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YorkshireThe curriculum below has been developed from contributions from all those involved in training in Yorkshire. It is intended as a guide to the breadth of knowledge and skill, which is required by a practising GP.
1.1 Clinical Competence The expected knowledge base of general practice trainees should include all parts (of all hospitals specialities) considered relevant and appropriate for general practitioners. Since such a list would be inordinately long, no attempt is made to specify such topics here. The GP Registrar will be expected to be familiar with all current relevant developments. The following competencies are considered worthy of special mention: 1.1.1 Therapeutics and Prescribing a) Pharmacodynamics, pharmacokinetics, indications, contra-indications, interactions and side effects of individual drugs and groups of drugs, which are commonly prescribed, in general practice. b) Safe and appropriate prescribing. c) Rational and cost effective prescribing. 1.1.2 Non-drug Management a) Appropriate and effective use of physical therapy. b) Awareness of complementary medicine. c) Appropriate and effective use of counselling and psychotherapy. 1.1.3 Emergency Care Care of acute and/or life threatening conditions in the practice setting. 1.1.4 Continuing Care a) Ability to construct and justify planned care of chronic diseases such as diabetes mellitus, asthma and hypertension. b) Recognition of appropriate settings, e.g. surgery, home, hospice, use of Community Health carers. c) The GP’s role in terminal care. 1.1.5 Health Promotion a) Knowledge of the principles and practice of preventive medicine in general practice. b) Provision of effective health education to individuals and groups. c) Awareness of national, regional and local initiatives in health promotion. 1.1.6 Psycho-social Factors Appreciation of and ability to define relationship between physical, psychological and social factors in breakdown of patients’ well being, and the appropriate development of management strategies for dealing with the above. Awareness of the possibility of intra-family violence. 1.1.7 Common Problems Management of minor, self-limiting ill health in the practice setting. 1.1.8 Diagnostic Procedures Safe, logical and cost-effective use of appropriate and relevant diagnostic procedures in the management of patients’ problems. 1.2 Management (excluding clinical management) Trainees should be familiar with: 1.2.1 Income Generation In particular – NHS (detailed in the SFA), non-NHS, cost effectiveness. 1.2.2 Expenditure Control Cost-effective, legitimate expenditure, presentation of accounts, tax optimisation. 1.2.3 The GP’s Independent Contractor Status Implications of the status, contractual liabilities defined in Terms of Service, aspects of Partnership. 1.2.4 Duties and Implications of the GP’s Role as an Employer The duties and functions of all practice staff should be well understood. 1.2.5 Information Systems The GP Registrar should be able to define the requirements of any system, together with its advantages, disadvantages and applications. This would include computer technology and manual records. 1.3 Socio-Political Trainees should appreciate the relationship between (and within) Primary Health Care and other systems of delivery of care, and the effects of significant changes in health care delivery. In particular, they should understand the form and functions of: 1.3.1 The NHS Concepts of the internal market, the purchaser/provider split, the GP’s role as a purchaser and as a provider. 1.3.2 GP Fund holding Philosophy, basic criteria, functions, outcomes. 1.3.3 Health Authority Organisation of primary care, and relationship of Health Authority to other NHS structures. 1.3.4 Local Medical Committee (LMC) and Other GP Representative Bodies Structure and functions of all representative and advisory bodies. 1.3.5 Primary Health Care Team Format, relationships, roles of individual members. 1.3.6 Caring Agencies other than Health-Service Based Existence and functions of voluntary agencies (national and local), C.A.B., patient care groups (e.g. Parkinson’s Society, Multiple Sclerosis Society), Social Services, Local Authority agencies (e.g. Housing, Education) 1.3.7 Ethnicity and Culture 1.3.8 Social Class and Education. Health and Gender. Age and Sex 1.4 Public and Community Health The health of his/her practice and locality population is a fast developing area in which the GP has a crucial role to play. 1.4.1 Individual/Population Health The GP Registrar should know how to identify individual patients and cohorts of patients, appreciate necessary interventions to ensure the health of the community (or parts of it), understand the relationship between the health of individuals and the health of the community, e.g. communicable diseases, coronary artery disease. 1.4.2 The Health of the Nation Appreciation of the role of the GP in meeting targets for his practice/ community; be familiar with developments as they arise. 1.4.3 Care in the Community Understanding and implementation of developments in community care, including specific and general areas such as early hospital discharge, health needs assessment of patients, health needs of patients requiring social care. 1.4.4 Epidemiology Understand risk and risk factors, terminology and definitions (e.g. SMR, PMR), spread of disease. 1.4.5 Statistics The GP Registrar requires a grasp of basic statistics, ability to interpret statistical information, understanding of relevance of basic statistical tests, theory and practice of research/trials. 1.4.6 Unrecognised Needs Understanding of principles and practice of screening, case finding. 1.4.7 Evaluation of Health Care Recognition and understanding of principles and practice of research, development and audit of structure, process and outcome of delivery of health care. 1.5 The Environment and Health The GP Registrar requires an appropriate depth and breadth of knowledge of: 1.5.1 Substance dependence/abuse 1.5.2 Occupation and health 1.5.3 Occupational Health Services and their relationship to Primary Health Care. 1.5.4 Environmental hazards and their avoidance. 1.6 Medico-Legal Aspects of Primary Health Care The GP Registrar should be aware of legislation that affects the delivery of primary health care: 1.6.1 Conditions and Terms of Service 1.6.2 Employment Law 1.6.3 Health and Safety at Work 1.6.4 COSHH Regulations 1.6.5 Mental health Act 1.6.6 Abortion Act 1.6.7 Misuse of Drugs 1.6.8 Road Traffic Act 1.6.9 EEC Regulations 1.6.10 Data Protection act 1.6.11 The Children’s Act 2.1 Problem Solving The GP Registrar should be able to demonstrate ability to: 2.1.1 Define the problem/make an early diagnosis. In order to do this he/she will make use of: a) Selective history taking leading to hypothesis formation and problem solving involving a selective examination and selective investigation. 2.1.2 Accurately interpret information gained. 2.1.3 Consider appropriate options at all stages. 2.1.4 Make relevant and full use of probabilities and prioritisation of the probabilities. 2.1.5 Live with uncertainty. 2.1.6 Incorporate the patient’s beliefs into potential solutions. 2.1.7 Consider the holistic nature of patients’ problems. 2.1.8 Intervene appropriately in terms of time and relevant action. In addition the GP Registrar will be able to anticipate the significant consequences of such action. 2.2 Communication The GP Registrar will be able to: 2.2.1 Define the aims of any type of communication with any individual or group. 2.2.2 Use effective communication to achieve such aims. 2.2.3 Demonstrate effective communication by various methods, e.g. a) verbal b) written – letters, reports, critical reading c) referrals d) the use of the telephone in communication with patients and colleagues. 2.2.4 Demonstrate all elements of consultation skills, and the ability to analyse his/her consultations into component skills. 2.2.5 Develop necessary computer literacy. 2.2.6 Produce clear, concise and relevant medical records by any appropriate means – including written. 2.3 Management The GP Registrar will be able to demonstrate those skills regarded as part of general management:- 2.3.1 Delegation of duties/work 2.3.2 The principles and practice of teamwork, including inter-personal relationships. 2.3.3 Personal issues: a) selection b) value c) appraisal d) job description and variation e) motivation 2.3.4 Practice business/finance, including Value-for-Money in all aspects of administration and activity. 