Placement Information Pack

Transcription

1 Gateshead Health Foundation NHS Trust Placement Information Pack Joint Placement Community Stroke Rehabilitation Team Queen Elizabeth Hospital and Adult Neurological Physiotherapy Team Bensham Hospital

2 Contents Clinical Placement Information Site maps Gateshead NHS Foundation Trust Department structure Adult neurological team Community stroke rehabilitation team Learning Zone Profile of learning opportunities Contact numbers Placement progression plan Negotiation of learning outcomes Preparation for placement

3 Clinical Placement Information Placement will be split between adult neurological Physiotherapy team and Community stroke rehab Team. A timetable will be drawn up detailing split of placement. Please contact clinical supervisor regarding location of first day on placement. Adult Neurological Physiotherapy team Location: Physiotherapy Department Bensham Hospital Saltwell Road Bensham NE8 4YL Tel: Main switchboard : Travel: There are buses from Gateshead interchange to Bensham Hospital Car Parking: Available on site Pay and display Community Stroke Rehab team Location Community stroke rehab team Stroke research Queen Elizabeth hospital Sherriff hill Gateshead NE9 6SX Tel : Travel: There are numerous buses from Gateshead interchange Car Parking: Available on site Pay and display Please inform us if you are travelling by car and we are able to arrange a temporary parking permit for you. Dining facilities: Small onsite canteen serving a range of hot meals and cold sandwiches / snacks. Staff room available with tea/coffee making facilities/fridge and microwave Uniform: Please inform us if you are travelling by car and we are able to arrange a temporary parking permit for you. Dining facilities: Onsite canteen serving a range of hot meals and cold sandwiches / snacks. Also a coffee shop and shop. Staff room available with tea/coffee making facilities/fridge and microwave Tunic or white polo shirt Blue trousers / plain blue tracksuit bottoms Blue / black shoes or plain white trainers Identity badge this will be obtained from Operational Services at QEH during the first two days of your placement. Working Hours: 9 am 5 pm(negotiable) Library / IT facilities: The Trust library is located at the Queen Elizabeth Hospital and holds a limited range of physiotherapy texts along with a larger range of medical and nursing texts. There are a range of journals held in paper and electronic formats. There is a dedicated IT room within the library itself and you are able to use the IT facilities onsite within the physiotherapy department at DHH.

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5 About Gateshead Health NHS Foundation Trust In April 2002, Community Services moved to be managed by Gateshead Primary Care Trust and Adult Mental Health Services moved to be managed by South of Tyne & Wearside Mental Health Trust. In April 2005, Learning Disabilities Services moved to be managed by Gateshead PCT. Health check ratings published on 17 October 2007 by the Independent Healthcare Commission reported the Trust as Good and Excellent for Quality of Services and use of resources respectively. Details can be found at During 2007/08 we employed 3,072 people and 61.68% of these were employed in direct clinical care. The Trust is a major employer in Gateshead, a key factor in the local economy. The Trust s income of 160.9m in 2007/08 came mainly from Gateshead Primary Care Trust. Our strategic aims for the future and for the development of our services are: providing the best possible quality of services and care offering rapid, responsive and accessible services running first class hospitals being the best possible employer making the best possible use of public money gaining appropriate recognition of our achievements The Trust provides a full range of local acute services for elective (planned) and emergency care including in-patient, out-patient, day case and day care. In addition, we provide sub-regional Breast Screening Services covering Gateshead, South Tyneside, Sunderland and parts of Durham and we are the North Eastern hub for the National Bowel Cancer Screening Programme. This covers an area East of the Pennines stretching from the Scottish border to Humber, a population of around 7 million people. Patient services are organised into five Divisions: Medical Services: Chest Medicine Diabetes Elderly Medicine and Older People s Mental Health Services Emergency Medicine Gastroenterology Haematology Intermediate Care Teams Medical Assessment and Admissions Rheumatology

6 Stroke Medicine Surgical Services: Chemotherapy Colposcopy General Surgery Gynaecology Gynaeoncology Preoperative Assessment Trauma and Orthopaedics Theatres Assessment & Diagnostic Services: Bowel Cancer Screening Breast Screening and Assessment Endoscopy Out-Patient Services Pathology Radiology Women & Children s Services: Acute Services for Children and Young People part of the Children s Trust Centre for Assisted Reproduction and Conception Obstetrics Clinical Support Services: Anaesthetics Critical care Dietetics Pharmacy Physiotherapy In addition the Trust provides a full range of services supporting our clinical activities. Services are provided from our three main hospital sites: Queen Elizabeth Hospital Bensham Hospital Dunston Hill Hospital The links the Trust and its staff have with our members, voluntary organisations and our partners across the local health economy and the wider community are greatly valued and hugely important in the development and delivery of services During 2007/08 we have continued to develop and improve services to enable us to provide the best quality of care for patients.

