JOB DESCRIPTION ENT/Ophthalmology with General Practice post GP+1

Transcription

1 JOB DESCRIPTION ENT/Ophthalmology with General Practice post GP+1 Job Title: Base: Responsible to: Working Hours: On-call: ST 1/2 ENT/Ophthalmology and GP Hospital Trust and GP practice Clinical Supervising Consultant in ENT or Ophthalmology according to rotation GP clinical supervisor in relevant practice As per rota and will depend on department 6 sessions of 4 hours minimum duration in GP OOH setting Duties of the post Attending ENT/Ophthalmic clinics Dealing with urgent ENT/Ophthalmic conditions. Assisting in theatre (minimal exposure, to facilitate learning) Participation in duty rota and hand over including: A face-to-face handover of care must take place at every change of shifts, with communication of details about all problem patients. Discharge and clinic summaries are to be dictated on patients. Results relating to their firm must be seen and signed daily. Clinical Governance Undertake induction and mandatory training, including completion of the Educational Agreement This includes completing training in basic ENT and Ophthalmic examination, the use of otoscope and ear microscope and suction clearance of external ear. Ophthalmoscopy etc In accordance with the Educational Contract, take part in audit.

2 Educational content: The post holder will be expected to attend weekly GP teaching sessions held on Wednesday afternoons at Education Centre. An appraisal will be made at the commencement of the Post and at the mid point of the post to review progress. The post holder will be entitled to study leave in accordance with national and local guidelines. Participation in appropriate departmental teaching and learning activities Ophthalmic Timetable TUES AM Mr. I. Rahman OPD TUES AM Mr. G. Naylor OPD THURS AM Casualty OPD (Pink Reception) THURS PM Macular Clinic Ophthalmic Day Case Unit Otolaryngology Timetable TUESDAY A.M. Out Patients Clinic Mr. A.J. Nigam TUESDAY P.M. Out Patients Clinic Mr. A.J. Nigam THURSDAY A.M. Theatres 5/6 Mr. A.J. Nigam FRIDAY A.M. Out Patients Clinic Mr. A.J. Nigam

3 GP learning objectives taken from RCGP curriculum statement 15.4 ENT. The knowledge base Symptoms: Hearing loss; ear wax, otalgia; discharging ear; dizziness; tinnitus; epistaxis; sore throat, hoarseness; dysphagia; croup; goitre, lymph nodes and other neck swellings; speech delay; foreign bodies; facial weakness. Common and/or important conditions: Otitis media (suppurative/secretory); otitis externa; perforated tympanic membrane; cholesteatoma Vertigo; Ménière s disease Bell s palsy; tempero-mandibular pain, trigeminal neuralgia Pharyngitis; tonsillitis; laryngitis; glandular fever; oral candida, herpes; salivary stones; gastro-oesophageal reflux disease (GORD) Infective and allergic rhinitis; sinusitis; nasal polyps Nasal fracture, haematoma auris Snoring and sleep apnoea Suspected head and neck cancer12 Unilateral hearing loss in the absence of external ear pathology or obvious cause. Investigation: Otoscopy Tuning fork tests Awareness of: pure tone threshold audiogram; speech audiometry, impedance tympanometry, auditory brainstem responses and otoacoustic emissions. Treatment: Watchful waiting and use of delayed prescriptions Nasal cautery Fractured nose (need manipulation under anaesthetic within two weeks for optimum result). Emergency care: Septal haematoma Epistaxis Tonsillitis with quinsy Otitis externa if extremely blocked or painful Foreign body Auricular haematoma or perichondritis. Prevention: Screening for hearing impairment in adults and children Awareness of iatrogenic causes of ototoxicity.

4 The Knowledge base RCGP curriculum chapter 15.5 Eye problems Symptoms: Key issues in the diagnosis of eye problems will be eliciting appropriate signs and symptoms, and subsequent investigation, treatment and/or referral of persons presenting with: Disorders of the lids and lacrimal drainage apparatus: Blepharitis Stye and chalazion Entropion and ectropion Basal-cell carcinoma Naso-lacrimal obstruction and dacryocystitis. External eye disease: sclera, cornea and anterior uvea: Conjunctivitis (infective and allergic) Dry eye syndrome Episcleritis and scleritis Corneal ulcers and keratitis Iritis and uveitis. Disorders of refraction: Cataract Myopia, hypermetropia, astigmatism Principles of refractive surgery Problems associated with contact lenses. Disorders of aqueous drainage: Acute angle closure glaucoma Primary open angle glaucoma Secondary glaucomas. Vitreo-retinal disorders: Flashes and floaters Vitreous detachment Vitreous haemorrhage Retinal detachment. Disorders of the optic disc and visual pathways: Swollen optic disc: recognition and differential diagnosis Atrophic optic disc: recognition and differential diagnosis Pathological cupping of the optic disc Migraine Transient ischaemic attacks (TIAs). Eye movement disorders and problems of amblyopic binocularity: Diplopia Non-paralytic and paralytic strabismus.

5 Investigations: Undertake an examination of the eye assessing both structure and function Understand the appropriate investigations to exclude systemic disease, e.g. erythrocyte sedimentation rate (ESR) test for temporal arteritis, chest X-ray for sarcoidosis, etc. Know the secondary care investigations and treatment including slit lamp, eye pressure measurement. Treatment: Understand and be able to explain to the patient about the use of medications including mydriatics, topical anaesthetics, corticosteroids, antibiotics, glaucoma agents Removal of superficial foreign bodies from the eye. Emergency care: Ability to recognise and institute primary management of ophthalmic emergencies and refer appropriately: Superficial ocular trauma, including assessment of foreign bodies, abrasions and minor lid lacerations Arc eye Severe blunt injury, including hyphaema Severe orbital injury, including blow-out fracture Penetrating ocular injury and tissue prolapsed Retained intra-ocular foreign body Sudden painless loss of vision Severe intra-ocular infection Acute angle closure glaucoma. Prevention: This will involve the following risk factors: Genetics family history Co-morbidities especially diabetes and hypertension. Overall Acquiring knowledge of the signs, symptoms, treatment or appropriate referral of common or important ENT and Ophthalmic presentations and conditions Gain skills in taking a thorough ENT and Ophthalmic history. Also in being able to use this information to form a differential diagnosis and formulate a sensible management plan. Ability to perform competent examination of ENT and Ophthalmic systems including use of Otoscope, Opthalmoscopy, visual acuity, external eye and ear examination Colour vision and visual field testing Gain knowledge and confidence in ENT and Ophthalmic investigations and treatments including Recognise ENT and ophthalmic emergencies and learn appropriate management.

6 Appraisal and Educational Assessment: Trainees should be appraised by the clinical supervisor at the beginning of their job, at 8 weeks and at the end of the job to provide educational feedback and suggest ways forward. Educational Assessment will be based on the GP curriculum and the requirements for assessments within this. At the end of the post the clinical supervisor will complete the clinical supervisors report in the trainees e portfolio. The trainee should give feedback on the training post.