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TRANSCRIPT
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Darent Val ley Hospi ta l
Department of Obstetrics and
Gynaecology
Handbook 2015-2016
Version 1.4 Waterstone 2010, Awadzi 2012
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Introduction
Welcome to the Kent Surrey Sussex (KSS) Deanery in general and Darent Valley Hospital in particular.
This faculty handbook is written for you as a postgraduate doctor and all who will be working with you dur-
ing your time here. Its purpose is to give you information about how the programme works, and who the
key people are who will be working with you. This handbook contains generic information, but is specifical-
ly written to support those of you who are on the Obstetric and Gynaecology Programme . It should be
read in conjunction with your curriculum (http://www.rcog.org.uk/education-and-exams/curriculum) and
your Speciality School Handbook.
This handbook is updated annually based on feedback to the Faculty Group from you as a postgraduate
doctor and from your supervisors.
Location
During your time with us you will be based at Darent Valley Hospital and Queen Mary’s, although you may
also accompany community midwives in the locality. The Postgraduate Centre, The Philip Farant Centre,
is located on Level 1.
Key People
There are several key people who will support you during you time with us.
Programme Lead (College Tutor): Miss Urmila Singh, [email protected] Secretary Julie
Cook, [email protected] Ext 8980.
Trust’s Director of Medical Education: Dr Ali Bokhari, [email protected]
Medical Education Manager (MEM): Mrs Claire Nottage, ext 8541.
Faculty Administrator: Sabrina Walby, ext. 8540
A list of people directly involved in your Programme e.g. Educational Supervisors, Clinical Supervisors,
Administrative Staff, Faculty Group, Deanery Staff, Deanery Careers and Library Knowledge Service Staff
with their contact details is given in Appendix A
Local programme administrative arrangements
The administrative arrangements for the local management of your programme are managed by the MEM / Faculty Administrator in conjunction with your Programme Lead. The national arrangements for the management of your programme are contained in your e-portfolio at www.rcog.org.uk. If you experience any local admin issues your first point of contact is the Postgraduate Centre.
The Obstetric Curriculum
[GEAR S 1.2; S 1.4; S1.5]
The curriculum for obstetrics and Gynaecology can be found at http://www.rcog.org.uk/education-and-exams/curriculum
A hard copy of these documents can also be found in the Education Centre or library.
The Local O&G Faculty is responsible for ensuring that the programme is such that it will enable you to meet specific competences required in any given year by your curriculum. It is important that you read the curriculum so that you are aware of what is required of you and the competencies that are required, in
order to complete your ST1/ST2 year satisfactorily. It is the acquisition of these competencies that will be assessed during the year using a selection of various Assessment Tools.
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Remember it is your responsibility to meet with your Educational Supervisor and in discussion with them arrange the appropriate assessments that will take place in order to satisfy the acquisition of these core competences.
Your Educational Supervisor is responsible for overseeing your training and making sure that you are making the necessary clinical and educational progress. You should have regular feedback from your Ed-ucational Supervisor. The responsibilities of an Educational Supervisor are given in the Gold Guide.
Educational Supervisors
Responsible for the supervision of trainees’ progress
Responsible for ensuring that trainees are making necessary clinical and educational progress
Educational Supervisors should have the training and ability to undertake appraisal, work with
portfolios and provide career advice, plus managing the trainee in difficulty.
Meet the trainee at least twice during the job and co-ordinate work-based assessments.
Clinical Supervisors are responsible for the day to day supervision of the trainee in the workplace, teach-ing on the job, regular feedback and rapid response to issues as they arise.
Aims and objectives of the O&G curriculum
The RCOG curriculum is approved by the General Medical Council, and all modules are presented in the same format. Modules outline the:
Knowledge criteria
Clinical competences
Professional skills and attitudes
Training support options
Evidence and assessment requirements.
How you complete the O&G curriculum
The O&G curriculum is competency based and after completing level one and two, you may then decide to follow level three or one of the sub specialties.
You will be supported during your time at Darent Valley Hospital by your allocated Educational Supervisor and Clinical Supervisors, all of whom will give you regular feedback about your progress. You should nev-er be in any doubt about your progress and what you can do to improve this.
The O&G Programme Structure
[GEAR S1.4; S 2.3]
This Faculty Handbook gives you details of how the national curriculum for O&G is organised here at Dar-ent Valley Hospital. It gives you details of your local programme which has been devised to meet the re-quirements of the O&G curriculum and shows how this works locally. It will include, ward based, half day local teaching, regional study days, clinical audit and exposure to academic opportunities.
