Endocrinology and Diabetes Curriculum August 2010

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Endocrinology and Diabetes Curriculum August 2010

  1. 1. SPECIALTY TRAINING CURRICULUM FOR ENDOCRINOLOGY AND DIABETES MELLITUS AUGUST 2010 Joint Royal Colleges of Physicians Training Board 5 St Andrews Place Regent’s Park London NW1 4LB Telephone: (020) 79351174 Facsimile: (020)7486 4160 Email: ptb@jrcptb.org.uk Website: www.jrcptb.org.uk Endocrinology and Diabetes August 2010 Page 1 of 61
  2. 2. Table of Contents 1 Introduction ....................................................................................................................... 3 2 Rationale ........................................................................................................................... 3 2.1 Purpose of the curriculum............................................................................................. 3 2.2 Development................................................................................................................. 3 2.3 Training Pathway .......................................................................................................... 3 2.4 Enrolment with JRCPTB............................................................................................... 4 2.5 Duration of training ....................................................................................................... 5 2.6 Less Than Full Time Training (LTFT) ........................................................................... 6 2.7 Dual CCT ...................................................................................................................... 6 3 Content of learning............................................................................................................ 7 3.1 Programme objectives.................................................................................................. 7 3.2 Good Medical Practice ................................................................................................. 7 3.3 Syllabus ........................................................................................................................ 8 4 Learning and Teaching ................................................................................................... 43 4.1 The training programme ............................................................................................. 43 4.2 Teaching and learning methods ................................................................................. 43 4.3 Research .................................................................................................................... 46 4.4 Academic Training ...................................................................................................... 47 5 Assessment..................................................................................................................... 48 5.1 The assessment system............................................................................................. 48 5.2 Assessment Blueprint................................................................................................. 48 5.3 Assessment methods ................................................................................................. 49 5.4 Decisions on progress (ARCP)................................................................................... 50 5.5 ARCP Decision Aid..................................................................................................... 51 5.6 Penultimate Year Assessment (PYA)......................................................................... 53 5.7 Complaints and Appeals............................................................................................. 53 6 Supervision and feedback............................................................................................... 53 6.1 Supervision ................................................................................................................. 53 6.2 Ensuring Safe Practice ............................................................................................... 54 6.3 Methods of Feedback and Supervision ...................................................................... 54 6.4 Appraisal..................................................................................................................... 54 7 Managing curriculum implementation ............................................................................. 55 7.1 Intended use of curriculum by trainers and trainees .................................................. 56 7.2 Recording progress .................................................................................................... 56 8 Curriculum review and updating ..................................................................................... 56 9 Equality and diversity ...................................................................................................... 57 10 Appendix 1 - Glossary..................................................................................................... 60 Endocrinology and Diabetes August 2010 Page 2 of 61
  3. 3. 1 Introduction Endocrinology and diabetes is a broad ranging subject and therefore an enticing one for trainees and consultants alike since it encompasses basic mechanisms of physiology and pharmacology coupled with the ability to improve quality of life and long-term outcomes through effective disease control, and often cure. Endocrine and metabolic diseases are some of the most commonly encountered medical conditions in the UK population. They are increasing in prevalence and impact in terms of health of the nation, emphasising the need to continue to strive towards improved health care delivery in this speciality. Endocrine diseases and diabetes affect every physiological system of the body determining that specialists enjoy a wide range of skills and expertise and make a major contribution to general medicine in its broadest sense. 2 Rationale 2.1 Purpose of the curriculum The purpose of this curriculum is to define the process of training and the competencies needed for the award of a certificate of completion of training (CCT) in Endocrinology and Diabetes Mellitus. The curriculum covers training in all four nations of the UK. 2.2 Development This curriculum was developed by a curriculum sub-group of the Specialty Advisory Committee (SAC) for Endocrinology and Diabetes Mellitus under the direction of the Joint Royal Colleges of Physicians Training Board (JRCPTB). It replaces the previous version of the curriculum dated May 2007 with changes to ensure the curriculum meets GMC’s standards for Curricula and Assessment and to incorporate revisions to the content and delivery of the training programme. Major changes from the previous curriculum include the incorporation of common, leadership and health inequalities competencies. The curriculum contents were chosen by the sub group of the SAC in Endocrinology and Diabetes Mellitus after extensive consultation with Regional Specialty Advisors, trainees, local training committees, and specialist societies. The curriculum was finally agreed by the SAC, which comprises deanery training programme directors, specialist society representatives, trainee representatives and lay members. The curriculum builds upon core elements in the medical training programme for post foundation years and is appropriate for those doctors seeking specialty accreditation in endocrinology and diabetes. 2.3 Training Pathway Specialty training in Endocrinology and Diabetes Mellitus consists of core and higher speciality training. Core training provides physicians with: the ability to investigate, treat and diagnose patients with acute and chronic medical symptoms; and with high quality review skills for managing inpatients and outpatients. Higher speciality training then builds on these core skills to develop the specific competencies required to practise independently as a consultant in Endocrinology and Diabetes Mellitus. Core training may be completed in either a Core Medical Training (CMT) or Acute Care Common Stem (ACCS) programme, this requires a minimum of 1 but typically 2 years of training following the F2 foundation year. The full curriculum for specialty Endocrinology and Diabetes August 2010 Page 3 of 61
