Royal College of Obstetricians and Gynaecologists Special Skills Training Module URODYNAMICS In collaboration with the British Society of Urogynaecology June 2002
Published by the RCOG Press at the Royal College of Obstetricians and Gynaecologists Registered Charity No. 213280 Royal College of Obstetricians and Gynaecologists 2002 Further copies of this module can be obtained from: Postgraduate Training Department Royal College of Obstetricians and Gynaecologists 27 Sussex Place Regent s Park London NW1 4RG Telephone: +44 (0) 20 7772 6200 Facsimile: +44 (0) 20 7723 0575 Website: www.rcog.org.uk Printed by Manor Press, Unit 1, Priors Way, Maidenhead, Berks. SL6 2EL
CONTENTS Page INTRODUCTION 3 Entry criteria 3 Training programme components 3 The logbook 4 TRAINING DETAILS 5 RECORD OF ATTENDANCE 6 BASIC SKILLS 7 SETTING UP EQUIPMENT 7 URODYNAMICS UROFLOWMETRY 7 RESIDUAL URINE VOLUME 8 URETHRAL FUNCTION TESTS 8 CYSTOMETRY 8 SUPPLEMENTARY INVESTIGATIONS 8 APPENDIX I: Contents of theoretical course 9 SPECIAL SKILLS TRAINEE REGISTRATION FORM 11 SPECIAL SKILLS REGISTRATION FORM FOR NON-TRAINING GRADES 13 CERTIFICATE OF COMPLETION OF TRAINING PROGRAMME 15 Urodynamics Special Skills Training Module 1
INTRODUCTION Urodynamic investigations are an essential component in the management of women who present with lower urinary tract symptoms. This module will help to equip individuals with the knowledge and skills required to use urodynamic investigations within the clinical context. Once trained, a clinician should be able to: 1. Undertake an appropriate urogynaecological clinical evaluation. 2. Select the optimum urodynamic investigation for individual patients. 3. Perform all relevant urodynamic investigations. 4. Establish a diagnosis and formulate a treatment plan. 5. Effectively communicate the above information to the patient and colleagues. This module has been designed for the training of gynaecologists. However, it is appreciated that urodynamic investigations are undertaken by a variety of medical disciplines as well as nurses, physicists and other professionals. Entry criteria As special skills training should follow the completion of core training, the following criteria must be met: 1 The trainee must have passed Part 2 MRCOG or hold an equivalent qualification. 2 The trainee must have satisfactorily completed the Core Logbook requirements. 3 The trainee must have obtained a satisfactory year three RITA. Registration with the RCOG for special skills training can only be made when the above criteria are met. Specialist Registrars with fixed term training appointments (FTTA) who wish to register with the RCOG for special skills training should also fulfil the above criteria. URODYNAMICS Training programme components The following are essential components of the training programme, and all of them have to be completed: 1. Training must be undertaken under the supervision of an identified preceptor for one year. The preceptor must be skilled in urodynamics and supervise at least one urodynamic session per week. The preceptor should undertake direct supervision of the trainee for the bulk of the module. On occasion the trainee may undertake sessions under the supervision of professionals other than the preceptor. In these circumstances, it is the preceptor s duty to ensure that the professional to whom the duty of training is delegated is sufficiently competent, willing and able to teach the trainee. Dual preceptorship is also acceptable. Under these circumstances, at least one of the preceptors should hold the MRCOG or FRCOG. 2. Trainees should obtain an application form for special skills training from the Postgraduate Training Department of the RCOG and get it completed. The special skills training plans of the Urodynamics Special Skills Training Module 3
URODYNAMICS trainee should be discussed at the year two RITA. During SpR year three, the trainee should obtain the chosen module and application forms from the RCOG Postgraduate Training Department, make contact with a preceptor in their chosen module, discuss rotations with the Deanery Specialist Training Committee (DSTC) and ensure that their application form is completed. At the Year Three RITA assessment, the trainee should ask the Chairman of the DSTC to sign the application form in support of the module and send a copy of the completed form to the RCOG. 3. Trainees should attend a theoretical course that should provide the essential knowledge component of training for this module. It is expected that trainees will also supplement their knowledge by reading standard textbooks and other literature. The theoretical course can be attended at any time after registration. 4 The practical component will involve attendance at clinics where patients are referred for urodynamic investigation. The trainee must attend at least 30 such sessions and attendance must be documented in the appropriate section of the logbook. 