2.3.5 Coping with uncertainty, particularly at times of change and the ability to manage change. 2.3.6 Effective and efficient use of time:- a) personal to the GP Registrar b) related to administration/organisation of the Practice. 2.4 Clinical There are specific areas of clinical activity in General Practice where GP Registrars will be expected to demonstrate expertise:- 2.4.1 Use of appropriate equipment 2.4.2 Minor Surgery 2.4.3 Child Health Surveillance 2.4.4 Resuscitation 2.4.5 Counselling 2.4.6 Stress Management 3.1 To Self and Others The GP Registrar should be able to:- 3.1.1 Recognise inappropriate or aberrant behaviour in self, colleagues and colleagues. 3.1.2 Recognise a sick colleague and respond appropriately. 3.1.3 Maintain his/her own physical, psychological and social well-being, and understand possible sequelae of any variation. 3.1.4 Define roles adopted in different situations, and how such roles govern power and influence : including the GP’s role in society. 3.1.5 Recognise the influence of culture or religion on effective and efficient health care undertaken by him/her. 3.1.6 Define the influence of external factors, e.g. family, finance on the GP’s work and strategies for coping with such influences in order to maintain an acceptable balance. 3.1.7 Recognise limitations, strengths and weaknesses in self and others, and use the opportunities and threats posed by such circumstances. 3.2 Ethics The GP Registrar shall demonstrate his appreciation of, and justified action on, a wide range of ethical and moral issues such as:- 3.2.1 Quality and value of human life. 3.2.2 Confidentiality 3.2.3 Rationing of health service resources and health care. 3.3 Professional Values Some personal attributes and values can be regarded as fundamental to the caring GP. The GP Registrar should be able to demonstrate:- 3.3.1 Empathy and a willingness to care at an appropriate level. 3.3.2 Respect for patients as people, not vehicles of pathology. 3.3.3 Tolerance, flexibility and respect for the views of others, including patients, peers and teachers. 3.3.4 Willingness to accept appropriate responsibility for personal and continuing care of his/her patients, and for colleagues and staff within the practice. 3.3.5 Commitment to quality in all his/her work. 3.4 Personal and Professional Growth During training in General Practice, the seeds will be sown for the GP Registrar’s continued development throughout his/her professional working life. He/she should be able to demonstrate:- 3.4.1 Recognition of strengths and weaknesses in performance as a doctor and educational needs to correct weaknesses. He/she will be prepared to make use of:- a) audit/performance review b) peer group review c) constructive criticism from others d) other appropriate methods of formative assessment 3.4.2 Definition and undertaking of appropriate means of meeting identified educational needs, such as:- a) self-directed learning b) distance learning c) learning on the job d) other recognised methods of CME 3.4.3 Ability to adapt to changing needs of individual patients and the community, and to produce positive change in self and others. 3.4.4 Ability to adapt to changes in the health care system produced by NHS regulations. 3.4.5 Clear, critical thinking and ability to justify decisions. 3.4.6 Continuing motivation of self and others. 3.4.7 Understanding of one’s own fallibility and limits of one’s own clinical competence.
HOSPITAL COMPONENT OF TRAINING You should obtain the core curriculum and subjective rating scale for each hospital post as you commence it. The core curricula are intended to provide you and your supervising consultant with a list of those areas of knowledge and skill, which are relevant to the particular speciality in the light of your General Practice training. You should also discuss your progress with the Consultants/Trainers/Course Organisers at regular intervals. Core curricula are currently available for:- a) Accident and Emergency b) Medicine for the Elderly c) Obstetrics d) Gynaecology and Genitourinary Medicine (*including Family Planning) e) Paediatrics f) Palliative Medicine g) Dermatology h) ENT i) Infectious Diseases j) Ophthalmology k) Rheumatology Evaluation of the posts will be an integral part of your training
A ACCIDENT AND EMERGENCY: CORE CURRICULUM This curriculum outlines the areas of the learning that can be achieved in senior house officer posts in Accident & Emergency Departments. Only a few senior house officers will gain experience in all of these areas during a six-month post. However, each GP Registrar should acquire the basic skills contained in the core list, which excludes those areas marked*. KNOWLEDGE BASE 1. ORIENTATION TO ACCIDENT & EMERGENCY MEDICINE a) Principles of Emergency Care: a.1 Recognition of threats to life or limb a.2 Evaluation of the emergency department patient a.3 appropriate assessment of minor conditions a.4 Pain control b) Emergency Medical Services: b.1 Pre-hospital care and the ambulance service b.2 Paramedic training and function b.3 Major incident planning b.4 Triage c. Ethical and Organisational Issues: c.1 Confidentiality c.2 Maintaining patient dignity and privacy c.3 Holistic care c.4 Communication with patients and relatives c.5 Team building Diagnosis, initial management or appropriate referral of the following:- II. CARDIOVASCULAR DISEASES a) Cardiopulmonary Resuscitation CPR: a.1 One-and two-rescuer CPR a.2 Conscious and unconscious victim a.3 Infant CPR b) Priorities in Cardiac Arrest – ACLS approach: b.1 Co-ordination and priorities in cardiac arrest b.2 Drugs and protocols b.3 Treatment of ventricular fibrillation/ventricular tachyarrhythmia’s/ asystole/electromechanical dissociation/bradyarrhythmias c. Chest pain evaluation d. Recognition and treatment of supra-ventricular and ventricular tachycardias: e. Recognition of hypertensive emergencies III TRAUMA a) Priorities in multiple trauma – ATLS approach: b) Head and facial trauma: c) Spinal trauma including recognition of normal and abnormal C-Spine X-rays: d) Chest trauma: d.1 Blunt/penetrating* d.2 Tension pneumothorax d.3 Pericardial tamponade* d.4 Massive haemothorax* d.5 Open chest wound d.6 Ruptured aorta* e) Abdominal Trauma: e.1 Blunt/penetrating e.2 Indications for diagnostic peritoneal lavage f) Genitourinary Trauma: g) Extremity Trauma: g.1 Skeletal trauma g.2 Vascular trauma h) Burns: IV SHOCK a) Definition and clinical findings b) Differential diagnosis (septic, hypovolaemic, anaphylactic, cardiogenic, neurogenic): c) Principles of fluid resuscitation: V GASTROINTESTINAL DISEASES a) Acute GI bleed: b) Dehydration: vomiting, diarrhoea: c) Abdominal pain evaluation: d) Significant foreign body ingestion: VI OPHTHALMOLOGICAL DISEASES a) Causes of red eye: a.1 Foreign body/corneal abrasion a.2 Conjunctivitis a.3 Acute glaucoma b) Eye Trauma: b.1 Chemical burns b.2 Hyphaema c) Importance of sudden visual impairment: d) Orbital cellulitis: VII PULMONARY DISEASES a) Acute respiratory failure: b) Acute asthma: c) Pulmonary oedema: d) Pulmonary embolus: e) Choking – foreign body: f) Pneumothorax: g) Pneumonia: h) Inhalation injury: i) Evaluation of dyspnoea: j) Carbon monoxide poisoning: VIII METABOLIC EMERGENCIES a) Hypoglycaemia; b) Ketoacidosis: c) Electrolyte abnormalities: d) Acid base abnormalities: IX GENITOURINARY DISEASES a) Urinary tract infection: b) Urinary flow obstruction: c) Nephrolithiasis: d) Venereal disease: e) Pelvic inflammatory disease*: f) Epididymitis: g) Testicular torsion: h) Balanitis: X OBSTETRIC/GYNAECOLOGICAL EMERGENCIES a) Ectopic pregnancy: b) Pregnancy with first or third trimester bleed: c) Sexual assault: XI TOXICOLOGICAL EMERGENCIES a) Initial recognition, treatment and removal of poisons: b) Role of poison centres: c) Management of common poisons (paracetamol, aspirin, narcotics etc): d) Specific therapy: XII CHILDHOOD EMERGENCIES a) Child abuse: b) Croup/epiglottitis: c) Fever evaluation in an infant: d) Serious dehydration: e) Meningitis: f) Seizures: XIII ENVIRONMENTAL EMERGENCIES a) Heat illness: b) Hypothermia: c) Near drowning: d) Electrial injury: e) Bites: f) Anaphylaxis: XIV ENT DISEASES a) Epistaxis/septal haematoma: b) Foreign bodies: c) Infections: d) Upper airway obstruction and the theory of cricothyroidotomy: e) Dental emergencies f) Maxillo-facial emergencies: XV NEUROLOGICAL DISEASES a) Coma: b) Headache: c) Meningitis: d) Seizures: e) Cerebro-vascular accident: f) Altered mental status: XVI MUSCULO-SKELETAL a) Orthopaedic and neurovascular extremity examination: b) Recognition and management of: b.1 Specific aspects of hand injury b.2 Strains/sprains b.3 Septic/irritable joint b.4 Fractures and dislocations b.5 Soft tissue injury/infection XVI BEHAVIOURAL EMERGENCIES a) Recognition of behavioural disorders caused by organic illness: b) Suicidal and homicidal evaluation: c) Recognition of acute psychosis: d) Performance of mental status examination*: e) Drug and alcohol abuse: SKILLSI. WOUND REPAIR a) Suture material, needles, instruments b) Types of wound c) Wound preparation d) Tetanus prophylaxis e) Local anaesthetic techniques f) Dressing techniques II CARDIOPULMONARY RESUSCITATION (FROM ACLS) III INITIAL TRAUMA MANAGEMENT (FROM ATLS) IV DEFIBRILLATION AND CARDIOVERSION a) Defibrillator operation b) Indications V VASCULAR ACCESS VI AIRWAY CONTROL a) Face ventilation (e.g. Laerdel) b) Intubation VII SPLINTING/IMMOBILISATION VIII CERVICAL SPINE IMMOBILISATION IX GASTRIC LAVAGE* X LOG ROLLING* XI SUPERFICIAL ABSCESSES-INCISION/DRAINAGE* XII NASAL PACKING* XIII NEEDLE THORACOSTOMY* XIV THORACOSTOMY TUB DRAINAGE* XV REDUCTION OF FRACTURES AND DISLOCATIONS* XVI PREPARATION OF MEDICO-LEGAL STATEMENTS TO THE POLICE/POLICE CORONER*
