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Core Curriculum: CiP 10

Capability in Practice 10: The doctor is competent in recognising, assessing and managing emergencies in obstetrics.

This CiP is grouped under Professional Identity 3: Clinical Expert

 

Key Skills

Descriptors

Manages pain and bleeding in the obstetric person

  • Performs focused history, appropriate examination and orders appropriate investigations.
  • Establishes fetal wellbeing.
  • Formulates a differential diagnosis.
  • Discusses diagnosis in a sensitive manner.
  • Formulates an appropriate and individualised management plan taking into account patient preferences and the urgency required.

Manages concerns about fetal wellbeing prior to labour

  • Appropriately assesses concerns regarding fetal movements.
  • Can use appropriate investigations to confirm the loss or death of a baby.
  • Discusses the diagnosis in a sensitive manner and recognises in cases where a baby has died the psychological impact on an individual and their family.
  • Is able to sensitively discuss management options where the death of a baby has occurred.
  • Can provide a supportive environment and signpost to relevant support services for an individual and her partner who have suffered the loss of a baby.

Manages suspected pre-term labour/ruptured membranes

  • Performs focused history, appropriate examination and orders appropriate investigations.
  • Establishes fetal wellbeing.
  • Discusses findings in a sensitive manner.
  • Formulates an appropriate and individualised management plan taking into account patient preferences and the urgency required.
  • Aware of additional issues at extremes of viability including ethical concerns and additional therapies which may be of benefit.

Manages labour

  • Demonstrates understanding of the physiology of labour.
  • Is aware of situations where labour may be more complex such as multiple pregnancy.
  • Uses history and clinical signs to anticipate possible problems.
  • Can formulate safe management plans taking into account the woman’s preferences.
  • Can succinctly explain management plans to women and birthing partners.

Manages intrapartum fetal surveillance

 

  • Can use intrapartum fetal surveillance strategies to help assess risk.
  • Can recognise abnormal fetal heart rate patterns, perform and interpret related tests.
  • Communicates concerns effectively and sensitively with colleagues, women and birthing partners.

Manages induction and augmentation of labour

  • Can formulate safe management plans for induction and augmentation taking into account the woman’s preferences.

Manages emergency birth and immediate postpartum problems

  • Can recognise when birth may need to be expedited.
  • Communicates concerns and recommendations effectively and sensitively with colleagues, women and birthing partners.
  • Formulates an appropriate and individualised management plan taking into account patient preferences and the urgency required.
  • Demonstrates the skills needed to facilitate safe operative birth.
  • Demonstrates skills in managing problems arising immediately postpartum.

Manages maternal collapse and people who are acutely unwell in pregnancy

  • Demonstrates prompt assessment of acutely deteriorating patient.
  • Performs procedures necessary in emergency situations.
  • Escalates to senior colleagues and other specialities.

Manages labour ward

 

  • Demonstrates leadership skills within the multidisciplinary team, anticipating problems, prioritising and managing obstetric care.
  • Recognises limitations and escalates care to senior colleagues and other specialities when appropriate.
  • Ensures continuity of care, effective handover and appropriate discharge plan.
  • Manages complex problems, including liaison with, and referral to, other specialties where appropriate. 
  • Demonstrates the skills to sensitively explain unexpected events of labour and birth and anticipates where later debrief may be necessary.

 

Evidence to inform decision

  • OSAT
  • CbD
  • Mini-CEX
  • MRCOG
  • Reflective practice    
  • TO2 (including SO)
  • NOTSS
  • Local and Deanery Teaching
  • RCOG eLearning
  • MRCOG Part 2

 

Mapping to GPCs

Domain 1: Professional values and behaviours
Domain 2: Professional skills

  • Practical skills
  • Communication and interpersonal skills
  • Dealing with complexity and uncertainty
  • Clinical skills (history taking, diagnosis and management, consent; humane interventions; prescribing medicines safely; using medical devices safely; infection control and communicable diseases)

Domain 3: Professional knowledge

  • Professional requirements
  • National legislative structure
  • The health service and healthcare systems in the four countries

Domain 4: Capabilities in health promotion and illness prevention

Domain 5: Capabilities in leadership and teamworking

Domain 6: Capabilities in patient safety and quality improvement

  • Patient safety
  • Quality improvement

Domain 7: Capabilities in safeguarding vulnerable groups