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ITP (CaTH) – CARTS and DERMATOLOGY for Bromley GP Specialist Training Programme Proposed Job Description, January 2008
Purpose of the jobThis 4 month post will commence in August 2008 and will be an innovative training post consisting of 1.5 days per week in General Practice plus 2 days per week attached to the CART team. The remaining time will consist of the GPTP half-day release course, a half-day attachment to the Dermatology department and a discretionary half day to be shared between dermatology and General Practice. This post will form part of a 3 year programme of GP specialist training. This post is firmly based in the community but will also allow the GPST 1 or 2 doctor to learn some specialist medicine that will be of value in General Practice. It would also give the doctor an induction into General Practice before the registrar year. It is important to stress that because the amount of time spent with the CARTS team and in Dermatology clinics is relatively short, it is essential to expose yourself to as much patient contact in these areas as possible to build up a suitable level of experience. CART attachment The Community Assessment Rehabilitation Team is a jointly funded enterprise between health and social services. It is managed by the PCT. Services are provided by personnel from primary, secondary and social care services The services aims to offer specialist assessment and rehabilitation to people with act functional difficulties resulting from acute illness or, deteriorating chronic illness. The service is provided in an environment that best suits the individual’s needs at the time. This may mean the prevention of inappropriate hospital admission of patients with medical illness whose needs can be met through skilled assessment and management in the community be that in a domestic or residential setting or the timely return to a community setting to recover from an episode of illness. The multi -professional team evaluates an individuals needs and offers treatment or support as appropriate .This may be physical, chemical, environmental or psychological treatment but it is offered in a coordinated and timely manor CART covers all aspects of rehabilitation in all adult age groups but by the nature of illness treated it predominantly manages older people and those with chronic neuro-muscular disabilities. It does not provide palliative care. This attachment will provide opportunities for the doctor in training to develop the core competencies of Person Centred Care, Specific problem-solving skills, Comprehensive approach, Community orientation and a Holistic approach. These will be Contextual to an individual patients needs and will encourage the appropriate professional Attitudes to be demonstrated in clinical practice. A diagnostic and scientific approach to acute functional decline will be encouraged. At the end of the attachment the GPST 1 or 2 doctor will be able to: 1. Demonstrate ability to assess patients with complex needs in their home setting: · To have sufficient knowledge to establish the nature of the medical problem. · Have a broad knowledge of medical conditions that present for assessment and rehabilitation in the community (see below). · Understand the limitations of community practice and develop an understanding of patients needs for admission to hospital and when more suitable alternatives can be used. · Be able to evaluate the social needs of the patient. · Be able to assess the mental health needs of patients with complex health problems. · Be able to understand the physical condition of the patients. · Show skills in prioritising the problem/s that need attention. · Contextualise the problem appropriately. · Understand the constraints of managing patients in the community. · Have a knowledge of the investigations available, their appropriateness in differing situations and develop the skill to interpret results. · Know when to intervene urgently if required.
2. Demonstrate skills and ability to work as part of a multidisciplinary team · To have the skills and attitude to work as part of a multidisciplinary team. · Assess patients with other team members. · Be able to work with shared protocols. · Communicate effectively with the team. · Respond to the needs of other team members. · Attend the Multidisciplinary Team meetings and present cases. 3. Be able to manage complex illness at home and prevent hospital admission: · Understand what medical and social support exists to care for patients at home. · Rationalise and prioritise treatment when dealing with co-morbidity. · Use evidence based medicine to manage the medical illness. · When to refer for rehabilitation. · When to admit patients to hospital. · Know who to refer to with in the multidisciplinary team to maximise the patient’s rehabilitation. · When and who to refer to for social care. · Communicate sensitively with patients about diagnosis and treatment plans. 4. Have broad knowledge of conditions that frequently require home assessments and rehabilitation.