B MEDICINE FOR THE ELDERLY: CORE CURRICULUM The educational aims are divided into five categories: 1. Human Development 2. Human Behaviour 3. Medicine and Society 4. Health and Diseases 5. The Practice At the conclusion of his vocational training the doctor should be able to:-1. Human Development a) Describe, discuss and compare the theories of ageing. b) Describe and relate the physical, psychological and social changes that may occur in old age. c) Relate these changes to the physical, psychological and social adaptations that the old person makes and to the breakdown of these adaptations. 2. Human Behaviour a) Describe the ways in which physical, psychological and social changes in the environment of the old person manifest themselves early as changes in behaviour. b) Describe the tendency to disengage in old age and the interplay between the previous personality and experience of the patient and the present tendency to disengagement. c) Describe in terms of the patient’s behaviour the consequences of an awareness of deterioration in sociability, motivation, mood or sexual function. d) Describe the effects of these behavioural changes in old age on family relationships. e) Describe those changes in behaviour, which may be the first manifestation of disease processes likely to occur in old age. f) Exhibit appropriate attitudes to the care of old people and manifest these attitudes in the doctor: patient relationship. g) Demonstrate an awareness of recent progress in gerontology 3. Medicine and Society a) Describe the influence of culture and social class on the status of old people in the family and in society at large. b) Describe how current medical education determines the personal care of the elderly by the profession. c) Describe and illustrate the relationship between the attitudes of society towards old people and the allocation of medical and social resources. d) Describe the development of social and medical care of the elderly in our society. e) Describe the major medical and social agencies, statutory and voluntary and specify their particular activities and areas of concern in the care of the elderly. f) Demonstrate the uses of epidemiology in the care of the elderly g) Describe the effects of government policy and the contractual obligations of general practitioners in the National Health Service for the care of the elderly. h) Construct appropriate programmes of preparation for retirement i) Demonstrate an understanding of the needs of the informal carers of older people and how these can be met if the continuing well-being of older people is to be maintained. j) Describe the ethical aspects of the care of older people and how they are taken into account in providing care through general practice. 4. Health and Disease a) Describe the physical factors, particularly diet, exercise, temperature and sleep which affect the health of the old person. b) Describe the social factors, including previous occupation, financial status, housing, social involvement and marital status, which influence life in old age and the inter-relation between health status and social status. c) Describe those threats of the integrity of the old person, such as retirement, bereavement, isolation, institutionalisation and impending death. d) Describe the importance of health education and health promotion in maintaining the health of older people and the practical implications for general practice. e) Describe the features, peculiar to the elderly, which modify the presentation of diseases, their course and management. f) Describe the management of the conditions and problems commonly associated with old age such as stroke, falls, Parkinson’s Disease and confusion etc. g) Illustrate the way in which a number of different disease processes commonly occur in the same old person. h) List the peculiar difficulties of taking a clinical history from an old person, with due regard to its slower tempo and possible unreliability and the evidence of third parties, and demonstrate the appropriate skills required. i) Outline the special features of the clinical examination of elderly men and women. j) Demonstrate understanding of the changes in the normal range of laboratory values that are found in older people. k) Describe the special features of prognosis of diseases in old age and relate these to an appropriate plan for further investigation and management. l) Describe the way in which the management of disease processes in old age is influenced by the psychological state and the social situation of the old person. m) List the special factors associated with the absorption, metabolism and excretion of drugs given to the elderly. n) Describe the hazards of drug treatment in old age, including the problems posed by multiplicity of drugs, non-compliance and iotrogenic disease. o) Demonstrate an appreciation of the uses and the limitations of surgery and rehabilitation in the treatment of old age. p) Describe the special features of psychiatric diseases in old age, including an appreciation of the features of brain failure and the effects of disorders of physical function on the mental state. q) Demonstrate the skills of taking a psychiatric history from an old person, including how to assess intellectual function (e.g. using short mental status questionnaires) and mood, and how to evaluate the testimony of third parties. r) Demonstrate the skills required in the management of old people with a psychiatric disorder such as:- i) Deciding on the appropriate milieu of treatment. ii) Listing the indications of specialist psychiatric or geriatric care. iii) Describing the indications and procedures for compulsory admission iv) Assessing the quality and motivation of those persons available to care for the patients. v) Advising on testamentary capacity and advising on the management of affairs, e.g. by the Court of Protection. 5. The Practice a) Organise his practice for the benefit of his elderly patients so as to ensure ease of contact, appropriate timing of appointments and satisfactory cover for emergencies as well as provide information about these services of the practice and opportunities for older people and their carers to comment on these. b) Develop policies for the primary care team, so as to ensure control of repeat prescriptions, the appropriate use of screening or case-finding programmes and the care of old people in all forms of residential accommodation. c) Develop systems and policies for the care of older people in all forms of residential accommodation. d) Advise individual patients about the available types of appropriate residential accommodation. e) Effectively use the various statutory and voluntary services for the support of the elderly in the community. f) Effect liaison and co-operate with the many different disciplines and persons involved in the care of the elderly. g) Demonstrate effective use of local hospitals resources, including general hospitals and general-practitioner beds. h) Demonstrate an understanding of the management of the transfer from one system of care to another, the complications that can arise and how they can be prevented and managed. i) Ensure that the provision of care promotes the patient’s sense of identity and personal dignity. j) Demonstrate understanding of the obligations of the general practitioner under the 1990 contract to older people on the practice list and the practicalities of how these can be fulfilled.
