Dartford and Gravesham NHS Trust Darent Valley Hospital INDUCTION HANDBOOK FOR THE PAEDIATRIC FACULTY GROUP August2015 1.
HEALTH EDUCATION KENT SURREY AND SUSSEX POSTGRADUATE FOR MEDICAL AND DENTAL EDUCATION PAEDIATRIC FACULTY HANDBOOK A GUIDE FOR POSTGRADUATE DOCTORS AND STAFF IN DARTFORD AND GRAVESHAM NHS TRUST This Handbook is mapped to the HEKSS Graduate Education and Assessment Regulations [GEAR] for Local Faculty Groups Introduction Welcome to The Philip Farrant Education Centre, Darent Valley Hospital. This Faculty Handbook is written for you as a Postgraduate Doctor and all who will be working with you during your time here at Darent Valley Hospital. Its purpose is to give you information about how your programme works, and who the key people are who will be working with you. This Handbook contains generic information, but is specifically written to support those of you who are on the Paediatric Specialty Training programme. It should be read in conjunction with your curriculum found at: http://www.rcpch.ac.uk/training-examinations-professional-development/postgraduatetraining/general-paediatric-training/gen This Handbook is updated annually based on feedback to the Faculty Group, from you as a Postgraduate Doctor in training and from your Supervisors. Location During your time with us you will be based at Darent Valley Hospital, Dartford and Gravesham NHS Trust. The Postgraduate Centre is at The Philip Farrant Education Centre, Darent Valley Hospital. Brief Profile of the Paediatric Department Darent Valley Paediatrics Unit is composed of: 9 Paediatric Consultants, 3 Community Paediatric Consultant 7 Trust Grades Doctors 2 Foundation Year 2 Trainees 2 GPST1/2 Trainees 1 Community GPST1/2 Trainee 1BBT trainee 2 Core Paediatric Trainees 1 Higher Acute Paediatric Trainee 1 Higher Community Paediatric Trainee The trainees will be based on 1) Willow Ward: the General Paediatric Ward and Paediatric Assessment Unit 2) Walnut Ward; the Special Care Baby Unit 3) Children Resources Centre: Paediatric Outpatient 4) Community paediatrics trainees in community with on call commitments in acute paediatrics The Willow Ward has 22 in patient beds, PAU has 4 beds and Walnut Ward has 18 SCBU cots. The Local Paediatric Curriculum includes opportunities for the trainees to work with other health care professionals such as: Specialist Nurses in General Paediatrics, Special Care Baby Unit, Paediatric A&E, Diabetes Nurses, and Children s Community Nurses Visiting Speciality Consultants in Endocrinology, Neurology, Cardiology, Genetics and Paediatric Surgery. 2.
Other members of the Multidisciplinary including Community Paediatrician, Occupational Therapist, Physiotherapist, Speech and Language Therapist and Dietician Key people There are several key people who will support you during your time with us. The Director of Medical Education is Dr Ali Bokhari (Ali.Bokhari@dvh.nhs.uk) The Clinical Director is Dr Alok Gupta (Alok.Gupta@dvh.nhs.uk) The Training Programme Lead and RCPCH tutor is Dr Abdul Hasib (Abdul.Hasib@dvh.nhs.uk) The Medical Education Manager is Mrs Claire Nottage (Claire.Nottage@dvh.nhs.uk) The Medical Education Officer is Mrs Sue Franklin (Sue.Franklin@dvh.nhs.uk) A list of Educational and Clinical Supervisors is given in Appendix A. Local Programme Administrative Arrangements The administrative arrangements for the local management of your programme are managed by the MEM and Faculty Administrator in conjunction with your Programme Lead. The national arrangements for the management of your programme are contained in your portfolio. If you experience any local administration issues your first point of contact is the Education Centre. The Paediatric Curriculum [GEAR S 1.2; S 1.4; S1.5] The curriculum for your Paediatric Programme can be found at http://www.rcpch.ac.uk/trainingexaminations-professional-development/postgraduate-training/general-paediatric-training/gen The Local Paediatric Faculty is responsible for ensuring that the paediatric programme is such that it will enable you to meet specific competences required in any given year by your curriculum. It is important that you read the curriculum so that you are aware of what is required of you and the competencies that are required, in order to complete you training satisfactorily. It is the acquisition of these competencies that will be assessed during the year using a selection of the various Assessment Tools. The Local Paediatric Faculty is responsible for ensuring that the Paediatric Programme is such that it will enable you to meet specific competences required in any given year by your Paediatric Curriculum. Your Educational Supervisor is responsible for overseeing your training and making sure that you are making the necessary clinical and educational progress. You should have regular