Dermatology It is vital that a GP has a good working knowledge of Dermatology and this attachment will offer you valuable experience and teaching in this subject. Despite your attachment being limited by time, we believe that with enthusiasm and application you can quickly become a useful member of the dermatology team and make a positive contribution to the smooth running of that particular session. Opportunities are given to attend specialist clinics on at least one or two occasions during the 4 month post. The more you contribute, the more enthusiasm you bring to the post, the more you will learn. This attachment should bring out the following core competencies in the learner: Person Centred Care, Specific problem-solving skills, Comprehensive approach. Additionally the learner should be able to clearly demonstrate the 3 essential application features that partner the competencies: Contextual, Attitudinal and Scientific. LEARNING OUTCOMES: The ST 1 or 2 doctor is expected to familiarise themselves with the section of the GP curriculum (15.1) which covers dermatological knowledge and skills. Reading around the subject is expected. The following learning outcomes have been developed with the Dermatology department and are the conditions commonly seen in the clinics. Recognise the signs and symptoms, appropriate investigations and treatment of the following common and/or serious dermatological conditions listed below:
Develop the following Dermatological Skills
Develop important communication skills and attitudes regarding: · Assessing the importance of the social and psychological impact of skin problems on the patient’s quality of life, including, for example, the effects of disfigurement. · Identifying the patient’s health beliefs regarding skin problems and either reinforce, modify or challenge these beliefs as appropriate. · Advising patients appropriately regarding lifestyle interventions including sun protection and occupational health advice. · Explaining diagnosis and treatment and the possible side effects of medications used. · Empower patients to self-manage their skin conditions as far as practicable e.g. eczema. Educational Plan: You will be attending a clinic every Friday morning and this will be your main learning opportunity. However the department runs other clinics during the week that would enhance your learning. Every opportunity will be made to allow you to attend these (eg release from HDRC on at least 2 Wednesdays in the 4 month rotation for the Pigmented Lesion Clinic). There will be flexibility within the Friday afternoon slot - we encourage you to participate in seeing ward referrals, nurse led treatments in the Day Treatment Centre and the wart clinic during this time. You will also have access to the Dermatology Unit library on Friday afternoons. As an adult learner you can intercalate this with your learning in your GP attachment. You will be expected to keep a logbook of cases you have seen (and enter them on your e-portfolio) to ensure coverage of the curriculum. You will also be expected to work up a ‘long-case’ during your dermatological attachment and present it at the end of your 4 months to the dermatology department and/or at the GP Presentation Evening. This case may have originated from your GP practice which you referred by usual methods to the Dermatology department. General Practice The GP section of the post will give a very good introduction to life as a GP Registrar and a foretaste of what you will be doing for the rest of your career. You will learn about the structure of general practice, learn to use computerised record systems and start consulting in General Practice. This will enable you to start your GPR year with more confidence. This attachment should bring out all the core competencies in the learner: Primary Care Management, Person Centred Care, Specific problem-solving skills, Comprehensive approach, Community Orientation and a holistic approach. Additionally the learner should be able to clearly demonstrate the 3 essential application features that partner the competencies: Contextual, Attitudinal and Scientific. At the end of the attachment the GPST 1 or 2 doctor will be developing the following skills: 1. Basic communication skills required for General Practice, demonstrating ability to:· Elicit a patient’s agenda · Elicit patients’ ideas concerns and expectations · Co-create with the patient a shared plan of management · Involve appropriately and communicate effectively with other professionals · Understand the factors in consultations which are associated with better patient outcomes · Manage time and resources effectively within the consultation 2. Learning objectives related to Care in the Community, demonstrating the ability to: · Manage primary contact with patients who need greater levels of support to enable them to remain in their homes and avoid hospital admission. · Demonstrate an understanding of the variable physical and social conditions that create the need for additional input and assessment. · Describe the roles of the primary health care team, allied health professionals, complementary therapists and secondary care (e.g. in shared care protocols), and refer to them appropriately. · Understand the indications for hospital referral. 3. Learning objectives related to skin problems, demonstrating ability to: · Manage primary contact with patients who have a skin problem. · Co-ordinate care with other primary care health professionals, dermatologists and other appropriate specialists, leading to effective and appropriate acute and chronic disease management including prevention and rehabilitation. · Make timely appropriate referrals on behalf of patients to specialist services, especially to rapid access pigmented lesion (Mole) clinics. · Promote skin well-being by applying health promotion and disease prevention strategies appropriately including sun protection, occupational health advice and hand-care. LocationCARTS will be based at Bassetts House, Farnborough, Kent but will involve working in the community. The clinical supervisor of the post will be Dr Bridget Lock. Dermatology will be based at Orpington Hospital. The dermatology consultant responsible for your Clinical Supervision will be Dr Michele Clements or other nominated consultant. The GP component takes place in a GP training practice and is supervised by a GP trainer. Whilst we try and arrange the 3 year programme to ensure that the GP specialist registrar has the same GP trainer for the ITP and ST3 this cannot be guaranteed. GPTP half-day release occurs on Wednesday afternoons in the Postgraduate Education Centre at the Princess Royal University Hospital. Educational Supervisors Your GP Educational Supervisor will be allocated at the start of your ST1 training and will continue this role during your ITP post. The Educational Timetable & what you will do