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What the trainee can learn at DVH
Assessment Modality
CbD Mini-CEX DOPS
Knowledge of Management of Emergencies:
Ectopic
Miscarriage
Eclampsia
Bleeding – APH (inc Abruption), PPH
Ovarian Cyst
GYNAECOLOGY COMPONENT
Knowledge of Management of Common Gynaecological
Presentations:
Gynaecology Clinic
Menstrual Problems – PMB/IMB/PCB, Dysmenorrhoea,
PV Discharge inc PID
Ovarian Problems – Cysts, PCOS
PMT
Continence, Genital Prolapse
Pelvic Pain inc Endometriosis
Vulval Disease
Sterilisation
Gynaecological Malignancy
Subfertility
Social Gynaecology
Awareness of what is involved and options available
Awareness medico-legal and ethical issues
Colposcopy Clinic
What services are offered and what patients can expect there
Specialised Clinics
Menopause and HRT
Continence Service
Others may become available locally in due course
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CbD Mini-CEX DOPS
Sexual Health Clinic (Overlap with Men’s Health)
Contact Tracing – Importance/How to Do this or Access
services
HIV Pre-Test Counselling
Psychosexual Counselling – Availability and simple strate-gies
Family Planning Clinic
What services are offered
Variety of contraceptive options available – risks and bene-fits of each, appropriate selection for the individual
OBSTETRICS COMPONENT
Specific Knowledge:
Pre-pregnancy counselling including high risk cases
e.g. Diabetic Mother, epilepsy
Normal Pregnancy and how identify those ‘at risk’ who
need higher level of monitoring
Pregnancy Problems – Experience in Labour Ward, ANC,
High Risk Cases – Medical (DM, Cardiac, Epilepsy), Addic-tion Problems
Clinical problems – Bleeding in late pregnancy, Abdominal
pain in pregnancy, Pre-eclampsia and Eclampsia
Post Natal Care – Awareness and Management of Potential Problems including infection and bleeding
Specific Skills:
Gynaecology and Menstrual History
Obstetric History
Sexual History
Speculum, Cervical smears, triple swabs, Bimanual exam
HIV Pre-Test Counselling
Female genital tract examination, breast examination
Appreciation of Roles of Others
Midwife
2. Incontinence service – specialist nurse, physiotherapy
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How the trainee can learn
LEARNING OPPORTUNITIES
Emergency Gynaecology Unit including the Early Pregnancy Unit
Seeing Emergency Referrals and Admissions – On Call Duties
Following the patient journey from admission to discharge – involved in ward rounds
Labour Ward
Day Care
Outpatient Clinics – General Gynaecology, Colposcopy, Antenatal clinic, Day Assessment Unit, Fetal Assessment Unit
Specialised Clinics and Services: Rapid access, Sexual Health Clinic (Gravesend). GAU, Urogynae., Outpatient Hystoroscopy, Early Pregnancy Unit.
Theatre experience – involvement would be tailored to each trainee’s requirements and ability.
Formal Teaching Sessions — Protected teaching on Wednesdays 08:30-09:30 and during Audits, CTG training, Skills drills, and Basic practical skills courses. In addition MRCOG group teaching is held Friday afternoons.
Induction
[GEAR S1.7; S1.8; S1.9]
You will be inducted to the Trust on the first Wednesday in October.
The O&G Specialty Induction usually takes place on the first Thursday in October. You will attend Post Graduate Education Centre initially where you will be given any necessary paperwork as well as meeting with Medical Staffing and Occupational Health. You will then be taken to the Gynaecology department where you will be given the Departmental Induction by the College Tutor
There will follow an afternoon of skills drills on the Friday of that week, and all trainees are expected to attend. Handover
The policy for handover is to ensure patient safety is the priority.
Before you go off duty, you must hand over all the patients to your successor by attending the Labour Ward Handover. The Handover document is saved on the computer’s Shared Drive, and is updated after every shift. This is of fundamental importance and time is allowed for it.
Ward rounds The schedule for ward rounds varies with each consultant, but we try to maintain the ‘firm’ structure. You will be responsible for the day-to-day care of the patients allocated to your team, in con-junction with your registrar.
Taking Consent
The policy for taking consent can be found under Policies and Procedures via the Hospital Intranet, and will be covered in your induction. You will be required to complete a competency form following your in-duction.
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Study Leave/Exams
The following principles guided the development of the national guidelines:
For the full guidelines please visit the Medical Education website for DVH.
Study Leave should:
enhance clinical, education and training
be planned as far in advance as possible, as an integral part of the education and training process
provide education and training not easily acquired in the clinical setting or locally, e.g. acquisition of a theoretical knowledge base such as basic sciences, statistics, etc...
Support Delivery of Curriculum Targets.
“All trainees should be encouraged to develop coherent plans for Study Leave early in their Specialty post or programme or StR training programme”.
Specialist Registrars and Specialty Trainees are entitled to up to a maximum of 30 days in a year (the year being calculated from the date of commencement of appointment or rotation). Leave to sit examinations necessary for the career advancement for the trainee is allowable but does not count against the annual Study Leave entitlement.
Trainees in Locum Specialty posts, those in Fixed Term Specialty Training Appointments (FTSTAs) and Locum Appointments for Training (LATs) exceeding three months are entitled to
Study Leave pro rata. There is no entitlement to Study Leave for Locum Appointments for Service (LAS).
