Topic outline

  • UNDERSTAND HOW THE HEALTH SERVICE IS ORGANISED

    Introduction:

    The ophthalmologist needs a good level of understanding of the way in which the Health Service is organised and managed, to include the interaction between major organisations such as the Department of Health, General Medical Council, the various Royal Colleges, and the primary and secondary healthcare delivery organisations.

    Think:

    • Who is ultimately responsible for the running of the Health Service?
    • What are the roles and responsibilities of the Department of Health?
    • How do Primary and Secondary Care Trusts relate to the DOH, and how is health care "purchased"?
    • What are the roles of the NHS commissioning board and the NHS confederation?
    • What do I know about NHS targets and how should I respond?
    • What are the roles and responsibilities of the GMC and the various Royal Colleges?
    • Which regulatory agencies are involved in the licensing and use of drugs and instruments, and what are their roles?
    • How do doctors, nurses, managers and patients have an input into the running of the National Health Service?
    • What are the differences in health legislation between the four UK countries and how does that affect my patient?
    • How does teaching fit into the role of the NHS and what other institutions are involved?

    Activity:

    • Read up from the study resources below.

    Resources:

    • UNDERSTAND THE PRINCIPLES OF CLINICAL GOVERNANCE

      Introduction:

      The ophthalmologist needs a good level of understanding of the principles of clinical governance. The ophthalmologist must have an appreciation of the application of clinical governance principles to their own practice.

      Think:

      oWhat is Clinical Governance?

      oHow is the quality of the delivery of clinical care assured?

      oHow do Clinical Governance principles respond when quality of clinical care is found to be below standard?

      oWhat are the principles of risk assessment and risk management?

      oHow can patient management pathways be best organised to ensure a failsafe system?

      oWhat is my role in ensuring that correct site procedures are performed?

      oWhat is my responsibility regarding others in the healthcare team whom I perceive to be a cause for concern?

      oIn practice, what does a "no-blame culture" mean to me?

      oWhat is the mechanism in my Trust for reporting of Critical Incidents and Serious Untoward Events?

      oWhat is a never event?

      oWhen should I "whistle blow" when I see evidence of seriously unsafe practice, and from whom should I seek advice before doing so?

      Activity:

      oRead up from the study resources below.

      oMake sure you attend, and actively contribute to, your department's audit/clinical governance/mortality and morbidity meetings.

      oAsk to be actively involved in the assessment and management of a Critical Incident or a Serious Untoward Event in your department and reflect on this in your e-portfolio diary.

      oEnsure you are a member of a medical defence society and be prepared to seek advice from them when potentially serious matters come to your attention

      Resources:

      owww.dh.gov.uk/PolicyAndGuidance/HealthAndSocialCareTopics/Cli nicalGovernance/fs/en

      oDiabetic Retinopathy Screening Programme Failsafe document http://www.retinalscreening.nhs.uk/pages/default.asp?id=7&sID=124

      oMedical Defence Union (MDU) at www.themdu.com

      oMedical Protection Society (MPS) at www.medicalprotection.org/uk

      oMedical and Dental Defence Union of Scotland (MDDUS) at www.mddus.com/mddus/home.aspx

      oGeneral Medical Council website http://www.gmc-uk.org/guidance/good_medical_practice.asp

      • PROFESSIONAL RELATIONSHIPS

        Introduction:

        The ophthalmologist should understand the importance of maintaining effective professional relationships with all other health professionals where there might be shared care of a patient's clinical problem. These relationships extend to other medical, nursing and paramedical colleagues, as well as to members of lay bodies, where those bodies have a legitimate interest in a patient's medical care.

        Think:

        ·What other medical, nursing, paramedical and lay persons/bodies have a role in the delivery of care to my patient?

        ·How best can I actively seek the views of other professionals?

        ·How should I best maintain the professional relationships between us to optimise the treatment of my patient?

        ·What do I do if that relationship fails or breaks down?

        ·Who is responsible for restoring clinical and other links between the various interested parties?

        ·How can I best give other professionals and lay bodies the benefit of my knowledge and expertise as a doctor?

        Activity:

        ·Read up from the study resources below.

        Resources:

        ·www.gmc-uk.org/guidance/good_medical_practice/index.asp#Wor king%20with%20Colleagues

        • LEADER/TEAM WORKING

          Introduction:

          The ophthalmologist should understand his role as the leader of a clinical team, involving nursing, paramedical and other workers involved in the clinical management of a patient under his care. He or she should acknowledge his part in multidisciplinary medical management, and be aware of and sensitive to the priorities of sometimes conflicting management strategies in the treatment of patients with multisystem disease.

          Think:

          ·What are the responsibilities of a clinical team leader?

          ·What are my responsibilities as patient advocate in relation to the team?

