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Knowledge Area 1 – Clinical skills

Capability in practice (CiP)

1: The doctor is able to apply medical knowledge, clinical skills and professional values for the provision of high-quality and safe patient-centred care

2: The doctor is able to successfully work within health organisations

6: The doctor takes an active role in helping self and others to develop

13: The doctor is able to champion the healthcare needs of people from all groups within society

14: The doctor takes an active role in implementing public health priorities for women and works within local, national and international structures to promote health and prevent disease

 

Summary Knowledge Requirements

PART 1 MRCOG

  • Patterns of symptoms and understand the importance of risk factors
  • Pathological basis for physical signs and clinical investigation
  • How to interpret results of clinical investigations

PART 2 MRCOG

  • Understand the important elements in an obstetric and gynaecological history
  • Understand the principles and legal issues surrounding informed consent, with particular awareness of the implications for the unborn child, post mortem examinations, consent to surgical procedures including sterilisation, parental consent and Fraser guidelines and medical certification.

PART 3 MRCOG

  • Take an obstetric and gynaecological history
  • Communicate effectively
  • Take notes concisely and accurately
  • Justify investigations and interventions
  • Critically interpret clinical findings and results of investigations
  • Critically discuss management options
  • Present a balanced view of the risks and benefits of interventions
  • Making an appropriate introduction explaining their name, role, purpose of interaction and establishing a rapport
  • Taking a concise, relevant history using a blend of mainly open and some closed questions, demonstrating a logical and clearly reasoned style of questioning
  • Empathy, active listening, responding to patient cues
  • Identifying and managing communication barriers including the use of interpreters
  • Giving information in manageable amounts using patient-friendly language, avoiding jargon and explain clinical terms
  • Encouraging dialogue and shared decision making
  • Negotiating skills but demonstrating respect for patient autonomy in decision making including when decisions are made against medical advice
  • Acknowledging and addressing patient’s concern
  • Taking informed consent including an awareness of mental capacity
  • Maintaining patient dignity at all times
  • Ensuring appropriate use of chaperones for intimate examinations, maintaining dignity at all times and being sensitive to cultural and religious issues

 