Study leave for the training grades is supported within cash limits from a unit budget delegated to Clini-cal Tutors by the Deanery. SPRs and STRs are entitled to up to a maximum of £800 per annum.
Expenses appropriately incurred for study leave within the British Isles might typically include:
registration and/or course fees for courses approved by School/STC and Deanery
reasonable subsistence
costs of moderate-priced accommodation, if no course is available locally
economy/standard travel expenses, if no course is available locally.
For Specialty trainees attendance at Deanery half-day or day release courses including “Regional Teach-ins” which take the trainee away from service e.g. when all the SpRs, StRs in the specialty travel to one central Trust or University Department for postgraduate teaching, will normally count as up to 20 days out of the 30 days entitlement per annum (leaving 10 days for other approved purposes). When such courses are counted against this study leave allowance the Deanery in consultation with the Specialty Training Committee Should have approved the course. This is subject to change.
Common purposes of study leave for Specialty Trainees and Specialist Registrars
(i) Attendance at courses to assist with preparation for examinations, e.g. acquisition of the necessary
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“theoretical knowledge base”.
(ii) Private study prior to examinations. This should be no more than one week and can only be grant-ed within the exigencies of the service. Private study leave should serve a specific defined pur-pose: aims and objectives should be discussed and agreed between the trainee and his/her train-er.
(iii) To take agreed professional and academic examinations (not counted against the annual allow-ance)
(iv) Attendance at courses to assist with the acquisition of an appropriate knowledge base or clinical skill not easily acquired in the clinical setting. Some specialties will require their trainees to attend specific courses to acquire a specialised knowledge base prior to clinical training e.g. radiobiology, radiation physics.
(v) Attendance at specialty association meetings either as a delegate or to present papers.
(vi) Trainees should choose from a portfolio of courses maintained and continually updated by the rele-vant core school, level one school, or Specialty Training Committee (STC). Trainees should attend courses proximal to their training base and within the Deanery where available.
(vii) Research supervisors should ensure that funding for research by StRsSpRs includes an element for relevant study leave, including presentation of papers at national and international meetings.
(viiii) Academic StRs must negotiate a pro-rata arrangement with their Programme Directors.
ST doctors are expected to take MRCOG part 1 and also part 11 depending upon their stage of train-ing. Study leave is toward the courses and if feasible before the exams. This should be applied well in advance.
How do you apply for Study Leave and Annual Leave in O&G?
Study Leave is partly internally covered. It will be your responsibility to ensure that the weekends worked are fair and equitable.
All Study Leave requests must be signed by Gabriel Awadzi, the RCOG Tutor. Numerous factors will be taken into account before approving, particularly:
1) Whether the course is appropriate and well regarded
2) The timing of Study Leave in relation to the examination to be taken.
3) Timing of the actual course.
4) Whether the absence of the trainee is likely to have a significant impact on service delivery. No more than 2 trainees are normally granted leave (study or annual leave at any one time) .
You are expected to keep a cumulative record of your study leave and also provide feedback on what you found most worthwhile. You will also be encouraged to begin accumulating interesting cases, audit, topic, teaching sessions etc. for the production of your own individual portfolio that you can take on from job to job. This can be used as a shop window display of your involvement in training and education as you pro-gress through your career.
Annual leave is currently built into the rota and therefore annual leave requests will not be required.
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Your Educational Supervisor – roles and responsibilities
You have all been allocated an Educational Supervisor who is a Consultant member of the O&G depart-ment, this person will be your Supervisor/Mentor/Tutor for the duration of your post here. It is important that you ensure to arrange to meet up with your Supervisor as soon as possible within the first 2 weeks of commencement at the Trust. You will also be responsible to arrange in advance further meetings, a mid-point review and an appraisal meeting at the end of your post. Your final end of year review needs to be arranged a few weeks prior to your end date. This is to ensure all the necessary paperwork is completed prior to sign off.
Your Educational Supervisor will help you to make the most of your time here, assist you in setting your objectives and give you career guidance. The meetings will consist of an informal appraisal every three months of how you are getting on, together with a formal assessment every 6 months. These assess-ments feed into the Annual Review of Competence Progression (ARCP). For urgent or personal problems you are free to approach any senior member of the department for help, as you think fit, and we would en-courage you to do so.
Urmila Singh, as College tutor, has overall responsibility for your training whilst in the Department and is available for confidential discussions if you are having any difficulties with your training or any other aspect of your stay. Please do not hesitate to contact her directly.
Your Clinical Supervisor – roles and responsibilities
[GEAR S1.6; S1.12; S1.14 ].
In each placement you will be allocated a Clinical Supervisor. In most cases, this will also be your Educa-tional supervisor.
Your Role as a Learner
You are responsible for your own learning within the programme with the support of key people as above. You should ensure that you have regular meetings with your supervisors, that you maintain your portfolio, keep up to date with assessments as required and be signed off.