feedback from your Educational Supervisor. The responsibilities of an Educational Supervisor are given in the Gold guide at http://www.mmc.nhs.uk/specialty_training/specialty_training_2011_final/gold_guide.aspx Educational Supervisors Responsible for the supervision of trainees progress Responsible for ensuring that trainees are making necessary clinical and educational progress Educational Supervisors should have training and ability to undertake appraisal, work with portfolios and provide career advice, plus managing the trainee in difficulty. Meet the trainee at least twice during the job and arrange work based assessments. Clinical Supervisors are responsible for day to day supervision of the trainee in the workplace, teaching on the job, regular feedback and rapid response to issues as they arise. The aims and objectives of the Paediatric Curriculum (GEAR S 1.4) The aim of paediatric curriculum is to produce high quality paediatricians with a broad range of skills, supported by assessments which are competency based. The competency frameworks which make up the curriculum can be viewed at http://www.rcpch.ac.uk/training-examinations-professional-development/postgraduatetraining/general-paediatric-training/gen and a version can also be found within the e-portfolio. There are different levels to the pathway through training and the competency frameworks reflect what areas should be 3.
covered during your training at these different levels. Level One Training By the end of Level One training trainees will have the following knowledge and understanding: Understand the duties and responsibilities of a pediatrician in the safeguarding of babies, children and young people Understand the duties and responsibilities of a paediatrician to support and enable parents and carers to be effective in caring for their children Know and understand the scientific base relevant to clinical practice in paediatrics Know the aetiology and patho-physiology of common and serious childhood conditions Understand the promotion of health and the management of ill-health in babies, children and adolescents Understand the specific health issues, diseases and disorders related to these stages of growth and development Recognise the mental health components of all paediatric illness Recognise the effects that school and other social settings may have on childhood illness and vice versa Understand the factors that affect a child s level of anxiety about illness, treatment or examination Recognise the impact on parents and the rest of the family of acute or chronic illness, hospitalisation or death of a child Understand the importance of effective strategies for the management of pain Understand the importance of agreed management plans for individual patients Understand the different factors that have an influence on the patient s journey Know about the agencies, both statutory and voluntary, that can provide support to children and their families in coping with their health problems Understand the limitations of their competence and know where and when tp ask for help, support or supervision Level Two Training By the end of Level Two training trainees will have the following knowledge and understanding: Understand the duties and responsibilities of a pediatrician in the safeguarding of babies, children and young people Understand the duties and responsibilities of a paediatrician to support and enable parents and carers to be effective in caring for their children Know and be able to apply the scientific base relevant to clinical practice in paediatrics Know the aetiology and patho-physiology of common and serious childhood conditions Understand the promotion of health and the management of ill-health in babies, children and adolescents Understand the specific health issues, diseases and disorders related to these stages of growth and development Recognise the mental health components of all paediatric illness Recognise the effects that school and other social settings may have on childhood illness and vice versa Understand the factors that affect a child s level of anxiety about illness, treatment or examination Recognise the impact on parents and the rest of the family of acute or chronic illness, hospitalisation or death of a child Understand the importance of effective strategies for the management of pain Understand the importance of negotiated management plans for individual patients and families, including self-care strategies Understand the different factors that have an influence on the patient s journey Know about the agencies, both statutory and voluntary, that can provide support to children and their families in coping with their health problems Understand the limitations of their competence and know where and when tp ask for help, support or supervision 4.