Before You Start:The post begins on a Wednesday of the first week of August, December or April. You should call +/or visit your training practice at least a month before hand in order to complete essential documentation that will ensure you are paid correctly. You will need to contact the PCT to ensure you are on the Performers List before you are allowed to see patients in General Practice. You need to confirm with CARTS and the Dermatology department when you commence your post and introduce yourself to them. The Educational Timetable:
This job presents many learning opportunities and we shall expect the post holder to demonstrate Adult Learning skills. Monday and Tuesday are allocated to your attachment to the CARTS team. This is a community based post and hence highly relevant to your training as a GP. You will spend all day Thursday, and Wednesday morning in your GP surgery. It is up to you to arrange tutorial time with your trainer. The Dermatology Department holds the Pigmented Lesion Clinic (PLC) on Wednesday afternoons. The Doctor is expected to attend the PLC clinic on at least 2 afternoons clinic in preference to the HDRC during the 4 month attachment. On Friday afternoon, the Dermatology department runs a Wart clinic, Day Treatment clinic (for Psoriasis and PUVA, eczema, leg ulcers etc) and sees the Ward referrals on Friday afternoon. The doctor is expected to familiarise themselves with these clinics during the 4 month attachment. If there are interesting ward referrals, the ST2 doctor is expected to accompany the dermatologist on the Friday afternoon. Friday afternoon is alternated between Dermatology and General Practice. On week 1 you will spend early afternoon with the Dermatology department and we suggest you sit in on a surgery on Friday evening with either your trainer or another doctor or nurse in the surgery. On week 2 you will spend Friday afternoon in your practice and do a surgery. · GP tutorial time to be protected and TBA with your trainer. General Practice component
GP Specialist Registrar’s duties and responsibilities a) The GP Registrar’s hours of work in the practice, the training programme and the regular periods of tuition shall be agreed between the GP Registrar and Trainer, making provision for appropriate half-day release and other commitments in accordance with the advice of the Regional General Practice Graduate Education Board. For a full-time GP Registrar, the GP Registrar’s hours of work in the practice, both during and outside normal hours shall also be in accordance with the advice of the Regional General Practice Education Board, and shall not exceed 56 hours of continuous duty. Periods of study leave (including day release) should be included as time spent in the practice for the calculation of average hours worked. For part-time GP Registrars appropriate pro rata reductions in hours of work should be stated explicitly. The GP Registrar will not be used as a substitute for a locum in the training practice. b) The GP Registrar undertakes the care, responsibility and maintenance of medical equipment and supplies provided by the Trainer and return such medical equipment and supplies to the Trainer at the end of the training period. c) If the GP Registrar undertakes work outside the practice, it should only be with the prior written agreement of the Trainer. d) The GP Registrar shall apply himself/herself diligently to the educational programme and to the Service Commitments under the direction of the Trainer in accordance with the advice of the Regional General Practice Graduate Education Board. NB: the GP Registrar is responsible for ensuring that all the necessary assessments due to this post are carried out in accordance with nMRCGP regulations. e) The GP Registrar shall keep proper records as are reasonably required by the Trainer. f)The GP Registrar shall provide, maintain and pay all running costs of suitable transport to enable him/her to carry out his/her responsibilities under this Agreement. OOH’s
This is an ITP post and you are expected to do 2 sessions of OOH’s (through EMDOC) during the 4 month job.Salary and allowances The trainer shall pay your salary and a motor vehicle allowance at rates applicable in Directions to Health Authorities under the National Health Service (General Medical Services) Amendment (No2) Regulations 2000, as amended from time to time, concerning GP registrars. The practice reclaims the money from the PCT. Annual leave/Study leaveBecause you are employed by the practice all annual leave & study leave requests go to your trainer and/or training practice manager (depending on arrangements in your particular training practice). You will also need to inform your Clinical Supervisors from the CARTS team and in the Dermatology department. You are entitled to 25 days annual leave taken pro-rota during this post. Assessment Assessment of the GP specialist registrar in post will occur in accordance with the new MRCGP (nMRCGP) regulations. This is part of the ongoing 3 year Workplace Based Assessment (WPBA) a record of which will be kept in the GP specialist registrar’s electronic portfolio (e-portfolio). The WPBA will be carried out mainly in the GP training practice and may include:
Evaluation of the Post Evaluation of the learning process will occur at 3 different stages in the GP part of the post: 1. The initial assessment of learning needs and formulation of a learning plan (with GP trainer). 2. The mid-point evaluation to see how the SHO is progressing and what further needs there are to address (with GP trainer +/- Programme Director). 3. The final evaluation of the learning process (with GP trainer) to: a) Check that the necessary assessments have taken place (see above) b) Obtain informal feedback from the GP specialist registrar regarding his/her experience of the post. Accountability The GP specialist registrar is accountable in the first instance to his or her GP trainer, particularly in the GP setting. He/she is also accountable whilst in the hospital setting to the specialist consultant acting as clinical supervisor. For any problems unresolved at this level the GP specialist registrar may then turn to the Programme Directors. Arrangements for Placements The Programme Directors co-ordinate the placements.
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