Education Agreement and Appraisal Paperwork
The educational contract, which is issued by the Post Graduate Centre and given to you at Induction, must be completed by yourself and your Supervisor before returning to the Post Graduate Education Centre within the first four weeks at the Trust. Also enclosed with the contract is your personal training plan which will help you establish the priorities for this post as well as the various appraisal forms and an as-sessment monitoring forms which need to be completed at the meetings you arrange during the year with your Educational Supervisor.
Self Appraisal Form
For your own learning, there is also a self-appraisal form which you should complete at the beginning and midway through your specialty training year. The aims of the self-appraisal are;
To provide the means for reflection and evaluation of your current practice.
To inform a discussion with your Educational Supervisor to help you both gain insight into your understanding of your current abilities.
This self-appraisal tool is designed to assess how confident you feel when asked to perform the tasks required of your grade. The information given will help to identify your strengths as a doctor and will assist you, with the help of your Educational/Clinical Supervisor, to agree what you need to learn. You may choose to revisit the self-appraisal throughout training year.
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It is essential for your own development that you complete this form honestly, identifying the areas where you feel your weaknesses lie and how confident you feel about undertaking the tasks required of you at this time.
After each appraisal meeting please send copies of all completed paperwork to Claire Nottage at Post Graduate Education Centre.
The Local Obstetric and Gynaecology Faculty Group
[GEAR S 6.1-6]
The O&G Faculty Group’s remit is threefold: to ensure that the local programme is fit for purpose and in line with the O&G curriculum requirements, to quality control the local O&G programme and to ensure that trainee progression is tracked, supported and audited. The Local O&G Faculty meets three times a year, in November, March and July. The Local Faculty’s work is quality controlled by the KSS Deanery Stand-ards for the Local Faculty Graduate and Education Assessment Regulations [GEAR].
Your Year Group [GEAR S6.10]
Each Specialty group needs to meet as a Year Group three times a year, to elect a Year Group Repre-sentative and to give feedback to Faculty about the local programme.
Your Year Group Representative
[GEAR S 6.10]
This is key part of the feedback process. This is a member of your cohort who will undertake to meet with the whole cohort [either face to face or by e-mail] to gather feedback about the local programme and to give this feedback at the thrice yearly meetings of the Local O&G Faculty Group. The feedback loop must be closed as relevant information / responses from the Local Faculty Group needs to go back to the co-hort. This is the responsibility of the Year Group Rep.
The Local Academic Board
There is a Local Academic Board in each Trust whose responsibility it is to ensure that postgraduate med-ical trainees receive education and training that meets local, national and professional standards. The LAB undertakes the quality control of postgraduate medical training programmes. It receives Annual Audit and Review Reports from Local Faculty Groups.
Your Specialty School
Details of your O&G School can be found at http://www.lpmde.ac.uk/ or https://kss.hee.nhs.uk/
You are encouraged to either make an appointment or call in to see the Head of Postgraduate Medical Education in the Postgraduate Centre to discuss any problems of a personal or career related nature.
We sincerely hope that you will find your attachment at Darent Valley Trust professionally rewarding. We recognise that every hard working doctor experiences periods of extreme physical and emotional stress and it is very important to me that you feel supported. Should you ever feel you need extra help during such a time please remember the following:
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How will you learn in this programme? In this programme we adopt a variety of learning approaches. These include web-based, ward based clini-cal teaching, exposure to outpatients and theatres at the appropriate identified level, group learning, pri-vate study, courses, reflective practice, audit projects, regular teaching specific to year and specialty, but also multi-specialty if appropriate.
Feedback
[GEAR S1.10; S1.11]
This is a crucial aspect of your programme. You can expect to receive detailed feedback on your progress from your Educational Supervisor and from your Clinical Supervisor. This will happen during on going re-view/appraisal meetings with your Educational Supervisor. You should have a clear idea of your progress in the programme at any given time and what you have to do to move to the next stage.
Learning Portfolio or E-Learning Portfolio [GEAR S1.17]
This is a key aspect of your learning in the programme. It is your responsibility to maintain an e- portfolio This is an essential mandatory requirement as it provides an audit of your progress and learning. Further information on how to manage and complete the specialty e-portfolio can be found at http://www.rcog.org.uk/education-and-exams/eportfolio
How are you assessed? [GEAR S 1.16; 18] This programme is competency based. The assessment tools are Multi-source Feed-back (MSF), Clinical Evaluation Exercise (Mini-CEX), Direct Observation of Procedural Skills (DOPs) and Case-based Discussions (CbD).
In this local programme relevant information about the local assessment process can be found on RCOG Website. You and your supervisor should receive feedback on your performance on a regular basis. It is your responsibility to undertake the assessment process in accordance with your specialty curriculum guidance.
You should check your e-mails on a regularly for any assessment updates
What is the Appeals Process
Please visit the following links; GMC or the (sections 7.118 – 7.152) for Specialty Training.
What if you need help? [GEAR S 2.4; 2.11; 2.12; 2.13]
Counselling & Mentoring Policy For Doctors In Training
The Postgraduate Centre operates an ‘Open Door’ approach and here you can find information about lo-cal trust policies e.g. Grievance; Bullying and Harassment and Equal Opportunities. These policies can also be accessed via the Hospital Intranet.
