RANZCOG Advanced Training Modules

Transcription

1 RANZCOG Advanced Training Modules Generalist Obstetrics ATM and Generalist Gynaecology ATM The Generalist ATMs in each of Obstetrics and Gynaecology provide a framework for trainees to consolidate and enhance the knowledge, clinical skills and professional abilities required to provide high level services in an urban or provincial setting across the Generalist Scope of Practice. The two Generalist ATMs include all compulsory requirements of advanced training across the common scope of practice. The two Generalist ATMs are compulsory for all FRANZCOG trainees except those who undertake the subspecialty pathway. The two Generalist ATMs may be undertaken concurrently or separately. Hospitals may offer one or both of the Generalist ATMs. The curriculum within these ATMs is designed to: Enhance progress from Senior Registrar to FRANZCOG graduate across the Generalist Scope of Practice as specified below. Position the Advanced Trainee to further increase their scope of practice following completion of the ATMs through exposure to more complex conditions and undertaking procedures beyond core training. Provide the FRANZCOG graduate with the foundation for a continuum of learning and ongoing CPD based on the FRANZCOG curriculum, allowing on-going skills development by the FRANZCOG graduate, as required for future scope of practice. Scope of Practice Having completed advanced training that includes the Generalist ATMs, the new Fellow will have obtained the Generalist scope of practice at Consultant level. The Generalist Scope of Practice includes additional aspects of general obstetrics and gynaecology that a non-generalist would not necessarily be able to perform independently at consultant level as described in the ATM documents. RANZCOG ATMs: Generalist Obstetric and Generalist Gynaecology Last updated 5 May

2 Generalist Obstetrics ATM Learning Outcomes By the end of the Generalist Obstetrics ATM the trainee should have demonstrable knowledge, clinical and professional skills relevant to the following to evidence-based standards: Antenatal, intrapartum and postnatal care of normal and complex pregnancies including: o Management of cervical insufficiency o Obstetric ultrasound to the level of: Cervical length measurement through the 2nd trimester of pregnancy Doppler and assessment of amniotic fluid for fetal wellbeing Placental location Estimated fetal weight (3 rd trimester) Volume of cases and/or procedures for logbook^ Obstetrics Logbook Operative vaginal delivery 25 Logbook Caesarean section: low complexity 30 Logbook Caesarean section: complicated (full dilatation, placenta praevia/accreta) 20 ^Supervision/teaching of junior trainees contributes to the logbook numbers. Estimated length of time for completion of this ATM: Trainees are expected to complete the training and assessment requirements for this ATM in a minimum of 26 weeks full time (or FTE equivalent) prospectively approved Advanced Training time in a post approved for completion of the Generalist Obstetric ATM. This ATM may be undertaken concurrently with other ATMs. Guidelines for training sites offering this module: As for all Advanced Training posts, prospective approval of training towards the Generalist Obstetrics ATM is required. Training sites electing to offer training for this ATM should be able to provide trainees with the necessary resources and clinical material to complete relevant training and assessment requirements as described above including access to minimum numbers of procedures (as primary operator or direct supervisor) to enable completion of the logbook requirements. Last updated 5 May

3 Obstetrics and Learning Clinical Knowledge and Reasoning Demonstrate knowledge and understanding of: HEP Log Book Pre-pregnancy, antenatal, intrapartum and postnatal care across all levels of complexity, with a need for consultation with a Maternal Fetal Medicine subspecialist only in the event of high complexity ST TSR TSR - 3/12 & 6/12 Clinical Skills: Be able to perform: Insertion and removal of elective cervical cerclage Obstetric ultrasound to the level of: diagnosis of viability, number of fetuses, multifetal gestation choronicity, gestational age and placental location Clinical Practice under Supervision elm Log Book TSR - 3/12 & 6/12 Cervical length measurement through the 2nd trimester of pregnancy TSR Doppler assessment of umbilical artery waveform and assessment of amniotic fluid for fetal wellbeing External cephalic version Preterm birth Normal vaginal delivery, operative vaginal delivery and caesarean section Complex vaginal delivery including breech, shoulder dystocia and multiple fetal delivery Recognise and manage maternal and fetal complications, which may develop during labour, including pre-eclampsia and fetal distress Manual removal of placenta Repair of perineal trauma including 3rd and 4th degree tears Examination under anaesthesia for postpartum haemorrhage Other procedures for management of postpartum haemorrhage including balloon tamponade and compression sutures Management of visceral and vascular trauma sustained at caesarean section Management of maternal collapse Caesarean Hysterectomy Basic neonatal resuscitation Adult resuscitation Evaluation of a perinatal death and provision of appropriate counselling. Last updated 5 May

4 Generalist Gynaecology ATM Learning Outcomes: By the end of the ATM the trainee should have demonstrable knowledge, clinical and professional skills relevant to the following to evidence-based standards: Outpatient and inpatient management of common gynaecological problems Management of gynaecological conditions including: o Performance of generalist level gynaecological surgery: Hysteroscopic polypectomy Endometrial ablation Laparoscopic surgery RANZCOG/AGES level 2b Abdominal hysterectomy Pelvic organ prolapse repair procedures (primary including vaginal hysterectomy) Surgical procedures for urinary stress incontinence (e.g. tension-free vaginal tape procedure) Management of gynaecological emergencies Workplace-based requirements Logbook*^ Gynaecology Logbook Laparoscopy RANZCOG/AGES level 2b or higher 20 Logbook Pelvic organ prolapse repair procedures (primary 10 including vaginal hysterectomy) other than procedures only involving vaginal hysterectomy or bladder neck support) Logbook Vaginal hysterectomy 5 Logbook Endometrial ablation 5 * The same theatre case may involve more than one procedure. E.g. Vaginal Hysterectomy with Anterior and Posterior Vaginal Repair and TVT would be listed under each of the three categories. ^Supervision/teaching of junior trainees contributes to the logbook numbers. Estimated length of time for completion of this ATM: Trainees are expected to complete the training and assessment requirements for this ATM in a minimum of 26 weeks prospectively approved Advanced Training time in a post approved for completion of the Generalist Gynaecology ATM. This ATM may be undertaken concurrently with other ATMs. Guidelines for training sites offering this module: As for all Advanced Training posts, prospective approval of training towards the Generalist Gynaecology ATM is required. Training sites electing to offer training for this ATM should be able to provide trainees with the necessary resources and clinical material to complete relevant training and assessment requirements as described above including access to minimum numbers of procedures (as primary operator or direct supervisor) to enable completion of the logbook requirements. Last updated 5 May