  4. 4. training in Endocrinology and Diabetes Mellitus therefore consists of the curriculum for either CMT or ACCS plus this specialty training curriculum for Endocrinology and Diabetes Mellitus. Further candidates may achieve this competence after a variable period in other training programmes in a different area of clinical practice, because of alteration of their career plans or failure to enter the programme at the first attempt. Core Medical training programmes are designed to deliver core competencies as part of specialty training by acquisition of knowledge, skills and behaviours as assessed by the workplace-based assessments and the MRCP(UK). Programmes are usually for two years and are broad-based consisting of four to six placements in medical specialties. These placements over the two years must include direct involvement in the acute medical take. Trainees are asked to document their record of workplace- based assessments in an ePortfolio which will then be continued to document assessments in specialty training. Trainees completing core training will have a solid platform of common knowledge and skills from which to continue into Specialty Training at ST3, where these skills will be developed and combined with specialty knowledge and skills in order to award the trainee with a certificate of completion of training (CCT). There are common competencies that should be acquired by all physicians during their training period starting within the undergraduate career and developed throughout the postgraduate career, for example communication, examination and history taking skills. These are initially defined for CMT and then developed further in the specialty. This curriculum supports the spiral nature of learning that underpins a trainee’s continual development. It recognises that for many of the competences outlined there is a maturation process whereby practitioners become more adept and skilled as their career and experience progresses. It is intended that doctors should recognise that the acquisition of basic competences is often followed by an increasing sophistication and complexity of that competence throughout their career. This is reflected by increasing expertise in their chosen career pathway. The approved curriculum for CMT is a sub-set of the Curriculum for General Internal Medicine (GIM). A “Framework for CMT” has been created for the convenience of trainees, supervisors, tutors and programme directors. The body of the Framework document has been extracted from the approved curriculum but only includes the syllabus requirements for CMT and not the further requirements for acquiring a CCT in GIM. Completion of CMT or ACCS and acquisition of full MRCP (UK) will be required before entry into Specialty training at ST3 (2011 onwards). Patients expect medical specialists to be highly competent, knowledgeable and intelligent, good communicators, professional, compassionate and committed to their speciality. For this reason, adequate evidence of successful completion of core training in accordance with the requirements of the JRCPTB is essential. 2.4 Enrolment with JRCPTB Trainees are required to register for specialist training with JRCPTB at the start of their training programmes. Enrolment with JRCPTB, including the complete payment of enrolment fees, is required before JRCPTB will be able to recommend trainees for a CCT / Certificate of Completion of CMT. Trainees can enrol online at www.jrcptb.org.uk Endocrinology and Diabetes August 2010 Page 4 of 61
  5. 5. 2.5 Duration of training Although this curriculum is competency based, the duration of training must meet the European minimum of 4 (four) years for full time specialty training adjusted accordingly for flexible training (EU directive 2005/36/EC). The SAC has advised that training from ST1 will usually be completed in 6 (six) years in full time training (2 years core plus 4 years specialty training) for trainees not wishing to obtain a dual CCT (see section 2.7) shown in figure 1.0. The majority of trainees will seek to acquire these additional competencies to enable them to achieve a dual CCT in Acute Internal Medicine or General Internal Medicine, and therefore in most cases training will be completed in 7 (seven) years. Figure 1.0 shows the training pathway of an Endocrinology and Diabetes Mellitus CCT trainee CCT after minimum of Selection Selection 72 months Core Medical Endocrinology FY2 Training or ACCS and Diabetes Mellitus Training SCE MRCP Work place based assessments Endocrinology and Diabetes August 2010 Page 5 of 61
  6. 6. Figure 2.0 shows the training pathway of a dual CCT trainee CCT after minimum of Selection Selection 84 months Core Medical Endocrinology FY2 Training or ACCS and Diabetes Mellitus Training GIM or AIM MRCP SCE Work place based assessments 2.6 Less Than Full Time Training (LTFT) Trainees who are unable to work full-time are entitled to opt for less than full time training programmes. EC Directive 2005/36/EC requires that: • LTFT shall meet the same requirements as full-time training, from which it will differ only in the possibility of limiting participation in medical activities. • The competent authorities shall ensure that the competencies achieved and the quality of part-time training are not less than those of full-time trainees. The above provisions must be adhered to. LTFT trainees should undertake a pro rata share of the out-of-hours duties (including on-call and other out-of-hours commitments) required of their full-time colleagues in the same programme and at the equivalent stage. EC Directive 2005/36/EC states that there is no longer a minimum time requirement on training for LTFT trainees. In the past, less than full time trainees were required to work a minimum of 50% of full time. With competence-based training, in order to retain competence, in addition to acquiring new skills, less than full time trainees would still normally be expected to work a minimum of 50% of full time. If you are returning or converting to training at less than full time please complete the LTFT application form on the JRCPTB website www.jrcptb.org.uk . Funding for LTFT is from deaneries and these posts are not supernumerary. Ideally therefore 2 LTFT trainees should share one post to provide appropriate service cover. Less than full time trainees should assume that their clinical training will be of a duration pro-rata with the time indicated/recommended, but this should be reviewed Endocrinology and Diabetes August 2010 Page 6 of 61
  7. 7. during annual appraisal by their TPD and chair of STC and Deanery Associate Dean for LTFT training. As long as the statutory European Minimum Training Time (if relevant), has been exceeded, then indicative training times as stated in curricula may be adjusted in line with the achievement of all stated competencies. 2.7 Dual CCT Trainees who wish to achieve a CCT in Acute Internal Medicine (AIM) and/or General Internal Medicine (GIM) as well as Endocrinology and Diabetes Mellitus must have applied for and successfully entered a training programme, which was advertised openly as a dual training programme. Trainees will need to achieve the competencies, with assessment evidence, as described in both the Endocrinology and Diabetes Mellitus and AIM or GIM curricula. Individual assessments may provide evidence towards competencies from both curricula. Postgraduate Deans wishing to advertise such programmes should ensure that they meet the requirements of both SACs. 3 Content of learning 3.1 Programme objectives The overall objectives of the training programme are to produce specialist practitioners who: 1 Show appropriate attitudes and communication skills in dealing with colleagues and patients; 2 Apply sound understanding of the biological and behavioural sciences and skill in diagnosis and management to ensure safe independent practice; 3 Establish a differential diagnosis for patients presenting with diabetes/endocrine disease by appropriate use of a clinical interview, physical examination and investigations; 4 Are competent in performing the core investigations of the specialty; 5 Can develop a management plan for ‘the whole patient’ and have sound knowledge of the appropriate treatments including health promotion, disease prevention and long-term management; 6 Use life-long learning skills to keep their expertise up to date; 7 Have the qualities of a teacher, team worker and leader; 8 Are able to manage and further develop integrated services in Endocrinology and Diabetes Mellitus; 9 Manage time and resources to the benefit of their patients and colleagues; 10 Practise medicine in accordance with the General Medical Council document ‘Good Medical Practice’; In many parts of the country services for patients with diabetes are delivered in the community. This curriculum sets out the competencies appropriate to the management of endocrinology and diabetes irrespective of the setting where care is delivered. 3.2 Good Medical Practice In preparation for the introduction of licensing and revalidation, the General Medical Council has translated Good Medical Practice into a Framework for Appraisal and Assessment which provides a foundation for the development of the appraisal and assessment system for revalidation. The Framework can be accessed at http://www.gmc-uk.org/Framework_4_3.pdf_25396256.pdf Endocrinology and Diabetes August 2010 Page 7 of 61
  8. 8. The Framework for Appraisal and Assessment covers the following domains: Domain 1 – Knowledge, Skills and Performance Domain 2 – Safety and Quality Domain 3 – Communication, Partnership and Teamwork Domain 4 – Maintaining Trust The “GMP” column in the syllabus defines which of the 4 domains of the Good Medical Practice Framework for Appraisal and Assessment are addressed by each competency. 3.3 Syllabus In the tables below, the “Assessment Methods” shown are those that are appropriate as possible methods that could be used to assess each competency. Whilst it is expected that all competencies will be achieved it is recognised that not all may be specifically assessed and where they are assessed not every method will be used. See section 5.2 for more details. “GMP” defines which of the 4 domains of the Good Medical Practice Framework for Appraisal and Assessment are addressed by each competency. See section 3.2 for more details. Syllabus Contents 1. Common Competencies ........................................................................................................ 10 1.1 The Patient as Central Focus of Care ...................................................................... 10 1.2 Prioritisation of Patient Safety in Clinical Practice .................................................... 11 1.3 Consultation .............................................................................................................. 11 1.4 Therapeutics and Safe Prescribing........................................................................... 13 1.5 Time Management .................................................................................................... 13 1.6 Personal Behaviour................................................................................................... 14 1.7 Team Working, Communication and Leadership ..................................................... 15 1.8 Quality Improvement, Governance and Complaints................................................. 15 1.9 Health Promotion and Public Health......................................................................... 17 1.10 Health Inequalities .................................................................................................. 18 1.11 Principles of Medical Ethics & Confidentiality and Consent ................................... 18 1.12 Legal Framework for Practice................................................................................. 19 1.13 Research................................................................................................................. 20 1.14 Evidence and Guidelines ........................................................................................ 20 1.15 Clinical Audit ........................................................................................................... 21 1.16 Teaching and Training ............................................................................................ 21 1.17 Management and NHS Structure............................................................................ 22 2. Diabetes................................................................................................................................. 24 2.1 Diagnosis and General Management of Diabetes Mellitus....................................... 24 2.2 Management of Delivery of Diabetes Care............................................................... 25 2.3 Diabetic Emergencies ............................................................................................... 26 2.4 Management of Patients with Diabetes during Acute Illness or Surgery.................. 26 2.5 Conception and Pregnancy in Diabetes ................................................................... 27 2.6 Age-related Conditions and Diabetes ............................................................................ 29 2.6.1 Young People ........................................................................................................ 29 2.6.2 Elderly People........................................................................................................ 29 2.7 Complications of Diabetes.............................................................................................. 31 2.7.1 Screening for the Complications of Diabetes ........................................................ 31 2.7.2 Macrovascular Disease.......................................................................................... 31 2.7.3 Eye Disease in Diabetes........................................................................................ 32 2.7.4 Renal Disease and Hypertension in Diabetes ....................................................... 32 2.7.5 Neuropathy, Foot Disease and Erectile Dysfunction in Diabetes.......................... 33 2.7.6 Lipid Disease ......................................................................................................... 34 Endocrinology and Diabetes August 2010 Page 8 of 61
  9. 9. 3. Endocrinology ........................................................................................................................ 36 3.1 Disorders of the Hypothalamus and Pituitary ........................................................... 36 3.2 Disorders of Growth and Development..................................................................... 36 3.3 Disorders of the Thyroid Gland................................................................................. 37 3.4 Disorders of the Adrenal Glands............................................................................... 38 3.5 Disorders of the Gonads ........................................................................................... 38 3.6 Disorders of Parathyroid Glands, Calcium Disorders and Bone............................... 39 3.7 Disorders of Appetite and Weight ............................................................................. 40 3.8 Miscellaneous Endocrine and Metabolic Disorders.................................................. 40 3.9 Imaging Techniques in Endocrinology...................................................................... 41 Endocrinology and Diabetes August 2010 Page 9 of 61
  10. 10. 1. Common Competencies 1.1 The Patient as Central Focus of Care To pursue a collaborative approach to the planning and implementation of patient care in particular to identify and facilitate the patient’s agenda encompassing their beliefs, concerns, expectations and needs Knowledge Assessment GMP Methods Demonstrate Knowledge of: Health needs of particular populations, e.g. ethnic minorities, and the CbD, MSF 1 impact of beliefs, culture and ethnicity in presentation of physical and psychological conditions Quality improvement methodologies, including methods of obtaining CbD, MSF 1 feedback from patients, the public and staff to improve patient care The concept of patient self-care and the role of the expert patient CbD, mini-CEX 1 The effect of long term conditions on social interactions, behaviour CbD, mini-CEX 1 and psychological health Skills Encourage the health care team to respect the philosophy of patient CbD, mini-CEX, MSF 3,4 focussed care Develop a self-management plan with the patient CbD, mini-CEX, 1,3,4 MSF, PS Support patients, parents and carers to engage with management CbD, mini-CEX, 3,4 plans and voice preferences about their care MSF, PS Develop and sustain supportive relationships with patients with whom CbD, mini-CEX 1,4 care will be prolonged and potentially life long Behaviours Support patient self-management CbD, mini-CEX, 3,4 MSF, PS Elicit beliefs, concerns and expectations of patients and carers mini-CEX, MSF 1,3,4 Act as patient advocate CbD, mini-CEX, 3,4 MSF, PS Take a holistic view to the management of the patient CbD, mini-CEX 3,4 Show willingness and support for patients in their own advocacy, CbD, mini-CEX, PS 3,4 within the constraints of available resources and taking into account the best interests of the wider community Listen to and reflect on the views of patients and carers mini-CEX, PS 3,4 Endocrinology and Diabetes August 2010 Page 10 of 61
  11. 11. 1.2 Prioritisation of Patient Safety in Clinical Practice To understand that patient safety depends on safe systems not just individual competence and safe practice Knowledge Assessment GMP Methods Demonstrate Knowledge of: Principles of risk assessment and management CbD 1,2 The hazards of medical equipment in common use CbD 1,2,4 The investigation of significant events, serious untoward incidents CbD, mini-CEX, MSF 1,2,4 and near misses Skills Recognise limits of own professional competence and when to seek CbD, mini-CEX, MSF 1,2 help from other professionals Ensure the correct and safe use of medical equipment, ensuring CbD 1,2 faulty equipment is reported appropriately Improve patients’ and colleagues’ understanding of the side effects CbD, mini-CEX 1,2,3 and contraindications of therapeutic intervention Sensitively counsel a colleague following a significant untoward MSF 2,3 event, or near incident Behaviours Maintain a high level of safety awareness at all times CbD, mini-CEX, MSF 2,4 Encourage feedback from all members of the team on safety issues CbD, mini-CEX, MSF 2,3,4 Report serious untoward incidents and near misses and co-operate CbD, mini-CEX, MSF 2,3,4 with their investigation Show willingness to take action when concerns are raised about CbD, mini-CEX, MSF 2,3,4 performance of members of the healthcare team, and act appropriately when these concerns are voiced to you by others Be aware of one’s own limitations, and operate within them CbD, mini-CEX 1,2,4 1.3 Consultation To develop the ability to elicit a relevant focused history and perform an accurate examination and synthesise this to establish a problem list increasingly based on pattern recognition including differential diagnoses and formulate a management plan To recognise the need, and develop the abilities, to communicate effectively and sensitively with patients, relatives and carers Knowledge Assessment GMP Methods Demonstrate Knowledge of: How to structure a consultation appropriately CbD, mini-CEX, PS 1 The basis for clinical signs and the relevance of positive and negative CbD, mini-CEX 1 physical signs The principles of breaking bad news depending on individual, social CbD 1,3 and cultural circumstances Skills Endocrinology and Diabetes August 2010 Page 11 of 61