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Professional Counselling A professional counsellor is available via the Occupational Health Department. Sessions are usually one hour long with a maximum of eight sessions. Appointments should be made through the Occupational Health Department.
Support available for doctors outside Dartford and Gravesham NHS Trust
The following support services are available.
The National Counselling Service for Sick Doctors Tel: 0870 241 0535
The Sick Doctor’s Trust www.sick-doctors-trust.co.uk Tel: 0370 444 5163
The BMA 24-hour stress counselling service for doctors www.bma.org.uk/practical-support-at-work
Tel: 08459 200 169
KSS Deanery also offers support for trainees in difficulty. Details of the KSS Deanery Trainees in Difficulty Guide can be found on the http://kssdeanery.ac.uk.
Good example included in the Operational Framework for Foundation
How can you access career support? [GEAR S3.1; 3.2; 3.3. 3.4]
Information about the KSS Deanery Career Service can be accessed at http://careers.kssdeanery.org. The Careers Lead for the O&G Faculty is Gabriel Awadzi extn 4328 or [email protected]
Using Educational Resources
There is a wide range of learning opportunities that you can access in addition to those whilst working in your clinical teams.
These include courses run by various organisations within the Trust and also by other local Community and Primary Care Trusts. Such courses can be accessed from the Education Centres, Training Depart-ment and or the hospital intranet.
There are regular teaching sessions and you are expected to attend these. A minimum of 75 % attend-ance is expected.
It is vital that you make use of these resources during your time here, and you will be expected to have made excellent use of your educational time whilst on the programme. This will be monitored and record-ed. You should therefore keep a personal log of educational activities completed during each post. This will then be reviewed by your Educational Supervisor at your appraisal.
GMC Ethical Guidelines
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[GEAR S1.19]
Please visit the following website for up to date guidelines. GMC | List of ethical guidance
How about Flexible Training?
[GEAR S1.15] Flexible Training relates to training on a less than full time basis. It is included as one of
the Improving Working Lives (England) standards. Flexible Training operates at all training grades across
the boundaries of Kent, Surrey and Sussex (KSS) and London. Please visit the following website for infor-
mation and guidance on how Flexible Training operates. Specialty Support at HEKSS.
Useful names & numbers Local, regional and national
KSS Deanery Website - http://www.kssdeanery.ac.uk
KSS Deanery Careers - http://careers.kssdeanery.org
KSS Deanery GEAR for Local Faculty Groups
Gold Guide - http://www.gmc-uk.org/education/undergraduate/15_6_provisions_of_the_gold_guide.asp
Faculty Group Educational Support
The KSS Deanery offers a range of educational support / programmes
For details please go to http://education.kssdeanery.ac.uk/fac_dev-Accredited_Programmes.php
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A USER'S GUIDE
FOR JUNIOR DOCTORS
DEPARTMENT OF OBSTETRICS &
GYNAECOLOGY, DVH
GUIDELINES & PROTOCOLS
2015-2016
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1. ON CALL:
The on call rota for Middle Grades and SHOs is determined weeks in advance by the rota and shifts. If you
wish to swap, you must inform your Consultant. Medical Staffing must also be informed.
The on take Consultant is the one who is on call for the night i.e, from 5pm onwards. All new admissions should be under his or her care. Where a patient is still actively under the care of a named consultant, they should be admitted under his or her care. The latter also applies for those who are readmitted following sur-gery. Such readmissions must be reviewed by the middle grade and the consultant within 24 hours. In the absence of the original consultant, the hot week consultant should be informed of all such patients.
Consultant are resident within the hospital for 92 hours per week including the weekends. They are therefore readily available to provide senior input.
The Consultant on call must be informed if any patient has an unexpected blood loss of over two litres. Equally, any urgent transfers, e.g. to ITU, must be notified to the Consultant on call. A list (not exclusive) of when to call a Consultant is in the Delivery Suite Guidelines.
2. WARD ROUNDS / WORKING DAY:
2.1. SHOs: Your working day is 8.30 AM to 5 PM (except during the shift weeks). You are expected to do a ward round on the Gynae ward and a proper round of the antenatal patients and a summary round of the postnatal patients first thing in the morning, even if you are assigned to other duties i.e. clinic or theatre.
We expect you to have seen all of your patients by 9 AM and then join clinic/theatre. The ward round is to prevent problems, which need sorting, only coming to attention late in the day. Once problems are identified, either deal with them or inform your Registrar / Consultant and then go to clinic / theatre.
2.2. Middle Grades: You are expected to have reviewed all your patients on both sides (Obstetrics & Gy-naecology) prior to attending your designated clinical sessions. It is not acceptable for you to plan to see your patients later in the day. Such practice leads to delayed discharges/ poor management delyed recognition of problems etc. If there are problems you cannot deal with independently, inform your Consultant or, if not available, then speak to the Consultant on call.
Failure to review your patients is frowned upon and will be taken into account when accessing your work eth-ic.