How you complete the Paediatric Curriculum This Paediatric curriculum is competency based and leads to the satisfactory completion of competencies. You will be supported during your time at Dartford and Gravesham NHS Trust by your Programme Lead, an allocated Educational Supervisor and Clinical Supervisors, all of whom will give you regular feedback about your progress. You should never be in any doubt about your progress and what you can do to improve this. The Paediatric programme structure (GEAR S1.4; S 2.3) This Faculty Handbook, however, gives you details of how the national curriculum for Paediatrics is organised here at Dartford and Gravesham NHS Trust. It gives you details of your local programme, which has been devised to meet the requirements of the Paediatric Curriculum and shows how this will work locally. Training opportunities include ward-based, half day local teaching, regional study days, clinical audit and exposure to academic opportunities. The programme is structured to comply with the Generic standards for training (July 2008) of the Postgraduate Medical and Education Training Board (PMETB) and the Gold Guide (http://www.mmc.nhs.uk/specialty_training/specialty_training_2011_final/gold_guide.aspx). You must make an appointment with your Educational Supervisor at the start of your appointment to create your Learning Agreement that should cover the learning opportunities for the whole year and to decide which examinations you expect to pass during the year. You need to state the type and frequency of Work Based Assessments that you will organise in each post. You will be expected to undertake one or more Clinical Audits and submit some research or clinical work for a national or international meeting for potential publication. You will have annual local and Deanery based Annual Review of Competence Progression (ARCP). Formal teaching is built into the weekly rota: Tuesday afternoon and Friday afternoon are allocated for teaching by the SpR or Consultant. There will also be an opportunity for SHOs to take part in case presentations and paper discussions. There is also a perinatal morbidity meeting with Obstetric Colleagues on 2 nd Tuesday of every month, joint meeting with Radiologist on first Tuesday of every month and joint meeting with community paediatrics colleagues on 3 rd Tuesday of every month. Trainees are encouraged to present cases in the perinatal meetings and attend specialist clinics. There is also Ward based teaching, regional study days, clinical audits and exposure to academic opportunities. The daily ward hand over takes place between 9AM 10AM in the Willow Ward doctor s office, which is attended by all the consultants. All the cases are discussed in detail which can be a useful educative session for the trainees. Induction/Handover/Taking consent (GEAR S1.7; S1.8; S1.9) You will be inducted to the Trust, your Specialty Programme and your Specialty Department (http://www.dvh.nhs.uk). There is a well established induction programme for junior doctors which includes mandatory training in resuscitation, child protection and common paediatrics emergencies. To ensure continuity of patient care the policy for handover is maintained at the highest level. The morning handover takes place at Willow ward daily at 9AM and is attended by all the consultants. All the cases are discussed and a management plan is made. This session can be a useful educational session for the junior doctors. The junior doctors are given training in taking consent during their stay in the department. They will be able to take informed consent for common practical procedures under the guidance from the seniors. Examinations The trainee is expected to complete all the parts of the MRCPCH exam during the first 3 years of training. To continue to Level 2 and Level 3 training, it is a requirement that you have passed the MRCPCH. Without the exam you may move into the ST4 year i.e. the first year of Level 2 training for ONE YEAR only. If you do 5.
