
only takes any leave after giving
appropriate notice to ensure that cover
is in place
Employ behavioural management skills with
colleagues to prevent and resolve conflict, and
enhance collaboration
Understand the principles of
confidentiality that provide boundaries to
communicate
Professional skills and attitudes
Accept additional duties in situations of
unavoidable and unpredictable
absence of colleagues ensuring that
the best interests of the patient are
paramount
Know techniques to manage anger and
aggression in self and colleagues
Know responsibility of the doctor in the
management of physical and/or mental ill
health in self and colleagues
ADMINISTRATION AND MANAGEMENT OF THE SERVICE
Demonstrate knowledge of the
responsibilities of the various Executive
Board members and Clinical Directors or
leaders
1,2
Demonstrate knowledge of the function
and responsibilities of national bodies
such as DH, HCC, NICE, NPSA, NCAS;
Royal Colleges, Faculties, specialty
specific bodies, representative bodies;
regulatory bodies; educational and
training bodies
Understand the guidance given on
management and doctors by the GMC
Understand the local structure of NHS
systems in own locality recognising the
potential differences between the four
countries of the UK
Demonstrate the ability to:

Discuss the local, national and UK
health priorities and how they impact on
the delivery of health care relevant to
obstetrics and gynaecology
Develop and implement organizational change:

development of strategy

formulate a business plan

manage a project
Demonstrate ability to:

Question existing practice in order to
improve services

Apply creative thinking approaches (or
methodologies or techniques) in order
to propose solution to service issues

Identify trends, future options and
1,2
Appreciate the importance of involving
the public and communities in
developing health services
Mini CEX
Attendance at
Directorate
management
meetings
Demonstrate a willingness to articulate
strategic ideas and use effective
influencing skills
Ability to collaborate with:

other professions

other agencies
MSF (TO1 and TO2)
Case-based discussion
Logbook
Management course
Reflective Diary
Equal opportunities
course
3
European Working
Time Directive.
Department of Health
website.
133
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Knowledge criteria
GMP
Clinical competency
strategy relevant to obstetrics and
gynaecology ,and delivering patient
services
Know the principles of service
development
Understand the structure and function of
healthcare systems as they apply to
obstetrics and gynaecology and within
the country that they work
Understand the consistent debates and
changes that occur in the NHS, including
the political, social, technical, economic,
organisational and professional aspects
that can impact on provision of service
Understand the importance of local
demographic, socio-economic and health
data and its use to improve system
performance
Understand the principles of:

Clinical coding

European Working Time Regulation
including rest provisions

National Service Frameworks

Health regulatory agencies e.g.
NICE, Scottish Government

NHS Structure and relationships

NHS finance and budgeting

Consultant contract and the
contracting process

Resource allocation

The role of the Independent sector
as providers of healthcare

Patient and public involvement
processes and role
GMP

Evaluate outcomes and re-assess the
solutions through research, audit and
quality assurance activities
Understand the wider impact of
implementing change in healthcare
provision and the potential for
opportunity costs
Training support
Evidence/assessment
Domain 3: Communication, Partnership and Teamwork.
Domain 4: Maintaining Trust
GMP
Be willing to participate in decision
making processes beyond the
immediate clinical care setting
Ensure professionalism by:

preparing for meetings- reading
agendas, understanding minutes, action
points and background research on
agenda items

Work collegiately and collaboratively
with a wide range of people outside the
immediate clinical setting

Professional skills and attitudes
Be open minded to new ideas
Support colleagues to voice new ideas
Take a proactive approach to new
technologies and treatments- strive for
continuing improvement in delivering
patient care services and be prepared
to change practice to achieve this
Participates in managerial meetings
Works with stakeholders to create and
sustain a patient-centred service
Employs new technologies
appropriately, including information
technology
Conducts assessments of the
community needs for specific health
improvement measures
Demonstrate commitment to
implementing proven improvements in
clinical practice and services
Obtain an effective evidence base
before declaring effectiveness of
changes
Understand the principles of recruitment
and appointment procedures
Maintain an attitude and behaviour that
assists with the dissemination of good
practice
Have an awareness of patient outcomes
reporting systems in obstetrics and
gynaecology and within the Trust and
establish how these relate to national
Recognise the importance of equitable
allocation of healthcare resources and
134
GMC Good Medical Practice (GMP) Domains:
Domain 1: Knowledge, skills and Performance
Domain 2: Safety and quality
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Knowledge criteria
GMP
Clinical competency
GMP
Professional skills and attitudes
programmes
of commissioning
Demonstrate knowledge of:

how decisions are made by
individuals, teams and the
organisation

Effective communication
strategies within an
organisation
Recognise the role of doctors as active
participants in healthcare systems
Understand management at the following
levels:

strategy development

creative solution and
innovation

business planning principles

project management
Recognise the role of patients and
carers (where relevant) as active
participants in healthcare systems and
service planning
Evidence/assessment
1,3,4
Equality and diversity
course
TO1 and TO2
Take an active role in promoting the
best use of healthcare resources
Shows willing to improve leadership
and managerial skills (e.g.
management courses) and engages in
leadership and management of the
service
RESPECTING EQUALITY AND DIVERSITY
1,3,4
1,3,4
Respect diversity and recognise the benefits it
may bring, as well as associated stigma
Respect diversity and recognise the
benefits it may bring, as well as
associated stigma
Be aware of the possible influence of and
sensitively include questions about socioeconomic status, household poverty,
employment status and social capital in
taking a medical history
Training support
Respond appropriately to health
service objectives and targets and
takes part in the development of
services
Understand:

the impact of service change

Barriers to change

Qualitative methods to gather
the experience of patients and
carers
Nationality and culture
GMP
Mini CEX
Be aware of the possible influence of and
sensitively include questions about socioeconomic status, household poverty, employment
status and social capital in taking a medical
history
4
Assess the patient’s ability to access
various services in the health and social
system and offer appropriate assistance
Recognise issues of health that are
related to social class
Assess the patient’s ability to access various
services in the health and social system and offer
appropriate assistance
Respect diversity of status and values
in patients and colleagues
Be confident and positive in one’s own
professional values
CbD
Reflecting practice
Respond to people in an ethical,
honest, and non-judgmental manner
Help to empower patients and negotiate complex
systems to improve health and welfare including,
where appropriate, the right to work
Use appropriate methods of ethical
reasoning to come to a balanced
decision where complex and conflicting
issues are involved
Where values and perceptions of health and
Accept uncertainty
135
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Knowledge criteria
Help to empower patients and negotiate
complex systems to improve health and
welfare including, where appropriate, the
right to work
GMP
Clinical competency
4
health promotion conflict, facilitate balanced and
mutually respectful decision-making
Communicate effectively with patients from
diverse backgrounds and those with special
communication needs, such as the need for
interpreters etc
Health promotion and disease
prevention
Evidence/assessment
GMC. Valuing
diversity guide. GMC
website.
Accessing information and services
Understand the implications of disability
discrimination legislation for healthcare
Training support
3
Communicate effectively and respectfully with
parents, carers etc.
Inequality and discrimination/
stigmatising
GMP
Adopt assessments and interventions
that are inclusive, respectful of
diversity and patient-centred.
Advanced communication skills
Identify and communicate effectively with
influential decision-makers/ facilitators of
change.
Professional skills and attitudes
Be aware of one’s own behaviour and
how it might impact on patients’ health
issues
Identify and communicate effectively with
influential decision-makers/ facilitators of change.
Where values and perceptions of health
and health promotion conflict, facilitate
balanced and mutually respectful
decision-making
Recognise how health systems can
discriminate against patients from diverse
backgrounds, and how to work to
minimise this discrimination. For example
in respect of age, gender, race, culture,
disability, spirituality, religion, and
sexuality
GMP
Be able to access and make use of appropriate
population, demographic, socio-economic and
health data
1
3
Conduct an assessment of community health
needs, and where appropriate apply these in
practice.
1,3
Recognise the stigmatising effects of
some illnesses and work to help in
overcoming stigma
Recognise that people can be denied
employment opportunities unnecessarily
through myths, stigma, dogma and
Seek out and utilise opportunities for health
promotion and disease prevention
Respond to questions honestly and
seek advice if unable to answer
Based on an understanding of risk, be able to
apply epidemiological principles and public health
approaches so as to reduce and prevent disease
and improve the health of populations
Recognise the duty of the healthcare
professional to act as a patient
advocate
Recognise important issues in preventative
healthcare, for example in sexual health,
Encourage recognition of the benefits
of health and wellbeing, and the
136
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Knowledge criteria
GMP
insufficient advocacy and support; be
aware of the role of doctors and other
services in combating this inequality
Recognise the effects of exclusion and
discrimination on physical and mental
health
Clinical competency
GMP
substance abuse etc, and take opportunities to
raise these issues in health promotion. For
example, explain to parents who smoke the health
risk that this poses to their children, including
those exposed to the effects of smoking in utero.
Professional skills and attitudes
GMP
Training support
Evidence/assessment
negative effects of no work and
inappropriate working
Recognise that individuals do not need
to be 100% to return to work
1
Advocacy and management
Recognise in routine practice the doctor’s role as
advocate and manager
Be aware of the role that individuals
(including patients and carers as well as
healthcare professionals) and services
can play in combating inequality and
discrimination and contribute
appropriately to this work.
Willingness to facilitate patient choice
Advocate and facilitate appropriate self-care
1
Personal beliefs and biases
Recognise that personal beliefs and
biases exist and understand their impact
(positive and negative) on the delivery of
health services• Be aware of similarities
and distinctions between the beliefs and
values of the doctor, the patient and the
policy-makers.
Recognise and be able to address the social,
biological and environmental determinants of
health (the bio-psycho-social model or the biosocio- psycho-existentialist model), and
collaborate with other professionals and agencies
to improve health and wellbeing.
Willingness to discuss intelligibly with a
patient the notion and difficulties of
prediction of future events, and the
benefit/risk balance of therapeutic
intervention
Willingness to adapt and adjust
approaches according to the beliefs
and preferences of the patient and/or
carers (where relevant)
Research articles
relating to
psychology of
disease and illness.
RCOG Patient
information. RCOG
website.
RCOG Recovering
Well Series. RCOG
website.
Construct an appropriate management
plan in conjunction with the patient,
carers (where relevant) and other
members of the clinical team and
communicates this effectively to the
patient and carers (where relevant)
Policy, research and change
Be aware of issues that might affect
health inequalities that are currently
under debate regarding changes in the
NHS, including the public policy process
Support and care
Recognise that return to work is one of
the key indicators of a successful
clinical outcome
Know where to ask for advice
Demonstrate ability to identify one’s
own biases and inconsistencies in
clinical reasoning
Be aware of local patient services and
how they can be accessed
Work with an appropriate knowledge of
guidance documents on supporting
people with long term conditions to selfcare
Show willingness to facilitate access to
the appropriate training and skills in
order to develop the patient's
137
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Knowledge criteria
GMP
Clinical competency
GMP
Professional skills and attitudes
GMP
Training support
Evidence/assessment
1,2,3
National Institute for
Clinical Excellence
(NICE). Infection.
Infection control
guideline. NICE
website.
CbD
confidence and competence to self
care and adapt appropriately as those
needs change over time
Be familiar with the range of agencies
that can provide care and support in and
out of hospital, and how they can be
accessed
Encourage recognition of the benefits
of health and wellbeing, and the
negative effects of no work and
inappropriate working
Be familiar with the range of agencies
that can support the disabled worker and
the disabled job-seeker.
Recognise that individuals do not need
to be 100% to return to work
INFECTION CONTROL
Understand the principles of infection
control as defined by the GMC
1,2
Recognise the potential for infection within
patients being cared for
1,3
Understand the principles of preventing
infection in high risk groups including
understanding the local antibiotic
prescribing policy
Counsel patients on matters of infection risk,
transmission and control
Understand the role of the Health
Protection Agency and Consultants
in health protection (previously
Consultants in Communicable Disease
Control – CCDC)
Recognise potential for cross-infection in clinical
settings
Actively engage in local infection
control procedures
Actively engage in local infection
control monitoring and reporting
processes
Reflective learning
Patient Survey
Prescribe antibiotics according to local
antibiotic guidelines.
RCOG Study Group.
Infection and
Pregnancy. RCOG
website.
Encourage all staff, patients and
relatives to observe infection control
principles
Practices aseptic technique whenever relevant
HEALTH PROMOTION AND HEALTH IMPROVEMENT
Understand the factors which influence
the incidence and prevalence of common
conditions
1,2
Understand the factors which influence
health and illness – psychological,
biological, social, political, cultural and
economic (especially poverty)
Understand the influence of lifestyle on
health and the factors that influence an
Identify opportunities to prevent ill health and
disease in patients and other actions which will
positively improve health and/or disease
outcomes
1,2,3
Identify the interaction between mental, physical
and social wellbeing in relation to health
Counsel patients appropriately on the benefits and
risks of screening and health promotion activities
Engage effective team-working around
the improvement of health
Encourage and support (where
relevant) screening to facilitate early
intervention
Remain non- judgemental, and respect
patient’s ideas, concerns and health
beliefs
2,3
RCOG webcast:
Climate Change and
its Impact on
Women's and
Children's Health.
RCOG website
CbD
Reflective learning
UK Faculty of Public
Health website
138
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Knowledge criteria
GMP
Clinical competency
GMP
Identify patients’ ideas, concerns and health
beliefs regarding screening and health promotion
programmes and is capable of appropriately
responding to these
individual patient to change their lifestyle
Understand the influence of culture and
beliefs on patients perceptions of health
Understand the possible positive and
negative implications of health promotion
activities e.g. immunisation
Professional skills and attitudes
GMP
Evidence/assessment
Awareness of the psychological
component of disease and illness
World Health
Organisation (WHO)
climate change.
WHO website.
Work collaboratively with other agencies to
improve the health of communities
World Health
Organisation (WHO)
Health Promotion.
WHO website.
Recognise and be able to balance autonomy with
social justice
Understand the relationship between the
health of an individual and that of a
community, and vice versa
Training support
Follow practices of health promotion specialists
Global Health
Council website
Know the key local concerns about health
of communities
RCOG International
Development.
RCOG website
Have an awareness of the role of other
agencies and factors including the impact
of globalisation (including climate
change) in increasing disease, and in
protecting and promoting health.
Have an awareness of the determinants
of health worldwide and strategies to
influence policy relating to health issues
including the impact of more
economically developed countries’
strategies on less economically
developed countries
ENVIRONMENTAL PROTECTION AND EMERGENCY PLANNING
Understand and outline the mechanisms
by which environmental chemicals have
an impact on human health
1,2
Understand and outline the mechanisms
by which adverse chemical exposure can
be mitigated e.g. decontamination,
specific antidotes. Understand how to
seek a second opinion and appropriate
expert advice
Recognises the potential for chemical or other
hazardous environmental exposure in relation to
an individual patient and manages patients in an
appropriate manner according to guidance
1,2
Actively engages in emergency
planning arrangements including
exercises in accordance with Trust
plans
1,2,3
CbD,
Reflective learning
Log of experiences
Recognises the importance of evidence-based
practice in relation to clinical effectiveness
Openly considers the possibility of
chemical or environmental exposure in
clinical work
Know the potential sources of information
139
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Knowledge criteria
GMP
Clinical competency
GMP
Professional skills and attitudes
Training support
Evidence/assessment
Domain 3: Communication, Partnership and Teamwork.
Domain 4: Maintaining Trust
GMP
and guidance to manage a case of
chemical etc exposure, including local,
regional and national sources
140
GMC Good Medical Practice (GMP) Domains:
Domain 1: Knowledge, skills and Performance
Domain 2: Safety and quality
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Competence level
Basic level
Intermediate level
Advanced level
Not required
Core Module 19 Logbook
Level 1
Date
Level 2
Signature
Date
Signature
Level 3
Date
Signature
Demonstrate effective team working
Show evidence of team leadership
Written communication
Signing perinatal death certificates
OM
Leadership in acute emergency
Training Courses or sessions
Date
Title
Signature of educational supervisor
141
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
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Authorisation of signatures (to be completed by the clinical trainers)
Name of clinical trainer (please print)
Signature of clinical trainer
COMPLETION OF MODULE 19
I confirm that all components of the module have been successfully completed:
Date
Name of educational supervisor
Signature of educational supervisor
142
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