SUBFERTILITY
Mdule 14 : Subfertility Learning utcmes: T understand the issues and demnstrate apprpriate knwledge, skills and attitudes in relatin t subfertility. Knwledge criteria Clinical cmpetency Prfessinal skills and attitudes Training supprt Evidence/assessment Epidemilgy, aetilgy, pathgenesis, clinical features, treatment and prgnsis f male and female subfertility Indicatins, limitatins and interpretatin f investigatins: endcrine measurements (male and female) semen analysis ultrasund ther imaging techniques genetic analysis perative prcedures Indicatins, techniques, limitatins and cmplicatins f surgery in relatin t: male and female subfertility endmetrisis develpmental disrders Indicatins, limitatins and cmplicatins f assisted reprductin techniques: vulatin inductin IVF and ICSI gamete dnatin Take histry and examine a cuple presenting with subfertility Arrange basic investigatins Cunsel cuples abut diagnsis and management ptins Perfrm the fllwing: diagnstic laparscpy staging f endmetrisis assessment f tubal patency diagnstic hysterscpy Shws an appreciatin f the imprtance f psychlgical factrs fr wmen and their partners Demnstrates respect fr wman s dignity and cnfidentiality Has an understanding f the issues relating t NHS funding and ratining f treatment Demnstrates the ability t deal sensitively with issues relating t the welfare f the child Has the ability t acknwledge cultural issues and issues relating t same sex partnerships and single parenthd Demnstrates the need t liaise effectively with clleagues in ther disciplines, clinical and nnclinical Apprpriate pstgraduate educatin curses Multidisciplinary and clinical team meetings StratOG.net: Subfertility e-tutrials Subfertility clinics Assisted reprductin sessins Useful websites: www.nice.rg.uk www.hfea.gv.uk Lgbk SOE EXIT EXAMINATION MRCOG Part 2 Case reprts Audit prjects OSATS: Diagnstic laparscpy Legal and ethical issues Mdule 14 Subfertility Curriculum
Appendix t Curriculum Mdule 14: details f knwledge criteria Epidemilgy, aetilgy, pathgenesis, clinical features, treatment and prgnsis f male and female subfertility: Female (vulatry disrders, tubal disrders, endmetrisis, cervical and uterine factrs, genetic and develpmental disrders). Male (structural, endcrine, pharmaclgical, infectius, lifestyle, genetic). Unexplained infertility. Lng-term sequelae f cancer treatment. Sterilisatin regret. Indicatins, limitatins and interpretatin f investigative techniques: Semen analysis. Endcrine assessment (see als Mdule 13): assessment f vulatin assessment f the subfertile male amenrrhea and ligmenrrhea plycystic vary syndrme hyperprlacinaemia thyrid/adrenal functin gnadal failure. Genetic analysis: chrmsme analysis, e.g. sex chrmsme abnrmalities Genetic abnrmities, e.g. cystic fibrsis. Ultrasund: Nrmal uterine and varian mrphlgy. Fllicular tracking Plycystic varies. Tubal patency. Other imaging techniques: Hystersalpinggraphy. Pituitary imaging. Cmputed tmgraphy. Magnetic resnance imaging. Operative investigative prcedures: Diagnstic laparscpy. Diagnstic hysterscpy. Indicatins, limitatins, techniques and cmplicatins f: Ovulatin inductin (clmifene, gnadtrphins, gnadtrphin-releasing hrmne). Other medical interventins (e.g. metfrmin, dpaminergic drugs). Intrauterine inseminatin. In vitr fertilisatin. intracytplasmic sperm injectin. Surgical sperm recvery. Legal and ethical issues: Human Fertilisatin and Embrylgy Act. Welfare f the child. Embry strage. Gamete dnatin. Surrgacy. Indicatins, limitatins and cmplicatins f surgery in relatin t male and female infertility: Reversal f sterilisatin and vasectmy. Adhesilysis. Salpingstmy. Surgical management f endmetrisis. Ovarian diathermy. Mymectmy. Hysterscpic surgery. Variccele. Mdule 14 Subfertility Curriculum
Fill in as a recrd f experience. Mdule 14 : Subfertility Skills Cmpetence level Basic training Intermediate training Advanced training Nt required Observatin Direct supervisin Independent practice Date Signature f trainer Date Signature f trainer Date Signature f trainer Take histry frm cuple Investigate female subfertility Interpret semen analysis Manage anvulatin Investigate tubal functin Cunsel abut management ptins Title Signature f educatinal supervisr Date Mdule 14 Subfertility Lgbk