Vocational Training in obstetrics and gynaecology should help future general practitioners to acquire the knowledge, skills and values that will enable them to provide a broad range of services for women and to an acceptable standard. Training should concentrate particularly on those conditions and activities that are common in general practice with particular emphasis on the normal and the prompt recognition of the abnormal. Programmes should prepare general practitioners to undertake intrapartum care if they wish to do so. a) For Shared Antenatal and Postnatal Care The doctor should:- 1. appreciate the preventive role, and understand the significance of all routine procedures used in modern antenatal care; 2. have a thorough understanding of the epidemiology of maternal and perinatal morbidity and mortality; 3. be able to undertake the initial management of common and life-threatening emergencies in early pregnancy. 4. Know when pregnant women require referral for specialist opinion or care and which are suitable for shared care or full care by the general practitioner. 5. Understand the principles of counselling a woman faced with possible or real problems of fetal malformation; 6. Know the methods by which congenital malformation of the foetus may be detected; 7. Be aware of the methods of, and provision for, education for pregnancy, childbirth and care of the new-born; 8. Understand the importance of social and emotional factors in pregnancy and childbirth; 9. Understand their own role and that of different members of the health team in this field; 10. Understand the management of common conditions for which pregnant women are admitted to hospital, e.g. premature labour, pre-eclampsia, multiple pregnancy, fetal growth retardation, antepartum haemorrhage, maternal disease etc; 11. Be able to recognise the signs and symptoms of the onset of labour; 12. Understand the principles and methods of the current management of labour; 13. Understand the importance of accurate and detailed records in all aspects of obstetric care and recognise the value of such records in clinical audit; 14. Be able to carry out routine examination of the new-born infant; 15. Understand the normal development of the new-born; 16. Recognise common diseases arising in the new-born; 17. Recognise congenital abnormalities in the new-born; 18. Understand how breast feeding is established and maintained; 19. Recognise and understand the management of physical and psychological problems of the mother in postnatal period, e.g. puerperal depression. 20. Understand the normal involutional processes in the postpartum period; 21. Understand the indications for maternal immunisation with anti D and rubella vaccine and the importance of confirming their efficacy; 22. Be able to advise and provide suitable methods of family planning. B. For Intranatal Care The doctor should:- 1. be able to conduct a normal delivery in a way that is based on an understanding of the physical and psychological processes of childbirth; 2. understand the indications and contra-indications for the induction of labour; 3. understand the physiology of uterine activity and the advantages and disadvantages of the use of oxytocics to augment vaginal delivery; 4. know the principles and practice of continuous fetal heart rate and acid-base monitoring and their implications; 5. recognise the abnormalities that may occur in labour necessitating transfer to specialist care e.g. fetal distress, haemorrhage, delay in labour, abnormal presentation etc; 6. be able to:- a) induce labour where appropriate; b) provide obstetric analgesia and local anaesthesia including pudendal block; c) carry out a low forceps delivery; d) resuscitate a shocked mother; e) resuscitate a shocked baby 7. understand the management of other abnormalities of labour, e.g. shoulder dystocia, breech twins; 8. be able to manage the third stage of labour including the immediate management of postpartum haemorrhage and retained placenta; 9. be able to suture episiotomies and lacerations; 10. be aware of special arrangements needed for home confinements; 11. be able to communicate with women in labour in order to become aware of their particular wishes and fears concerning its conduct so that they can be active participants in the decisions concerning its management, and so that they can understand the procedures proposed for their own safety and that of their babies; 12. understand the local arrangements for intrapartum care in the setting of general practice.
D GYNAECOLOGY & GENITO-URINARY CONDITIONS: CORE CURRICULUM The doctor should:- 1. understand the role of the general practitioner in and techniques used in general practice: a) for health education and sex education in children, adolescents and older women; b) for the prevention of gynaecological disease, e.g. cervical carcinoma, genital infection; 2. be able to take a gynaecological history, carry out a full and appropriate examination and conduct appropriate investigations on patients of all ages; 3. understand the physical problems relating to congenital abnormalities of the female genital tract; 4. be able to advise and provide suitable methods for family planning; 5. understand the principles involved in counselling patients with psychosexual problems; 6. be able to advise, investigate and, where appropriate, refer patients with problems relating to infertility; 7. be able to manage abortion in general practice, including emergency treatment, counselling and aftercare; 8. understand the management of common problems relating to menstruation, e.g. amenorrhoea, dysmenorrhoea, menorrhagia, polymenorrhoea, pre-menstrual syndrome; 9. understand the management of patients suffering from infections of the genital tract, including sexually transmitted disease; 10. know the steps required for the early diagnosis of neoplasia of the genital tract and the general practitioner[s role in management; 11. understand the physiology and management of the menopause; 12. understand the management of stress incontinence and prolapse; 13. be aware of ethical and legal aspects of gynaecological problems, e.g. chaperoning, age of consent, assault, sexually transmitted disease; 14. understand the role of other professionals in these fields.
FAMILY PLANNING AND CONTRACEPTION The provision of family planning services is an important part of general practice. Training in family planning should enable general practitioners to provide the whole range of family planning methods. To do this they will acquire the knowledge of current family planning methods, their effectiveness and complications and they should be able to relate these to the needs of individual patients. They will be skilled in practical procedures such as cap fitting and the insertion of intrauterine contraceptive devices. They will possess the consultation skills needed for the contraceptive interview. The content of family planning training should reflect the recommendations presented in the Handbook of Contraceptive Practice prepared by representatives of the Royal College of Obstetricians and Gynaecologists and the Royal College of General Practitioners. This can be summarised as follows:- I. KNOWLEDGE This will include:- a) knowledge about the range of contraceptive methods available and their acceptability, effectiveness and the complications associated with them. These will include the condom, the different oral contraceptive pills, intrauterine contraceptive devices, depot injection techniques, barrier and chemical methods, rhythm methods, post coital contraception and male and female sterilisation techniques; b) knowledge about the contraceptive methods appropriate for specific patient groups and the ethical and practical problems associated with them. This will include patients who seek contraceptive advice before the age of consent, or after pregnancy, or in the lactating woman, as well as contraception for the older woman, for the mentally handicapped, for those with medical problems such as diabetes mellitus and for those at higher risk such as smokers; c) knowledge of the complications that can arise with all forms of contraception – how these can be prevented, recognised and managed together with the ways of managing these and the indications for specialist referral; d) knowledge of the role of other professional groups involved in family planning such as health visitors and midwives, and the contribution of practice nurses in providing contraceptive services. II SKILLS Skills should cover the skills needed to undertake: a) the contraceptive interview – to include history of contra-indications and risk factors, the clinical examination, advising patients and opportunities for health counselling; b) counselling appropriate for the various methods available and for recognising the concerns that users may have; c) the fitting of caps and intrauterine contraceptive devices; d) the administration of contraceptive services for a practice population; e) the maintenance of practice equipment and for ensuring its safety; f) audit of the provision of contraceptive services within the practice – for collecting data about work undertaken; for monitoring performance against agreed standards and in relation to such outcome measures as unplanned pregnancies. III ATTITUDES a) Training must foster the appropriate attitudes in doctors in a sensitive area of practice: in particular, the view of the doctor about a patient’s personal behaviour should not interfere with the quality of service being provided; b) the doctor should be sensitive to the anxieties of certain groups such as teenagers and those requesting post-coital contraception; c) the doctor should be aware of his/her own need for continuing learning in this field and the ways in which clinical audit can contribute to this.
