Dartford and Gravesham NHS Trust Darent Valley Hospital INDUCTION HANDBOOK FOR THE ANAESTHETIC FACULTY GROUP

Dartford and Gravesham NHS Trust Darent Valley Hospital INDUCTION HANDBOOK FOR THE ANAESTHETIC FACULTY GROUP August 2015 Page 1

KENT SURREY AND SUSSEX POSTGRADUATE DEANERY FOR MEDICAL AND DENTAL EDUCATION ANAESTHETICS FACULTY HANDBOOK A GUIDE FOR POSTGRADUATE DOCTORS AND STAFF IN DARTFORD AND GRAVESHAM NHS TRUST This Handbook is mapped to the KSS Deanery s Graduate Education and Assessment Regulations [GEAR] for Local Faculty Groups Introduction Welcome to 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 Anaesthetic programme. It should be read in conjunction with your curriculum found at http://www.rcoa.ac.uk/index.asp?pageid=57. 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. The anaesthetic department is seen as a friendly and dynamic department. Anaesthetic Services Provided at Darent Valley Hospital for:- 6 Main Theatres 3 Day Care Theatres Intensive Therapy Unit Obstetric Unit with 2 operating theatres Emergencies in CT Scanner/Interventional Radiology Pre-Operative Assessment Acute Pain Chronic Pain at Darent Valley Hospital and Queen Marys Sidcup Anaesthetic Training for the following specialities is provided: Colorectal/Vascular/General Surgery Orthopaedics Urology Day Care Anaesthesia, including Paediatric Day Care ENT ITU Obstetrics Page 2

ANAESTHETIC DEPARTMENT PORTFOLIO Dr Mike Protopapas Clinical Director, ICM Lead Dr Mike Abbott Consultant Anaesthetist Dr Raman Madan Airway Dr Basil Al-Shakarchi Educational Supervisor Dr Thippa Raghuraman Audit, Drug and Therapeutics Dr Prasad Vyakarnam Lead Paediatric Anaesthetist, Core TPD KSS Dr Anu Relwani Leadership tutor Dr Francoise Iossifidis Lead for Obstetric Anaesthesia Dr Sanjay Parmar Dr Mallikarjunappa Satisha Dr Darshinder Sethi Obstetric Anaesthetist Educational Supervisor Obstetric Anaesthetist Educational Supervisor College Tutor Dr Mansoor Sange Dr Madhusudhan Mali Dr Sanjay Kuravinakop ICM college Tutor Educational Supervisor Consultant in Chronic Pain Consultant in Chronic Pain Dr Suleman Rashid ICM and A&E consultant Dr Indu Karangoda Dr Zak Belagodu Dr Usmani ICM ICM Consultant Chronic pain Page 3

Key people There are several key people who will support you during your time with us. The College Tutor is Dr Darshinder Sethi (darshinder.sethi@dvh.nhs.uk) The Director of Medical Education is Dr Ali Bokhari The Medical Education Manager is Mrs Claire Nottage (Claire.Nottage@dvh.nhs.uk) The Medical Education Officer is Mrs Sabrina Walby 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 e-portfolio. If you experience any local administration issues your first point of contact is the Postgraduate Centre. The Anaesthetic Curriculum [GEAR S 1.2; S 1.4; S1.5] The curriculum for your Anaesthesia Programme can be found at www.soan.kssdeanery.org/curriculum-curriculum.php or on the Royal College of Anaesthetists website at www.rcoa.ac.uk and a hard copy is also in your portfolio. The Local Anaesthetic Faculty is responsible for ensuring that the anaesthetic 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. 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. 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 Anaesthetic Curriculum (GEAR S 1.4) The aims and objectives of the anaesthetics curriculum for CT1-2 are: obtain the initial assessment of competency obtain the Assessment of Basic Competency in Obstetric Anaesthesia Page 4