Detailed Knowledge Requirements

  • Define the patterns of symptoms and identify risks factors in women presenting with obstetric and gynaecological problems
  • Comprehend the different elements of history taking
  • Recognise that patients do not present their history in a structured fashion
  • Recognise that the woman’s wishes and beliefs and their history should inform examination, investigation and management
  • Understand the importance and conventions of accurate clinical note keeping
  • Know the relevance of data protection
  • Understand clinical priorities according to urgency and importance
  • Understand that effective organisation, prioritisation and delegation is key to time management
  • Understand the importance of prompt investigation, diagnosis and treatment in disease and illness management
  • Understand the roles, competencies and capabilities of other professionals and support workers
  • Understand that some factors adversely affect team performance. Have knowledge of methods to rectify issues.
  • Understand the components of effective collaboration and team working
  • Understand the roles and responsibilities of members of the healthcare team
  • Understand the components of effective verbal and non-verbal communication
  • Structure a consultation appropriately
  • Importance of the woman’s background, culture, education and preconceptions (beliefs, ideas, concerns, expectations) to the process
  • Outline the impact of healthcare beliefs, culture and ethnicity in presentations of physical and psychological conditions.
  • Outline health needs of particular populations; e.g. the elderly, ethnic minorities
  • Be aware that the way in which bad news is delivered to a patient can affect them for the rest of their life in terms of emotions, perception of the condition and their ability to cope. It also irretrievably affects the subsequent relationship with the patient
  • Aware that every patient may require different levels of explanation and have different responses and way of coping with bad news
  • Aware that bad news is confidential but the patient may wish to be accompanied
  • Aware that once the news is given, patients are unlikely to take anything subsequent in, so a further appointment should be made for soon afterwards
  • Aware that ‘breaking’ bad news can be extremely stressful for the professional involved
  • Aware that, as with all clinical encounters, the interview at which bad news is given will be an educational opportunity
  • Know that bad news may be expected or unexpected and it cannot always be predicted
  • Know that sensitive communication of bad news is an essential part of professional practice
  • Know that bad news has different connotations depending on the context, individual, employment, social and cultural circumstances
  • Understand the need for a targeted and relevant clinical examination
  • Understand the pathophysiological basis of physical signs, both positive and negative
  • Understand the indications, risks, benefits and effectiveness of investigations
  • Comprehend constraints to performing physical examination and strategies that may be used to overcome them
  • Comprehend the limitations of physical examination and the need for adjunctive forms of assessment to confirm diagnosis
  • Recognise that use of a chaperone in obstetrics and gynaecology is always recommended
  • Define the steps of diagnostic reasoning
  • Conceptualise the clinical problem in a clinical and social context
  • Recognise how to use expert advice, clinical guidelines and algorithms
  • Be aware of and maintain an up to date knowledge of research evidence regarding the most important determinants of health
  • Know how to access and use local health data
  • Know how to access resources for community action and advocacy (e.g. resources, legislation, policy documents).
  • Action plans and post procedural rehabilitation and re-integration guidance
  • Recognise and appropriately respond to sources of information accessed by patients
  • Define the concepts of the natural history of disease and assessment of risk
  • Awareness of evidence-based guidance on return to work times
  • Able to define the role of rehabilitation and the role of support services and the multidisciplinary team to facilitate long-term care
  • Outline the concept of quality of life and how this can be measured whilst understanding the limitations of such measures for individual patients
  • Outline the concept of patient self-care and the role of the expert patient
  • Understand and be able to compare and contrast the medical and social models of disability
  • Know about the key provisions of disability discrimination legislation
  • Understand the relationship between local health, educational and social service provision, including the voluntary sector
  • Understand different methods of ethical reasoning to come to a balanced decision where complex and conflicting issues are involved
  • Be aware of the indications, contra-indications, adverse effects, drug interactions and dosage of commonly used drugs in obstetrics and gynaecology practice
  • Have a familiarity of the range of adverse drug reactions to commonly used drugs, including complementary medicines
  • Be aware of the potentially adverse effects of medication on performance and safety at work
  • Know the range of drugs requiring therapeutic drug monitoring and interpret results
  • Define the effects of age, body size, organ dysfunction and concurrent illness on drug distribution and metabolism relevant to the trainee’s clinical practice
  • Understand the roles of regulatory agencies involved in drug use, monitoring and licensing e.g. NICE, Committee on Safety of Medicines, Medications and Healthcare Products Regulatory Agency (MHRA) and hospital formulary committees
  • Understand the importance of non-medication based therapeutic interventions including the legitimate role of placebos
  • Understand specific legal issues about consent in under 16-yr olds, and vulnerable adults
  • Understand the implications of the Sexual Offences Act 2003
  • Be aware of diversity
  • Be aware of the implications of the legal status of the unborn child
  • Understand appropriateness of consent to post mortem examination
  • Outline the procedures for seeking a patient’s consent for disclosure of identifiable information
  • Understanding the ethical and legal issues surrounding female genital mutilation (FGM)
  • Understanding the ethical and legal issues of organ donation
  • Be aware of relevant strategies to ensure confidentiality
  • Outline and follow the guidance given by the GMC on confidentiality
  • Be aware when confidentiality might be broken
  • Understand the principles of data protection including electronic and administrative systems
  • Understand that interpreters and patient advocates must be aware of confidentiality issues
  • Recall the obligations for confidentiality following a patient’s death
  • Know that all decisions and actions must be in the best interests of the patient
  • Understand the legislative framework within which healthcare is provided in the UK and/or devolved administrations, in particular:
  • death certification and the role of the Coroner/Procurator Fiscal;
  • child protection legislation;
  • mental health legislation (including powers to detain a patient and giving emergency treatment against a patient’s will under common law);
  • withdrawing and withholding treatment;
  • decisions regarding resuscitation of patients;
  • surrogate decision making;
  • organ donation and retention;
  • communicable disease notification;
  • medical risk and driving;
  • Data Protection Act and Freedom of Information Act;
  • provision of continuing care and community nursing care by a local authorities
  • Understand that there are differences between health-related legislation in the four countries of the UK and know the legislation as it relates to the country in which you practice
  • Understand sources of medical legal information
  • Understand disciplinary processes in relation to medical malpractice
  • Understand the procedure to be followed when personal health and substance abuse is suspected
  • Ensure that all decisions and actions are in the best interests of the patient and the public good
  • Be familiar with and uphold the rights of children and vulnerable adults
  • Be familiar with and uphold the rights of disabled people to participate in healthy and rewarding employment
  • Practise in accordance with an appropriate knowledge of contemporary legislation
  • Act with appropriate professional and ethical conduct in challenging situations.
  • Know the legal responsibilities of completing maternity, birth, sickness and death certificates
  • Understand abortion certificates HSA 1 and HSA 4, and be aware of exemptions for those who will not participate in abortion services for moral or religious reasons
  • Know the types of deaths that should be referred to the Coroner/Procurator Fiscal
  • Understand the principles of advance directives and living wills
  • Be aware of the indications for section under the Mental Health Act (1983)
  • Outline the principles of the Mental Capacity Act
  • Demonstrate knowledge of the professional, legal and ethical codes of the GMC, e.g. Fitness to Practice and any other codes pertaining to obstetrics and gynaecology
  • Be aware of prejudice and preferences within self, others, society and cultures
  • Beware of the define the standards of practice defined by the GMC when deciding to withhold or withdraw life-prolonging treatment
  • Outline the main methods of ethical reasoning: case-based reasoning, the justification of decision and moral judgment
  • Know the overall approach of value- based practice and how this relates to ethics, law and decision-making
  • Principles of effective negotiation
  • Characteristics and phase of negotiation
  • Tips and tactics for influencing others and arriving at win-win situation
  • Techniques in assertion and persuasion
  • Understanding yourself, how conflict arises and the principles for resolution
  • Respect diversity and recognise the benefits it may bring, as well as associated stigma
  • Be aware of the possible influence of and sensitively include questions about socio-economic status, household poverty, employment status and social capital in taking a medical history
  • Assess the patient’s ability to access various services in the health and social system and offer appropriate assistance
  • Help to empower patients and negotiate complex systems to improve health and welfare including, where appropriate, the right to work
  • Where values and perceptions of health and health promotion conflict, facilitate balanced and mutually respectful decision-making
  • Identify and communicate effectively with influential decision-makers/ facilitators of change.
  • Understand the implications of disability discrimination legislation for healthcare
  • Recognise how health systems can discriminate against patients from diverse backgrounds, and how to work to minimise this discrimination. For example in respect of age, gender, race, culture, disability, spirituality, religion, and sexuality
  • Recognise the stigmatising effects of some illnesses and work to help in overcoming stigma
  • Recognise that people can be denied employment opportunities unnecessarily through myths, stigma, dogma and insufficient advocacy and support; be aware of the role of doctors and other services in combating this inequality
  • Recognise the effects of exclusion and discrimination on physical and mental health
  • Be aware of the role that individuals (including patients and carers as well as healthcare professionals) and services can play in combating inequality and discrimination and contribute appropriately to this work.
  • Recognise that personal beliefs and biases exist and understand their impact (positive and negative) on the delivery of health services
  • Be aware of similarities and distinctions between the beliefs and values of the doctor, the patient and the policy-makers.
  • Work with an appropriate knowledge of guidance documents on supporting people with long term conditions to self-care
  • Be familiar with the range of agencies that can provide care and support in and out of hospital, and how they can be accessed
  • Be familiar with the range of agencies that can support the disabled worker and the disabled job-seeker.
  • Understand the factors which influence the incidence and prevalence of common conditions
  • Understand the factors which influence health and illness – psychological, biological, social, political, cultural and economic (especially poverty)
  • Understand the influence of lifestyle on health and the factors that influence an individual patient to change their lifestyle
  • Understand the influence of culture and beliefs on patients perceptions of health
  • Understand the possible positive and negative implications of health promotion activities e.g. immunisation
  • Understand the relationship between the health of an individual and that of a community, and vice versa
  • Understand and outline the mechanisms by which environmental chemicals have an impact on human health
  • Understand and outline the mechanisms by which adverse chemical exposure can be mitigated e.g. decontamination, specific antidotes. Understand how to seek a second opinion and appropriate expert advice
  • Know the potential sources of information and guidance to manage a case of chemical etc exposure, including local, regional and national sources
  • Have an awareness of the role of other agencies and factors including the impact of globalisation (including climate change) in increasing disease, and in protecting and promoting health.
  • Have an awareness of the determinants of health worldwide and strategies to influence policy relating to health issues including the impact of more economically developed countries’ strategies on less economically developed countries