  12. 12. Establish a rapport with the patient and relevant others (e.g. carers) CbD, mini-CEX, PS 1,3 Listen actively and question sensitively to guide the patient and to mini-CEX, PS 1,3 clarify information Identify and manage communication barriers, tailoring language to CbD, mini-CEX, PS 1,3 the individual patient and others and using interpreters when indicated Recognise that effective history includes information from other CbD, mini-CEX 1,3,4 sources and may require several discussions with the patient and other parties, over time Recognise that the patient’s agenda and the history should inform CbD, mini-CEX 1 appropriately targeted examination, investigation and management Recognise and respond appropriately to the use of non verbal CbD, mini-CEX 1,3 communication from patients and carers Perform an examination relevant to the presentation and risk factors CbD, mini-CEX 1,3 that is valid, targeted and time efficient Use interactive methods within the consultation (eg risk calculators, CbD, mini-CEX 1,3 educational material) to improve patient understanding Deliver information compassionately, and appropriate to the patient’s CbD, mini-CEX, PS 1,3 needs and level of understanding Manage time and draw consultation to a close appropriately CbD, mini-CEX 1,3 concluding with a summary and appropriate action plan Check the patient’s/carer’s understanding, encouraging questions CbD, mini-CEX, PS 1,3 and ensuring that all concerns/questions have been covered Manage follow-up effectively and safely, utilising a variety of methods CbD, mini-CEX 1,3 (e.g. phone call, email, letter) Make accurate contemporaneous records of the discussion CbD, mini-CEX 1,3 Recognise the impact of bad news on the patient, carer, supporters, CbD, mini-CEX, MSF 1,3 staff members and self Behaviours Approach clinical encounters with compassion and professionalism, CbD, mini-CEX, 1,3,4 using appropriate behaviour and language MSF, PS Recognise when the offer/ use of a chaperone is appropriate CbD, mini-CEX 1 Ensure examination whilst clinically appropriate considers social, CbD, mini-CEX, MSF 1,4 cultural and religious boundaries to examination and make alternative arrangements when appropriate. Take leadership and demonstrate to others good practice in breaking CbD, MSF 1 bad news Show willingness to discuss intelligibly with a patient the notion and CbD, mini-CEX 2,3 difficulties of prediction of future events, and benefit/risk balance of therapeutic intervention Endocrinology and Diabetes August 2010 Page 12 of 61
  13. 13. 1.4 Therapeutics and Safe Prescribing To develop your ability to initiate, review and monitor appropriate therapeutic and preventive interventions relevant to clinical practice (including non – medication based treatments). Knowledge Assessment GMP Methods Demonstrate Knowledge of: Indications, contraindications, adverse reactions, interactions and CbD, mini-CEX 1,2 dosage of commonly used drugs Tools to promote patient safety and prescribing, including electronic CbD, mini-CEX 1,2 clinical record systems and other IT systems Roles of local and national regulatory agencies involved in drug use, CbD, mini-CEX 1,2 monitoring and licensing Skills Advise patients (and carers) about use of medications prescribed, CbD, mini-CEX 1,2,3 their benefits, important interactions and adverse drug effects Prescribe appropriately in pregnancy, and during breast feeding CbD, mini-CEX 1,2 Make appropriate dose adjustments following therapeutic drug CbD, mini-CEX 1,2 monitoring, or physiological change (e.g. deteriorating renal function) Engage the patient / carer to optimise concordance with therapeutic CbD, mini-CEX. PS 2,3,4 regimens Behaviours Appreciate the role of non-medical prescribers CbD, mini-CEX, MSF 1,3 Ensure prescribing information is shared promptly and accurately CbD 1,2,3 amongst a patient’s health providers, including between primary and secondary care Participate in adverse drug event reporting mechanisms CbD, mini-CEX 1,2,3,4 1.5 Time Management To demonstrate increasing ability to prioritise and organise clinical and clerical duties in order to optimise patient care and clinical team resource. Knowledge Assessment GMP Methods Demonstrate Knowledge of: Effective organisation being key to time management CbD 1 Prioritising work according to urgency and importance with some CbD, MSF 1,2,3 tasks having to wait or be delegated to others Skills Regularly review and re-prioritise personal and team work load and CbD, mini-CEX 1,3 reorganise Organise and manage workload effectively and flexibly CbD, mini-CEX 1 Make appropriate use of other professionals and support workers CbD, mini-CEX, MSF 1,3 according to competencies Behaviours Work flexibly and deal with tasks in an effective and efficient fashion CbD, MSF 3 Endocrinology and Diabetes August 2010 Page 13 of 61
  14. 14. Recognise when you or others are falling behind and take steps to CbD, MSF 3 rectify the situation 1.6 Personal Behaviour To develop the behaviours that will enable the doctor to become a senior leader who is trusted and able to deal fairly in all situations Knowledge Assessment GMP Methods Demonstrate Knowledge of: The concept of modern medical professionalism CbD 1 Skills Practise with professionalism including: CbD, mini-CEX, 1,2,3,4 • Integrity MSF, PS • Compassion • Altruism • Continuous improvement • Aspiration to excellence • Respect of cultural and ethnic diversity • Regard to the principles of equity Be able to handle enquiries from the press and other media CbD, MSF 1,3,4 effectively Recognise the manifestations of stress on self and others and now CbD, MSF 1,2,3 where and when to look for support Use a reflective approach to practice with an ability to learn from CbD, MSF 1,3 previous experience Apply creative thinking approaches (or methodologies or techniques) CbD, MSF 1,3 in order to propose solutions to service issues Behaviours Recognise the need to improve clinical leadership and management MSF mini-CEX 1,2,3 skill Recognise situations when it is appropriate to involve professional MSF mini-CEX 1,2 and regulatory bodies Show willingness to act as a leader, mentor, educator and role model CbD, MSF 1,3 Be willing to accept mentoring as a positive contribution to promote CbD, MSF 1 personal professional development Participate in professional regulation and professional development CbD, MSF 1 Recognise personal health as an important issue mini-CEX, MSF 1,2,3 Respond constructively to the outcome of reviews, assessments or CbD, MSF 1,2,3 appraisals of performance Endocrinology and Diabetes August 2010 Page 14 of 61
  15. 15. 1.7 Team Working, Communication and Leadership To develop the skills necessary to make teams more effective and better able to deliver better care Knowledge Assessment GMP Methods Demonstrate Knowledge of: The components of effective collaboration and team working CbD 1,3 The roles and responsibilities of members of the healthcare team CbD 1,3 Ways in which individual behaviours impact on others: personality CbD, MSF 1,3 types, group dynamics, learning styles, leadership styles The role of team dynamics in the way a group, team or department CbD, MSF 1,3 functions Skills Demonstrate leadership and provide supervision in education and CbD, mini-CEX , 1,3,4 training of junior colleagues and other members of the healthcare MSF team Effective handover of care between shifts and teams CbD, mini-CEX 1,3 Lead and participate in interdisciplinary team meetings and CbD, mini-CEX, MSF 3 understand your role within that team Prevent and resolve conflict within the team, providing feedback and CbD, MSF 2,3,4 rectify team dysfunction Encourage staff to develop and exercise their own leadership skills CbD, MSF 3 Behaviours Encourage an environment that is open to exploring concerns about CbD, MSF 3,4 the safe working of the team Recognise the importance of induction for new members of a team CbD, MSF 3,4 Recognise the importance of prompt and accurate information CbD, mini-CEX, MSF 3 sharing with other team members including Primary Care Respect the skills and contributions of colleagues CbD, MSF 3 Take full part in multidisciplinary meetings CbD, MSF 3 Maintain confidentiality where appropriate within team discussions CbD, MSF 3,4 1.8 Quality Improvement, Governance and Complaints To recognise the desirability of monitoring performance, learning from mistakes and adopting no blame culture so as to ensure high standards of care and optimise patient safety Knowledge Assessment GMP Methods Demonstrate Knowledge of: The elements of clinical governance CbD, MSF 1,2 The fact that governance safeguards high standards of care and CbD, MSF 1,2 helps to improve clinical services The features of a safe working environment CbD 1,2 Procedures for handling complaints CbD 1,2 Endocrinology and Diabetes August 2010 Page 15 of 61
  16. 16. The difference between system and individual errors (personal and CbD, MSF 1 organisational) Principles of an effective apology CbD, MSF 1,4 Sources of help and support for patients and yourself when a CbD, MSF 1,4 complaint is made about yourself or a colleague Skills Deal appropriately with concerned or dissatisfied patients or relatives CbD mini-CEX 1,2,3,4 Contribute to quality improvement processes, e.g: AA, CbD 2 • Audit of personal and departmental/directorate/practice performance • Errors / discrepancy meetings • Critical incident and near miss reporting • Unit morbidity and mortality meetings • Local and national databases Reflect regularly on your standards of medical practice in accordance CbD 1,2,3,4 with GMC guidance on licensing and revalidation Explain clearly to the patient the events leading up to a medical error CbD, MSF, PS 1,3 or serious untoward incident, and sources of support for patients and their relatives Deliver an appropriate apology and explanation CbD, MSF, PS 1,3,4 Use assessment, appraisal, complaints and other feedback to discuss CbD 1 and develop an understanding of own development needs Behaviours Show willingness to participate in safety improvement strategies such CbD, MSF 2,3,4 as critical incident reporting Contribute to processes where complaints are learned from and acted CbD, MSF 2,3,4 upon Demonstrate personal commitment to reflect on and improve CbD, MSF 2,3,4 performance in the light of feedback and assessment Contribute to a fair and transparent culture around complaints and CbD, MSF 1 errors engaging with a no blame culture Recognise the rights of patients, family members and carers to make CbD, mini-CEX, MSF 1,2,3,4 a complaint Recognise the impact of a complaint upon self and other team CbD 3 members and seek appropriate help and support Be prepared to accept leadership and responsibility with regard CbD, mini-CEX, MSF 2,3,4 complaints and to admit errors Endocrinology and Diabetes August 2010 Page 16 of 61
