Newcastle Foundation Curriculum
1.1 Good Clinical Care
1.1. (A) HISTORY, EXAMINATION &
RECORD KEEPING SKILLS
Objective: To provide the trainee with the
knowledge and skills and attitudes to be able to take a history and examine
patients, prescribe safely and keep an accurate and relevant medical record.
|
Subject |
Knowledge |
Skills |
Attitudes |
|
(i) History |
Symptom patterns
Alarm symptoms
Understands the use of open/closed questions
|
Able to elicit a relevant history
Identify and synthesise problems
Take a history in difficult circumstances e.g.:
·
when English is not the patient’s
first language
·
confused patients*
·
deaf patients*
·
patients* with psychiatric/psychological problems where
there are doubts over the informant’s reliability
·
patients* with special educational needs
·
questions regarding sexual behaviour and orientation
·
children where parent is the informant
·
child abuse/neglect |
Consider the impact of:
·
physical problems on psychological and social well being
·
physical illness presenting with psychiatric symptoms
·
psychiatric illness presenting with physical symptoms
·
psychological / social distress on physical symptoms (somatisation)
·
family dynamics |
|
(ii) Examination
|
Patterns of clinical signs including mental state
|
Explain examination procedure and minimise patient
discomfort
Elicit signs and use instruments appropriately
Able to examine children of all ages
|
Consider:
·
patient* dignity
·
the need for a chaperone |
|
(iii) Treatment (Therapeutics) |
Effects of disease on prescribing:
·
hepatic
·
renal
Effects of patient factors on prescribing:
·
drugs allergy
·
genetic susceptibility to adverse drug reactions
·
pregnancy
Effects of drug interactions:
·
metabolism by CYP450 isoenzymes. Drugs that require
therapeutic monitoring.
|
Take a drug history
Use the BNF and other sources of information
Write a clear and unambiguous prescription
Liaise with ward pharmacist
Explain drug therapy to patient
Safely prescribe in pregnancy
Prescribe oxygen and blood products safely
Initiate management of carbon dioxide retention and
transfusion reactions if they arise
|
Show appropriate attitudes to patients and their
symptoms and be conscious of religious and other beliefs, notably in the
area of blood products. Clearly and openly explain treatments and
side-effects of medication. |
|
(iii) Medical record keeping, letters etc |
Structure of:
·
medical notes
·
discharge letters
·
discharge summaries
·
outpatient letters
·
prescriptions
Role of medical records in generation of central data
returns |
Record accurately and legibly in the medical notes
including:
·
history
·
examination
·
summary
·
problem list
·
differential diagnosis
·
initial investigation and management plan
·
investigation results and action taken
·
conversations e.g. between team members and patient/relatives
Date and sign each entry (with time of first contact)
Appropriate IT skills
|
Strive to ensure that notes are accessible to all
members of the team and patients /relatives under certain circumstances
Consider the importance of:
·
timely dictation
·
cost-effective use of medical secretary time
·
prompt and accurate communication between primary and
secondary care
Understand the importance
of clear definition of diagnosis and procedures for coding for central
returns
Keen to use/learn about new technology |
1.1. (b) Time
Management, Risk Management and Decision
Making
Objective: To provide
trainees with the knowledge, skills and attitudes to manage time and clinical
priorities effectively.
Subject
|
Knowledge |
Skills |
Attitudes |
|
(i)Time management |
Which patients/tasks take priority
Which patients/tasks need formal hand-over |
Start with the most important tasks
Work more efficiently as clinical skills develop
Recognise when he/she is falling behind and
re-prioritise or call for help
Allows time for effective hand-over |
Have realistic expectations of tasks to be completed by
self and others
Willingness to consult and work as part of a team |
|
(ii) Risk management |
Complications and side effects of treatments |
Discusses risks with patients
Critical incident analysis |
Willingness to accept patients* views/choices |
|
(iii) Decision making |
Clinical priorities for investigation and management |
Analyse and manage clinical problems
Involve patients and other professionals |
Be flexible and willing to change
Be willing to consider who is the most appropriate
decision maker |
1.2 Communication Skills
Objective: To provide
the trainee with the knowledge, skills and attitudes to be able to communicate
effectively with patients, relatives and colleagues in the circumstances
outlined below.