5 Office Gynaecology: Management of common office gynaecological problems including: and Learning Clinical Knowledge and Reasoning Demonstrate knowledge and understanding of: HEP Clinical Presentations Contraception Subfertility Abnormal vaginal bleeding including menorrhagia, postmenopausal bleeding, Pelvic pain Vaginal discharge Vulval pruritus and other common vulval presentations Clinical Skills: Be able to perform: Insertion & Removal of IUCD, Insertion & Removal of Long Acting Contraceptive Device (e.g. Implanon or Jadelle) Endometrial sampling (Pipelle, curettage) Fitting of vaginal pessary for prolapse Clinical Practice under Supervision elm Logbook Management of common acute gynaecological problems and gynaecological emergencies Clinical Knowledge and Reasoning and Learning Demonstrate knowledge and understanding of: Clinical Presentations Heavy vaginal bleeding Acute Lower Abdominal Pain Acute sepsis Postoperative (acute) complications HEP Clinical Conditions Miscarriage, ectopic pregnancy Ovarian cyst and other adnexal complications Pelvic Infection Secondary Haemorrhage following gynaecological surgery Last updated 5 May

6 Clinical Skills: Be able to perform: Minor perineal surgery (e.g., Bartholin s cyst or abscess, marsupialisation, excision vulval cyst) Dilatation & Curettage Hysteroscopy Colposcopy Laparoscopic surgery RANZCOG/AGES level 2b or higher Emergency Hysterectomy Clinical Practice under Supervision elm Log Book Gynaecological Surgery and Learning Clinical Knowledge and Reasoning Demonstrate knowledge and understanding of: Clinical Presentations Pelvic organ prolapse Urinary incontinence HEP Log Book Clinical Conditions Fibromyoma, endometrial polyp Adenomyosis, endometriosis Cervical intra-epithelial neoplasia Investigation, triaging and appropriate management of adnexal mass (pre and post-menopause) Clinical Skills: Be able to perform: RANZCOG/AGES level 2b laparoscopy Abdominal hysterectomy Pelvic organ prolapse repair procedures (including vaginal hysterectomy) Surgical procedures for urinary stress incontinence (e.g. tension-free vaginal tape procedure) Endometrial ablation procedures LLETZ and Cone biopsy Clinical Practice under Supervision elm TSR Log Book Last updated 5 May

7 During Advanced Training, trainees have the opportunity to build on core competencies already achieved and develop higher level skills that will enable the transition to Consultant, including the following: Professional Skills and Learning Be able to: Communication Recognises and repairs communication errors quickly and adapts style appropriately and sensitively to ensure effective communication with patients, support groups, colleagues. Establishes professional relationships with all healthcare team members, contributes to interdisciplinary team activities and provides appropriate feedback to others. Relevant annual meetings and conferences HEP TSR AA Teaches at undergraduate & postgraduate levels; provides guidance, advice and feedback; and conducts of procedural and surgical skills of junior registrars. Learning Actively seeks information to enhance the breadth and depth of their knowledge; identifies own learning needs and resources; recognises and seeks learning opportunities. AA Research AA Critically appraises a paper, tests ideas gained from the literature with senior colleagues, undertakes a clinical review and initiates one s own research. Leadership and Management Manages independently across common and selected scope of practice. Independently performs common specified advanced skills and those within selected scope of practice and expertise. Recognises limits of practice and seeks assistance from specialist colleagues when the situation is complex. Applies advanced level clinical reasoning and judgment; can manage complexity and uncertainty and devise options and adapt management plans. Effectively manages resources, clinical teams, resolves conflicts, prepares rosters, sets priorities and appraises work practices within the unit. Develops guidelines, protocols and checklists where appropriate. Last updated 5 May

8 Audit Leads root cause(s) analysis and other methods to review incidents, errors and adverse events. Participates in clinical governance and takes responsibility to implement change to reduce risk. Health Advocacy Acts as a role model for others in demonstrating ethical attitudes and conduct and encouraging peers to practice medicine consistent with the obligations involved in a selfregulating profession. Acts as a health advocate to improve health outcomes within the broader community, cognisant of the relevant health, social, cultural and economic needs. Considers the health and safety needs of colleagues and responds when appropriate to ensure optimal level of performance. s Glossary of terms Formative LB Logbook In-training 3-monthly appraisal: All ATMs are required to include a regular in-training appraisal, conducted 3 monthly, to be undertaken by the Training Supervisor. This should provide an opportunity to discuss aspects of the training and assessment that have been undertaken within the 12 week period of training Summative In-training 6-monthly assessment: All ATMs are required to include a regular in-training assessment, conducted 6 monthly, to be undertaken by the Training Supervisor. This should provide an opportunity to discuss aspects of the training and assessment that have been undertaken within the 6 month period of training and Learning Strategies: elm elearning module ST Supervised Training HEP Hospital Education Program (include here any hospital meetings, case reviews etc. that would be relevant) TSR Training Supervisor Reports Last updated 5 May