  17. 17. 1.9 Health Promotion and Public Health To develop the ability to work with individuals and communities to reduce levels of ill health, remove inequalities in healthcare provision and improve the general health of a community. Knowledge Assessment GMP Methods Demonstrate Knowledge of: The factors which influence the incidence and prevalence of diabetes CbD, SCE 1 – psychological, biological, social, cultural and economic especially poverty The value of screening programmes and understand the positive and CbD, mini-CEX 1 negative effects of screening on the individual The role and availability of barriers to community based health CbD 1 strategies on prevention and treatment of diabetes and obesity Skills Identify opportunities to promote changes in lifestyle and other CbD, mini-CEX actions which will positively improve health and/or disease outcomes Identify patient’s ideas, concerns and health beliefs regarding CbD, mini-CEX, PS screening and health promotion programmes and be capable of appropriately responding to these Work collaboratively with other agencies to improve the health of CbD, mini-CEX 1,2 communities Behaviours Engage in effective team-working around the improvement of health CbD, MSF 1,3 Encourage appropriate screening and facilitate early intervention CbD 1 Endocrinology and Diabetes August 2010 Page 17 of 61
  18. 18. 1.10 Health Inequalities To positively influence health determinants and inequalities Assessment GMP Knowledge Methods Demonstrate Knowledge of: The fact that good health includes both mental and physical health CbD 1, 2,4 The implications of disability discrimination legislation for healthcare CbD, mini-CEX, SCE 1,4 How health systems can discriminate against patients from diverse CbD, mini-CEX,PS 1,2,4 backgrounds, and how to work to minimise this discrimination; The stigmatising effect of some illnesses CbD, mini-CEX 1,2,3 The range of agencies that can support the disabled worker and the CbD 1 disabled job-seeker The influences of environment and behaviour on health CbD 1,3 Skills Help to empower patients and negotiate complex systems to improve CbD, mini-CEX 1,2, 3,4 health and welfare including, where appropriate, the right to work Assess the patient’s ability to access various health services CbD, mini-CEX 1,2,3 Assess community health needs in relation to demographic, socio- CbD, mini-CEX 1 economic and health information and where appropriate apply these in practice Behaviours Respect diversity of status and values in patients and colleagues mini-CEX, MSF 1,3,4 Respond to people in an ethical, honest and non-judgemental manner MSF, PS 1,3,4 1.11 Principles of Medical Ethics & Confidentiality and Consent To know, understand and apply appropriately the principles, guidance and laws regarding medical ethics and confidentiality Knowledge Assessment GMP Methods Demonstrate Knowledge of: The principles of medical ethics CbD, SCE 1,2,4 The principles of data protection, freedom of information and CbD 1,2,4 information governance The problems posed by disclosure in the public interest, without CbD, mini-CEX 1,4 patient’s consent The role and legal standing of advance directives CbD, mini-CEX 1 The importance of the patient’s level of understanding and mental CbD, mini-CEX 1 state (and also that of the parents, relatives or carers when appropriate) and how this may impair their capacity for informed consent Skills Use and share information with the highest regard for confidentiality, CbD, mini-CEX, MSF 1,2,3,4 and encourage such behaviour in other members of the team Endocrinology and Diabetes August 2010 Page 18 of 61
  19. 19. Outline and follow the guidance given by the GMC on confidentiality CbD, mini-CEX 12,4 Counsel patients on the need for information distribution within CbD, MSF 1,3,4 members of the immediate healthcare team Behaviours Encourage informed ethical reflection in others CbD, MSF 1,3,4 Show willingness to seek advice of peers, legal bodies, and the GMC CbD, mini-CEX, MSF 1,2,3,4 in the event of ethical dilemmas over disclosure and confidentiality Respect patient’s requests for information not to be shared, unless CbD, mini-CEX, PS 1,3,4 this puts the patient, or others, at risk of harm Show willingness to share information about their care with patients, CbD, mini-CEX,PS 1,3,4 unless they have expressed a wish not to receive such information Respect a patient’s rights of autonomy even in situations where their CbD, mini-CEX, PS 1,2,3,4 decision might put them at risk of harm Not withhold information relevant to proposed care or treatment in a CbD, mini-CEX 1,3,4 competent patient Seek to obtain consent only for those procedures, which the trainee is CbD, mini-CEX 1,3,4 competent to perform, in accordance with advice of GMC Show willingness to obtain a second opinion, senior opinion, and CbD, mini-CEX, MSF 1,2,3 legal advice in difficult situations of consent or capacity Inform a patient and seek alternative care where personal, moral or , CbD, mini-CEX, PS 1,3,4 religious belief prevents a usual professional action 1.12 Legal Framework for Practice To understand the legal framework within which healthcare is provided in the UK Knowledge Assessment GMP Methods Demonstrate Knowledge of: The legislative framework within which healthcare is provided in the CbD, SCE 1,2 UK The NHS disciplinary processes CbD, MSF, SCE 1 The role of the medical practitioner in relation to personal health and CbD, MSF, SCE 1 substance misuse, including understanding the procedure to be followed when such abuse is suspected Skills Ability to cooperate in relevant circumstances with other agencies CbD, 1,2,3, 4 with regard to legal requirements and reporting Ability to prepare appropriate medical legal statements CbD, 1,2,3,4 Behaviours Show willingness to seek advice from the employer, appropriate legal CbD 1 bodies (including defence societies), and the GMC on medico-legal matters Promote informed reflection on legal issues by members of the team; CbD, mini-CEX 1,3 Endocrinology and Diabetes August 2010 Page 19 of 61
  20. 20. 1.13 Research To understand the principles of research and research governance Knowledge Assessment GMP Methods Demonstrate Knowledge of: The GMC guidance on good practice in research CbD 1,2 The principles of research governance CbD, SCE 1,2 The differences between audit and research CbD Research principles CbD, SCE 1 The principles of qualitative, quantitative, bio-statistical and CbD 1 epidemiological research methods Skills Develop critical appraisal skills and apply these when reading CbD 1 literature Demonstrate the ability to write a scientific publication CbD 1 Demonstrate good verbal and written presentations skills CbD,AA 1 Behaviours Follow guidelines on ethical conduct in research and consent for CbD 1 research 1.14 Evidence and Guidelines To develop the ability to construct evidence based guidelines and protocols and make optimal use of best evidence in making decisions about the care of patients Knowledge Assessment GMP Methods Demonstrate Knowledge of: The application of statistics in scientific medical practice SCE, CbD 1 The role and limitations of evidence in the development of clinical SCE, CbD 1 guidelines and protocols The processes that result in nationally applicable guidelines (e.g. SCE, CbD 1 NICE and SIGN) Skills Demonstrate the use of literature databases AA, CbD 1 Appraise and apply retrieved evidence to address a clinical question AA, CbD 1 Behaviours Keep up to date with national reviews and guidelines of practice (e.g. AA, CbD 1 NICE and SIGN) Contribute to the construction, review and updating of local (and CbD, MSF 1 national) guidelines of good practice using the principles of evidence based medicine Recognise the occasional need to practise outside clinical guidelines CbD, mini-CEX,MSF 1 Endocrinology and Diabetes August 2010 Page 20 of 61
  21. 21. 1.15 Clinical Audit To develop the ability to perform an audit of clinical practice and to apply the findings appropriately and complete the audit cycle Knowledge Assessment GMP Methods Demonstrate Knowledge of: The different methods of obtaining data for audit AA, CbD 1,2,3 The role of clinical audit AA, CbD 1,2,3 The steps involved in completing the audit cycle AA, CbD 1,2,3 The working and uses of national and local databases used for audit AA, CbD 1,2,3 Patient outcome reporting systems within the specialty and the AA, CbD 1,2,3 organisation, and how these relate to national programmes Skills Design, implement and complete audit cycles AA, CbD 1,2 Contribute to local and national audit projects as appropriate AA, CbD 1,2 Support audit by junior medical trainees and encourage within the AA, CbD 1,2 multi-disciplinary team Behaviours Recognise the need for audit in clinical practice to promote standard AA, CbD 1,2 setting and quality assurance Contribute to local and national audit projects AA, CbD 1,2 1.16 Teaching and Training To develop the ability to teach or train a variety of different audiences in a variety of different ways with appropriate assessments Knowledge Assessment GMP Methods Demonstrate Knowledge of: Adult learning principles relevant to medical education CbD Techniques for effective appraisal and performance review CbD 1 Identification of learning methods and effective learning objectives MSF 1 and outcomes The role of workplace-based assessments CbD, MSF 1 The appropriate local course of action to assist a trainee experiencing CbD, MSF 1 difficulty in making progress within their training programme Skills Provide effective after teaching, and promote learner reflection CbD, MSF 1 Demonstrate effective lecture, presentation, small group and bed side CbD, MSF, TO 1,3 teaching skills Provide appropriate career support, or refer trainee to an alternative CbD, MSF 1,3 effective source of career information Participate in strategies aimed at improving patient education e.g. CbD, MSF 1 talking at support group meetings Endocrinology and Diabetes August 2010 Page 21 of 61