7 Stroke / Neuro Service Team Structure Assistant Divisional Manager Katy Stainsby Team Leader Band 8a Paul Johnson Stroke Rehab Ward 22 Band 7 Christine Cantwell Band 6 Jackie Gardiner Band 6 Rotational Band 6 Rotational TI Glynis Bingham PTA Harry Charlton Community Stroke Rehab Team Band 7 Lorna Stephenson Band 5 Lara Malone Band 5 (split with adult Neuro) TI Susan Burn PTA Carole Allen Adult Neuro Team (BGH) Band 8a Paul Johnson Band 7 Jenny Wilson Band 5 (split with CSRT) PTA Angela Kirsopp

8 Adult Neurological Physiotherapy Service The Adult Neurological Physiotherapy Service is based at Bensham Hospital and provides physiotherapy assessment and treatment to all adults (16 +) with a neurological impairment who live in Gateshead or who are registered with a Gateshead GP. Patients are seen either within the physiotherapy department or in their own homes (including residential and nursing homes). The physiotherapy team consists of: Clinical Specialist Physiotherapist Band 7 physiotherapist (full time) Junior physiotherapist (0.5 shared with CSRT) 2 x physiotherapy assistants (both part time) The proportions of different neurological conditions seen by our service is as follows: Stroke 26% Parkinsons Disease 21% Multiple Sclerosis 16% Muscular Dystrophy 3% Motor Neurone Disease 3% Brain Injury 5% Spinal Cord Injury 4% Walking Aid 5% Other 17% (Data from Feb 2008) Referrals are received principally from Consultants, GPs, Nurse Specialists, Physiotherapists and other Health Professionals. Physiotherapy intervention will vary depending upon the nature of the condition and the individual needs of the patient but could involve: a) Assessment followed by advice, arranging of equipment or referral to another health or social care professional. b) Assessment followed by a course of specific goal orientated treatment (department or home based). c) Assessment followed by intermittent episodes of maintenance therapy and monitoring / ongoing review. Although the team is a physiotherapy team we do liaise with other members of the healthcare team both within health and social care.

9 Community Stroke Rehabilitation Team The Community Stroke Rehabilitation Team (CSRT) is based at Queen Elizabeth Hospital. It provides specialist MDT assessment and treatment for patients following a stroke, delivering an individualised structured programme of rehabilitation. The team consists of the following core staff: Occupational Therapists Physiotherapists Speech and Language Therapists Nursing Staff Technical Instructors We liaise closely with the in-patient stroke unit, stroke consultant and Stroke Association and refer onto Psychology and other organisations as appropriate. Team staffing Physiotherapy 0.74 WTE - Clinical specialist Physiotherapist Band 7 1 WTE Band 5 Physiotherapist 0.5 WTE Band 5 (shared with Adult Neuro Team) 1 WTE TI (band 4) (supports all disciplines within team) 1WTE Band 3 physiotherapy assistant 0.65 WTE TI (band 4) Post vacant Occupational Therapy 2 WTE equivalent band 6 OT follow up patients from the in-patient setting into the community, therefore staffing is provided from the whole stroke OT team 1 WTE TI (TT) (band 3 (under review)) (supports all disciplines within team) Speech and Language Therapy 1 WTE band 6 Nursing Staff 1 WTE band 7 (Job shared)