2.3. Consultants: Each Consultant has at least one fixed ward round per week where all his/her team are expected to attend.
2.4. Labour Ward: The Consultant covering Labour Ward in the morning will provide a Consultant Ward round on Labour Ward each day, 830am on week days and during the morning on weekends/holidays. The Consultants taking over on call for the night will go to Labour ward and cover in person until 10 pm.
The Middle Grade on call together with the Anaesthetic Registrar are required to do a ward round at
around 9 PM.
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2.5 Consultant’s leave: If your Consultant is on leave, another consultant is usually allocated to cover their operating list. The team members should therefore attend for their usual sessions. This will be specified on the on call rota.
3. INVESTIGATIONS:
It is the responsibility of the SHO to know which tests have been done and to check the results. If they are abnormal either deal with them directly or inform your Registrar / Consultant. It is indefensible, when tests were thought necessary and performed, not to check the results and even worse to document an ab-normal result with no action being taken! If (urgent) results are not back when you leave / change shift, etc. inform the SHO taking over of the outstanding result.
As a safeguard, this should be noted on the Gynaecology hand over sheet.
If urgent investigations are needed, telephone the relevant department.
Always follow procedure when taking blood for cross-matching or group & save. Blood samples without the correct identification, i.e. full name, date of birth and hospital / NHS number will be reject-
ed by the laboratory.
4. PRE OPERATIVE & ROUTINE ADMISSIONS:
4.1. Routine admissions. Recently, there have been instances where patients with potentially life threat-ening conditions were put on the waiting list for routine / day case surgery, e.g. a patient with von Willebrand’s disease was put on Day Care list, as was a patient with a VSD who needs temporary cardiac pacing for any anaesthetic. If you see any patients needing admission who have a medical problem, it is always prudent to check with the Registrar/ Consultant to avoid unnecessary cancellations later.
All patients must be discussed with your senior colleagues before they are placed on the waiting list.
4.2. Pre-operative assessment clinic held in the Day unit is nurse led. It is there to reduce cancella-tions of patients not fit for surgery, so it has a very important function. Therefore it is absolutely vital that at pre-operative assessment clinic
- all the patients records are up to date (no letters, clinic details etc missing),
- all results of tests mentioned in these documents have been performed and the results are in the notes,
- if there are abnormal test results that have a bearing on the operation the Registrar/Consultant must be informed,
- the necessary investigations are performed
- if the patient has a condition needing admitting earlier (e.g. diabetes, lung problems etc) it is clearly stated what has to happen when the patient arrives on the ward (e.g. insulin sliding scale, chest physio etc)
If patients with problems are admitted before the day of operation it is the responsibility of the ward nurses to inform the SHO of the admission and the responsibility of the SHO to institute the appropriate treatment.
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4.3. Routine admissions for Caesarean Section arrive on Delivery Suite on the morning of the operation, unless medically indicated otherwise.
5. CONSENT & THEATRE:
No one should seek to gain consent for a procedure with which they are not familiar or for which they have received no training to take consent. The doctor should be able to answer questions about the pro-cedure and should have access to senior personnel when he / she cannot answer the questions.
The College tutor provides training for gaining consent on the commonly performed procedures in Obs & Gynae.
5.1 Following training and supervision, SHOs can gain consent for minor and intermediate operations if they are familiar with the operation; major operations or operations with which the SHO is not familiar are con-sented by the Consultant / Middle Grade.
5.2 The Theatre Scheduling Department prepare the elective operating lists. For patients undergoing
urgent/ emergency surgery, the SHO attends the main theatre and writes the details into the CEPOD list and Handover sheet. When the CEPOD list starts at 08:30am, there is agreement that two surgical manage-
ment of miscarriage.
5.3 No one is to leave the operating theatres wearing theatre shoes. Clean theatre blues with outdoor shoes are acceptable. When returning to theatre, new blues must be worn. Anybody seen outside Theatres or Delivery Suite with theatre shoes may be disciplined.
It is forbidden to attend non-clinical areas, e.g, canteen, coffee shop etc. in theatre blues.
5.4 SHOs are encouraged to perform minor surgery like surgical management of miscarriage or laparosco-pies under supervision.
However no re-do operations may be performed by an SHO.
6. GUIDELINES & PROTOCOLS:
There are guidelines on the treatment of various conditions on the Labour Ward (Obstetrics) and the Gynae Ward & Gynae Assessment Clinic/EPU. It is everybody's responsibility to familiarise themselves with these guidelines within the first two weeks.
There are also Trust guidelines on such issues as bullying, anti-harassment policy etc. These can be found on ADAGIO, the Trust’s Intranet. This is accessible from the computer on Delivery Suite (the room with the hand-over board), the Gynae Ward, EPU/GAU (and the computers in the library.
7. PAPERWORK:
All entries in notes must be timed, dated and signed. Underneath the signature, your name must be writ-ten LEGIBLY in capital letters together with your grade. It is also good practice to time all entries in the notes. It is the SHOs' responsibility to complete the paperwork on the wards, especially the electronic dis-charge . These must be done with great care as they are often the only written communication the GPs re-ceive.
Discharge letters without diagnosis or follow up arrangements are not acceptable. The discharge letters are used for coding, which is the way how the hospital is paid. The discharge letters must be done timely. Please note that the patient receives a copy of the discharge letter. This is the only source of information for
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patient and GP. It is important to provide correct and relevant information.
Use the term ‘miscarriage’ or ‘termination of pregnancy’; never use the term ‘abortion’.
Standard for record keeping:
'All professionals should make clear and adequate notes. The standard should be that which enables
a colleague coming new to the case to be properly informed.' (CESDI recommendation 5th report)
8. ULTRASOUND:
8.1. GYNAE: Juniors are encouraged to use the Ultrasound scanners to gain experience. However the pa-tients must be warned beforehand that no definite diagnosis may be made. The scan is mainly to offer reas-surance to patients where a live fetus can be demonstrated. If there is no viable pregnancy or if there is a dubious or uncertain result, no definite information must be given to the patient. The opinion of the on call Registrar/Consultant should be sought and the patient should be referred either to the Ultrasound depart-ment or the Registrar/Consultant to conduct an Ultrasound. Trainee doctors must not make the diagnosis of a miscarriage or ectopic pregnancy on Ultrasound scan on their own without the second opinion of an experienced sonographer.
8.2. OBSTETRICS: There is a scanner on Labour ward for obstetric use. Again as in Gynaecology, it is important that the patients are warned about the level of expertise of the person scanning. Provided that the patients are informed and give their verbal consent, it is acceptable to ask patients whether they would be willing to act as scanning ‘teaching material’. During such sessions no medical diagnosis may be made. The maximum time for such ‘training scans’ is 10-15 minutes.
8.3 THE ULTRASOUND PROBES of the scanners are very delicate and fragile. Not handling them care-fully can break the transducers. If there is dry old gel on the membranes this may cause cracking of the membranes and ruin the transducers. At the end of each scan the gel has to be wiped off very carefully by the user. The connection of the transducer to the cable is also a delicate point and bending the connec-tion strongly may break the cables within.
8.4 SWITCHING OFF the USS machine at the wall before it is switched off at its proper on/off button pre-vents the machine from orderly shut down. REMEMBER, Ultrasound machines are computers with a USS probe attached. Not shutting it down properly can have the result that all the original settings for the machine are lost and the machine malfunctions the next time it is used.
9. EPU (Early Pregnancy Unit)
EPU patients are either seen via A&E or directly referred to the EPU. EPU has its own folder with guidelines. If patients are seen in A&E, the EPU team should be informed by writing in the A&E card that the patient is for EPU follow up. The card should then be handed over to the A&E ward clerk. The EPU team collect the cards the next working day and they will contact the patients. Patients should
not be told to attend the EPU without an appointment.
10. SWABS:
When operating with a scrub nurse, the scrub nurse is responsible for the swab check. However we often op-erate without one, e.g. repairing episiotomies, SMM etc. In these cases, it is the responsibility of the operator to check the swabs and the sharps and the operator will be held responsible for any problems that may arise as a consequence of not following this protocol. To document the swab count a special proforma exists
on Delivery Suite
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11. TEACHING & AUDIT:
There are various teaching sessions during the week. It is important that all junior staff attend and arrive in time. If at all possible there should be no clinical responsibilities during these times to avoid interruptions and continuous paging which disturbs meetings. It is your responsibility to make sure the wards have no fur-
ther need to page you. This of course excludes emergencies / the on-call team.
There are the following teaching times:
Each Friday 2-5PM protected teaching time, Seminar Room, GOPD. This is part of the normal working week and non-attendance is viewed as absence from work. Mr El-Sayed is the lead for this.
Each 1st Friday of the month: Labour Ward Forum, where we discuss Obstetric guidelines, this is from 12:30 until 13:30, you are invited to attend.
Each Friday at 9.15AM , Gynae-Oncology MDM, Phillip Farrant Centre, this is a working cancer MDM with video links to the Maidstone Cancer Centre. This is NOT a teaching session, but you are very welcome to attend.
Gynae Risk Management Meeting.
Each month there is a half-day Audit meeting rotating through Tuesday, Wednesday and Thursday. You are expected to attend and present audit projects.
Perinatal Mortality Meeting, 3rd Tuesday of the month,12:30-13:30
Colposcopy MDM, 1st Tuesday of the month at 08:30.
Confirm venue with Jackie Hambridge x4331
12. TRAINING & ASSESSMENTS:
12.1. Training: SpRs will get the training and experience according to their SpR year and competence.
Especially we will endeavour to give the SpRs as much operating experience as possible. This means though that SHOs will get less major surgery. We will give the SHOs opportunity to get competence on ward work, outpatient clinic experience with supervision, and minor surgery. We will also teach the SHOs during the Consultant Labour ward sessions to do Caesarean sections and all the other practical procedures needed on Labour ward but SHOs must accept that we cannot necessarily train them in procedures such as hysterec-tomies.