  22. 22. Be able to lead departmental teaching programmes including journal CbD, TO 1 clubs Recognise the trainee in difficulty and take appropriate action CbD 1 including where relevant referral to other services Behaviours Balance the needs of service delivery with education CbD, MSF 1 Demonstrate willingness to teach trainees and other health and social CbD, MSF 1 workers in a variety of settings to maximise effective communication and practical skills and to improve patient care Maintain honesty and objectivity during appraisal and assessment CbD, MSF 1 Show willingness to participate in workplace-based assessments and CbD, MSF 1 demonstrate a clear understanding of their purpose Show willingness to take up formal training as a trainer and respond CbD, MSF 1,3 to feedback obtained after teaching sessions 1.17 Management and NHS Structure To understand the structure of the NHS and the management of local healthcare systems Knowledge Assessment GMP Methods Demonstrate Knowledge of: The guidance given on management to doctors by the GMC CbD 1 The local structure of NHS systems in your locality recognising the CbD 1 potential differences between the four countries of the UK The changes that occur in the NHS including the political, economic CbD 1 and organisational aspects that can impact on provision of service The principles of: CbD 1 • Clinical coding • European Working Time Regulations including rest provisions • National Service Frameworks • NHS Structure and relationships • NHS finance and budgeting, the contracting process and resource allocation • Consultant contract • The role of the Independent sector as providers of healthcare • Patient and public involvement processes and role The principles of recruitment and appointment procedures CbD 1,4 Processes of assessment of community needs pertaining to speciality CbD 1,3 The duties, rights and responsibilities of an employer, and of a co- CbD 1,3,4 worker Skills Participate in managerial meetings CbD, MSF 1,3 Work with stakeholders to create and sustain a patient-centred CbD, mini-CEX 1 service Behaviours Respond appropriately to health service objectives and targets and CbD, mini-CEX 1,2 Endocrinology and Diabetes August 2010 Page 22 of 61
  23. 23. take part in the development of services Show willingness to improve managerial skills (e.g. management CbD, MSF 1 courses) and engage in management of the service Commitment to the proper use of public money; showing a CbD 1 commitment to taking action when resources are not used efficiently or effectively Endocrinology and Diabetes August 2010 Page 23 of 61
  24. 24. 2. Diabetes 2.1 Diagnosis and General Management of Diabetes Mellitus Diagnosis and general management of people with, or at increased risk of, diabetes mellitus Assessment GMP Knowledge Methods Demonstrate Knowledge of: The diagnostic criteria for diabetes mellitus and identify the different CbD, mini-CEX, SCE 1,2 types The diagnostic criteria for pre-diabetes and identify the different types CbD, SCE 1,2 The underlying basis of metabolic disturbances and principles of CbD, SCE 1,2 management The principles of lifestyle management including some knowledge of CbD, mini-CEX, SCE 1,2 nutrition (including carbohydrate counting and healthy living) The characteristics of the range of oral hypoglycaemic drugs CbD, mini-CEX, SCE 1,2 available and identify appropriate use in the clinical setting The characteristics of the range of insulins available and define their CbD, mini-CEX, SCE 1,2 use in intensive insulin management The systems used to monitor blood glucose including continuous CbD, mini-CEX, SCE 1,2 glucose monitoring systems The use of technology in diabetes such as diabetes databases and CbD, mini-CEX 1,2 the use of meter / pump downloads The principles of structured education in the management of diabetes CbD, mini-CEX 1,2 (such as DAFNE / DESMOND) Appropriate strategies for the prevention and detection of diabetes CbD, SCE 1,2 mellitus Appropriate preventive strategies / treatments for micro and CbD, mini-CEX, SCE 1,2 macrovascular complications of diabetes National (evidence based) therapeutic targets CbD, mini-CEX, SCE 1,2 Skills Be able to elucidate an appropriate history and interpret tests done to CbD, mini-CEX, SCE 1,2,3,4 differentiate different types of diabetes Be able to contribute to and support a programme or strategy CbD, SCE 1,2,3,4 designed to prevent or delay the onset of diabetes mellitus Educate patients in the use of insulin delivery devices including CbD, mini-CEX, PS, 1,2,3,4 syringes, pens and pumps SCE Educate people in the use of home blood glucose monitoring systems CbD, mini-CEX, PS, 1,2,3,4 SCE Give advice on the indications for insulin therapy in type 2 diabetes CbD, mini-CEX 1,2,3,4 Make appropriate insulin dose adjustments including different CbD, mini-CEX 1,2,3,4 regimens for intermittent insulin therapy and insulin pump therapy Give appropriate advice about dose adjustment in response to blood CbD, mini-CEX, SCE 1,2,3,4 glucose levels, exercise, alcohol etc Identify complications of diabetes and perform annual screening for CbD, mini-CEX, SCE 1,2,3,4 complications Identify patients appropriate for psychological intervention CbD, mini-CEX 1,2,3,4 Endocrinology and Diabetes August 2010 Page 24 of 61
  25. 25. Give appropriate advice about employment, driving, exercise, alcohol, CbD, mini-CEX, PS, 1,2,3,4 weight management, smoking and family planning SCE Behaviours Ability to understand the implications and concerns arising from a CbD, mini-CEX, 1,2,3,4 diagnosis of diabetes and provide advice in a non-judgmental manner MSF, PS Recognise the central role of the patient in the management of their CbD, MSF, PS 1,2,3,4 diabetes Understand the cultural and educational barriers to good glucose CbD, MSF, PS 1,2,3,4 control Recognise the impact of diagnosis of diabetes on carers and their CbD, mini-CEX, 1,2,3,4 role in the management of diabetes MSF, PS Ability to understand and personalise treatments and targets to the CbD, mini-CEX, 1,2,3,4 individual patient’s circumstances MSF, PS 2.2 Management of Delivery of Diabetes Care Management of Delivery of Diabetes Care with regard to patients and carers, other health care professionals and relevant organisations Assessment GMP Knowledge Methods Demonstrate Knowledge of: The different settings in which diabetes care can be delivered and the CbD, SCE 1,2,3 different models of diabetes care delivery (i.e. primary care, intermediate care and secondary care) The factors which influence commissioning diabetes care within the CbD, SCE 1,2,3 NHS Which aspects of diabetes care can be appropriately delivered in CbD, mini-CEX 1,2,3 different clinical settings The role of information technology in integrating care across different CbD, mini-CEX 1,2,3 providers The role of diabetes networks and advisory groups in the organisation CbD, mini-CEX, SCE 1,2,3 of care Skills Identify appropriately patients who can be managed in different CbD, mini-CEX, SCE 1,2,3,4 settings such as primary care, intermediate care and multidisciplinary (sub-speciality) specialist care Interact with different providers of care to develop cohesive local CbD, mini-CEX, SCE 1,2,3,4 pathways for delivery of care Ability to develop business cases to improve care delivery locally CbD, mini-CEX, SCE 1,2,3,4 Behaviours Recognise the importance of multidisciplinary team working CbD, mini-CEX 1,2,3,4 Recognise the importance of primary secondary care interface in CbD, MSF 1,2,3,4 management Recognise the importance of PCT and hospital management support CbD, mini-CEX 1,2,3,4 in care delivery Understand economic and cultural barriers to the delivery of CbD, mini-CEX 1,2,3,4 integrated diabetes care Endocrinology and Diabetes August 2010 Page 25 of 61
  26. 26. 2.3 Diabetic Emergencies Manage hyperglycaemic metabolic emergencies and severe hypoglycaemia and advise about future prevention. Assessment GMP Knowledge Methods Demonstrate Knowledge of: Diagnosing and distinguishing between the types of diabetic CbD, mini-CEX, SCE 1,2 hyperglycaemic metabolic emergency The underlying basis of metabolic disturbances and principles of CbD, SCE 1,2 management Diagnosing and managing severe hypoglycaemia and advice about CbD, mini-CEX, SCE 1,2,3,4 future prevention Identifying patients with hypoglycaemia unawareness and advising CbD, mini-CEX, SCE 1,2,3,4 them appropriately Skills Identify and differentiate between different hyperglycaemic CbD, mini-CEX, SCE 1,2 emergencies Formulate appropriate plan for investigation and management, CbD, SCE, mini-CEX, 1,2,3,4 including identifying appropriate patients for escalation of treatment to SCE critical care Identify factors that may have contributed to hyper or hypoglycaemic CbD, mini-CEX, SCE 1,2,3,4 emergencies Give advice about future prevention of hyper and hypoglycaemic CbD, mini-CEX 1,2,3,4 emergencies Behaviours Recognise and judge the urgency and severity of the emergency CbD, mini-CEX 1,2,3,4 Communicate with other health care professionals and convey MSF 1,2,3,4 management plans Recognise the impact of hypoglycaemia unawareness on the lifestyle CbD, mini-CEX, MSF 1,2,3,4 of patients, their families and their carers 2.4 Management of Patients with Diabetes during Acute Illness or Surgery Management of Patients with Diabetes During Acute Illness or Surgery Assessment GMP Knowledge Methods Demonstrate Knowledge of: The impact of acute illness on glycaemia and it’s effects / implications CbD, mini-CEX, SCE 1,2 on current management The impact of other treatments such as steroids / parenteral nutrition CbD, SCE 1,2 on glycaemia The metabolic requirements of patients with diabetes during surgery CbD, SCE 1,2 The implications of glucose control during other illnesses such as CbD, SCE 1,2 cardio- and cerebrovascular illnesses Skills Endocrinology and Diabetes August 2010 Page 26 of 61