|
Circumstance |
Knowledge |
Skills |
Attitudes |
|
(i) Within a consultation |
How to structure the interview to identify the
patient’s
·
concerns / problem list
·
expectations
·
understanding
·
acceptance |
Listen
Use of appropriate questioning techniques including
open and closed questions
Avoid jargon and use familiar language
Use interpreters appropriately
Give clear information and feedback to patients* and
share information with relatives when appropriate
Reassure ‘worried well’ patients*
Telephone skills |
Possess empathy and ability to form therapeutic
relationships with patients*
Consider the importance of:
·
involving patients* in decisions
·
offering choices
·
respecting patients* views
·
when to involve senior help
|
|
(ii) Breaking bad news
|
How to structure the interview and where it should take
place
Normal bereavement process and behaviour
Awareness of organ donation procedure and role of local
transplant co-ordinators |
Avoid jargon and use familiar language
Encourage questions
|
Act with empathy, honesty and sensitivity
|
|
(iii) With colleagues |
How and when to communicate effectively with other
members of the care team and with medical colleagues especially at handovers |
Identify patient’s* anxieties and issues of
concern
|
Be aware of :
·
who needs to know what information
·
others’ perspectives in contributing to management decisions |
|
(iv) Complaints |
Awareness of the local complaints procedure |
Adopt behaviour likely to prevent a complaint occurring
Deal appropriately with dissatisfied patients /
relatives |
Act with honesty and sensitivity in a
non-confrontational manner |
1.3 Maintaining
Good Medical Practice
1.3 (A) LEARNING (see
also 1.6):
Subject
|
Knowledge |
Skills |
Attitudes |
|
(i) Life long learning |
Define continuing professional development
Understand the role of appraisal
Understand the role of assessment |
Recognise and use learning opportunities
Maximise the potential of personal study
Compose a personal learning plan |
Be:
·
self-motivated to learn
·
eager to learn
·
willing to learn from colleagues
·
willing to critically evaluate own work and make appropriate
changes
·
willing to consider criticism |
1.3 (b) Evidence, Audit
and Guidelines:
Objective: To provide
trainees with the knowledge, skills and attitudes to use evidence, guidelines
and audit to benefit patient care.
Subject
|
Knowledge |
Skills |
Attitudes |
|
(i) Evidence based medicine (EBM) |
Principles of EBM
Types of clinical trial
|
Critically appraise evidence
Competently use databases, the library and the internet
Discuss relevance of evidence with individual patients
|
Keen to use evidence to support patient care
|
|
(ii) Audit |
The audit cycle
Data sources for audit
Understand data confidentiality |
Be involved in on-going audit
Manage change |
Consider the relevance of audit to:
·
benefit patient care
·
clinical governance |
|
(iii) Guidelines |
Advantages and limitations of guidelines
Methods of determining best practice |
Use local guidelines
|
Consider individual patient needs when using guidelines |
1.4 (A) Professional behaviour and Probity:
Objective: To ensure that trainees develop the knowledge, skills and
attitudes to act in a professional manner at all times.
Subject
|
Knowledge |
Skills |
Attitudes |
|
(i) Doctor-patient relationship |
Aspects of a professional relationship |
Avoid unnecessary personal comments
Ensure all discussion / examination is relevant
Deal with inappropriate behaviour in patients*
e.g. aggression, violence, sexual harassment |
Adopt a non-discriminatory attitude to all patients*
and recognise their needs as individuals
Broad willingness to place need of patients above own
convenience
Be aware of patients’ expectations around personal
presentation of individual doctors
Behave with honesty |
|
(ii) Continuity of care |
Relevance of continuity of care
Understand personal and collective responsibility for
patient welfare
|
Ensure satisfactory completion of reasonable tasks at
the end of the shift/day with appropriate handover
Produce accurate handover documentation
Ensure forward planning, information giving and liaison
with colleagues
Make adequate arrangements to cover leave |
Recognise the importance of:
·
punctuality
·
attention to detail |
|
(iii) Recognises own limitations |
Extent of own limitations and when to ask for advice
|
Summarise cases and ask relevant questions when seeking
advice from others |
Be willing to consult and have respect for colleagues
Be open to constructive criticism |
|
(iv) Stress
|
The effects of stress
Knowledge of support facilities |
Develop coping mechanisms for stress and ability to
seek help if appropriate |
Recognise the manifestations of stress in self &
others |
|
(v) Interaction with other professionals including
·
members of a team
·
hospital & GP
·
hospital & other agencies e.g. social services |
Roles and responsibilities of team members and other
professionals in patient care
How teams work effectively
When to involve multidisciplinary teams in care
decisions
|
Seek to involve other professionals in the management
of patients and their illnesses where appropriate
Delegate, show leadership and supervise safely
Handover safely
Seek advice if unsure
Communication between team members (see 1.2iii)
|
Be tolerant, flexible and respectful of other
professional viewpoints and recognise good advice
Be conscientious and behave with honesty
Recognise own limitations |
|
(vi) Relevance of outside bodies |
The relevance to professional life of:
·
The Royal Colleges
·
GMC
·
Postgraduate Dean
·
Defence unions
·
BMA |
Recognise situations when appropriate to involve these
bodies/individuals |
Accept professional regulation
|
The term patient should include
where appropriate “patient and parent, guardian or carer”
1.4 (B) Ethics and Legal
issues
Objective: To provide
trainees with the knowledge and skills to cope with ethical and legal issues
which occur during the management of patients with general medical problems.
Subject
|
Knowledge |
Skills |
Attitudes |
|
(i) Informed consent
|
Process for gaining informed consent
Associated legal framework
Children’s rights including Gillick competence
Adults with incapacity (Scotland)
Implications of HIV testing |
Give appropriate information in a manner patients*
understand and be able to obtain consent from patients*
Deal with patients* who cannot give informed
consent
Appropriate use of leaflets and written material |
Consider the patient’s needs as an individual |
|
(ii) Confidentiality
|
Strategies to ensure confidentiality
Functions of Caldecott Guardians
Limits to confidentiality
|
Use and share all information appropriately
Avoid discussing one patient in front of another
Ensure privacy when discussing sensitive issues |
Respect the right to confidentiality |
|
(iii) Legal issues, particularly those relating to:
·
death certification
·
role of the Coroner/ Procurator Fiscal
·
mental illness
·
advance directives and living wills
·
DVLA
 | child protection |
|
Legal responsibilities of completing death certificates
Types of deaths to be referred to the Coroner/
Procurator Fiscal
Situations where compulsory detention under a section
of the Mental Health Act would be appropriate
Conditions that patients should report to the DVLA and
doctors’ responsibilities if they fail to do so
|
Complete death certificates
Liaise with the Coroner/Procurator Fiscal
Discuss whether the patient has an advance directive or
living will
Share information in professional manner with inter agency team members
|
Show attention to detail and recognise pressures of
time
Respect living wills and advance directives
Non judgemental compassionate approach |
1.4 (C) Patient Partnership and Health
Promotion:
Objective: To provide the trainee with the
knowledge, skills and attitudes to be able to educate patients* effectively.
|
Subject |
Knowledge |
Skills |
Attitudes |
|
(i) Educating patients*
about:
·
disease
·
investigations
·
therapy |
Natural history of common
diseases
Investigation procedures
including possible alternatives / choices
Strategies to improve
adherence to therapies |
Give information to patients
clearly
Encourage questions
Negotiate individual
treatment plans, encouraging ownership and responsibility for action to be
taken by the patient on deterioration or improvement |
Consider involving patients*
in developing mutually acceptable investigation plans
Encourage patients* to
access:
·
further information
·
patient* support groups |
|
(ii) Environmental & lifestyle risk factors
|
Risk factors for disease including:
·
diet
·
exercise
·
social deprivation
·
sexual behaviour
·
occupation
·
substance abuse
·
accidents and child abuse |
Advise on lifestyle changes
Involve other health care workers, social workers and
teachers as appropriate
Assess an individual patient’s risk factors |
Consider the social and environmental circumstances of
patients* |
|
(iii) Smoking |
Effects of smoking on health
Implications of addiction
Smoking cessation strategies |
Identify ‘ready to quit’
smokers
Advise on smoking cessation
and supportive measures
|
Have a non-judgemental
approach
Consider the importance of
support during smoking cessation |
|
(iv) Alcohol |
Effects of alcohol on health
and psychosocial well-being
Local support groups
/agencies |
Take an alcohol history
Advise on appropriate
drinking levels or drinking cessation |
Have a non-judgemental
approach
Suggest patient support
groups as appropriate |
|
(v) Epidemiology &
screening |
Data collection methods and
their limitations
Notifiable diseases
Principles of prevention,
health surveillance & screening |
Assess an individual
patient’s risk factors
Encourage participation in
appropriate disease prevention or screening programmes |
Consider the:
·
positive & negative aspects of prevention
·
importance of patient confidentiality
Respect patient autonomy |
|
(vi) Infection control |
Prevention of spread of
infection: hand washing (eg for MRSA) and need for isolation facility for
multi-resistant organisms (eg MDRTB)
Be familiar with common
infection control procedures including universal precautions against
blood-borne viruses |
Attend infection control
education programme
Recognise when to involve
infection control team |
1.5 Teaching and Training (see
also 1.3):
Objective: To provide
trainees with the knowledge, skills and attitudes to become life-long learners
and teachers.
Subject
|
Knowledge |
Skills |
Attitudes |
|
(i) Teaching |
How adults learn
Learner-centred approach |
Use all opportunities for teaching
Communicate and share information one-to-one and in
small groups
Always seek feedback
|
Demonstrate willingness, enthusiasm and patience to
teach
|
|
(ii) Presentations |
Features of an effective presentation |
Give presentations to small groups e.g. journal club
Present material in different presentation media |
Be confident and not intimidated when presenting
Embrace new technology |
Introduction
This section of the curriculum outlines areas in
which all junior doctors should receive training and therefore forms a
fundamental component of the foundation programme.
The objectives cover problems which are
cross-specialty as well as common problems encountered in emergency patients.
It is expected that on completion of the
two years all trainees should be competent and feel confident in the areas
outlined appropriate to the specialties covered. In addition trainees will be
expected to demonstrate how individual competencies can be combined to provide
appropriate and timely care to put it within the clinical settings of primary
and secondary care.
This is a minimum standard and is not meant to
be restrictive.
Objective: To provide
the trainee with the knowledge and skills to be able to assess and initiate
management of patients presenting as emergencies with the problems outlined
below. For each scenario trainees should in particular gain knowledge,
competencies and skills to recognise the critically ill and:
·
immediately assess and
resuscitate if necessary
·
formulate a differential
diagnosis and refer as appropriate
·
select relevant investigations
and accurately interpret reports/results
·
communicate the diagnosis and
prognosis – see Generic Skills
·
reassess as appropriate
|
Knowledge |
Skills |
|
·
Common presenting symptoms and signs of acute illness
including breathlessness, hypoxaemia, hypotension, oliguria, chest pain,
nausea, vomiting headache, and confusion or coma
·
Clinical interpretation of acutely abnormal physiology
·
Common derangements of arterial blood gases
·
Causes of impaired level of consciousness including fits and
faints
·
Causes of acute abdominal pain, including gastrointestinal,
surgical, gynaecological/urological, cardiac/vascular, and neurogenic
·
Safe oxygen therapy
·
Safe use of analgesic drugs; routes and methods of
administration
·
Acute confusional states including acute psychosis: causes,
assessment and initial management
·
Deliberate self-harm: modes of presentation, causation,
initial treatment for most common forms of self-poisoning, psychological
support
·
Causes of acute visual impairment
·
Resuscitation protocols to Immediate Life Support level (PRHOs
= F1)
Resuscitation protocols to
Advanced Life Support level (by end of Foundation Years) |
·
identify, assess, and initiate treatment in critically ill
patients
·
promptly assess the airway, breathing and circulation in the
collapsed patient
·
document acutely abnormal physiology
·
establish venous access with attention to infection control
measures
·
deliver a fluid challenge safely to acutely ill patients to
optimise cardiac output
·
reassess acutely ill patients within an appropriate period
following initiation of treatment
·
undertake a focussed history and examination to establish a
differential diagnosis
·
request senior or more experienced help when appropriate
·
succinctly present the relevant clinical details of an acutely
ill patient to a senior doctor
·
assess level of consciousness
·
manage patients with impaired consciousness including fits and
faints
·
determine need for “nil by mouth” status
·
insert a naso-gastric tube
·
select appropriate initial investigations to explore the
differential diagnosis
·
communicate effectively with other specialties when
appropriate
·
identify concurrent comorbid diseases and their relevance to
the acute illness
·
select, prescribe and monitor safe and effective analgesia for
patients with acute pain
·
initiate resuscitation of the patient who has sustained a
cardiorespiratory arrest
·
safe defibrillation |
2 (B) Resuscitation
Objective: To provide the trainee with the
knowledge, competencies and skills to be able to recognise critically ill
patients, take part in advanced life support, feel confident to initiate
resuscitation and use the local protocol for deciding when not to resuscitate
patients.