12.2. Assessments: All SHOs and all SpRs must have their training assessment forms completed at regu-lar intervals. You have been given the forms at the beginning of your contract from Medical Staffing. It is your responsibility to arrange these meetings and get the relevant forms completed! This is part of
your contract and it is essential that you comply.
13. ROTA & HOLIDAYS:
13.1. Rota: The SHO & Middle Grade Rota is determined in advance through the partial shift system. Any changes have to be agreed by the two people swapping and notified in good time to the Rota Co-
Ordinator and the Consultants.
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13.2. Leave: SHOs and Middle Grades can swap their weeks, for SHOs so that they have more than one-week holiday in one go, for middle Grades to better accommodate their wishes. This has to be agreed be-tween the two Doctors swapping and Medical Staffing and the relevant Consultants have to be informed.
No more than ½ of the consultant body away at any one time
Strictly ‘first come, first served’ .
There should be no more than 2 Registrar grade or SHO grade doctors away at any time.
If leave has not been booked in time for the end of contract (SpRs or SHOs), the leave will lapse.
Penny Cheale, Lead Secretary, will liaise with medical staffing with regards to leave.
14. REFERRALS:
Emergency referrals from GPs or other departments usually go to the middle Grades or Consultants. If there are referrals, which are deemed unsuitable or unsafe, inform the Consultant on call so that s/he can speak to the referring doctor and decide whether to accept a patient or not.
15. UNTOWARD EVENTS / RESPONSIBILITY:
There is a maternity risk management policy that is displayed on the red risk boards in all clinical areas. The policy is also on ADAGIO. Each clinical area displays trigger lists, which should prompt an incident form. It is your responsibility to complete a form, if you are responsible for an incident. It is not the responsibility of the midwife. These forms are sent to Joanne Seymour, if obstetric, (Clinical Governance Midwifery Manager) who is based on Cedar ward; if gynaecology the forms are sent to Mr Awadzi as the Consultant responsible for Gynae risk management or to Mr Gupta, Clinical Director, or Alex Tan, General Manager. All incidents are discussed at weekly risk meetings. Any near misses are discussed at additional meetings. Any untoward inci-dents must be reported to the risk managers (Mr El’Matary (Obstetrics)/Mr Awadzi (Gynae)). This may oc-
cur in absolute confidence.
A junior doctor’s personal responsibility ends when s/he informs and involves a more senior doctor.
However, not following instructions (i.e. the SHO not doing blood gases when the Registrar suspected pulmo-nary embolus) will be viewed very dimly and such actions will then be the personal responsibility of the junior.
If ANYBODY in the department is unhappy about decisions / actions taken, s/he can approach the next in line of responsibility including the Consultant on call at home and at any time. It is better to contact seniors personally and discuss prior to recording in documentation.
16. IMPORTANT OBSTETRIC INFORMATION:
In the Antenatal notes are areas with special instructions. Any Obstetric patient with problems will have them noted there together with the relevant management plan. A failure to check this during all antenatal
encounters with a pregnant woman can cause potential problems to the woman and will be viewed with grave concern.
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Consultant Staff
Andreas Lesseps
Colposcopy, Advanced laparoscopic surgery & Hysteroscopic Surgery
Secretary: Jan Ellis Extension 8770 Email [email protected]
Annette Schreiner
Medical Director, Maternal Medicine ANC only
Secretary: Mina Smith Extension 8768 Email [email protected]
Mike Jones
Colposcopy, Vulvoscopy
Secretary: Penny Cheale Extension 8778 Email [email protected]
Rob MacDermott
Lead for RAC services. Urogynaecology, Advanced Prolapse Surgery,
Secretary: Noreen Crampton Extension 8443 Email noreen.crampton @dvh.nhs.uk
Urmila Singh
College Tutor. Colposcopy Lead. Lead for Diabetes & Pregnacy
Secretary: Julie Cook Extension 8980 Email [email protected]
Mark Waterstone
High-risk Obstetrics, CTG Training.
Secretary: Julie Hartley Extension 4331 Email [email protected]
Atef El-Matary
Fetal Medicine, HIV, Obstetric Lead
Secretary: Julie Hartley Extension 4331 Email: [email protected]
Gabriel Awadzi
Lead for EPAU & GAU. Gynae Risk Management Lead. Minimal access surgery.
Secretary: Penny Cheale Extension 8778 Email: [email protected]
Mohsen El-Sayed
Undergraduate Lead for teaching
Secretary: Chantelle Penny [email protected] Extension 8446
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Penny Cheale, Lead Secretary or Noreen Crampton can provide an up to date list of Con-
sultant lead Clinical Sessions.
Abhishek Gupta
Clinical Director, Urogynaecologist
Secretary: Rhianna Websdale [email protected] Extension 4329
Sandra Bynoe
Deanery Lead for Simulation, FGM Lead
Secretary: Mina Smith [email protected] Extension 8768