Topic outline

  • LEARNING RESOURCES

    Think:
    • Is there a role for rationing in healthcare?
    • What should I do if the best treatment for my patient is not available at my hospital ,what conflicts of responsibility may I meet in my practice? (eg family versus work)
    • Does research ever conflict with patient care?
    • What prejudices can I identify in myself? - and what can/should I do about them?
    • What prejudices can I identify in "the system", and can I do anything to help solve these?
    • How may my patient be stigmatised by their eye condition?
    • How can I show this patient that I care without being patronising?
    • How would I feel if I had their problem or if I were their relative/carer?
    • How can I know whether their feelings are different from mine?
    • How can I be an advocate for those with visual impairment, helping to combat the myths and stigma associated with it?
    Activity:
    • Initiate discussion on these issues with friends and colleagues, both medical and lay
    • Discuss day-to-day rationing issues with your trainer
    • Analyse your own motives from time to time
    • Plan research carefully and always ensure ethical approval is obtained
    • Attend the/medical ethics/bioethics teaching methodology module at your institution
    • Ensure your assessments and interventions are always patient-centered, and respectful of diversity
    Resources:

    • RECORDS

      Activity:

      • Talk to personnel in Hospital Audit and research departments
      • Attend local induction programmes
      • Contact local IT department for in-house training of EPR and/or PAS

      Resources:

      • GUIDELINES

        Think:

        • How are clinical guidelines produced?
        • What levels of evidence contribute to guidelines, and how are they differentially weighted?
        • How can guidelines influence your practice?


        Activity:

        • Check Data Protection Act 1998 and www.the-mdu.com www.medicalprotection.org and www.hospital-doctor.net
        • Be aware of Patient confidentiality guidelines (hospital, GMC and Medical Defence Union)
        • Actively seek opportunities to contribute to local and/or national evidence based guidelines
        • Check regularly for new safety guidelines from national organisations (NCEPOD, NPSA etc.)

        Resources:

        • Local  country t guidelines

          • Local Hospital charter andguidelines
          • Disease specific guidelines
          • COECSA guidelines
          • http://www.doctors.net.uk -eCME module 'good medical records

        • PORTFOLIO

          Think:

          • Why is maintaining a personal portfolio throughout your career important?


          Activity:

          • Look at the College website for what must be included (and properly labelled and assigned) in your e-portfolio
          • You should also include anything else you think is relevant to your training within your e-portfolio

          Resources:

          • INFORMATION TECHNOLOGY

            Think:

            • Keep in mind email etiquette and protocol
            • Be secure on-line and do not share personal details
            • Is email the most appropriate form of communication for the task?
            • What IT tools and databases can be used in enhancing the effectiveness and safety of my clinical practice? (e.g. clinic lists, prescribing tools, drug databases, medicolegal information etc.)
            • What is meant by "Clinical Coding" and what systems are in common use?

            Activity:

            • Make use of local IT department for training
            • Use PowerPoint or similar software regularly so as to become fully fluent in its use in presentations

            • MANAGE PATIENT REFERRALS

              Think:

              • About local hospital referral guidelines and protocol

              Activity:

              • Discuss appropriateness/guidance of referrals initially with Clinical Director/educational supervisor/senior trainee

              • WAITING LIST MANAGEMENT

                Manage waiting lists

                Activity:

                • Liaise with Admissions department and theatres
                • Carry out audit to see whether improvements can be made in theatre efficiency

                • NATIONAL DATABASES

                  Think:

                  • How can I be actively involved?
                  • How should I access reports from the databases and use them to influence my practice?

                  Resources:

                  • CRITICAL INCIDENT MANAGEMENT

                    Think:

                    • What are my responsibilities regarding Critical Incidents in which I am involved?
                    • How can I learn about management of Critical Incidents even if I am not directly involved?
                    • What can we learn from Critical Incidents to ensure they do not recur?
                    • How will serious incidents, critical events and significant events be used in revalidation


                    Activity:

                    • Approach audit and pharmacy department
                    • Be aware of critical incident form location, discuss the form with charge nurse/theatre manager
                    • Read up on root cause/significant event analysis and the role of human factors
                    • Make sure that you understand how revalidation will apply to you during training and how significant events will contribute to the ARCP process
                    • Read and ensure that you understand the guidance on revalidation from the GMC
                    • Ensure the event and reflection thereon is recorded in your e-portfolio

                    Resources:

                    • Adverse incident reporting and significant event auditing: AIR and SEA rescue BMJ Career Focus 2004;328:173-174
                    • Institute for Safe Medication Practices http://www.ismp.org
                    • Your own LETB/Deanery will have guidance on revalidation and ARCP.
                    • Hospital Standard operating procedures

                    • COMPASSIONATE APPROACH TO PATIENT CARE

                      Think:

                      ·What approach would I like my doctor to take if I were the patient?