E PAEDIATRICS: CORE CURRICULUM It is stressed that the following objectives could only be achieved by an appropriate mix of experience available in hospital, general practice and community clinics. The educational aims are divided into five categories:- 1. Human Development 2. Health and Disease 3. Human Behaviour 4. Medicine and Society 5. Practice Organisation 1. Human Development At the completion of his training, the doctor should be able to demonstrate that:- a) he has knowledge of the important norms of physical, intellectual, emotional and social development at different ages; b) he can carry out the basic methods of assessment of these modes of development from birth up to, and including adolescence; c) he can recognise common deviations from the normal; d) he understands the role of the health visitor in developmental assessment; e) he can recognise when there is a need for referral for more elaborate or specialised assessment. 2. Health and Disease Health At the completion of his training the doctor should be able:- a) through his knowledge of the norms of development, physical, intellectual, emotional and social, to describe what characterises health in children. b) to describe the needs of children at different ages and the factors, whether hereditary or environmental, which favour their health and happiness. c) To demonstrate that he recognises the value of health education, whether about parenthood in general, or about feeding and physical care of children; and the value of disease education, i.e. the prevention of certain diseases, the recognition and home management of common disorders and the use of health and social services. Diseases He should be able always to recognise and, in many instances, to treat the following conditions:- d) Acute conditions threatening life In the newborn; infections, surgical conditions, some life-threatening congenital abnormalities, hypoglycaemia and hypothermia. In infants; acute respiratory disorders, gastrointestinal infections, meningitis. In older children; asthma, ‘acute abdomen’, accidents (including self-poisoning). In adolescents; suicidal behaviour. e) Conditions which, if not recognised early, can lead to disability or premature death In the newborn: infections, jaundice, congenital malformations not immediately apparent, renal conditions, metabolic errors. The recognition of prematurity and dysmaturity. In infants and older children; malignant disease, respiratory infections with complications, epilepsy, abnormal relations in a family, includes battering. f) Common conditions In the newborn; minor disorders, e.g. birth marks, feeding problems. In infants; feeding and sleep problems, respiratory tract infections, parasite infections and eczema. In older children; minor injuries, epilepsy, migraine, and behaviour and sleep problems, enuresis and faecal incontinence. In adolescents; behaviour problems, hypochondriasis, depression. g) Handicaps and their supervision Asthma, congenital handicaps, including heart disease, diabetes, haemophilia, epilepsy, cerebral palsy, mental handicap, social disadvantage. In relation to all these conditions listed in Diseases above, he should be able to demonstrate that he has been concerned with some aspects in particular: i) early diagnosis ii) prevention, where possible iii) management at home iv) psychological and social aspects, where important v) the sick child’s individuality vi) the indications for referral to a consultant or a social agency vii) education of parents about common disorders and about the use of health services. 3. Human Behaviour At the end of his training, the doctor should be able to demonstrate his understanding: a) of the ways in which the doctor’s behaviour towards a child and/or his parents can influence the success or failure of a consultation and the solution of a problem. b) of the ways in which the behaviour of a child, acutely or chronically ill, can influence the behaviour of the rest of the family. c) of the ways in which the behaviour of the family, particularly the parents, can influence the health, happiness and social behaviour of a child (and the behaviour of a child that of his parents). d) of the ways in which family relationships and attitudes, healthy and unhealthy, towards children may persist from one generation to another. e) of the potential importance of the ‘milestones’ or ‘normal crises’ in a child’s life (weaning, habit training, separation from mother, starting school, puberty, falling in love and early sexual experiences, as causes of persisting difficulty and indicators of family stress). 4. Medicine and Society At the end of his training, the doctor should be able to demonstrate: a) that he understands the influence of culture and class on the incidence, presentation and management of different illnesses; b) that he is aware of the prevalence of the different types of children’s illnesses in his practice population; c) that he is aware of the contribution of epidemiology to understanding the causes of some disorders of children; d) his knowledge of the roles of health visitors, social workers and other helping agencies in the care of children, whether well or ill; e) that he is aware of what is known about the incidence, cause and prevention of socio-medical problems such as smoking, alcoholism, drug addiction, pregnancy in girls still at school and juvenile crime; f) that he understands the medical aspects of adoption; 5. Practice Organisation At the end of his training, the doctor shall be able:- a) to demonstrate his knowledge of the organisation of paediatric services n this country and compare them with contrasting systems in other countries; b) to describe how practice organisation must meet the special challenges of sick children – the need for easy contact, quick appointments and satisfactory emergency cover; the need for time for dealing with parental anxiety, for communicating with health visitors and social workers, for home visits; the need for suitable accommodation and equipment in the practice building; c) to describe the organisation of a well-baby clinic (screening, records, immunisation).