Authrisatin f signatures (t be cmpleted by the clinical trainers) Name f clinical trainer (please print) Signature f clinical trainer OSAT Recrd all frmal assessments until trainee passess. Recrd date f satisfactry assessment. Diagnstic Date Date Date Date Date laparscpy Signature Signature Signature Signature Signature COMPLETION OF MODULE 14 I cnfirm that all cmpnents f the mdule have been successfully cmpleted: Date Name f educatinal supervisr Signature f educatinal supervisr Mdule 14 Subfertility Lgbk
DIAGNOSTIC LAPAROSCOPY Trainee Name: StR Year: Date: Assessr Name: Clinical details f cmplexity/ difficulty f case Pst: Perfrmed Needs Nt independently help Applicable Preparatin f the patient: Ensures crrect psitining f the patient Checked r bserved catheterisatin, pelvic examinatin and insertin f uterine manipulatr where apprpriate Establishing pneumperitneum Demnstrates knwledge f instruments and can truble sht prblems Check patency and functin f Veress (if used) Crrect incisin Cntrlled insertin f Veress (if used) Insufflatin t at least 20 mmhg Cntrlled insertin f primary prt Cntrlled insertin f secndary prt under direct visin Operative prcedure Maintains crrect psitin f ptics Clear inspectin f pelvic and abdminal structures Mvements: fluid and atraumatic Apprpriate use f assistants (if applicable) Crrect interpretatin f perative findings Remval f prts under direct visin Deflatin f pneumperitneum Apprpriate skin clsure PLEASE TICK RELEVANT BOX Bth sides f this frm t be cmpleted and signed Mdule 14 Subfertility OSATS
GENERIC TECHNICAL SKILLS ASSESSMENT Assessr, please ring the candidate s perfrmance fr each f the fllwing factrs: Respect fr tissue Time, mtin and flw f peratin and frward planning Knwledge and handling f instruments Suturing and kntting skills as apprpriate fr the prcedure Technical use f assistants Relatins with patient and the surgical team Insight/attitude Dcumentatin f prcedures Frequently used unnecessary frce n tissue r caused damage by inapprpriate use f instruments. Many unnecessary mves. Frequently stpped perating r needed t discuss next mve. Lack f knwledge f instruments. Placed sutures inaccurately r tied knts insecurely and lacked attentin t safety. Cnsistently placed assistants prly r failed t use assistants. Cmmunicated prly r frequently shwed lack f awareness f the needs f the patient and/r the prfessinal team. Pr understanding f areas f weakness. Limited dcumentatin, prly written. Careful handling f tissue but ccasinally causes inadvertent damage. Makes reasnable prgress but sme unnecessary mves. Sund knwledge f peratin but slightly disjinted at times. Cmpetent use f instruments but ccasinally awkward r tentative. Kntting and suturing usually reliable but smetimes awkward. Apprpriate use f assistant mst f the time. Reasnable cmmunicatin and awareness f the needs f the patient and/r f the prfessinal team. Sme understanding f areas f weakness. Adequate dcumentatin but with sme missins r areas that need elabrating. Cnsistently handled tissues apprpriately with minimal damage. Ecnmy f mvement and maximum efficiency. Obviusly planned curse f peratin with effrtless flw frm ne mve t the next. Obvius familiarity with instruments. Cnsistently placed sutures accurately with apprpriate and secure knts and with prper attentin t safety. Strategically used assistants t the best advantage at all times. Cnsistently cmmunicated and acted with awareness f the needs f the patient and/r f the prfessinal team. Fully understands areas f weakness. Cmprehensive legible dcumentatin, indicating findings, prcedure and pstperative management. Based n the checklist and the Generic Technical Skills Assessment, Dr has achieved/failed* t achieve the OSAT cmpetency Needs further help with: Cmpetent t perfrm the entire * prcedure withut the need fr * supervisin Date Date Signed (trainer) Signed Signed (trainee) Delete where applicable, and date and sign the relevant bx Signed Mdule 14 Subfertility OSATS