                      ·How can I tell whether my patient would like me to take that approach?

                      ·How can I learn to tailor my approach to the patient's needs?

                      ·How can I ensure that my body language is consistent with what I say?

                      ·How can I ensure that the patient feels valued and important?

                      ·How can I ensure that lack of privacy does not adversely affect the consultation?

                      Activity:

                      ·Go on a communication course

                      ·Observe senior staff in their approach to a range of patients

                      ·Ask yourself (and them!) why they took that approach

                      ·Decide if it was the right approach - and if not, why?

                      Resources:

                      • PATIENT AUTONOMY

                        Think:

                        ·What is in the best interest of my patient?

                        ·Can I think of any situation in which I should go against this?

                        ·How am I fulfilling my role as advocate for my patient?

                        ·What should I do if the best treatment for my NHS patient is not available on the NHS?

                        ·What prejudices may I have which could adversely affect my decision?

                        ·For what reasons may a patient actively or passively, fail to comply with best advice?

                        ·How hard should I try to persuade such a patient to change their mind?

                        ·Can I continue to treat a patient who chooses not to take my advice?

                        ·What other actions should I take if a patient chooses not to take my advice?

                        ·How do I empower the patient to take responsibility for their own condition?

                        ·How should I distinguish between factual knowledge and moral values in guiding a patient to a decision?

                        Activity:

                        ·Observe how senior colleagues handle difficult decision-making

                        ·Ask them afterwards why they handled it in this way

                        ·Discuss with them how you would have handled the situation

                        ·Ask colleagues to observe you when you are in such a situation and to give you feedback on how you coped

                        Resources:

                        http://www.ethics-network.org.uk/ethical-issues/confidentiality/confidentiality

                        • PATIENT CONFIDENTIALITY

                          Think:

                          ·Why is medical confidentiality so important?

                          ·How can I ensure it is protected?

                          ·Can I use my email for patient data?

                          ·What are the Data Protection Act and Freedom of Information Act and how do they apply to me?

                          ·What is a "Caldicott Guardian"?

                          ·What is "Information Governance"?

                          ·What would be the consequences if any of my electronic devices or memory devices were stolen?

                          ·Do I carry any temporary patient data on paper? And do I look after this carefully and dispose of this appropriately?

                          ·Is my logbook appropriately anonymised and secure?

                          ·When must I obtain my patient's permission to communicate with others about her/him?

                          ·Are there any situations in which confidentiality should be breached?

                          ·What should I do if I have a patient whose vision is inadequate for driving but who insists on continuing?

                          Resources:

                          • SEEK HELP

                            Think:

                            • What sources of help can I call on? - does it always have to be my consultant?
                            • If I ask for help too often, will my consultant think I am useless and give me a bad reference?
                            • Asking for help should not be seen as a sign of inadequacy
                            • Why else might you ask for help?
                            • What other benefits are there beyond the care of the patient you are treating?
                            • (In any particular clinical situation) Is there any risk to the patient if I proceed with an uncertain management plan?
                            • Do I need to ask for help here and now? - is it urgent?

                            Activity:

                            • Discuss in advance with colleagues who can provide what sorts of advice, and what sort of problems are to be regarded as urgent
                            • When on-call, ensure you always know how to contact the next most senior member of the team
                            • Reflect on the help given to consider in which other situations similar advice might be applicable

                            • ENGAGED IN APPRAISAL AND REVALIDATION

                              Think:

                              • What is the purpose of appraisal?
                              • How does it differ from assessment?
                              • What is the purpose of revalidation?
                              • What can I gain from them which may improve my performance as an ophthalmologist?
                              • How can I best prepare for them, so as to gain the most from them?
                              • What lessons can I learn from appraisal and revalidation as a trainee which will be useful after I am accredited?