10 Referral Criteria Resident of Gateshead or GP belongs to Gateshead Primary Care Trust Within 1 year of new episode stroke Stroke to be the main presenting problem that requires specialist stroke rehabilitation Patient is able to be safely maintained in their own environment Rehabilitation must be able to take place without undue risk to staff Role of CSRT To facilitate early hospital discharge for stroke patients. To facilitate a seamless transition between hospital and community and to develop collaboration with appropriate agencies. To improve the functional ability of patients, living in their own homes to their optimum level. The CSRT has two main areas of involvement:- Active Treatment Supported Discharge Active Treatment These patients need to have rehabilitation potential. This group of patients should be able to transfer with the assistance of one person (this can be with the use of equipment). These patients will be assessed and appropriate team members required will be identified. A treatment programme will be discussed and agreed with patients and relatives, aimed at achieving specific functional goals. The CSRT can be involved with patients for a period of approximately 6 weeks; however this is flexible to meet patient s needs. Patients with ongoing needs can be referred onto other services e.g. Adult Neuro physio rehab, Bensham Hospital Supported living team at Social Services

11 Supported Discharge This group of patients have limited rehab potential, but have complex physical and environmental needs. The team aims to support the patient, families and carers/support agencies to ensure a seamless transition from hospital to community. The team will provide advice on the management of this group of stroke patients at home. This may include advice on: Moving and handling Equipment Patient s daily routine We will accept patients who require a hoist transfer. This group of patients will not receive active rehabilitation from the team. Team Standards Assessment by CSRT within 48 hours of referral or hospital discharge. Following CSRT assessment and discussion with patient, rehab goals to be set and reviewed regularly in multi-disciplinary team meetings. Patients will be discharged following a team review. The review will occur within a 6 week timeframe. If patients on review have further rehabilitation potential, a further course of goal orientated rehabilitation may be offered. At point of discharge contact details of CSRT will be left with the patient. A discharge summary will be completed. Copies sent to patient, GP, consultant and any other relevant party. Location of Assessment / Treatment The patient is always assessed in their own environment, allowing staff to fully identify the patient s problems. Following initial assessment it is identified which team members need to be involved. Referrals may be made for equipment or to outside agencies. Location of intervention is based on clinical need and meeting identified goals. Intervention may be based At home Physiotherapy gym based sessions In community setting (ie working on outdoor mobility /use of public transport.)

12 Physiotherapy gym sessions are limited and are only routinely available twice a week. Gym sessions are arranged if: Specialist equipment is required for treatment sessions eg: parallel bars, treadmill, and adjustable bed. May not be appropriate to treat patients in own home (space, environment, distraction, staff safety) However ability of patient to travel to QEH needs to be taken into consideration may include issues of impact on condition, dependence upon hospital transport provision, accessibility of home environment. The current flexibility of the service to provide either department, home based or community based therapy or a mixture of the three is viewed as a service strength and adds to the efficiency of the service. It is also in keeping with government priorities around locally delivered services and patient centred care.

13 COMMUNITY STROKE REHAB TEAM (CSRT) AND ADULT NEURO TEAM (ANT) LEARNING ZONE * Indicates IPL learning opportunities Rehab UK GP Neuro consultant Wheelchair Services Ward 22 (Stroke Rehab Ward) Social Services Jubilee Day Hospital Journal Club PD Nurses Stroke Association Admin Staff OT* PHYSIO CSRT/ANT Gateshead Equipment Services Rehab Assistant Stroke* Assessment Nurse CLASP *Nurse CT Scan Dysphagia Nurse CROP Team SALT* Stroke Consultant Library Supported Living Team Motor neurone disease response team GP s MS Nurses Falls Team ABI Team

14 Profile of Learning Opportunities To develop an appreciation of the impact of both acute and progressive neurological conditions on the functional independence of people living in community settings To develop an appreciation of the various sources of support, both formal and informal, available to and accessed by adults with neurological impairments living in community settings. To develop skills of assessment of movement dysfunction secondary to a range of neurological conditions To develop the ability to frame and prioritise problems related to movement and function with respect to patient / carer perceptions and therapist perceptions To develop skills in treatment planning and intervention in both community and department settings To develop skills in the choice and implementation of outcome measurement in neurological rehabilitation To develop skills of communication both with patients who have barriers to communication and with other health professionals To explore the relevance of differing models of rehabilitation eg. medical, biosychosocial etc. in the management of adults with neurological conditions in the community To develop an awareness of a range of assistive devices and equipment available to support individuals function within community settings To raise your awareness of government and NHS initiatives such as National Service Frameworks and National Clinical Guidelines in relation to adults with neurological conditions Gain an in depth understanding of stroke diagnosis and stroke pathway To increase your understanding of the roles of other health professionals such as Occupational Therapists, Speech and Language Therapists and Specialist Nurses working in the field of adult neurological and stroke rehabilitation Opportunities can be arranged by contacting the appropriate staff member/department