5 A summary of observations of clinical practice and formal testing of a minimum of 30 patients must be undertaken, including symptoms, urodynamic tests, diagnoses and treatment recommendations. Additionally, the trainee should write up ten referenced case reports of interesting patients, covering a range of pathologies, including details of the patient s assessment and diagnosis, and a critical review of the urodynamic traces including artefacts. Each of these critiques should be not more than a thousand words in length. These should be completed to the preceptor s satisfaction. Training will be deemed to be complete when all the components have been completed to the satisfaction of the preceptor. The Completion of Training Certificate should be signed by the preceptor and trainee and sent to the Postgraduate Training Department at the RCOG. The logbook This logbook defines the skills required for urodynamic investigation in women. Completion of the logbook will allow the preceptor and trainee to monitor progress and identify deficiencies over the course of training. It is important to note that the logbook is a record of competence rather than experience. The preceptor and trainee will review the progress of training every two months. Competence will be documented by the preceptor signing the appropriate sections of the logbook. The levels of competence are: Level 1 performed the exercise under direct supervision Level 2 performed the exercise independently. It is imperative that all participants appreciate that the trainee s progress has to meet standards that satisfy the preceptor. At the end of the training programme, the preceptor has to certify that the skills attained by the trainee are to his/her satisfaction. 4 Special Skills Training Module Urodynamics
TRAINING DETAILS Trainee name: Address: National Training Number: Preceptor: URODYNAMICS Address: Date of commencement of training: Date of attendance at theoretical course: Date of completion of training: Urodynamics Special Skills Training Module 5
URODYNAMICS RECORD OF ATTENDANCE Date Number of studies Supervised Independent 6 Special Skills Training Module Urodynamics
BASIC SKILLS SKILL Level 1 Level 2 Preceptor to sign and date Supervised Independent when competence achieved History (including assessment of symptoms, severity and quality of life) Examination (including neurological assessment, prolapse staging, bladder neck mobility and demonstration of stress incontinence) Pre-urodynamic investigations (including urinalysis, MSU, frequency/volume chart and pad test) Patient counselling on urodynamics Assessment of the circumstances during the study (including patient mobility, medications, position for urodynamics) Knowledge and appropriate use of ICS terminology SETTING UP EQUIPMENT URODYNAMICS SKILL Level 1 Level 2 Preceptor to sign and date Supervised Independent when competence achieved Calibration of flow transducer, UPP withdrawal machine, transducers, pump for filling speed Familiarity with three way taps (flushing through, zeroing, recording of pressures) Familiarity with catheters used (solid state transducers, fluid filled system) UROFLOWMETRY SKILL Level 1 Level 2 Preceptor to sign and date Supervised Independent when competence achieved State indications Explain investigation to patient Describe flowmeter type Calibration Identify artefacts Interpretation of results Urodynamics Special Skills Training Module 7
URODYNAMICS RESIDUAL URINE VOLUME SKILL Level 1 Level 2 Preceptor to sign and date Supervised Independent when competence achieved Measurement by catheterisation Measurement by ultrasound Estimation by palpation URETHRAL FUNCTION TESTS SKILL Level 1 Level 2 Preceptor to sign and date Supervised Independent when competence achieved Urethral pressure profile (explain test, indications, study conditions, perform procedure, obtain good quality trace, describe and interpret results) CYSTOMETRY SKILL Level 1 Level 2 Preceptor to sign and date Supervised Independent when competence achieved Explain test to patient, indications, study conditions Zeroing of pressure transducers Performance of test as per ICS recommendations (catheterisation, position stated, filling speed decision, provocative tests, voiding cystometry) Quality of trace and artefacts Description and interpretation of results, including diagnosis Treatment recommendations SUPPLEMENTARY INVESTIGATIONS The following investigations are not available in all units. Knowledge regarding the indications for their use, method of performance and interpretation will be obtained from the theoretical course. In addition, all trainees must have seen them performed, and this attendance must be recorded below by the person performing the test. It may be necessary for trainees to visit another department to gain this experience. TEST Date observed Signature of person performing test Video cystourethrography Valsalva leak point pressures Ambulatory urodynamic monitoring Distal urethral and bladder neck electric conductance test 8 Special Skills Training Module Urodynamics