  27. 27. Adjust therapy in the short term to manage glucose control during CbD, mini-CEX, SCE 1,2,3,4 acute illness Manage diabetes appropriately in patients on steroids or parenteral CbD, mini-CEX, SCE 1,2,3,4 nutrition Manage diabetes appropriately in peri-operative patients CbD, mini-CEX, SCE 1,2,3,4 Be able to supervise and advise other health care professionals in the CbD, mini-CEX, MSF 1,2,3,4 management of patients with diabetes who are under their care Behaviours Recognise the importance of multidisciplinary team working CbD, mini-CEX, MSF 1,2,3,4 Recognise the need for specialist diabetes care in different clinical CbD, mini-CEX, MSF 1,2,3,4 environments Awareness of the importance of glucose control in patients who are CbD, mini-CEX, MSF 1,2,3,4 acutely unwell 2.5 Conception and Pregnancy in Diabetes Manage pre-conception, conception and pregnancy in the diabetic woman in order to optimise outcome Assessment GMP Knowledge Methods Demonstrate Knowledge of: Discuss the importance of glucose control in pre-conception and CbD, mini-CEX, SCE 1,2 during pregnancy and the need for family planning in fertile women of all ages The effect of diabetes on the pregnant woman and her foetus, and CbD, mini-CEX, SCE 1,2 strategies for their amelioration The effect of pregnancy on diabetes management and glycaemia CbD, mini-CEX, SCE 1,2 The risk factors for gestational diabetes and current diagnostic criteria CbD, mini-CEX, SCE 1,2 and appropriate screening strategies Describe the different available methods of contraception CbD, mini-CEX, SCE 1,2 Skills Discuss the importance of diabetes in pregnancy and the need for CbD, mini-CEX, PS 1,2,3,4 family planning in fertile women of all ages Advise women about the importance of pre-conception care and CbD, mini-CEX, PS, 1,2,3,4 potential risks of diabetic pregnancy, including progression of SCE complications Advise women with diabetes regarding contraception CbD, mini-CEX, PS, 1,2,3,4 SCE Optimise glycaemic and blood pressure control prior to and CbD, mini-CEX, SCE 1,2,3,4 throughout pregnancy Manage other aspects of pregnancy such as folate supplements and CbD, mini-CEX, SCE 1,2,3,4 rubella vaccination Diagnose and manage gestational diabetes CbD, mini-CEX 1,2,3,4 Deliver antenatal care in the setting of a joint obstetric clinic CbD, mini-CEX, 1,2,3 MSF, SCE Manage glycaemia during labour and delivery CbD, mini-CEX, SCE 1,2,3,4 Endocrinology and Diabetes August 2010 Page 27 of 61
  28. 28. Manage intercurrent illness and events such as administration of mini-CEX, SCE 1,2,3,4 steroids in order to mature fetal lungs Behaviours Exhibit a non judgemental attitude to women who have difficulty in CbD 4 achieving glycaemic targets prior to conception or during pregnancy and support their efforts to do so. Communicate and work with obstetric and midwifery colleagues in the CbD, MSF 2,3 joint management of diabetic pregnancy Endocrinology and Diabetes August 2010 Page 28 of 61
  29. 29. 2.6 Age-related Conditions and Diabetes 2.6.1 Young People Ability to provide care to young people with diabetes in transition to adult services Assessment GMP Knowledge Methods Demonstrate Knowledge of: The effects of diabetes on normal growth and development in children CbD, SCE 1,2 The physiological, psychological and social factors affecting CbD, mini-CEX, SCE 1,2,3,4 glycaemic control in adolescence Awareness of ways in which individual behaviour can impact on CbD, mini-CEX, MSF 1,2,3,4 young people Awareness of the rights of children and young people CbD, SCE 1,3,4 Skills Provide care to young persons with diabetes in transition to the adult mini-CEX, CbD 1,2,3,4 service Recognise common risk taking behaviour in young persons and its mini-CEX, CbD 1,2,3,4 effects on diabetes Recognise the potentially negative effects of adolescent behaviour on CbD, mini-CEX, MSF 1,2,3,4 diabetes and the impact it may have on family and personal relationships Behaviours Exhibit a non judgemental attitude in addressing the problems of a mini-CEX, MSF, PS 3,4 young patient with diabetes and demonstrate preparedness to change behaviour in response to feedback and reflection Respond to the physiological, psychological and social problems of CbD, mini-CEX, MSF 1,2,3,4 maintaining glycaemic control in adolescence and the concerns and anxieties of parents / carers Adopt a patient focussed approach that acknowledges values that mini-CEX, MSF, PS 3,4 may not be shared by the trainee 2.6.2 Elderly People Provide care for and manage elderly patients with diabetes Assessment GMP Knowledge Methods Demonstrate Knowledge of: The potential effects of co-morbidities associated with ageing on CbD, mini-CEX, SCE 1,2 diabetes treatments and control The effects of aging including associated disability on access to CbD, mini-CEX 1,2,3,4 healthcare The diversity of agencies and healthcare workers that can support CbD, mini-CEX, SCE 1,2,3 elderly patients living in the community Skills Adapt therapeutic targets and diabetes treatment regimens to the CbD, mini-CEX 1,2,3,4 individual patient taking account of co-morbidities Endocrinology and Diabetes August 2010 Page 29 of 61
  30. 30. Manage the specific social and medical needs of elderly patients with CbD, mini-CEX 1,2,3,4 diabetes in the community Advise about the care of older people in residential and nursing care CbD, mini-CEX 1,2,3,4 taking into account appropriate utilisation of health service resources Assess and advise so as to minimise risk especially for elderly CbD, mini-CEX 1,2,3,4 vulnerable patients Behaviours Adopt a patient centred approach recognising that diabetes CbD, mini-CEX, PS 1,2,3,4 management and therapeutic targets may need adjustment in elderly patients with disability, social isolation and co-morbidity Adopt a team approach in co-ordinating, in some cases leading but CbD, mini-CEX, MSF 1,2,3,4 always acknowledging, the efforts of agencies and individuals managing older patients with diabetes Endocrinology and Diabetes August 2010 Page 30 of 61
  31. 31. 2.7 Complications of Diabetes 2.7.1 Screening for the Complications of Diabetes Understand the principles and practice of screening for diabetic complications Assessment GMP Knowledge Methods Demonstrate Knowledge of: The principles and practice of screening CbD, mini-CEX, SCE 1,2 Skills Practice effective strategies in the implementation of a screening CbD 1,2 programme for diabetes complications Behaviours Recognise the criteria for urgent referral to appropriate services CbD, MSF 1,2,3,4 when diabetic complications are identified 2.7.2 Macrovascular Disease Identify, investigate, treat and make appropriate referrals for patients with macrovascular disease Assessment GMP Knowledge Methods Demonstrate Knowledge of: The importance of hyperglycaemia as a risk factor for CbD, SCE 1,2 macroangiopathy Other risk factors for macroangiopathy including elements of the so- CbD, SCE 1,2 called metabolic syndrome The presenting features of cerebrovascular, cardiovascular and CbD, SCE 1,2 peripheral vascular disease The available treatments for non glycaemic risk factors for CbD, SCE 1,2 macroangiopathy Skills Identify and manage glycaemia and other modifiable risk factors for CbD, mini-CEX 1,2 macroangiopathy Diagnose and manage heart failure in diabetes CbD, mini-CEX 1,2 Investigate and manage diabetic patients with established CbD, mini-CEX 1,2 macrovascular disease Manage diabetic patients suffering acute myocardial infarction and CbD 1,2 stroke Behaviours Recognise when to refer patients for specialist investigation and CbD, mini-CEX 1,2,3,4 treatment (e.g. Cardiology, Vascular surgery) Endocrinology and Diabetes August 2010 Page 31 of 61
  32. 32. 2.7.3 Eye Disease in Diabetes Identify and prevent diabetic eye disease Assessment GMP Knowledge Methods Demonstrate Knowledge of: How diabetes can affect different parts of the eye CbD, mini-CEX, SCE 1,2 The pathogenesis and different stages of diabetic retinopathy SCE, CbD 1,2 The importance of visual acuity testing and retinal screening CbD, SCE 1,2 The available treatments for eye complications CbD, SCE 1,2 The implications of eye complications on driving / employment CbD, mini-CEX, SCE 1,2,4 The structure of a retinal screening programme CbD, mini-CEX, SCE 1,2,3 Skills Diagnose cataract, and all grades of severity of retinopathy using mini-CEX 1,2 direct ophthalmoscopy Interpret retinal photographs CbD, mini-CEX 1,2 Identify other ocular disorders associated with diabetes CbD, mini-CEX, SCE 1,2 Perform and interpret visual acuity testing mini-CEX 1,2 Discuss the importance of glycaemic control and blood pressure CbD, mini-CEX 1,2,3,4 management in diabetic eye disease Recognise the types of diabetic eye complications which need urgent CbD, mini-CEX 1,2,3 ophthalmology referral Behaviours Practice primary prevention of diabetic eye disease mini-CEX 1,2 Refer the appropriate patients for specialist ophthalmic assessment CbD, mini-CEX, MSF 1,2,3 Communicate to patients and advise accordingly about the mini-CEX, PS 1,2,3,4 treatments available for eye complications and the implications of eye complications on driving / employment Recognise the importance of retinal screening and contribute to local CbD, MSF 1,3 diabetic retinopathy screening programmes Recognise the impact of diabetes eye complications on patients CbD, PS 1,3,4 lifestyle 2.7.4 Renal Disease and Hypertension in Diabetes Prevent, identify and manage renal disease and hypertension in people with diabetes Assessment GMP Knowledge Methods Demonstrate Knowledge of: How diabetes can affect different parts of the kidney SCE 1 The pathogenesis and different stages of diabetic nephropathy SCE 1 The effect of hypertension on diabetic nephropathy CbD, SCE 1,2 The significance of proteinuria in the increased incidence of CbD, SCE 1,2 macroangiopathy Endocrinology and Diabetes August 2010 Page 32 of 61