15 Opportunity Contact OT Kathleen O Neil * TI3 Nurse Alison Thompson Susan Burn Claire Gilchrist/Sandra Bruce Speech and language therapist Lucinda Somersett Stroke Association CTScans 2747 W22 Stroke rehab Jackie Gardiner 3902 * IPL learning opportunities

16 CONTACT NUMBERS Lorna Stephenson (Clinical Specialist Physiotherapist) Band 5 Physiotherapist (Lara Malone) Kathleen O Neil (Clinical Specialist Occupational Therapist) Name Extension Mobile Alison Thompson(TI3) 2851 Susan Burn(TI3) 2851 CSRT Admin 2851 CSRT fax 2842 / 2854 Ward Ward 22 (gym) 3902 Ward 22 (office) 3903 QEH Physio 2320 BGH Physio 5156 Adult neuro team 5155 Bensham OT 5226 Stroke Association CT Scan 2747 Speech and Language 2599 Hospital switchboard Dialling from outside to extension Bleep ext bleep no. + ext phone dialling from

17 Community Neurology/Stroke rehab Clinical Placement Plan of Progression The following represents a general plan for progressing student activities during a first placement in a community neurology/stroke setting. This is meant as a guide only and will be adapted to individual students depending on their own abilities, prior knowledge and experience. If there is any aspect of this plan that concerns you please feel free to discuss this with your clinical educator. Day 1 Induction to workplace, colleagues, hospital and local health and safety policy. Introduction to office systems, paperwork and staff safety on the community team. Introduction to articles and references related to stroke. Work with supervisor during home visits. Set dates for learning objectives, half way assessment and final assessment. If needed register car for parking permit. Day 2 Continue to work with supervisor in community setting and begin to get some hands on experience i.e. variations in tone. Register at the hospital library. Day 3-5 Attend team meeting to meet all members of the team and familiarise self with various paperwork systems. Set learning objectives. Continue to work with supervisor in community. Teaching sessions on stroke and rehabilitation, the delivery of the sessions may vary e.g. informal discussion/practical.

18 Week 1 All students would be expected to take a proactive approach to discussing their learning objectives. 1 st year student Most of the first week will be spent working with the clinician in the community setting. There will be some teaching sessions covering stroke, normal movement, facilitation and discussions around community rehabilitation. The clinician will be looking at general communication skills and appropriate questions and a willingness to get involved with patients as appropriate. The student would be expected to use any unscheduled time for self study and reflection. Start to organise visits with other members of the MDT with support of educator, at times convenient to student and educator to aid in completion of learning objectives. 2nd/3 rd year student As above however these students would be expected to require less support in organising visits with MDT members. Undertake components of a subjective and objective assessment with guidance from clinical educator. Identify problems in conjunction with clinical educator. Implement aspects of treatment interventions in conjunction with clinical educator. Begin to develop a systematic approach to documentation of assessment and treatment interventions with guidance from clinical educator. Communicate non-complex information clearly too clinical educator and patients.

19 Week 2 At the end of week 2 the mid way assessment will take place 1 st year student Begin to carry out a subjective assessment for 2-3 patients. Discuss each assessment with clinician and formulate a problem list and initial treatment plan. Begin to analyse movement in discussion with clinician. Begin to participate in team meeting if appropriate. Liaise with other MDT members when appropriate. 2 nd year student Complete a new assessment independently with only prior discussion of case with clinical educator. Communicate principal findings from subjective and objective assessment to clinical educator. Frame and prioritise patient s problems with guidance from clinical educator (bias towards movement problems). Discuss potential short and long term goals with patient in conjunction with clinical educator. Formulate initial treatment ideas with guidance from clinical educator. Implement initial treatment interventions in conjunction with clinical educator. Carry out appropriate treatment sessions using mobilisation and facilitation skills with assistance/ guidance from clinician. Communicate to patient the key findings of assessment and initial treatment interventions. Document assessment findings and initial treatment interventions with guidance from clinical educator. Communicate effectively with the MDT as appropriate.