not complete the exam by the end of the ST4 year, you will be asked to leave the training programme. Study Leave Study leave is managed by the Medical Education Department, although any requests must be discussed and authorised by the Educational Supervisor and the person responsible for the rota. The following principles guided the development of the national guidelines: For the full guidelines please visit: http://kssdeanery.org/study-leave Study Leave should: (i) enhance clinical, education and training (ii) be planned as far in advance as possible, as an integral part of the education and training process (iii) provide education and training not easily acquired in the clinical setting or locally, e.g. acquisition of a theoretical knowledge base such as basic sciences, statistics, etc. (iv) support Delivery of Curriculum Targets Your Educational Supervisor roles and responsibilities (GEAR S1.6) Your Educational Supervisor is responsible for overseeing your training and ensuring sure that you make the necessary clinical and educational progress. You should have regular feedback from your Educational Supervisor. The responsibilities of an Educational Supervisor are given in the Gold Guide. Your Clinical Supervisor roles and responsibilities (GEAR S1.6; S1.12; S1.14) Your Clinical Supervisor is responsible for your progress within each placement and for your day-to-day clinical progress. You should have regular feedback from your Clinical Supervisor. The process by which information about your progress is collated by your Educational Supervisor from your Clinical Supervisor is through appraisal, assessment and annual planning. Your role as a learner You are responsible for your own learning within the programme with the support of key people as above. You should ensure that you have regular meetings with your supervisors, that you maintain your portfolio, keep up to date with assessments as required and be signed off at the end of the year. How you will learn in this programme In this programme we adopt a variety of learning approaches. These include web-based, CDs, ward-based clinical teaching, exposure to outpatients and theatres at the appropriate identified level, group learning, private study, courses, reflective practice, audit projects, regular teaching specific to year and Specialty, but also multi-specialty if appropriate. The Local Paediatric Faculty Group (GEAR S 6.1-6) The Paediatric Faculty Group s remit is threefold: to ensure that the local paediatric programme is fit for purpose and in line with the curriculum requirements, to quality control the local paediatric programme and to ensure that trainee progression is tracked, supported and audited. The Local Paediatric Faculty meets at least three times a year and its work is quality controlled by the KSS Deanery Standards for the Local Faculty Graduate and Education Assessment Regulations (GEAR). Your Year Group Representative (GEAR S 6.10) This is key part of the feedback process. This is a member of your cohort who will undertake to consult with the whole cohort (either face-to-face or by e-mail) to gather feedback about the local programme and to give this feedback at the meetings of the Local Paediatric Faculty Group. The feedback loop must be closed as relevant information/responses from the LFG need to go back to the cohort. This is the responsibility of the Year Group Representative. 6.
The Local Academic Board There is a Local Academic Board (LAB) in each Trust whose responsibility it is to ensure that postgraduate medical trainees receive education and training that meets local, national and professional standards. The LAB undertakes the quality control of postgraduate medical training programmes. It receives Annual Audit and Review Reports from LFGs. Your Specialty School Details of your Paediatric School can be found at http://kssdeanery.org/specialty/current-trainees/paediatrics Feedback (GEAR S1.10; S1.11) This is a crucial aspect of your programme. You can expect to receive detailed feedback on your progress from your Educational Supervisor and from your Clinical Supervisor. This will happen during on going review meetings with your Educational Supervisor. You should have a clear idea of your progress in the programme at any given time and what you have to do to move to the next stage. Training Portfolio (GEAR S1.17) This is a key aspect of your learning in the programme. It is your responsibility to maintain an e- portfolio. This is an essential mandatory requirement as it provides an audit of your progress and learning. Further information on how to manage and complete the specialty e-portfolio can be found at http://www.rcpch.ac.uk/training-examinations-professional-development/assessment-andexaminations/assessment-tools/eportfol Assessments (GEAR S 1.16; 18) This programme is competency based. You will be assessed using the assessment tools identified by the college as appropriate to your level of expertise. For further details please see http://www.rcpch.ac.uk/training-examinations-professionaldevelopment/postgraduate-training/general-paediatric-training/gen The assessments are recorded in your portfolio. It is your responsibility to undertake the assessment process in accordance with the curriculum guidance. On the following page is a table taken from the college guidelines outlining the assessments required for each year of training. http://www.rcpch.ac.uk/training-examinations-professionaldevelopment/postgraduate-training/general-paediatric-training/gen#curriculum 7.