  33. 33. The treatment thresholds of blood pressure in patients with diabetes CbD, mini-CEX, SCE 1,2 and nephropathy Describe the available tests for diagnosing nephropathy and explain CbD, mini-CEX, SCE 1,2 the importance of screening for early nephropathy Describe the treatments available for diabetic nephropathy and CbD, mini-CEX, SCE 1,2 hypertension Skills Manage hypertension according to current guidelines CbD, mini-CEX 1,2 Manage glycaemia in patients with renal impairment CbD, mini-CEX 1,2,3 Diagnose nephropathy and distinguish between its different stages CbD, mini-CEX 1,2 (early / late) Evaluate other macrovascular risk factors in patients with diabetic CbD, mini-CEX 1,2 nephropathy Advise/counsel patients about the significance of nephropathy mini-CEX, PS 1,4 Behaviours Communicate to patients the importance of blood pressure and mini-CEX, PS 2,3,4 glycaemic management in the prevention and slowing of progression of nephropathy Communicate the significance of a diagnosis of nephropathy to mini-CEX, PS 2,3,4 patients Communicate with colleagues in specialist nephrology services and CbD, MSF 2,3 refer patients appropriately Recognise the implications of a diagnosis of diabetic nephropathy on CbD, mini-CEX, PS 2,4 patients, their carers and families. 2.7.5 Neuropathy, Foot Disease and Erectile Dysfunction in Diabetes To understand principles of management of diabetes related foot disease and erectile dysfunction Assessment GMP Knowledge Methods Demonstrate Knowledge of: How diabetes can affect different parts of the nervous system CbD, SCE 1,2 The pathogenesis and different manifestations of diabetic neuropathy CbD, SCE 1,2 The principles of infection control CbD 1 The risks of antibiotic therapy and importance of prescribing policies CbD, mini-CEX, SCE 1 Skills Diagnose the different patterns of autonomic and somatic poly- and CbD, mini-CEX 1,2 mononeuropathies, including performance of appropriate examination Manage the neuropathies, including neurogenic pain and the CbD, mini-CEX, SCE 1,2,4 manifestations of autonomic neuropathy Assess vascular supply and neurological status of the lower limb mini-CEX 1,2 Identify patients at risk of foot problems and advise on prevention CbD, mini-CEX 1,2,4 Manage established diabetic foot problems including use of CbD, mini-CEX, SCE 1,2 Endocrinology and Diabetes August 2010 Page 33 of 61
  34. 34. appropriate antibiotic treatment Evaluate and manage erectile dysfunction in diabetic men CbD, mini-CEX 1,2 Counsel patients on matters of infection risk, transmission and control CbD, mini-CEX, PS 2,3 Actively engage in local infection control procedures CbD 1 Prescribe antibiotics according to local antibiotic guidelines and liaise CbD, mini-CEX 1 appropriately with microbiological services Recognise potential for cross-infection in clinical settings CbD, mini-CEX 1,2 Behaviours Select appropriate treatment particularly for neurogenic pain and mini-CEX, SCE 1,2 manifestations of autonomic neuropathy Demonstrate effective management of established diabetic foot CbD, mini-CEX 1,2,4 problems including communication of advice on prevention of foot ulceration Recognise the importance of the multidisciplinary team in the CbD, MSF 1,2,3 prevention and management of diabetic foot problems Recognise when to refer patients for specialist foot care CbD Exhibit appropriate behaviours when discussing erectile dysfunction mini-CEX, PS 1,3,4 and communicating range of treatment options Recognise the impact of amputation on patients and their carers and CbD, mini-CEX 3,4 the importance of effective rehabilitation Encourage all staff, patients and relatives to observe infection control CbD, MSF 1,3 principles Recognise the risk of personal ill-health as a risk to patients and CbD, MSF 1,3 colleagues in addition to its effect on performance Practice aseptic technique whenever relevant MSF 1 2.7.6 Lipid Disease To be able to diagnose and manage disorders of lipid metabolism Assessment GMP Knowledge Methods Demonstrate Knowledge of: The pattern of lipid abnormalities seen in patients CbD, mini-CEX, SCE 1,2 Range of treatments available for managing lipid abnormalities CbD, mini-CEX, SCE 1,2 Skills Select appropriate patients to screen for dyslipidaemia mini-CEX 1,2 Assess cardiovascular risk in relation to the patient’s lipid profile CbD, mini-CEX 1,2 Diagnose and manage patients with primary and secondary lipid CbD, mini-CEX 1,2 disorders Communicate the cardiovascular risk of hyperlipidaemia to patients mini-CEX, PS 1,2,4 Behaviours Select appropriate treatment for individual patients CbD, mini-CEX 1,2 Explain the importance of screening for lipid abnormalities in diabetes CbD, mini-CEX, PS 1,2,4 Recognise the need to refer patients with atypical or severe CbD, MSF 1,2,3,4 Endocrinology and Diabetes August 2010 Page 34 of 61
  35. 35. dyslipidaemia to specialist services Endocrinology and Diabetes August 2010 Page 35 of 61
  36. 36. 3. Endocrinology 3.1 Disorders of the Hypothalamus and Pituitary To diagnose, manage and provide care for patients with disorders of the hypothalamus and / or the pituitary gland Assessment GMP Knowledge Methods Demonstrate Knowledge of: The causes, investigations and treatments for disorders of the CbD, mini-CEX, SCE 1,2 hypothalamus and pituitary Skills Perform and interpret basal and dynamic tests of pituitary function CbD, mini-CEX, SCE 1,2,3 Demonstrate an ability to diagnose and provide first line management CbD, mini-CEX, PS, 1,2,3 of functioning and non functioning pituitary tumours Demonstrate an ability to diagnose and monitor optic nerve CbD, mini-CEX, PS, 1,2 compression Provide immediate and long term care to patients with mass effects CbD, mini-CEX, 1,2,3,4 from pituitary enlargement Demonstrate ability to diagnose and manage hypopituitarism CbD, mini-CEX, , 1,2,3,4 Demonstrate ability to diagnose and manage diabetes insipidus CbD, mini-CEX, 1,2,3 Demonstrate ability to manage patients during and after surgery for CbD, mini-CEX, 1,2,3,4 pituitary tumours Demonstrate ability to diagnose and manage patients with SIADH, CbD, mini-CEX 1,2,3 thirst dysregulation and other disorders of water balance. Behaviours Recognise the need for appropriate referrals for pituitary surgery and CbD, mini-CEX 1,2,3 radiotherapy Recognise the role of the multidisciplinary team in the management of CbD, mini-CEX, MSF 1,2,3,4 pituitary tumours Recognise the need for urgent referral of patients presenting with CbD, mini-CEX 1,2,3 symptoms of optic nerve compression Recognise the impact of hypothalamic / pituitary disorders on patients CbD, mini-CEX, PS 1,2,3,4 and carers 3.2 Disorders of Growth and Development To assess normal growth and development by the use of growth charts and assessment of pubertal stage, and to diagnose and treat growth disorders Assessment GMP Knowledge Methods Demonstrate Knowledge of: Methods of assessment of normal growth and development by the CbD, mini-CEX, SCE 1,2 use of growth charts and assessment of pubertal stage Describe the diagnosis and management of endocrine growth CbD, mini-CEX, SCE 1,2 disorders Skills Endocrinology and Diabetes August 2010 Page 36 of 61
  37. 37. Demonstrate ability to diagnose and manage disorders of growth and CbD, mini-CEX 1,2,3 maturation, particularly constitutional delay in growth in puberty Behaviours Recognise the impact of growth and pubertal disorders on the patient CbD, mini-CEX, 1,2,3,4 and his / her family MSF, PS 3.3 Disorders of the Thyroid Gland To understand the physiology and biochemistry of thyroid hormone, and to be competent to diagnose, manage and provide care for patients with thyroid disease, including thyroid eye disease and thyroid disorders during pregnancy Assessment GMP Knowledge Methods Demonstrate Knowledge of: Explain disease states in terms of disorders of physiology and CbD, mini-CEX, SCE 1,2 biochemistry of thyroid hormones and TSH The Causes of thyroid dysfunction and goitre, their diagnosis and CbD, mini-CEX, SCE 1,2 their management The regulations applicable to the use of radioactive iodine for benign SCE 1,2 thyroid disease Methods of diagnosis and treatment of thyroid eye disease CbD, mini-CEX, SCE 1,2 The Iinfluence of pregnancy on tests of thyroid function and their CbD, mini-CEX, SCE 1,2 interpretation Describe the implications of pregnancy for the management of thyroid CbD, mini-CEX, SCE 1,2 disease Skills Interpret thyroid function test results to diagnose and exclude thyroid CbD, mini-CEX, SCE 1,2,3 disease and to recognise assay interferences Demonstrate ability to diagnose and manage simple non-toxic goitre CbD, mini-CEX, 1,2,3 and solitary thyroid nodules Perform and/or refer appropriately for fine needle aspiration cytology CbD, mini-CEX 1,2,3 of the thyroid Use and/or refer for the use of radioisotopes to diagnose thyroid CbD, mini-CEX, 1,2,3 disorders Use and/or refer for the use of radioisotopes in the treatment of CbD, mini-CEX, 1,2,3 hyperthyroidism and goitre Demonstrate the ability to diagnose and manage primary and CbD, mini-CEX, MSF 1,2,3,4 secondary hypothyroidism Demonstrate the ability to manage thyroid emergencies including CbD, mini-CEX, 1,2,3,4 thyroid patients in critical care MSF, Provide perioperative care for patients undergoing thyroid surgery CbD, mini-CEX, 1,2,3,4 (particularly preoperative preparation) Demonstrate the ability to investigate and manage patients with CbD, mini-CEX, 1,2,3,4 thyroid eye disease Demonstrate the ability to manage thyroid disorders during and after CbD, mini-CEX, 1,2,3,4 pregnancy MSF, Endocrinology and Diabetes August 2010 Page 37 of 61

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