20 3 rd year student Complete a new assessment independently with only prior discussion of case with clinical educator. Communicate principal findings from subjective and objective assessment to clinical educator. Frame and prioritise patient s problems with guidance from clinical educator (bias towards movement problems). Discuss potential short and long term goals with patient in conjunction with clinical educator. Discuss potential methods of outcome measurement with clinical educator. Formulate initial treatment ideas with guidance from clinical educator. Implement initial treatment interventions in conjunction with clinical educator. Carry out appropriate treatment sessions using mobilisation and facilitation skills with guidance from clinician. Communicate to patient the key findings of assessment and initial treatment interventions. Document assessment findings and initial treatment interventions with guidance from clinical educator. Communicate to patient the key findings of assessment and initial treatment interventions. Communicate effectively with the MDT as appropriate. To know how to refer a patient to members of the MDT and identify at what stage it is appropriate to do so. Show awareness of relevant research.

21 Week 3 1 st year student Carry out subjective assessments using developed questioning skills to gain accurate information specific to the community setting. To be able to use the assessment to identify and formulate a problem list, goals and an initial treatment plan in discussion with clinician. To be able to document assessments within 24 hours in a clear format, maintaining legal standards. Be able to complete a movement analysis with support of clinician. Assist with treatment plans as directed to gain practical handling/treatment skills. Communicate effectively with the MDT as appropriate. 2 nd year student Complete a full assessment using developed questioning skills in order to complete a problem list, goals and treatment plan with minimal guidance from clinician. Communicate assessment findings to clinical educator and suggest a prioritised problem list (incorporating physical and psychosocial perspectives). Suggest possible short and long term goals and actively discuss these with clinical educator. Propose initial treatment plan and actively discuss potential progression of treatment with clinical educator (consider self help strategies for patient / carers). Implement treatment plans with guidance from clinical educator. Show some awareness of objective measurements used. Communicate to patient (and carers) the aims, effects and limitations of treatment. Provide appropriate advice for patients and carers. To be able to document assessment/intervention within 24 hours in a clear and concise format, maintaining legal standards.

22 Contribute to MDT weekly meeting and liaise with all relevant members of the MDT. Communicate to other members of the physiotherapy and / or health care team appropriate aspects of patient care / management. To need minimal assistance in the ordering of equipment from various agencies. Reflect on above assessment and treatment activities with regard to the evidence base for practice. 3 rd year student Be able to carry out assessments of stroke patients using developed questioning skills and discuss observations in relation to tone, alignment, selective movement and functional activity with clinician. Communicate assessment findings to clinical educator and suggest a prioritised problem list (incorporating physical and psychosocial perspectives). Suggest possible short and long term goals and actively discuss these with clinical educator. Propose initial treatment plan and actively discuss potential progression of treatment with clinical educator (consider self help strategies for patient / carers). Work on assessment, analysis, treatment and documentation with minimal assistance from clinician. Show awareness of a range of objective measurements and be able to choose and discuss measurements for use appropriately. To be able to document assessments/interventions within 24 hours and between community visits in a concise and complete format, maintaining legal and professional standards. Communicate to patient (and carers) the aims, effects and limitations of treatment. Demonstrate communication skills through contributions to the MDT weekly meeting and liaison with all relevant members of the MDT. Communicate to other members of the physiotherapy and / or health care team appropriate aspects of patient care / management. To be able to order equipment from appropriate agencies. Reflect on above assessment and treatment activities with regard to the evidence base for practice.

23 Week 4 At the end of this week the final assessment will take place. 1 st year student Complete detailed subjective assessment and discuss with clinician pertinent aspects to assess during the objective assessment. Communicate effectively at the team meeting and with other members of the MDT when appropriate. Participate safely in an established treatment plan i.e. gait re-education. To begin to carry out aspects of the objective assessment with guidance and discuss findings with clinician. To need minimal assistance in the ordering of equipment from various agencies. Show awareness of relevant research. 2 nd year student Continue to develop assessment skills to be able to identify problems, goals and treatment plans. Should be able to relate observations of movements/gait to deviations in tone, alignment, selective movement and functional activity with some assistance from clinician. Discuss assessment findings and identified problems with patient with minimal guidance from clinical educator. Negotiate with patient short and long term goals with minimal guidance from clinical educator. Plan and implement treatment strategies and demonstrate / discuss potential treatment progression with some assistance from clinician. Show awareness of a range of objective measurements and begin to be able to choose and discuss measurements for use appropriately. Discuss and justify treatment / management strategies with respect to the evidence base for practice. Demonstrate effective communication with other health professionals in verbal and written format.