Subject
|
Knowledge |
Skills |
|
(i) Resuscitation |
Contents of Advanced Life Support course |
Be ALS certified |
|
(ii) Do not resuscitate orders
(DNR) |
Local and national protocols for DNR orders
Legal and ethical considerations |
Support patients and families
Respect living wills and advance directives
Act with empathy and sensitivity
Breaking bad news – see 1.2ii |
2 (C) i Management of
the ‘Take’
Objective: To provide
the trainee with the knowledge, competencies and skills to be able to safely
manage an acute ‘take’.
|
Subject |
Knowledge |
Skills |
|
(i) ‘Take’ management |
Indications for urgent investigation and therapy
Skills and capabilities of members of the ‘on-take’
team
When to seek help |
Ability to prioritise
Interact effectively with
other health care professionals
Keep patients and relatives informed
Receive and make referrals appropriately
Cope with stress
Delegate effectively and safely
Keep an accurate patient list
Handover safely with appropriate documentation |
2 (C) ii Discharge planning
Objective: To provide the trainee with the
knowledge and skills to be able to plan discharges for patients.
|
Subject |
Knowledge |
Skills |
|
Discharge planning
|
Impact of physical problems on activities of daily
living
Roles and skills of members of the multidisciplinary
team including nurses, OTs, physiotherapists, discharge co-ordinators and
social workers
Impact of unnecessary hospitalisation
Available support in primary care |
Recognise when in-patient care is not required
Partake in discharge planning meetings
Liaison and communication with patient, family and
primary care
Be aware of family dynamics and socio-economic factors
influencing success of discharge
Write reports for appropriate bodies |
2 (D) Nutrition
Objective: To provide the trainee with the
knowledge and skills in the nutritional issues listed below.
Subject
|
Knowledge |
Skills |
|
(i) Nutritional status |
Impact of:
·
disease on nutritional status
·
malnutrition on clinical outcomes |
Assessment of nutritional status
Recognise cultural and religious issues |
|
(ii) Nutrition support |
Principles and routes of nutrition support
Role of nutrition support team (NTS) |
Identify those needing nutrition support or advice
Recognise:
·
the skills of others e.g. specialist nurses, pharmacist,
dieticians
·
when to consult NTS |
Introduction
The foundation years are a phase of increasing
clinical responsibility, a key element of this is the ability of doctors to
select and interpret reports of investigations.
Training in selection, requesting and
interpretation of reports of some investigations may have taken place as an
undergraduate, however, it is important that these skills are developed and
widened. It is also vital that trainees learn to critically evaluate when
investigations are not required and are not cost effective. Where
national and local guidelines on selection of investigations exist, they should
be used. For example, the Royal College of Radiologists’ document ‘Making best
use of a Department of Clinical Radiology’ gives helpful guidance to doctors
requesting imaging and trainee doctors should be familiar with this.
The investigations listed are those that are very
frequently requested on acutely ill patients with detailed objectives, skills
and knowledge.
As in the core skills section the objectives
listed below apply to all trainees on completion of the two years.
Again this is a minimum standard and not meant
to be restrictive.
Aims:
To produce doctors who are competent and
confident to select, request and interpret reports of commonly used
investigations required for diagnosis and management of patients who present as
emergencies.
Objectives:
For each of the investigations listed in this
section:
Trainees should be able to :
|
explain the nature of the investigation to patients |
|
explain why it is required |
|
explain the implications of possible results and actual
results when available |
|
gain informed consent |
Trainees should also
learn to :
| recognise the need for an investigation result to impact on management |
| avoid unnecessary investigations |
| recognise that investigation reports often require the professional
opinion of an individual who therefore needs relevant information on the
request form |
| recognise that reports may need review in the light of changing
circumstances |
| act on the results in a timely and appropriate fashion |
Investigations commonly
requested for acutely ill patients
Objective: To provide the trainee with the
knowledge and skills to be able to select, request appropriately and accurately
interpret reports of the frequently used investigations, used to manage acutely
ill patients, listed below. For all investigations it is vital that trainees
recognise abnormalities which require immediate action.
|
Investigation |
Knowledge |
Skills |
|
Full blood count
Urea and electrolytes
Blood glucose
Cardiac markers
Liver function tests
Amylase
Calcium and phosphate
Coagulation studies
Arterial blood gases
Inflammatory markers
|
Circumstances requiring urgent results
Significance of major abnormalities
|
Use results reporting
system
Record and tabulate where
appropriate
Interpret results and when
to request further specialist advice
|
|
12 lead ECG |
Normal ECG intervals
Patterns for common abnormalities |
Use of ECG machines
including how to connect limb and chest leads
Recognise:
·
common abnormalities
·
normal variants
·
abnormally connected leads
·
when to repeat |
Chest Xray
Abdominal Xray
Ultrasound, CT and MRI |
Circumstances requiring:
·
urgent requests
·
particular views
Normal findings
Imaging appearances of common abnormalities
Recognition of the risks of radiation |
Communicate well with radiologists, radiographers and
other staff
Recognise common abnormalities
Recognise: the need for radiological advice |
|
Microbiological samples
|
Type of samples and
collection method required
Specificity and sensitivity |
Interpret results |
Practical
procedures
Introduction
Training in some practical
procedures may have taken place in the undergraduate years and/or in the first
foundation programme (PRHO) year but it is important that skills are developed
and widened in the second year so that trainees become competent and feel
confident to perform commonly required practical procedures. Listed here are
those procedures that doctors at the end of the foundation years should be
competent and feel confident to perform.
Again these are a minimum standard and not meant
to be restrictive.
Aims:
To produce doctors who are competent and
confident to perform common practical procedures required for diagnosis and
management of patients who present acutely.
Objectives:
A. General Knowledge and
Skills:
For each procedure
doctors should:
| Know indications and contraindications |
And be able to:
| Explain the procedure to the patient including possible complications and
gain informed consent for procedures carried out by the trainee |
| Prepare the required equipment including a sterile field |
| Position the patient and give premed / sedation as required, involving the
anaesthetist where appropriate |
| Adequately prepare the skin including local anaesthetic |
| Arrange appropriate aftercare /monitoring |
| Safely dispose of equipment including sharps |
| Document the procedure, including labelling of samples and instructions
for monitoring post procedure |
| Record complications |
At all times doctors should recognise what are the limits
of their competence and to seek advice and help where appropriate
Procedures which PRHOs (F1) should be competent
and confident to perform. Trainees are expected to maintain and improve these
skills such that by the end of F2 they should be able to help others when the
procedures are difficult.
|
Venepuncture, cannulation and venesection |
|
Blood cultures from peripheral and central
sites |
|
Intravenous infusions including the
prescription of fluids, blood and blood products |
|
Performing an ECG |
|
Arterial blood sampling |
|
Injection - subcutaneous, intradermal,
intramuscular and intravenous |
|
Urethral catheterisation - male and female |
|
Airway care including simple adjuncts |
|
Nasogastric tube insertion |
by the end of F2 year, trainees should also be
competent and confident to perform:
|
Central venous access |
Each specialty will also
specify a range of procedures relevant to that specialty in which the trainees
will be expected to become proficient eg pleural aspiration, skin suturing,
lumbar puncture.
Methods of learning:
In general training in practical procedures
should include:
|
reading up on the theory or studying virtual training
packages on the Internet |
|
where available use a skills laboratory |
|
observing first hand |
|
being themselves observed performing the procedure by a
competent practitioner who has recent relevant experience of the procedure.
|
|