These objectives have been developed from those of the joint working party of the Royal College of General Practitioners and the Royal College of Psychiatrists published in 1978(1). Those marked with an asterisk (*) will need a substantial contribution from training in the setting of primary care if they are to be achieved. Vocational Training should enable future general practitioners to be able to:- a understand the doctor: patient relationship and its therapeutic value; b acquire skills in the consultation and particularly in listening, in recognising clues and in providing explanations; c *have knowledge of the emotional, intellectual and social development of the individual development, from infancy to senescence; d *understand the psychological causes and consequences of physical illness, as well as individual development, in terms of the patients’ interpersonal relationships and of their social group membership and of their family; e be aware of the factors that are conducive to or destructive of mental health; f have knowledge of the interactions of medical practice with the social and educational services in the assessment of many mental disorders, especially concerning the involvement of the family; g understand the roles of other professional groups involved in the care of patients with mental disorder and behaviour problems, and in particular voluntary agencies and local authority social services departments; h develop the clinical skills needed in the recognition, elucidation and management of mental and emotional disorder including:- h.1 taking a psychiatric history; h.2 making an accurate diagnosis; h.3 formulating the psychodynamics of a case, and their relationship to assessment and management; h.4 prescribing drug treatment; h.5 advising relatives, sometimes in very difficult and deteriorating circumstances; h.6 planning interviews to modify behaviour; h.7 referral for specialist advice; h.8 to ascertain what further investigation is required to make an accurate diagnosis. (Not all these skills will necessarily apply in every case). i. Have knowledge and understanding of mental and emotional disorder and in particular; i.1 acute disorders that are threatening to life; i.1a of the suffer, e.g. suicidal depression, i.1b of others, e.g. aggressive reactions in the psychopathic patient; i.2 Disorders which, if recognised early, may be managed or whose complications may be reduced – e.g. school refusal, early depression presenting with somatic complaints, postnatal mental illness, including depression, or dementia. i.3 *disorders not normally themselves dangerous which become dangerous in certain situation, e.g. mono-symptomatic phobias; i.4 *common conditions unlikely to require referral to a specialist or admission to hospital – e.g. temper tantrums, enuresis; i.5 *the effects of bereavement and loss and their complications; i.6 continuing care of chronic conditions – e.g. manic-depressive illness or mental handicap; i.7 the pharmacology of drugs used in psychiatry, their indications, their side effects and their interactions with other drugs; i.8 early recognition and management of substance misuse; i.9 the impact on children of parental mental illness. *j. Have knowledge of the psychological aspects of physical illnesses and of medical and surgical treatments. Examples which illustrate the wide range of these include: j.1 post myxoedema, influenzal depression, asthma and peptic ulcer; j.2 the effects on a young child of admitting the mother to hospital; j.3 surgical operations in general; j.4 the results of mutilating operations or of chronic physical disease such as rheumatoid arthritis. *k. Be able to recognise deviations from the expected norms of development, such as mental handicap, dyslexia, behaviour disorders and personality disorders: l. Be aware of the wide variety of non-pharmacological methods of treatment available for psychiatric disorders, for example counselling, family therapy, psychodynamic psychotherapy, cognitive therapy and behavioural therapy: m. Be aware of the effects of the attitudes of the doctor and those who work with him upon the patient and the management of the illness: n. Understand the placebo effects of drugs: o. Appreciate the different models of working together between general practitioners and psychiatrists: p. Be aware of the Mental Health Act 1989 and the Children Act 1989 and their implications for general practice and the Misuse of Drugs (Notification of and Supply to Addicts) Regulations 1973.
G PALLIATIVE MEDICINE: CORE CURRICULUM This curriculum defines minimum standards for GP Registrars in general practice. The list is not necessarily exhaustive, and may be developed further by Directors of Postgraduate General Practice Education, course organisers, trainers or GP Registrars. 1. Physical Aspects of Care The doctor should:- a) know the definitions of terminal illness and of palliative medicine: b) be aware that cancer is not always a terminal illness: c) understand that care of persons with a potentially life-threatening disease which may be curable, but in which there is uncertainty (e.g. Hodgkin’s disease), requires many aspects involved in palliative medicine: d) know the patterns of disease, markers of disease progression and the range of treatments available at each stage of disease, for the following range of diseases: d.1 malignant diseases d.2 acquired immune deficiency syndrome (AIDS) d.3 chronic debilitating neurological conditions, in particular, motor neurone disease (amyotrophic lateral sclerosis). f. understand that patients with other diseases, e.g. cardio-respiratory failure, may be terminally ill; g. be able to anticipate likely potential problems caused either by the disease or by treatments; h. have skills in diagnosis and manage incidental conditions and iatrogenic illness: Pharmacology The doctor should: a) know what drugs are commonly used for the control of symptoms, their usual frequency of administration, typical dosage and common adverse effects; b) know the various routes by which drugs can be administered and when each is appropriate; know the indications for a syringe driver; c) know how to set up a syringe driver; d) know the compatibility and miscibility of drugs used in syringe drivers; e) know the effects of renal or liver failure on metabolism and elimination of drugs commonly used in palliative medicine; f) understand the importance of the pharmacokinetics of drugs when prescribing to control persistent symptoms; g) be able to weigh up the benefits and risks of different drugs for symptom control; be aware that these may change as a patient's condition deteriorates; h) know the equivalent dose of different opiods; i) know and be able to recognise the less common adverse effects of drugs used in terminal care; Symptom Control a) Determine the cause of individual symptoms which may be: a.1 caused by the cancer itself a.2 caused by anti-cancer and other treatments a.3 related to the cancer and/or debility a.4 caused by a concurrent disorder b) Manage each of the symptoms appropriately; c) Understand the place of palliative surgery, radiotherapy, chemotherapy and hormone therapy. Specific symptoms to be considered are: d) Pain diagnosis of different types of pain including: d.1 the differentiation between nociceptive and neuropathic pain; d.2 responsiveness and resistance to opioids; d.3 taking a pain history and monitoring response to treatment, including the use of pain charts; d.4 Non-drug treatment; d.5 common nerve blocks; d.6 the range of treatments for difficult pain problems. e) Anorexia e.1 nausea and vomiting e.2 constipation e.3 intestinal obstruction e.4 hiccups e.5 dysphagia f) Sore mouth: f.1 candidiasis f.2 mouth care g) Cough: g.1 dyspnoea h) Weakness: h.1 lethargy i) Depression and appropriate sadness: i.1 fears and anxieties i.2 acute confusional states (delirium) j) Pressure area care: j.1 indications for different topical dressings j.2 managing fungating wounds, including controlling smell and local bleeding.