Appendix I Contents of theoretical course Attendance at a theoretical course is mandatory and can be undertaken at any time after enrolment. The contents of the theoretical course should include at least the following, in addition to covering the subjects outlined in the syllabus above: Basic principles of urodynamics, physics, anatomy and physiology. Patient assessment: clinical assessment frequency volume chart analysis urinalysis and MSU Basic urodynamic techniques: getting started, how to set-up and use equipment uroflowmetry and post void residuals cystometry (filling and voiding) URODYNAMICS Specialised urodynamic techniques: video urodynamics ambulatory urodynamic monitoring urethral function tests (e.g. Valsalva leak-point pressures, urethral pressure profiles, urethral electric conductance) Interpretation of traces Detection and correction of artefacts Urodynamic demonstration to include relevant clinical groups Report writing and treatment recommendations Interactive discussion Urodynamics Special Skills Training Module 9
Royal College of Obstetricians and Gynaecologists Please insert name of module: SPECIAL SKILLS TRAINEE REGISTRATION FORM Please complete both sides of the form in block letters in black ink. TO BE COMPLETED BY TRAINEE To be completed and returned to the: Special Skills Secretary, Postgraduate Training Department, RCOG, 27 Sussex Place, Regent s Park, London NW1 4RG. SURNAME:... OTHER NAMES:... RCOG REG NO:... (V)NTN: / / / MALE FEMALE ENTRY CRITERIA: (you must have possession of the MRCOG) Date obtained MRCOG: / / NAME AND ADDRESS OF TRAINING CENTRE:...... DATE OF COMMENCEMENT OF TRAINING: / / I WILL/HAVE ATTEND(ED) THE APPROVED THEORETICAL COURSE: If you have attended please give date: / / Would you like to receive information on the approved theoretical course: YES NO Trainee s signature:...date:... Please complete overleaf
TO BE COMPLETED BY PRECEPTOR(S) Name of preceptor(s) in charge of training: 1. Name:... 2. Name:... Post:... Post:... Department address: Department address: I agree to provide the training necessary for the completion of this Special Skills Module. Preceptor name (1): Preceptor name (2): Date:... Date:... TO BE COMPLETED BY THE RCOG COLLEGE TUTOR I confirm that the trainee can undertake this module of Special Skills Training under the supervision of the preceptor(s) listed above. Please print name:... Signature:... Date:... TO BE COMPLETED BY THE CHAIRMAN OF THE DEANERY SPECIALIST TRAINING COMMITTEE I confirm that the trainee has completed core training and that the Deanery Specialist Training Committee has approved the training module for the trainee, preceptor(s) and programme of training. Please print name:... Signature:... Date:... IT IS THE RESPONSIBILITY OF THE TRAINEE TO OBTAIN THE REQUIRED SIGNATURES FOR THIS FORM BEFORE FORWARDING TO THE COLLEGE
Royal College of Obstetricians and Gynaecologists SPECIAL SKILLS REGISTRATION FORM FOR NON-TRAINING GRADES Please insert name of module: To be completed and returned to the: Special Skills Secretary, Postgraduate Training Department, RCOG, 27 Sussex Place, Regent s Park, London NW1 4RG. Please complete both sides of the form in block letters in black ink. TO BE COMPLETED BY DOCTOR SURNAME:... OTHER NAMES:... RCOG REG NO:... MALE FEMALE ENTRY CRITERIA: (you must have possession of the MRCOG) Date obtained MRCOG: / / NAME AND ADDRESS OF TRAINING CENTRE:...... DATE OF COMMENCEMENT OF TRAINING: / / I WILL/HAVE ATTEND(ED) THE APPROVED THEORETICAL COURSE: If you have attended please give date: / / Would you like to receive information on the approved theoretical course: YES NO Doctor s signature:...date:... Please complete overleaf
TO BE COMPLETED BY PRECEPTOR(S) Name of preceptor(s) in charge of training (please print name): 1. Name:... 2. Name:... Post:... Post:... Department address: Department address: I agree to provide the training necessary for the completion of this Special Skills Module. Preceptor signature (1): Preceptor signature (2): Date:... Date:... TO BE COMPLETED BY THE CLINICAL DIRECTOR I confirm that the doctor can undertake this module of Special Skills Training under the supervision of the preceptor(s) listed above. Please print name:... Signature:... Date:... TO BE COMPLETED BY THE CHAIRMAN OF THE DEANERY SPECIALIST TRAINING COMMITTEE I confirm that the trainee has completed core training and that the Deanery Specialist Training Committee has approved the training module for the doctor, preceptor(s) and programme of training. Please print name:... Signature:... Date:... IT IS THE RESPONSIBILITY OF THE DOCTOR TO OBTAIN THE REQUIRED SIGNATURES FOR THIS FORM BEFORE FORWARDING TO THE COLLEGE
Royal College of Obstetricians and Gynaecologists NOTIFICATION OF COMPLETION OF TRAINING MODULE (To be completed by preceptor) I certify that has completed the training module in urodynamics to my satisfaction. I confirm that I have had regular assessment sessions with the trainee and each of the required skills in the logbook has been attained. Date of commencement of practical training: Date satisfactorily completed theoretical course: / / / / Trainee name:... Trainee signature:... Date:... Preceptor(s) in charge of training. Preceptor name (1): Preceptor name (2): Preceptor name (1): Preceptor name (2): Date:... Date:... Department address: Department address: Authorised by the Chairman of the Deanery Specialist Training Committee Please print name:... Signature:... Date:... This certificate of completion of training should be sent to the Special Skills Secretary, Postgraduate Training Department, RCOG, 27 Sussex Place, Regent s Park, London NW1 4RG.