Level 1 Level 2 Level 3 ST1 ST2 ST3 ST4 ST5 ST6 ST7 ST8 Level 1 training (ST1-3) is General Paediatrics based in acute settings (24 36 months) By the end of ST2 trainees must complete: MRCPCH Part 1a and 1b By the end of ST3 trainees must complete: MRCPCH Part 2 MRCPCH Clinical Level 2 Training (ST4-5: 12 24 months) Trainees at this level are expected to complete: 12 months of General Paediatrics 6 months of Neonatology 6 months of Community Paediatrics Trainees may apply for the NTN Grid process Level 3 Training (ST6-8: 24 36 months) Trainees follow a programme in: General Paediatrics General Paediatrics with 12 months in a sub- specialty Sub- specialty (GRID Approved) All Level 3 trainees will be expected to undertake the START assessment 6 months prior to the completion of ST 8: trainees are eligible to apply for their CCT/CESR By the end of Level 1 Trainees must complete APLS course Mini- CeX: 6 per training year CbD: 4 per training year procedures in the Level 1 curriculum Mini- CeX: 6 per training year CbD: 4 per training year procedures in the Level 1/2/3 curriculum Mini- CeX: 6 per training year CbD: 4 per training year procedures in the Level 1 curriculum Mini- CeX: 4 per training year CbD: 8 per training year procedures in the Level 2 curriculum SAIL: 5 letters per training year Mini- CeX: 4 per training year CbD: 8 per training year procedures in the Level 2 curriculum SAIL: 5 letters per training year Mini- CeX: 4 per training year CbD: 6 per training year procedures in the Level 3 curriculum SAIL: 5 letters per training year PaedCCF: 1 for Level 3 Mini- CeX: 4 per training year CbD: 6 per training year procedures in the Level 3 curriculum SAIL: 5 letters per training year PaedCCF: 1 for Level 3 Mini- CeX: 4 per training year CbD: 6 per training year procedures in the Level 3 curriculum SAIL: 5 letters per training year PaedCCF: 1 for Level 3 eportfolio and trainers reports to be kept at each training year LTFT Training pro rata assessments per training year 8.
DOPS The college has also identified key procedures which need to be learnt at each level. Below is a list of the DOPS you are expected to achieve for each level. This list is a minimum, and you will be expected to be competent in other skills as well as they come along. You will not be able to cover all these DOPS in the year you are with us, but aim to get as much experience as possible. This means getting involved when complicated cases come in. Level 1 (ST1-ST3) Collection of blood from central lines Umbilical artery and venous cannulation and sampling Venesection, peripheral venous cannulation, and capillary blood sampling Suprapubic aspiration of urine Urethral catheterisation Electrocardiogram and Non-invasive blood pressure measurement Lumbar puncture Bag, valve and mask ventilation External chest compression Tracheal intubation of term newborn babies Level 2 (ST4-ST5) Peripheral arterial cannulation Perform basic lung function tests Administer intra dermal, subcutaneous, intramuscular, intravenous injections Percutaneous long-line insertion Needle thoracocentesis for pleural effusion or pneumothorax Intubation of newborn infants of most gestations Administration of surfactant Insertion of intraosseous needle CbD (Case Based Discussions) 83% of all paediatric admissions present in one of six ways fever, rash, convulsions, abdominal pain, gastroenteritis and respiratory. These topics are covered in the Wednesday afternoon teaching programme, but they should also be discussed as CbDs sometime during your training ideally more than once. Remember, that 4 is a minimum number you can do many more! It is also useful way to discuss other unusual interesting admissions. These admissions also make a good basis to look up a topic for Journal Club. 3 should be chosen by yourself and 3 by your supervisor. During a CbD, expect to be asked about your management plan, your choice of investigations, consultation with ward guidelines, your reasons for discussing with someone more senior and your choice of treatment. Mini-CeX Children are different from adults, and it does take some time to develop the skill to adapt your history taking and examination. Once again, for acute admissions, you should cover the 6 commonest presentations. For ST1-3 trainees, a good time to do mini-cex is in outpatients, or when a consultant is covering as a registrar on the ward. For ST 4-8 trainees, at least one and preferably more mini-cex should be in the community or CDC. Meetings relating to assessment The KSS Deanery s School of Paediatrics will contact all trainees to arrange the Annual Review of Competency Progression (ARCP). A satisfactory outcome will lead to progression to the next year of training or the end of a fixed term training post. The Appeals Process (GEAR S2.14) In the event that you fail to gain certification you can appeal to the Paediatric Faculty Group in accordance with the guidelines set out by the Gold Guide. 9.