                              Activity:

                              • Ask senior trainees how they prepare - ask them to show you their portfolio, and to advise you on yours after you have started it
                              • Ask your trainer what is expected of you in this regard
                              • Try to keep up-to-date with your portfolio, don't leave it all until the night before your ARCP!
                              • Read GMC documentation on revalidation and keep up-to-date with changes and developments
                              • When you are a more-senior trainee go on a course for appraisers and then ask to get involved in the appraisal of others - and seek constructive feedback

                              Resources:

                              • EQUALITY AND ETHICS

                                Think:

                                • Is there a role for rationing in healthcare?
                                • What should I do if the best treatment for my patient is not available on the NHS?
                                • What conflicts of responsibility may I meet in my practice? (eg family versus work)
                                • Does research ever conflict with patient care?
                                • What prejudices can I identify in myself? - and what can/should I do about them?
                                • What prejudices can I identify in "the system", and can I do anything to help solve these?
                                • How may my patient be stigmatised by their eye condition?
                                • How can I show this patient that I care without being patronising?
                                • How would I feel if I had their problem or if I were their relative/carer?
                                • How can I know whether their feelings are different from mine?
                                • How can I be an advocate for those with visual impairment, helping to combat the myths and stigma associated with it?

                                Activity:

                                • Initiate discussion on these issues with friends and colleagues, both medical and lay
                                • Discuss day-to-day rationing issues with your trainer
                                • Analyse your own motives from time to time
                                • Plan research carefully and always ensure ethical approval is obtained
                                • Go on an "Equality and Diversity" course - it will probably be essential when you become a trainer yourself
                                • Ensure your assessments and interventions are always patient-centered, and respectful of diversity

                                Resources:

                                • PROBITY

                                  Think:

                                  • What does "probity" mean?
                                    • Dictionary definition
                                    • For me in practice
                                  • Have I slipped up integrity-wise in the past?
                                  • Is there anything I do now which could be interpreted as showing dubious probity?
                                  • What conflicts of interest have I met so far in my career, or might I meet in future?
                                  • What should I do if ethics and values are compromised, e.g. my patient's interests seem to conflict with the interests of my research, my employer, my colleagues, my family or myself?
                                  • Am I always honest about my mistakes, with patients and colleagues?

                                  Activity:

                                  • Talk these issues over with colleagues (both medical & non-medical) and your trainer
                                  • Take part in ethical discussions and forums
                                  • Check through your financial interests and ensure there are no conflicts here
                                  • Ensure that all research is fully "ethics-approved"
                                  • Ensure mistakes are always treated as learning opportunities
                                  Resources:

                                  • PRACTICE ACCORDING TO NATIONAL LEGAL REQUIREMENTS

                                    Think:

                                    • What actually are the duties of doctor?
                                    • How do these apply to me in my everyday practice?
                                    • What duties, rights and responsibilities do I have as an employer (where relevant) or co-worker? (regarding safety of fellow staff as well as patients)

                                    Activity:

                                    • Think about a doctor you admire. What is it about the way they interpret and fulfil their duties which appeals to you - and how can you best emulate them?
                                    • Talk these issues over with colleagues (both medical & non-medical) and your trainer
                                    • What disciplinary processes may be used against me in the event of malpractice either in clinical or medicolegal practice?

                                    Resources:

                                    • DATA PROTECTION

                                      Think:

                                      • In what circumstances may I be at risk of offending under this law?
                                      • What sort of data is protected?
                                      • What should I do if I need to collect personal data?
                                      • Who can give me advice?

                                      Activity:

                                      • Discuss the issue with your trainer or a senior member of the IT department
                                      • Read your Trust's IT policy
                                      • Find out who is your Trust's Caldicott Guardian and talk to her/him about any problems
                                      • Ensure that you always seek Trust approval and ethics committee approval for any research

                                      Resources:

                                      • National institutes of medical records websites
                                      • National medical councils

                                      • HUMAN TISSUE

                                        Think:

                                        • In what circumstances may my research ideas put me at risk of breaking the law on human tissue?
                                        • What are my responsibilities when I am seeking/obtaining/using donor tissue?

                                        Activity:

                                          • Talk to your local transplant coordinator
                                          • Always ensure that your research projects are properly approved
                                          • If you intend to retrieve donor tissue yourself, make sure you go on a suitable course first or are trained by someone who has been on a course
                                        Resources:


                                        • Child Protection and Safe Guarding

                                          Think:
                                            • Why should I take an interest in this subject?

                                            • When should I be on the lookout for signs of abuse/neglect?

                                            • Who can I turn to for urgent help on this matter?

                                            • What should I do if I am asked to examine a potentially abused patient?