          ·How do I ensure the cohesion and efficient functioning of the team?

          ·In particular, how can I encourage good team dynamics, especially ensuring that all members contribute, and build and maintain good relationships within the team?

          ·How can I demonstrate that I am ready to take on a leadership role within the team?

          ·As the leader, how can I ensure that I am accessible to team members?

          ·How do I identify and remedy breakdowns in team effectiveness sensitively and assertively? Especially in regard to unprofessional behaviour, bullying and/or harassment, and conflict management.

          ·Am I aware of national and local regulations and protocols that govern our action in the health service, not just as an individual but within a team?

          ·How can I actively promote professional activities and values?

          ·In what circumstances should I accept that the team has different opinions to mine and what attitude should I take on such occasions?

          ·How can I appropriately praise staff when they do well?

          ·How can I best identify when other team members are struggling or failing, or under stress (e.g. with patients receiving bad news), and how can I best support them?

          ·How can I encourage a whole-team approach to patient safety?

          ·How do I ensure that new staff are properly inducted and that no-one practices beyond their capabilities?

          Activity:

          ·Explore leadership styles and prejudices with colleagues and trainers in a peer-learning environment, and discuss these where relevant in CbD.

          ·Seek opportunities to act in a leadership role under the supervision of more senior colleagues e.g. running a theatre list, chairing a meeting, organising a teaching session

          ·Reviewing or introducing a change in practice in your team/unit

          ·Where appropriate, get feedback using the North Western Deanery Learning Development Tool (LDT)

          ·Read up from the study resources below.

          Resources:

          ·http://www.bristol-inquiry.org.uk/final_report/report/sec2chap22_10.htm

          ·https://www.nwpgmd.nhs.uk/medical-leadership/leadership-development-tools

          ·Executive summary of the Francis report http://www.midstaffspublicinquiry.com/

          Assessment:

          ·Case Based Discussion

          ·https://www.nwpgmd.nhs.uk/medical-leadership/leadership-development-tools

          • ROLE AS A RESEARCHER

            Introduction:

            The ophthalmologist should understand the importance of research in the field of ophthalmology, and seek to promote it wherever possible.

            Think:

            ·What is research?

            ·Do I need to obtain some research skills in order to understand research publications?

            ·What sort of research can I do?

            ·Where do I get ideas for research from?

            ·What do I know about research ethics and the law in relation to research?

            Activity:

            ·Attend a research skills course

            ·Contact your local research ethics committee.

            ·Contact your Trust R&D department

            ·Read published research

            ·Attend journal clubs

            ·Ask others if there are any projects you can join

            ·Discuss research ideas with your trainers

            ·Seek opportunities to contribute to clinical trials through ophthalmology UK Clinical Researtch Network (UKCRN) in centres during your training

            Resource:

            ·http://www.dh.gov.uk/en/Managingyourorganisation/Informationpolicy/Patientconfidentialityandcaldicottguardians/DH_4100563

            ·http://www.gmc-uk.org/guidance/ethical_guidance/research.asp

            ·International Conference on Harmonisation - Good Clinical Practice (ICH-GCP) training, which can be done online

            Reflect:

            ·How could that published research project have been carried out differently?

            ·What sort of research questions have been left unanswered?

            • ROLE AS A TEACHER

              Introduction:

              The ophthalmologist should understand the importance of teaching and be able to make a positive contribution to the undergraduate and postgraduate development of doctors, nurses and paramedical staff in the field of ophthalmology.

              Think:

              ·How do I learn to best effect?

              ·What opportunities are there for teaching others?

              ·How can I optimise the teaching of others in different settings?

              ·What is the optimum way of teaching others?

              ·What teaching aids do I need, and where can I source them from?

              ·What skills do I need to be a good trainer?

              ·Are there any "training the trainer" courses I could attend?

              ·How can I ensure that patient safety if maintained as I teach others?

              ·What are the forms of assessment (formative, summative) and what are their roles in medical education? (especially work-place based assessment)

              ·How can I contribute to the organisation of teaching and training in my unit?

              ·What should I do if I become aware of a trainee in difficulty?

              ·How should the needs of service and training be balanced?

              ·How can I receive feedback on my teaching and training?

              Activity:

              ·Seek opportunities to teach junior colleagues, students and allied professionals

              ·Contribute to the organisation of training in your unit

              ·Seek opportunities to act as a mentor e.g. to medical students

              ·Speak to your College Tutor about taking on the role of Associate College Tutor

              Resources:

              ·www.rcophth.ac.uk/trainingthetrainers

              ·https://www.nwpgmd.nhs.uk/medical-leadership/leadership-development-tools

              ·GMC accreditation of trainers

              • ROLE AS A MANAGER

                Introduction:

                The ophthalmologist should acknowledge the role of medical staff in medical management, and should be able, where necessary and where called upon, to make a positive contribution to the management of departments, Trusts and the wider community for the better delivery of ophthalmic health care.

                Think:

                ·What are the objectives and roles of medical managers in my trust?

                ·Why is it important for me to be involved?

                ·Where can I obtain training in medical management techniques?

                ·What is my responsibility and role in ensuring efficient and effective use of resources?

                ·What role can I play in appraising other staff and ensuring they are playing their full role in meeting service objectives?

                ·Should I consider a higher qualification in medical management? If not, how involved should I be?

                ·What sort of risks does a service face on a day-to-day basis?

                ·What techniques can be used to assess risks associated with a proposed change in service provision and modification of clinical services?

                ·How can risk be reduced?

                ·Where can I obtain human factors or patient safety training?

                ·What are my responsibilities in regard to the development and maintenance of a safe environment for patients and staff?

                ·When should I consider involving medical regulatory bodies?

                ·Do I know how to report serious issues within my trust?

                ·What regulations cover cover statutory rest periods and what part can I play in ensuring they are satisfied?

                ·How can I ensure that there is appropriate involvement of patients and the public in the management of my department?

                Activity:

                ·Seek opportunities to work with a manager to identify risks associated with a proposed change in service provision

                ·Discuss with colleagues how procedures and processes can be modified to improve patient and staff safety

                ·Try and attend management meetings e.g. subspecialty or unit service meetings and contribute

                Resources:

                ·http://www.gmc-uk.org/publications/gmc_today/gmc_today_june08/management_matters.asp

                ·http://www.dh.gov.uk/en/Aboutus/MinistersandDepartmentLeaders/ChiefMedicalOfficer/CMOPublications/QuoteUnquote/DH_4102564

                ·http://www.gmc-uk.org/guidance/current/library/management_for_doctors.asp

                • APPLY CLINICAL REASONING USING AN EVIDENCE BASED APPROACH

                  Make decisions by applying appropriate and clear reasoning using evidence based approach

                  Think:

                  • How can I apply critique and analytical methods to published research?
                  • How best can I keep myself up-to-date with relevant clinical evidence?

                  Activity:

                  • Ensure you discuss evidence for your decisions informally with trainers and fellow trainees, and especially when undertaking CbD assessments
                  • Make use of hospital and departmental library
                  • Make use of e-learning resources, especially e-learning for health (www.e-lfh.org.uk) and any others.
                  • Arrange and participate in journal clubs

                  Resources:

                  • Textbook of Evidence based Ophthalmology- available in hardcopy, PDA and PC (PDF)
                  • BMJ Clinical Evidence
                  • NHS Evidence (including Cochrane Library) www.evidence.nhs.uk
                  • Evidence based medicine- How to Practice and Teach EBM. David L Sackett, et al
                  • Cogni-Q- PDA based data updated frequently www.unboundmedicine.com

                  Assessment :

                  Case based discussion

                  • DEPARTMENTAL AUDIT

                    Participate in departmental audit and understands its value in improving practice.Audit is an essential component of clinical governance. All ophthalmology departments are required to undertake a review of the clinical services they provide. The review should compare these clinical services to a defined standard. The standards used might be published by international and national bodies, commissioners, the Trust or agreed as best practice in the department. 

                    Think:

                    • Which audit standards can be applied to clinical practice in your department?
                    • What were the results of any audits carried out in your department?
                    • Were the recommendations identified from the audit implemented?
                    • Which areas of clinical practice lend themselves to audit?
                    • How can I ensure that patient feedback on service provision is obtained and incorporated into departmental processes?
                    • What methods of data collection are available to me?
                    • How can audit improve practice?
                    • What is the "audit cycle"?


                    Activity:

                    • Approach and discuss ideas with supervising Consultant and local audit department
                    • Read about the principles of audit
                    • Identify the clinical lead for audit in your department
                    • Get involved in any current audits that are taking place
                    • Present a departmental audit to the clinical team and upload your presentation to your e-portfolio (your educational supervisor, programme director or clinical audit lead must validate this)
                    • Organise the introduction of recommendations from an audit
                    • Complete the audit loop by reviewing changes in practice that have occurred as a result of the last audit
                    • Submit a poster of your audit to a local or national conference e.g. the RCOphth annual Congress/ COECSA CONGRESS
                    • Upload an audit to your e-portfolio describing your contribution to the process (no more than 3 trainees can claim a significant contribution to an audit (your educational supervisor, programme director or clinical audit lead must validate the audit document)
                    Resources:
                      • Still needed

                    • PERSONAL AUDIT


                      • HEALTH ECONOMICS/MANAGING RESOURCES

                        • PREPARE MONITORING AND EVALUATION TOOLS OF PROJECTS