k) Stoma care: l) Incontinence: l.1 bladder spasm and rectal tenesmus; 1.2 smell, including the management of fungating lesions. m) Sexual problems: n) Lymphoedema: o) Infections in the immunocompromised patient especially: o.1 HIV infected patients o.2 post chemotherapy. p) hypercalcaemia: q) spinal cord compression: r) superior vena caval obstruction: s) massive haemorrhage: The doctor should be able to manage: t) fungating lesions including malodour and choice of dressings; u) fistulae; v) restlessness in the last days of life; w) raised intracranial pressure; x) malignant effusions; y) iatrogenic disease; The doctor should be able to:- z) recognise limits of attainable symptom control: aa) give permission to other carers to fail in attempts to achieve complete symptom control; The doctor should demonstrate skills in the appropriate use of:- ab. Syringe drivers; ac. Aids to daily living; ad. An indwelling epidural catheter; ae. Local anaesthetic and steroid injections; af. Nebulised local anaesthetics and opioids; The doctor should demonstrate an understanding of the role of complementary therapies. The doctor should demonstrate an understanding of the place of palliative surgery, radiotherapy and hormone manipulation. 2. PSYCHOSOCIAL ASPECTS OF CARE Social and Family The doctor should: a) be able to assess the differing perceptions and expectations of disease and treatment amongst the various family members; b) be able to draw up a family tree (genogram) and understand its uses; c) understand the importance of family meetings; d) understand the psychodynamics of interpersonal relationships and the changes that can occur in illness; Communication Skills The doctor should demonstrate skills towards both patient and family in the following: a) empowering the patient to exercise autonomy; b) active listening; c) assessment of patient’s level of awareness; d) informing of the diagnosis and/or deterioration gently and sensitively; e) imparting appropriate information about illness and its management’ f) breaking bad news; g) dealing with difficult questions; h) eliciting and dealing with fears; Psychological Responses The doctor should recognise and deal with the following in both patient and family: a) anger; b) guilt; c) transference; d) collusion and conspiracy of silence; e) the special needs of children; f) responses to loss (grief) that are manifest at various stages of illness; The doctor must understand that the patient’s perception of hope may not be for a ‘cure’, but instead, for example, a pain free death, honesty or the chance to see a longed-for grandchild. Sexuality The doctor should understand:- a) the patient’s perception of his/her sexuality, including body image and personal appearance, and the effect of the disease on this; b) how alterations in libido affect the emotional health of the relationship between a patient and his/her partner; c) the need for privacy for patient and family to express affection. Grief The doctor should demonstrate an ability to:- a) understand the normal process of grief; b) recognise the patient’s response to loss, e.g. of health, of limb, of role in life; c) help prepare carers for bereavement; d) support the person in grief; e) anticipate and identify the complicated grief reaction; f) support and manage the person with a complicated grief reaction; g) assess the need for the support of other agencies h) recognise children's special needs in bereavement. Dealing with own Feelings There is a need for all doctors to:- a) recognise and deal with emotional stress in oneself and others in the primary care team; b) identify where general practitioners can obtain support appropriate to their own needs and the value of asking for help; c) recognise the source and effects of one’s own opinions and judgements; d) recognise the danger of transposing one's own opinions or judgements onto patients or families; e) consider how to deal with the guilt feelings arising from perceived deficiencies in care; f) have insight into one’s own personal and professional limitations. 3. CULTURAL ISSUES Religious Beliefs The doctor should recognise and consider the importance of, and the effect of: a) the beliefs of the patient, the carers and the doctor on any process of care; b) the practices of the major religions as related to death; c) helping meet spiritual needs either personally or by referral; Cultural Influences The doctor should recognise and consider the important effect of cultural influences including language on all aspects of palliative care. 4. ETHICAL ISSUES The doctor should demonstrate, in practice, respect for the patient as a person, ‘autonomy’, which involves: a) agreeing priorities and goals with the patient and carers; b) discussing treatment options with the patient and jointly formulating care plans; c) not withholding information desired by the patient at the request of a third party; d) fulfilling the patient’s need for information about any treatments; e) respecting the patient’s wish to decline treatment; The doctor should show respect for life and acceptance of death, by understanding that: f) treatment should never have the specific induction of death as its aim; g) a doctor has neither right nor duty, legal or ethical, to prescribe a lingering death: The doctor should: h) understand the issues which surround requests for euthanasia i) recognise the dangers of professionals making judgement based on factors such as pre-morbid disability or the age of the dying person (e.g. death of handicapped child, death of elderly person): j) aim to do good, ‘beneficence’, and avoid harm, ‘non-maleficence’: k) assess the risks versus the benefits of each clinical decision; The doctor should understand: l) the right of the individual patient to the highest standard of care within the resources available: m) the decisions involved in the allocation and use of resources: 5. TEAMWORK The doctor must:- a) demonstrate an ability to work in a multi-disciplinary team; b) be aware of skills in others, e.g. specialist and non-specialist nurses, occupational therapists, social workers; c) understand the value of team support mechanisms; d) be aware that effective leadership of the team may on occasions be best devolved to others; e) be sensitive to the difficulties involved in teamwork, e.g. understanding boundaries and inter-professional rivalry; f) be aware of the role of other organisations, including self-help and support groups; 6. PRACTICAL ISSUES Interface between General Practitioners and Consultant Specialists The doctor should understand:- a) the relationship and responsibilities of the specialist towards the patients; b) the relationship between primary care team and the hospital based team; c) the signs that communication between these services is in jeopardy; d) the action needed to ensure clear role definition; e) the need for the patient and family to understand the different roles and when and how to contact the most appropriate individual: Practical Support: The doctor should know how to obtain the following: a) appliances, such as a commode; b) occupational therapist assessment for modifications to the home to assist with activities of daily living; c) physiotherapy services; d) support services available to care for the person dying at home, especially home help, sitter services (day and night), volunteer help with shopping, meals on wheels and specialist nursing (Marie Curie or Macmillan); e) assessment for and provision of wheelchairs and cushions; f) the services of a Disablement Services Centre for artificial limbs and appliances; g) relevant grants, funds and allowances; Organisational Issues The doctor should know about:- a) controlled drugs procedures – national regulations and local policy; b) identification and certification of death; c) when to inform the coroner; d) cremation regulations; e) procedures for relatives following death (and understand how cultural influences may affect this): f) the role of the undertaker g) facilities provided by different places of care: home / hospital / hospice / other: H DERMATOLOGY: CORE CURRICULUM 1. Human Development Vocational Training should enable future GPs to:- a) describe the structure and function of the skin; b) discuss the way that skin structure and function is affected by age, sex and ethnic origin. 2. Human Behaviour Vocational Training should enable future GPs to:- a) describe the way in which a skin disorder affects the mood, personality, social and sexual functions of the patient; b) demonstrate an awareness of a patient’s ‘body image’ and the way that this may be affected by the existence of a skin disorder. 3. Medicine and Society Vocational Training should enable future GPs to:- a) describe and discuss the common occupational skin disorders and the way in which the presence of a skin condition affects the employability of patients; b) demonstrate their awareness of the use and abuse of cosmetics and self-prescribed skin medication; c) describe the way in which society reacts to patients with skin disorders. 4. Health and Disease Vocational Training should enable future GPs to:- a) describe the recognition and management of common skin infections and infestations; b) describe the diagnosis and treatment of benign and malignant skin tumours; c) describe the diagnosis and management of other common skin disorders; d) describe the cutaneous manifestations of general medical disorders; e) discuss the pharmacology of agents used topically and systemically to treat skin conditions. 5. The Practice Vocational Training should enable future GPs to:- a) describe the importance of Health Education and Health Promotion in the early recognition of skin tumours; b) develop systems for the treatment of benign skin tumours by means of surgery and cryotherapy; c) demonstrate an effective use of local hospital resources, especially referral of patients to local Dermatology Departments.
a) Knowledge: The GP Registrar shall be able to understand: a.1 the inter-relationship of ear, nose and throat physiology; a.2 the anatomy and inter-relationship of the nasal cavity, sinuses and middle ear; a.3 the role of lymphoid tissue in the head and neck in health and disease; a.4 the factors in allergy affecting the nose and sinuses; a.5 the difference between reversible and irreversible disease in the nose, sinuses and middle ear; a.6 the gross anatomy of the ear, external, middle and inner; a.7 normal and abnormal wax formation in the external ear; a.8 the difference between a safe and unsafe perforation of the tympanic membrane. a.9 the differential diagnosis of otorrhoea and otalgia; a.10 the difference between conductive and nerve deafness; a.11 the diagnosis of secretory otitis media; a.12 a pure tone audiogram and impedance test and be able to interpret same, and know other tests that can be performed to investigate deafness; a.13 the mechanism of vertigo; a.14 common problems of saliva and salivary glands; a.15 the relationship of tonsils to pharyngeal disease; a.16 the importance of hoarseness of the voice and its diagnosis; a.17 the difference between dysphagia for solids, liquids and saliva; a.18 the use and misuse of ENT drugs; a.19 the timing of dentition; a.20 stridor in children b) Skills: The GP Registrar shall be able to demonstrate: b.1 the use of auroscope in identifying ear pathology; b.2 the use of microscope for the same; b.3 the use of tuning forks to identify deafness; b.4 ear syringing and suction clearance techniques; b.5 whisper and picture tests for children with hearing impairment; b.6 pure tone audiograms and impedance testing; b.7 mirror examination of larynx to identify disease; b.8 palpation of neck to detect disease; b.9 examination of a nose with and without fibre-optic equipment; b.10 the technique to control epistaxis
J INFECTIOUS DISEASES: CORE CURRICULUM a) Knowledge: The GP Registrar shall be able to:- a.1 recognise the significance of commonly presenting exanthems a.2 understand and evaluate different approaches to feeding management in paediatric gastroenteritis; a.3 appreciate the rational basis for sensible antibiotic use; a.4 develop an awareness of how other systemic illness may present in the guise of an infectious disease; a.5 develop an awareness of the more rare infectious diseases and their complications, e.g. kawasaki, tropical infection, infection in the immune-compromised host, HUS, Henoch-Schonlein Purpura; a.6 understand and manage: i) acute bacterial and viral meningitis ii) acute gastroenteritis iii) pneumonias iv) malaria v) bacteraemia and septicaemia vi) HIV infection vii) Immunodeficiency syndromes b) Skills: The GP Registrar shall be able to demonstrate: b.1 appropriate physical examination of babies, children and adults b.2 concise clerking and clear unambiguous descriptions of rashes and their clinical relevance b.3 competence in essential diagnostic procedures, e.g. lumbar puncture, sigmoidoscopy. c) Evaluation of Posts: The vocational training post should fulfil the following criteria: c.1 a balanced experience of relevant infectious diseases c.2 adequate cover for training and education c.3 an acceptable workload
K OPHTHALMOLOGY: CORE CURRICULUM The educational aims are divided into five categories: 1. Health and Diseases 2. Human Development 3. Human Behaviour 4. Medicine and Society 5. The Practice *: Expertise may need 6-month post At the conclusion of his/her vocational training the doctor should be confident in the management of:- 1. Health and Diseases Clinical Method a) Examination of eye. Direct ophthalmoscopy b) *Use of Slit Lamp. Indirect ophthalmoscopy c) Use of mydriatics and other diagnostic agents Emergencies a) Penetrating and blunt trauma. Chemical and UV Radiation Injury. b) Acute glaucoma. c) Retinal detachment. d) Acute vascular disorders of the retina. e) Herpes simplex keratitis. Herpes zoster ophthalmicus. f) Facial nerve palsy g) Optic neuritis, papilloedema, ischaemic optic neuropathy (arteritic and non-arteritic forms). Common Eye Disorders a) Blepharitis. Conjunctivitis b) Dacryocystitis and disorders of tear ducts c) Uveitis d) Cataract, aphakia, pseudoaphakia e) Age-related macular degeneration f) Chronic glaucoma g) Effect of hypertension h) Effect of diabetes Neuro-Ophthalmology a) Paralytic squints b) The eye in cerebrovascular disease c) Nystagmus d) Transient loss of vision. Refractive Problems a) Myopia, Hypermetropia. Astigmatism. Presbyopia b) Assessment of acuity c) Problems associated with contact lenses d) Role of surgery in treatment of refractive error. Treatment a) The pharmacology and use of oral and topical agents in ophthalmology. The effect of drugs on the eye. b) Incision of meibomian cysts c) Dilation of tear ducts d) Removal of conjunctival and corneal foreign bodies 2. Human Development a) Normal development of eye and visual apparatus b) *Congenital abnormalities of eye and eyelids c) *Normal development of binocular vision and acuity d) Detection of visual problems in new-born and infants e) *Detection of squints f) Vision screening in pre-school children g) Genetic advice and counselling 3. Human Behaviour a) Relationship between eye disorders and other disabilities b) Prevention of injuries to eyes at home and work c) Patient education on detection of visual problems d) Value of regular optician checks. Exemption from charges. e) Hysteria and its ‘diagnosis’. 4. Medicine and Society a) Vision problems and driving. b) Career guidance to those who are colour blind. c) Definition of blindness and partial sightedness. Registration., Value of registration. Methods of registration. Specialist social workers. d) Social support for visually handicapped adults: i) RNIB. Talking book services ii) Social Services iii) Local services iv) Care of family. Financial support v) Low vision aids. e) Social support of visually handicapped child: i) Statementing. Education Act ii) Schooling. Peripatetic teachers iii) Career guidance. 5. The Practice * a) Equipment needed in General Practice. *Minor surgical procedures. b) Role of GP, Optometrist, Orthoptist, Eye Clinic, Community Eye Clinics, School Health Service. c) Organisation of screening for:- i) Vision disorders in children ii) Diabetic retinopathy iii) Glaucoma
J RHEUMATOLOGY & REHABILITATION: CORE CURRICULUM 1. Structure and Function of Joints Vocational Training should enable future GPs to:- a) describe the structure and function of the joints and their associated soft tissues; b) discuss the way that the structure and function is affected by the age and the sex of the patient. 2. Human Behaviour Vocational Training should enable future GPs to:- a) describe the way in which rheumatic disease affects the mood, personality, social and sexual functions of a patient. b) demonstrate an awareness of a patient’s ‘body image’ and the way that this may be affected by rheumatic disease. 3. Medicine and Society Vocational Training should enable future GPs to:- a) describe and discuss the common forms of rheumatic disease and the way in which they may affect employability of patients. b) describe the development of social and medical care for patients with rheumatic disease in society. c) Demonstrate an understanding of the needs of patients with rheumatic disease and how these can be met both by medical and other ancillary staff within the hospital and primary care setting. 4. Health and Disease Vocational Training should enable future GPs to:- a) describe the physical factors which affect joint function, in particular diet, exercise, weight and occupation; b) describe the diagnosis and management of common rheumatic disorders; c) describe the diagnosis and management of soft tissue complaints; d) be able to examine and treat conditions of:- i) hand, wrist, arm, shoulder ii) foot, knee, hip iii) back, neck e) discuss the use and pharmacology of first line agents in the treatment of rheumatic diseases; f) discuss the use and pharmacology of disease modifying drugs and their monitoring in general practice; g) demonstrate an appreciation of the timing and use of orthopaedic surgery in patients with rheumatic disease; h) know when to recommend and how to administer steroid and anaesthetic injections to joints and associated tissues: i) tenosynovitis ii) carpal tunnel syndrome iii) epicondylitis iv) painful shoulder v) sacro iliac problems vi) O.A. knee. Knee effusions vii) ankle viii) bursitis i) assess disability, handicap and impairment; j) interpret laboratory results relevant to rheumatology; k) emergencies – assess the urgency of rheumatological conditions – early RA, pyogenic conditions; l) be familiar with diagnosis and management of:- i) osteoarthritis ii) osteoporosis iii) gout iv) polymyalgia and giant cell arthritis v) rheumatoid arthritis vi) seronegative arthropathy vii) Raynaud’s Phenomenon viii) collagenosis – early diagnosis and management ix) The systemic effects of rheumatological disorders x) Tenosynovitis xi) Pyrophosphate arthropathy xii) Sports injuries and other soft tissue injuries xiii) fibromyalgia m) understand the value of:- i) physiotherapy ii) occupational therapy iii) physical therapy iv) aids and appliances in treatment. 5. The Practice Vocational Training should enable future GPs to:- a) organise and equip a Practice to facilitate the access and treatment of patients with rheumatic disease; b) develop policies for the integration of the primary care team to assess and treat patients with rheumatic disease with particular reference to physiotherapy and occupational therapy; c) identify roles for primary carers such as the Practice Nurse with responsibility for monitoring second line drugs; d) demonstrate an understanding of the effective use of hospital resources and the setting up of a ‘shared care’ approach with all professional colleagues who may be involved in the care of patients with rheumatic diseases.
September 2001 The Yorkshire Deanery Department for NHS Postgraduate Medical and Dental Education Willow Terrace Road University of Leeds LEEDS LS2 9JT Revised July 2002 |
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