                                          Activity:
                                            • Read up about safeguarding issues

                                            • Ensure you comply with mandatory Trust training and certification on safeguarding

                                            • Invite a senior paediatrician to come and talk to your local postgraduate meetings

                                            • Talk to your paediatric and general medical colleagues about these issues before you have to deal with them yourself

                                            • Talk to your medical defence society immediately if you have any concerns which you cannot resolve with local help

                                          Resources:
                                          • Time Management

                                            Think:

                                            • Do I ever waste time?

                                            • When did I last find it difficult to fit everything I had to do into the time available?

                                            • How did I cope on that occasion? - Could I have done better, and if so, how?

                                            • When time is short at work, which activities should I give priority to?

                                            • How can I avoid offending others when I do not have time for them?

                                            • What is my reaction when colleagues are too busy to help me?

                                            • What situations do I find stressful? Why?

                                            • Is it possible for me to avoid such situations without shirking my responsibilites?

                                            • When it is not possible what should I do?

                                            • When is it appropriate to delegate tasks to others, or simply to ask for help?

                                            • What matters to me most in my life?

                                            • Do I take enought physical exercise?

                                            Activity:

                                            • Talk to colleagues and trainers about how they cope with shortage of time and/or stress

                                            • Watch how they actually cope in such situations

                                            • Think of a time when you think you coped badly and try to work out what you should have done - discuss with colleagues if necessary

                                            • Remind yourself from time to time that everyone finds this sort of thing difficult

                                            • Enrol on a time management course, and/or ask your programme director to arrange one for you and your colleagues

                                            Resources:

                                            • Reflective practice

                                              Adopts reflective practice

                                              Introduction:

                                              All trainees must be able to adopt the principles of reflective practice. They must maintain a reflective diary as part of their portfolio and use this in their appraisals.

                                              Think:

                                              • What information do I need to keep for my training portfolio?

                                              • How often should I update the information?

                                              • Who acts as guarantor of accuracy of the information, apart from myself?

                                              • How often should I arrange a portfolio review with my trainer?

                                              • Have I got adequate backup information if the portfolio is lost/damaged?

                                              Resources:

                                                • Self learning

                                                  Introduction:

                                                  All trainees must be able to identify and respond to their learning needs. They must be able to prepare and follow a learning plan. They must utilise all learning opportunities that are made available.

                                                  Think:

                                                  • How do I learn, to best effect?

                                                  • Who will tutor me, and in what kind of learning environment?

                                                  • How do I arrange a programme of learning for any given task?

                                                  • How often should I meet with and discuss my progress with my Educational Supervisor?

                                                  Resources:

                                                  • Career development

                                                    Introduction:


                                                    All trainees must take responsibility for their own career development with the support and guidance of the educational supervisors.

                                                    Think:

                                                    • Is my clinical training delivering the educational targets I need to complete the requirements of Higher Specialist Training?

                                                    • Am I aware of what those targets are and the recommended timing of acquisition of clinical skills

                                                    • Do I need targeted retraining in any specific subspecialty field?

                                                    Resources:


                                                      • Continous professional development

                                                        Introduction:

                                                        All trainees must show that they actively participate in continuing professional development.

                                                        Activity:

                                                        • Maintain and keep up to date a clinical and learning activities portfolio

                                                        • Ensure regular, recorded and verified attendance at postgraduate teaching opportunities

                                                        • Ensure reasonable spread of subspecialty specific and non-specialty generic learning activities

                                                        • Ensure that you keep up to date with therapeutic alerts etc.

                                                        Resources:


                                                        • Career development

                                                          Introduction:


                                                          All trainees must take responsibility for their own career development with the support and guidance of the educational supervisors.

                                                          Think:

                                                          • Is my clinical training delivering the educational targets I need to complete the requirements of Higher Specialist Training?

                                                          • Am I aware of what those targets are and the recommended timing of acquisition of clinical skills

                                                          • Do I need targeted retraining in any specific subspecialty field?

                                                          Resources:


                                                          • Personal Health

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                                                            Introduction:

                                                            All trainees must take responsibility for their own personal health and well-being. They must take appropriate steps to protect patients when their own health is affected by illness or disability.

                                                            Think:

                                                            • Is my personal physical and mental health in any way compromised in such a way that delivery of clinical care to my patients is at risk?

                                                            • Do I need to seek the advice of colleagues, educational supervisors, occupational health, etc, for advice on my fitness to practice?

                                                            • Has my fitness to practice ever been called into question?

                                                            Resources: