OBSTETRICS AND GYNAECOLOGY Urogynaecology

Transcription

1 Pst CSCST TRAINING IN OBSTETRICS AND GYNAECOLOGY Urgynaeclgy Ryal Cllege f Physicians f Ireland,

2 This curriculum f training in Urgynaeclgy under the specialty f Obstetrics and Gynaeclgy was develped in 2017 and underges an annual review by the Subject Matter Expert Suzanne O Sullivan, Dr Ann O Shaughnessy, Head f Educatin, Innvatin & Research and by the Training Cmmittee. The curriculum is apprved by the Faculty f Obstetrics & Gynaeclg y. Versin Date Published Last Edited By Versin Cmments /07/2017 Ann Cughlan New Curriculum Ryal Cllege f Physicians f Ireland,

3 Table f Cntents Table f Cntents Intrductin... 4 Entry Requirements... 5 Recruitment and Selectin... 5 Duratin and Organisatin f Training... 5 Training Prgramme... 5 Trainee Numbers... 5 eprtfli... 5 Prgramme Management... 6 Specialty Sectin... 7 Basic Skills... 8 General urgynaeclgy assessment Examinatin Investigatins Multiprfessinal wrking (allied specialties) Surgical skills Dcumentatin f Minimum Requirements fr Training Ryal Cllege f Physicians f Ireland,

4 Intrductin Intrductin This 1 year pst CSCST Fellwship cncerned with Urgynaeclgy, Urdynamics and Vaginal Surgery is designed t dvetail with the Irish Higher Specialist Training prgramme in Obstetrics and Gynaeclgy. It takes int accunt the majr areas f cmpetence required by the subspecialist in Urgynaeclgy and will be supervised by the Faculty f Obstetrics and Gynaeclgy f the Ryal Cllege f Physicians in Ireland. The prgramme will prvide the clinical fundatin fr managing wmen with pelvic flr disrders and future develpment f an interest in urgynaeclgy. This prgramme is designed fr peple with a desire t practise Urgynaeclgy as a special interest. On cmpletin, individuals shuld: understand the basics f Urgynaeclgy MDT in the management f pelvic flr disrders be able t take a histry and examine patients with pelvic flr disrders wrk as a multidisciplinary team and understand the rle f related specialties undertake basic investigatins including labratry urdynamics understand the rle fr mre advanced investigatins such as vide urdynamics and ambulatry urdynamics undertake primary cntinence and prlapse surgery understand the rle f cmplex and re-d pelvic flr surgery understand reginal referral pathways fr cmplex and recurrent cases understand the imprtance f audit be able t use evidence-based guidelines and write new guidelines where needed. Urdynamic investigatins are an essential cmpnent in the management f wmen wh present with lwer urinary tract symptms. This mdule is designed t equip individuals with the knwledge and skills required t undertake urdynamic investigatins within the crrect clinical cntext. Once the prgramme is successfully cmpleted a clinician shuld be able t; Undertake an apprpriate urgynaeclgical clinical evaluatin. Perfrm all relevant urdynamic investigatins. Establish a diagnsis and frmulate a treatment plan. Effectively cmmunicate the infrmatin required t bth the patient and clleagues. Ryal Cllege f Physicians f Ireland,

5 Intrductin Entry Requirements Applicants fr the Pst CSCST Fellwship in Urgynaeclgy will have successfully cmpleted the RCPI Higher Specialist Training prgramme in Obstetrics and Gynaeclgy within tw years f the start date f the Pst CSCST Fellwship prgramme. Prir experience in Urgynaeclgy during Obstetrics and Gynaeclgy training wuld be an advantage. Recruitment and Selectin Pst CSCST Fellwship training in Urgynaeclgy will build n brad basic and early cre specialist training in Obstetrics and Gynaeclgy. This is in line with training mdels internatinally. Selectin f candidates fr Pst CSCST Fellwship training in Urgynaeclgy will be via a cmpetitive recruitment prcess crdinated by the relevant Training Bdy. Recruitment will fllw similar timeline where pssible t HST recruitment and pst will cmmence in July f each year (unless therwise specified). Duratin and Organisatin f Training The Pst CSCST Fellwship in Urgynaeclgy is a ne year training prgramme designed t dvetail with the Irish Higher Specialist Training prgramme in Obstetrics and Gynaeclgy The curriculum is cmpetency-based, hwever it is anticipated that the candidate will cmplete training within ne year. The curriculum takes int accunt the majr areas f cmpetence required by the subspecialist in Urgynaeclgy and will be supervised by the Faculty f Obstetrics and Gynaeclgy f the Ryal Cllege f Physicians in Ireland. Dctrs wh have successfully cmpleted the RCPI Higher Specialist Training prgramme in Obstetrics and Gynaeclgy and are within tw years f cmpletin will be deemed eligible t apply fr the Pst CSCST Fellwship in Urgynaeclgy Cmpletin f this prgram will ensure the knwledge and cmpetencies in all areas f the curriculum, meeting internatinal standards fr best practice and allwing candidates t practice as a subspecialist in Urgynaeclgy Training Prgramme The training prgramme ffered will prvide pprtunities t fulfil all the requirements f the curriculum f training fr Urgynaeclgy in apprved training hspitals. Each pst within the prgramme will have a named trainer/educatinal supervisr and the prgramme will be under the directin f the Natinal Specialty Directr fr Obstetrics and Gynaeclgy Trainee Numbers It is expected that the Pst CSCST Fellwship in Urgynaeclgy will be awarded t ne candidate per year. eprtfli The trainee will be required t keep their eprtfli up t date and maintained thrughut their Fellwship training. The eprtfli will be cuntersigned as apprpriate by the Trainer t cnfirm the satisfactry fulfilment f the required training experience and the acquisitin f the cmpetencies set ut in the Curriculum. This will remain the prperty f the Trainee and must be prduced at the end f year Evaluatin meeting. At the end f year Evaluatin, the eprtfli will be examined. The results Ryal Cllege f Physicians f Ireland,

6 Intrductin f any assessments and reprts by the named trainer/educatinal supervisr, tgether with ther material capable f cnfirming the trainee s achievements, will be reviewed. Prgramme Management Crdinatin f the training prgramme will lie with the Medical Training Department. The training year will usually run frm July t July in line with HST prgrammes Annual evaluatins will usually take place between April and June each year Each trainee will be registered t the eprtfli and will be expected t fulfil all requirements relating t the management f yearly training recrds Opprtunities fr audit and research may be available Each trainee will be issued with a training agreement n appintment t the training prgramme and will be required t adhere t all plicies and prcedures relating t Pst CSCST Fellwships. Ryal Cllege f Physicians f Ireland,

7 Specialty Sectin Specialty Sectin Ryal Cllege f Physicians f Ireland,

8 Specialty Sectin Basic Skills Objective: The bjective is t equip individuals with the knwledge and skills required t undertake urdynamic investigatins within the crrect clinical cntext including the ability t: Undertake an apprpriate urgynaeclgical clinical evaluatin. Perfrm all relevant urdynamic investigatins. Establish a diagnsis and frmulate a treatment plan. Effectively cmmunicate the infrmatin required t bth the patient and clleagues. Knwledge Histry t include assessment f symptms, severity and quality f life Examinatin t include neurlgical assessment, prlapse staging, assessment f bladder neck mbility and demnstratin f stress incntinence Investigatins prir t urdynamics including urinalysis, MSU, frequency vlume charts and pad test. Patient cunseling prir t perfrming a urdynamic investigatin Knwledge and apprpriate use f ICS terminlgy Skills Calibratin f flw transducers. Calibratin f Urethral Pressure Prfile (UPP) withdrawal machine. Use f apprpriate pump filling speeds. Familiarity with three-way taps including flushing, zering and recrding f pressures Urflwmetry a. Understand the indicatin fr the investigatin b. Explain the prcedure t the patient Crrect interpretatin f the results and identificatin f any artefacts Residual Urine Vlume a. Measurement by ultrasund b. Measurement by catherisatin Filling/Viding Cystmetry a. Explain the prcedure t the patient b. Zering f pressure transducers c. Perfrm the test in accrdance with ICS recmmendatins in terms f catherisatin, psitin, filling speed, prvcatin tests and viding cystmetry d. Cmment n the quality f their trace btained including any artifacts e. Describe and interpret the results giving an accurate diagnsis. f. Prvide apprpriate treatment recmmendatins Ryal Cllege f Physicians f Ireland,

9 Specialty Sectin Assessment and Learning Methds Urethral Functin Tests Trainees shuld undertake a minimum f five UPP investigatins. They shuld be in a psitin t explain the test t a patient. Perfrm the prcedure and btain gd quality traces and interpret the results Ryal Cllege f Physicians f Ireland,

10 Specialty Sectin General urgynaeclgy assessment Histry Objectives: T demnstrate the knwledge, skills and attitudes required fr clinical assessment f pelvic flr dysfunctin. Understand the different facets f btaining a urgynaeclgical histry Obtain a general histry. Obtain urinary/prlapse/bwel histry. Assess impact f symptms n quality f life (QL) and be familiar with tls fr bjective assessment f pelvic flr dysfunctin. Knwledge Terminlgy used fr pelvic flr dysfunctin Relatinship between pelvic flr symptms and ther medical cnditins Bladder diaries Validated questinnaires used in urgynaeclgy Evidence-based guidance Take an apprpriate histry Present a relevant urgynaeclgical histry including impact f cnditin n QL Interpret bladder diaries Able t select apprpriate standardised symptm and QL questinnaires Skills Ability t take an apprpriate histry and use terminlgy in accrdance with the Internatinal Cntinence Sciety Ability t use clinical histry and bladder diary t make an initial diagnsis Ability t cmmunicate patient s symptms and understand their severity and scial and psychlgical impact Ability t select and analyse apprpriate questinnaires Ability t use evidence-based guidance in clinical practice Assesment and learning Attend urgynaeclgy clinics Case discussin and bservatin f senir medical staff Recrd f cases seen CBD Ryal Cllege f Physicians f Ireland,

11 Specialty Sectin Examinatin Objectives: T be able t carry ut a cmpetent examinatin. Undertake a general examinatin. Undertake a pelvic examinatin and be familiar with standardised methds f assessment f pelvic rgan prlapse. Undertake a relevant neurlgical examinatin. Knwledge Examinatin findings relevant t pelvic flr disrders Examinatin findings relevant t patients with pelvic rgan prlapse Neurlgical findings in denervatin f the pelvic flr Neurlgical cnditins that affect the lwer urinary tract (e.g. multiple sclersis) Objective methds fr assessment f pelvic rgan prlapse Skills Perfrm an apprpriate general pelvic flr and neurlgical examinatin Ability t carry ut a relevant examinatin and elicit abdminal and pelvic findings Ability t describe stage f pelvic rgan prlapse using a recgnised methd Ability t perfrm neurlgical examinatin f the S4 pathway Ability t cmmunicate significance f clinical findings t the patient Ability t put clinical findings in the cntext f the patient s symptms Assessment and learning Attend supervised clinics Observatin f senir medical staff, assisting and case discussin with senir staff Recrd f cases seen CBD Ryal Cllege f Physicians f Ireland,

12 Specialty Sectin Investigatins Objectives: T be able t select apprpriate tests, carry ut the test prficiently and interpret the results. Initial assessment f pelvic flr symptms and signs. Learn t interpret results f labratry investigatins in the cntext f the patient s symptms Knwledge Relevant anatmy and physilgy Urdynamics including: urine culture and cytlgy pad tests assessment f urinary: residual urflwmetry subtracted dual-channel cystmetry Mdalities fr imaging the urinary tract Indicatins fr advanced urdynamics (i.e. vide urdynamics, ambulatry urdynamics and urethral functin studies) Skills Perfrm apprpriate investigatin Understands when t refer fr further investigatin Ability t assess urinary residual by bladder scan Ability t describe tests t patient and refer t relevant specialist Ability t explain the relevance f the test findings t the patient and t cmmunicate the results with sensitivity Ability t make apprpriate requests fr imaging f the lwer urinary tract Ability t understand the impact f results n clinical management Awareness f reginal referral pathways and rle f reginal subspecialist in the management f cmplex cases Assessment and learning Direct bservatin f senir clleagues Cmpletin f urdynamics mdule Multidisciplinary team meetings Ryal Cllege f Physicians f Ireland,

13 Specialty Sectin Urdynamics case lg bk OSATS (a trainee shuld cmplete ten, shwing cntempraneus evidence f prgressin t full cmpetency; at least five shuld indicate cmpetency in all technical aspects) CbD Ryal Cllege f Physicians f Ireland,

14 Specialty Sectin Multiprfessinal wrking (allied specialties) Objectives: T be able t select an apprpriate cnservative treatment pathway. Learn t refer t apprpriate discipline r specialty fr further investigatin r treatment. Understand and set treatment gals. Knwledge Knw hw t cntribute t the multidisciplinary team Pharmaclgical actin and adverse effects f antimuscarinics Principles f pelvic flr muscle training and rle f different physical therapies Principles f bladder retraining Nn-surgical management f pelvic rgan prlapse Basic understanding f anrectal dysfunctin Skills Understand the rle f drug therapy fr wmen with veractive bladder symptms Understand the rle f pelvic flr re-educatin in female urinary incntinence Understand the indicatins fr vaginal pessaries Understand the indicatins fr anrectal investigatin Ability t recgnise the imprtance f nnsurgical management in the treatment pathway Ability t prescribe apprpriately and cunsel n success and adverse effects Ability t instruct a patient in bladder training Awareness f referral f patients t physitherapists and nurse specialists at an early stage f the treatment pathway Ability t wrk in a multidisciplinary team and t liaise apprpriately with cmmunity cntinence services Ability t cunsel patients n cntainment measures and supprt grups Ability t cunsel, select and fit an apprpriate vaginal pessary fr pelvic rgan prlapse Ability t cunsel n simple treatments fr faecal incntinence and refer apprpriately Assessment and learning Attend a physitherapy clinic Observe multidisciplinary case discussin Case lg bk CBD Ryal Cllege f Physicians f Ireland,

15 Specialty Sectin Surgical skills Objectives: T be clinically cmpetent in assessment prir t surgery fr stress urinary incntinence (SUI) and pelvic rgan prlapse (POP). T understand and be able t cunsel patients n the prgnsis and cmplicatins f surgery fr SUI and POP. T be clinically cmpetent in undertaking vaginal hysterectmy and clprrhaphy as primary surgery fr POP. T be clinically cmpetent in undertaking a mid-urethral tape prcedure as primary surgery fr SUI. T be able t manage cmmn cmplicatins f vaginal surgery and understand when t invlve ther specialists. T understand indicatins fr referral t a urgynaeclgy subspecialist. Knwledge Knwledge f equipment, diathermy instrumentatin and theatre set-up Awareness f ptential surgical cmplicatins Understand the management f majr haemrrhage Understand the indicatins and cmplicatins f the fllwing prcedures: cystscpy clpsuspensin mid-urethral slings bladder neck injectins Knwledge f surgical management f detrusr veractivity Knwledge f surgical management f faecal incntinence Knwledge f surgical prcedures fr recurrent POP and SUI Skills Be able t perfrm and manage cmplicatins f the fllwing prcedures: cystscpy anterir repair psterir repair vaginal hysterectmy mid-urethral tape (TVT r TOT)(It is estimated that a trainee will need t cmplete a minimum f 20 f each type f prcedure befre independent cmpetency is assessed) Able t manage pstperative viding difficulty Recgnise indicatins fr referral Recgnise referral t subspecialist Select patients apprpriately fr vaginal surgery Cunsel n vaginal surgery including nnsurgical alternatives, surgical cmplicatins and utcme Ryal Cllege f Physicians f Ireland,

16 Specialty Sectin Perfrm vaginal and stress cntinence surgery in a fluent and safe manner Recgnise and apprpriately manage intraperative visceral injury including repair f simple perative bladder injury and pstperative bladder drainage Instruct nursing staff n catheter management fllwing cntinence surgery Supervise a patient underging a prgramme f intermittent self-catheterisatin Recgnise rle f ther specialists in the management f surgical cmplicatin Assessment and learning Training prgramme Direct bservatin/cnsultant supervisin within the mdule Case lg bk OSATS x 10 (a trainee shuld be able t shw cntempraneus evidence f prgressin in surgical cmpetence and have achieved full cmpetency fr each surgical prcedure) CBD Ryal Cllege f Physicians f Ireland,

17 Minimum Requirements Dcumentatin f Minimum Requirements fr Training Required/ Minimum Curriculum Requirement Desirable Requirement Reprting Perid Frm Name Sectin 1 - Training Plan Persnal Gals Plan (Cpy f agreed Training Plan fr the mdule signed by bth Trainee & Trainer) Required 1 Specialty Mdule Frm 052 Weekly Timetable (Sample Weekly Timetable fr mdule) Required 1 Specialty Mdule Frm 045 On Call Rta (where apprpriate) Required 1 Specialty Mdule Frm 064 Sectin 2 - Training Activities Urgynaeclgy clinics (min 3 per week) Required 120 Specialty Mdule Frm 001 Clinics Attendance at Physitherapy clinic Required 1 Specialty Mdule Frm 001 Prcedures/Practical Skills/Surgical Skills Cystscpy Required 10 Specialty Mdule Frm 004 Anterir Repair Required 10 Specialty Mdule Frm 004 Psterir Repair Required 10 Specialty Mdule Frm 004 Vaginal Hysterectmy Required 10 Specialty Mdule Frm 004 Mid-urethral tape (TVT r TOT) Required 10 Specialty Mdule Frm 004 Curses Urdynamics Curse Required 1 Specialty Mdule Frm 006 In-huse activities MDT Meeting Required 1 Specialty Mdule Frm 011 Sectin 3 - Educatinal Activities Teaching Basic Practical Skills Required 1 Specialty Mdule Frm 013 Sectin 4 - Assessments OSATS Cystscpy Required 10 Specialty Mdule Frm 156 Anterir Repair Required 10 Specialty Mdule Frm 026 Ryal Cllege f Physicians f Ireland,

18 Minimum Requirements Psterir Repair Required 10 Specialty Mdule Frm 024 Vaginal Hysterectmy Required 10 Specialty Mdule Frm 040 Required/ Minimum Curriculum Requirement Desirable Requirement Reprting Perid Frm Name Mid-urethral tape (TVT r TOT) Required 10 Specialty Mdule Frm 034 Required Specialty Mdule Uplad t Investigatins 10 persnal library Specialty Mdule Uplad t Case reprts (1000 wrds max) Required 10 persnal library Case-based discussin Required 1 Specialty Mdule Frm 020 Ryal Cllege f Physicians f Ireland,