Advanced Training Skills Module August Vulval Disease

Transcription

1 Introduction Vulval Disease This module is designed to provide training in all aspects of vulval disease. Successful completion of the ATSM will equip an individual to develop this aspect of care in their future practice. It is also a component of knowledge for those doctors wishing to work in community based Gynaecology or for those providing a Gynaecological Oncology service in the future. The multi disciplinary nature of the present service provision for women with vulval disease requires that trainees attend clinics in Dermatology and Genitourinary medicine as well as specialist vulval Clinics. The psychosexual effects of many of these disease processes require the trainees to gain an understanding of the work of colleagues in clinical psychology. The role of physical therapies in the management of vulval pain syndromes is an important aspect of care and provision for this type of therapy is limited, hence trainees may need to access this in different regions. The trainee is encouraged to join the British Society for the Study of Vulvo-Vaginal Disease and must attend at least one BSSVD meeting as part of the ATSM. The ATSM must be undertaken with the supervision of an identified educational supervisor who must be able either to provide access to all components of the module or to arrange for the trainee to attend the appropriate clinic with other colleagues. Learning outcome To demonstrate appropriate knowledge, skills and attitudes in relation to the care of patients with vulval disorders. To competently diagnose and manage common vulval disorders. Successful completion of the ATSM will enable a trainee to: confidently diagnose and manage common vulval conditions recognise the pyschological effect vulval disease can cause confidently use available diagnostic aids including colposcopy take outpatient skin biopsies and interpret histological reports work well as part of a multidisciplinary team refer to colleagues in other specialties appropriately understand the implications of a chronic pain syndrome be able to undertake and utilise clinical audit in this area of practice 1

2 Knowledge criteria Clinical competency Professional skills and attitudes Training support Evidence/ Assessment Knowledge of the anatomy, embryology and physiology of the vulva and vagina Knowledge of skin micro structure and pathology To demonstrate awareness of the changes in the vulva and vagina in all ages of women and be aware of the physiological versus pathological appearances. Able to perform general skin examination Demonstrate sensitivity and appropriate behaviour with awareness of child protection legislation, requirements for chaperone Medical literature. E.g. The Vulva, Ridley. PG Courses e.g. BSSVD educational meetings Attend Histopathology case review meetings Course certificate Knowledge of examination techniques: Colposcopy Application of acetic acid Role of Toluidine blue Biopsy techniques Local anaesthetic properties Able to examine the vulva, vagina and cervix with appropriate positioning of the patient, use of light, local magnification and specula as necessary. Perform colposcopy of the lower genital tract: -Recognise colposcopic features of the normal cervix, vagina and vulva. Able to explain procedures clearly and obtain informed consent Attend Dermatology clinics BSSP approved basic colposcopy course BSCCP course Supervised vulval clinics E-learning resources e.g. ISSVD web site Course certificate Case Logbook Record of clinic attendance and log of cases Perform directed biopsy in clinic setting. Control bleeding from biopsy sites. Awareness of data storage and protection requirements Document clearly findings Use clinical photography appropriately Appreciate the importance of psychological factors for patients. CbD 2

3 Knowledge criteria Clinical competency Professional skills and attitudes Show empathy with patients. Training support Evidence/ Assessment CbDs Epidemiology, aetiology, diagnosis, prevention, management, prognosis, complications and anatomical considerations of pre-malignant conditions of the lower genital tract with particular reference to VIN and Paget s disease Knowledge of Dermatoses: Lichen sclerosus Eczema Dermatitis Lichen planus Psoriasis Lichen simplex - Including the aetiology, epidemiology, natural history, associated medical conditions and prognosis. Recognise, counsel and plan the initial management of pre-malignant conditions and features suggestive of invasive disease of the lower genital tract. Advise appropriate investigation for cases with Paget s disease and plan follow up for both VIN and Paget s Recognise features in the history and clinical signs Plan and perform appropriate investigations, including investigations of related medical conditions Institute first line treatment and arrange appropriate follow up Ability to explain the prognosis and the need for follow up Explain, clearly and openly, treatment, complications and side effects. Local and regional protocols and guidelines for management of VIN. Multi-disciplinary and clinical team meetings. Attendance at vulval clinics OSATS Record of clinic attendance and case logbook OSATS. Clinical assessment of vulva. 3 Recognise precipitating factors, risk of neoplastic change, need for excision biopsy Undertake preoperative assessment for and perform excision biopsy of lesion on the vulva Demonstrate excellent record keeping Effectiveness in liasing with colleagues in other disciplines, particularly dermatology, genitourinary medicine and psychosexual medicine. Document findings, collate results and communicate results to patients and GP.

4 Knowledge criteria Clinical competency Professional skills and attitudes Training support Evidence/ Assessment Knowledge of the diagnoses for vulval pain Able to take a detailed pain and sexual function history. Differentiate between different pain syndromes and plan management accordingly Attend dermatology and GU clinics CbD Knowledge of available drugs for pain management, the effectiveness, side effects and complications of treatment Understand examination findings First line management: Pain modifying drugs Topical agents Physical therapies Show empathy and allow expressions of anger and manage appropriately Able to explain timeframe for treatment and response MTD or equivalent with Psychosexual counsellor ISSVD publications on classification and nomenclature. Case logbook Knowledge of other pain syndromes, common pain pathways, modern neuropathic research findings and their influence on Vulval Pain. Offers support with knowledge of voluntary organisations and web sites e.g. Vulval Pain Association Recognise the role of alternative therapies without being judgmental Attendance at local vulval pain society meetings Attendance at local Pain Management Clinics Service administration: knowledge of modern NHS service requirements Recognise the support necessary for small specialist clinics Courses on the NHS management 4

5 Vulval Disease Skill Competence level Level 1 Level 2 Level 3 Date Signature Date Signature Date Signature History and examination related to vulval disease including general skin examination Colposcopy of the vulva Outpatient vulval skin biopsy Excision biopsy of vulval lesion Diagnose and manage Lichen Sclerosus Diagnose and manage Lichen Simplex Diagnose and manage Lichen Planus Diagnose and manage unifocal VIN Diagnose and manage multifocal VIN Diagnose vulval pain syndormes Manage provoked vulvodynia Manage unprovoked vulvodynia Manage poor responders to treatment of vulval pain 5

6 Training courses or sessions Title Signature of educational supervisor Date Basic vulval disorders course Basic colposcopy course (BSCCP approved) Attendance at vulval clinics Attendance at dermatology clinic Attendance at GUM clinic (female) 6