Pass the primary FRCA Pass the Annual review of certificate of progress (ARCP) Complete the required work placed assessments Obtain the Basic Level Training Certificate 21 months anaesthesia and 3 months intensive care medicine (ICM). How you complete the Anaesthetic Curriculum This Anaesthetic curriculum is competency based and leads to the Certificate of Completion of Training (CCT). 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 Anaesthetic programme structure (GEAR S1.4; S 2.3) This faculty handbook gives you details of how the national curriculum for Anaesthesia is organised here at Dartford and Gravesham NHS Trust. It gives details of your local programme which has been devised to meet the requirements of the Anaesthesia curriculum and shows how this works locally. It will include theatre based teaching, half day local teaching, regional study days, clinical audit and exposure to academic opportunities. The programme is structured to comply with the Standards of Training of the Postgraduate Medical and Education Training Board (PMETB) and the Gold Guide (Gold Guide ) The Anaesthetic Curriculum is given at www.soan.kssdeanery.org/curriculum- Curriculum.php or on the Royal College of Anaesthetists website at www.rcoa.ac.uk and is taught within a structure of formal and informal teaching sessions in a clinical environment or at weekly departmental teaching sessions (including morning Intensive Care sessions). The minimum time spent in core training will normally be two years of which 21 months must be in anaesthesia and three months in Intensive Care Medicine (ICM). The RCA encourages modular training whenever possible but recognises that this can cause practical difficulties in smaller hospitals. The first six months At the start of their training trainees must pass an initial assessment of competency comprising: preoperative assessment; general anaesthesia for ASA I or II patients (including equipment and anaesthetic machine checks); rapid sequence induction; CPR skills; and clinical judgement, attitudes and behaviour. Until this initial assessment of competency is passed trainees cannot practice anaesthesia without immediate supervision. During the first six months trainees should learn the basic principles of safe and effective anaesthesia, resuscitation, and both the prevention and treatment of pain. Emphasis should be placed on the role of the anaesthetist in the peri-operative care of the surgical patient, thus a guided introduction to the pre-operative assessment and post-operative care is just as important as the practice of anaesthesia. The following basic units should be covered within this period: Page 5

care of the patient; anaesthetic equipment; basic techniques in anaesthesia; basic techniques in local anaesthesia; and anaesthetic pharmacology. Training for the next 18 months The following areas of basic training should be covered in this period: obstetric analgesia, anaesthesia and resuscitation; pain management/control/treatment; the upper airway and its problems; peri-operative care of the patient for major surgery; anaesthesia for day case surgery; paediatric anaesthesia; anaesthesia in the elderly; and specific anaesthesia and medical problems. In this period trainees widen their experience to obtain the Basic Level Training Certificate and become eligible for appointment as a Specialty Registrar (StR). By the end of this stage trainees should be able to: undertake the anaesthetic care of most routine cases; assist in the anaesthetic care for more complex surgery; provide anaesthetic care for routine obstetric practice; organise, with the surgical team, an emergency list; identify potential problems and seek appropriate help; understand the principles underlying the care of patients in Intensive Care and High Dependency Units; understand the principles of pain management; participate in audit; and pass an examination of knowledge and certain skills. 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 will also 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). 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). Patient safety is paramount in your programme. The policy and process for addressing concerns about patients safety are available via Trust Intranet (ADAGIO) http://nww.dvh.nhs.uk/homepage/ The policy for handover to ensure patient care is Page 6

At 8:00, the theatre on call person hands over the arrest bleep and patients. Electronic handover sheet to be updated and handed over for ITU patients. Examinations During the training programme, you will take an examination in two parts; the Primary and the Final which together form the Fellowship of the Royal College of Anaesthetists (FRCA). The Primary is subdivided into an MCQ (sat at the end of the first year) and an OSCE / oral viva exam (sat by the end of the second year). The Final must be completed by the end of ST4. All exams are set and supervised by the Royal College of Anaesthetists. The primary FRCA timetable http://www.rcoa.ac.uk/docs/examscalendar08-09.pdf and eligibility can be found at http://www.rcoa.ac.uk/docs/regulations2008.pdf 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://cssag.kssdeanery.org/files/kss%20study%20leave%20guidelines%20updated%20 Nov%202007.pdf 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) (iv) 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. 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 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. You should meet with your ES once a month to update your progress 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, Page 7

that you maintain your portfolio, keep up to date with assessments as required and be signed off at the end of the year. The Local Anaesthetic Faculty Group (GEAR S 6.1-6) The Anaesthetic Faculty Group s remit is threefold: to ensure that the local anaesthetic programme is fit for purpose and in line with the curriculum requirements, to quality control the local anaesthetic programme and to ensure that trainee progression is tracked, supported and audited. The Local Anaesthetic 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 a 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 Anaesthetic 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. 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 Anaesthetic School can be found at http://www.kssdeanery.org/specialty/anaesthetics 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. 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. A survey is carried out of trainees overall performance twice a year anonymously. This is formal feedback and should be discussed with your ES 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. Page 8

Training Portfolio (GEAR S1.17) This is a key aspect of your learning in the programme. It is your responsibility to maintain a 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 portfolio can be found at: http://www.rcoa.ac.uk/index.asp?pageid=982&searchstr=portfolio Assessments (GEAR S 1.16; 18) This programme is competency based. The assessment tools are explained in the curriculum at http://www.rcoa.ac.uk. It is your responsibility to undertake the assessments in accordance to the curriculum. All of your assessments must be recorded in your portfolio. Meetings relating to assessment The KSS Deanery s School of Anaesthetics 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 Anaesthetic Faculty Group in accordance with the guidelines set out by the Gold Guide (http://www.jrcptb.org.uk/sitecollectiondocuments/gold%20guide.pdf) 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://careers.kssdeanery.org 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. When On-Call Core trainees responsibilities are as follows: Take over bleep 242 at 8.00am. Acute Pain ward round at 8.15am with Pain Consultant and Team. Once Pain Round is completed he/she is expected to go to ITU, help the ITU on-call person to examine the patients, fill in the daily sheets and attend ITU Ward Rounds. Page 9

He/she will leave ITU to assess patients for CEPOD lists at 12.00pm. Must discuss the CEPOD cases with the Consultant in charge of CEPOD lists. Attend ward patients for pain relief as required. Attend Trauma/Emergency calls by liaising with the ITU on-call person. Handover theatre emergencies and potential pain problems to the night on-call person at 20.00 hours. Please read and follow the Pain Protocols. A copy of this is kept in the Trainees Room. 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 Rota Managers. 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.gmcuk.org/guidance/good_medical_practice/index.asp Less than Full Time Training (GEAR S1.15) Details can be obtained from the Education Centre or the KSS Deanery Website at www.kssdeanery.ac.uk Useful names and numbers Local, regional and national KSS Deanery Website - http://www.kssdeanery.ac.uk KSS Deanery Careers - http://careers.kssdeanery.org KSS Deanery GEAR for Local Faculty Groups PMETB Standards for Training - http://www.pmetb.org.uk Gold Guide www.soan.kssdeanery.org/goldguide-gold_guide.php Specialty Links http://www.rcoa.ac.uk. Page 10

Faculty Group educational support The KSS Deanery offers a range of educational support/programmes For details please go to http://education.kssdeanery.ac.uk/fac_dev- Accredited_Programmes.php Page 11

Appendix A Here is a list with contact details of Education and Clinical Supervisors in the Trust who will be working with you. Consultants Dr Mike Protopapas Dr Francoise Iossifidis Dr Malli Satisha Dr Basil Al-Shakarchi Dr Sanjay Parmar Dr Darshinder Sethi Dr Prasad Vyakarnam Dr Thippa Raghuraman Dr Madhusudhan Mali Dr Mansoor Sange Dr Anu Relwani Dr Mike Abbott Dr Suleman Rashid Dr Sanjay Kuravinakop Dr Indu Karangoda Dr Azfer Usmani Dr Belagodu (Mike.Protopapas@dvh.nhs.uk) (Francoise.Iossifidis@dvh.nhs.uk) (Mallikarjunappa.Satisha@dvh.nhs.uk) (Basil.Shakarchi@dvh.nhs.uk) (Sanjay.Parmar@dvh.nhs.uk) (Darshinder.Sethi@dvh.nhs.uk) (Vyakarnam.Prasad@dvh.nhs.uk) (Thippa.Raghuranam@dvh.nhs.uk) (Madhusudhan.Mali@dvh.nhs.uk) (MSange@nhs.net) (Anu.Relwani@dvh.nhs.uk) (Mike.Abbott@dvh.nhs.uk) (Rashid.Suleman@dvh.nhs.uk) (Sanjay.Kuravinakop@dvh.nhs.uk) (Indu.Karangoda@dvh.nhs.uk) (Azfer.Usmani@dvh.nhs.uk) (z.belagodu@nhs.net) Page 12