Annual Appraisal The three integrated components of the training process (appraisal, assessment and annual planning) contribute to the Annual Review of Competence Progression (ARCP) that are managed by the KSS Deanery and occur towards the end of the year. If you require help (GEAR S 2.4; 2.11; 2.12; 2.13) The Darent Valley Hospital s Education Centre operates an Open Door approach and here you can find information about local Trust policies, e.g. Grievance, Bullying and Harassment and Equal Opportunities. In addition, these policies can be found on the Trust s intranet site Accessing Dartford and Gravesham Information Online (ADAGIO). KSS Deanery also offers support for trainees in difficulty (TiD). Details of the KSS Deanery Trainees in Difficulty Guide can be found on the KSS Deanery website. Career support (GEAR S3.1; 3.2; 3.3. 3.4) Information about the KSS Deanery Career Service can be accessed at http://kssdeanery.org/education/aboutcareers In addition to your supervisors, Dr Vincent Kika, Consultant in Accident and Emergency is the designated Career Lead and is happy to provide career guidance and support. Appointments can be arranged through the Education Centre. Personal Job Description The ST1 ST3 trainees work at Senior House Officer level and the ST4 ST8 trainees work at Registrar level. The Core Trainees work in a 1:8 full shift rota and the Higher Specialty Registrars work in a 1:7 full shift rota. A week of clinics is incorporated in the rota in each cycle. The junior doctors are trained well in the management of common paediatric and neonatal problems. They are expected to clerk the patients, do investigations and commence treatment and formulate a management plan under the guidance of consultants. Consultant support is available all the time and the junior doctors are well supervised. Using educational resources The library, situated in The Philip Farrant Education Centre, Darent Valley Hospital, offers a wide range of services for doctors. As well as loaning books to you we can show you how to access electronic resources including full text journals, e-books and a range of healthcare databases. Simon Millgate, Head of Library Services, and his team can help you with your literature searches or can do them for you. There are PCs in the library with Internet access for use by library members. Opening times are Monday-Thursday 08:30 1700hrs and Friday 08:30 16:30hrs. More information can be found on the Trust s intranet site ADAGIO. Study and Annual Leave (GEAR S1.13) Study leave entitlement is 30 days per year. Annual leave is 32 days per year increasing with seniority. Application forms for Study Leave are held within the Education Centre and all annual leave should be discussed with the Medical Staffing Officer, Jade Bourne (01322 428763). GMC Ethical Guidelines (GEAR S1.19) The GMC has published Good Medical Practice which sets out the principles and values on which good practice is founded; these principles together describe medical professionalism in action. The guidance is addressed to doctors, but it is also intended to let the public know what they can expect from doctors. More information is available from the GMC at http://www.gmc-uk.org/guidance/good_medical_practice.asp 10.
Less than Full Time Training (GEAR S1.15) Details can be obtained from the Education Centre or the KSS Deanery Website at http://kssdeanery.org/ Useful names and numbers Local, regional and national KSS Deanery Website - http://kssdeanery.org/ KSS Deanery Careers - http://kssdeanery.org/education/about-careers KSS Deanery GEAR for Local Faculty Groups PMETB Standards for Training - http://www.gmc-uk.org/ Gold Guide http://www.mmc.nhs.uk/specialty_training/specialty_training_2011_final/gold_guide.aspx Specialty Links http://www.rcpch.ac.uk/ Faculty Group educational support The KSS Deanery offers a range of educational support/programmes For details please go to http://kssdeanery.org/education/about-careers List of contact details of Education & Clinical Supervisors at DVH Dr. Selwyn D Costa (Selwyn.D Costa@dvh.nhs.uk) Dr. Alok Gupta (Alok.Gupta@dvh.nhs.uk) Dr Ali Bokhari (Ali.Bokhari@dvh.nhs.uk) Dr. Abdul Hasib (Abdul.hasib@dvh.nhs.uk) Dr. Chandra Hedge (Chandra.Hedge@wkpct.nhs.uk) Dr. Gautam Kulkarni (Gautam.Kulkarni@dvh.nhs.uk) Dr. Suresh Kumar (suresh.kumar@dvh.nhs.uk) Dr. Shahinul Khan (shahinul.khan@nhs.net) Dr Bharath Gowda (bgowda@nhs.net) 11.