24 3 rd year student Arrange appointment and undertake assessment of new patient independently. Following a detailed assessment be able to formulate a problem list, short and long term goals and a treatment plan. Discuss assessment findings and identified problems with patient with minimal guidance from clinical educator. Negotiate with patient short and long term goals with minimal guidance from clinical educator. Be able to progress treatment and demonstrate how progress can be measured objectively. Identify and undertake relevant outcome measurement. Plan and implement treatment strategies and demonstrate / discuss potential treatment progression. Work independently in assessment, analysis, treatment and documentation with specific help from clinician only when required. Discuss and justify treatment / management strategies with respect to the evidence base for practice. Discuss patient management with clinical educator with respect to any relevant health policies. Communicate effectively with all members of the MDT. Demonstrate effective communication with other health professionals in verbal and written format. Use relevant research to evidence treatments.

25 Negotiation of Learning Outcomes Complete an accurate and relevant assessment of a stroke/neurology patient within the community. o Written evidence, for example a comparison of the first and last assessment would show improvement. o Improvements would also take place through discussion with clinician. Understand the role of other professionals within the MDT in stroke/neurology care. Access to an extensive MDT to gain increased understanding of roles including: o OT o Rehabilitation Assistant o CLASP nurse (Community Liaison and Stroke Prevention Nurse) o Acute stroke nurse o Speech and Language therapist o Dysphagia nurse o Stroke Association Produce written evidence of what was learned from visits, this may be in the form of a reflective diary. Increase knowledge of commonly encountered medications in the management of stroke/neurological patients. o Produce a glossary using the BNF Gain experience in the assessment of tone and to discuss the management of high/low tone patients. o This could be achieved through using a reflective diary, making notes from a text book and through discussion with clinician Access to increased understanding of a stroke diagnosis as there is the opportunity to attend CT scans.

26 Preparing for your Placement In order to gain the maximum benefit from your placement you may wish to complete some preparatory reading. It will be very useful to have a look back at your university learning materials with specific reference to: Path physiology of Stroke, Multiple Sclerosis and Parkinson s Disease Principles of neurological assessment Therapeutic interventions in neurological physiotherapy Principles of outcome measurement Reflection on your learning and development portfolio The following sources may also be useful in order to support your learning: Edwards S (2002) Neurological Physiotherapy 2 nd Edition. Churchill Livingstone. Chapter 2 - Assessment, Outcome Measurement and Goal Setting in Neurological Physiotherapy Chapter 3 - An analysis of Normal Movement as the basis for the development of treatment techniques. Shumway-Cook A and Woollacott MH (2001) Motor Control theory and practical applications 2 nd Edition. Lippincott, Williams and Williams. Chapter 5 A Conceptual Framework for Clinical Practice. Stokes M (2004) Physical Management in Neurological Rehabilitation 2 nd Edition. Elsevier Mosby. Chapter 1 Motor Control Chapter 3 Principles of Physiotherapy Assessment and Outcome Measurement Chapter 21 The Theoretical Basis of Neurological Physiotherapy Selected chapters on pathophysiology and management of neurological conditions Please understand that the above are suggested areas for you to dip in and out of and not to have read exhaustively!! We will guide you to further reading during your placement based on your individual needs. Please feel free to telephone us prior to the

27 commencement of your placement in order to deal more fully with any queries that you may have. We recognise that different individuals have different learning styles and we will discuss this with you during the early part of your placement. We will try to be adaptable to your needs but we also ask you to recognise our primary commitment to our patients and the Trust. You will work closely with your clinical educator(s) but it may also be appropriate for you to spend some time with other members of the physiotherapy team. There are also potential opportunities to spend short periods of time in other areas of neurological physiotherapy such as Inpatient Stroke Rehabilitation. Depending on your understanding of other health professional s roles in neurological rehabilitation there is the potential for us to arrange some time with other members of the MDT. You will be welcome to attend any in-service training sessions that we feel are appropriate for your learning. We would encourage you to make good use of your Professional Development Diaries as an aid to reflection both prior to and during your placement. This will be helpful in identifying and achieving any additional learning outcomes over and above the core learning outcomes for your placement. We hope that you will enjoy your placement with us and that we can make a positive contribution to your learning.