KENT SURREY AND SUSSEX POSTGRADUATE DEANERY FOR MEDICAL AND DENTAL EDUCATION

KENT SURREY AND SUSSEX POSTGRADUATE DEANERY FOR MEDICAL AND DENTAL EDUCATION TRAUMA & ORTHOPAEDICS FACULTY HANDBOOK 2015 A GUIDE FOR POSTGRADUATE DOCTORS AND STAFF IN DARENT VALLEY HOSPITAL DARTFORD & 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 the Kent Surrey and Sussex Postgraduate Deanery [KSS Deanery]. Welcome to the Postgraduate Centre in Dartford & Gravesham NHS Trust. 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. 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 Trauma & Orthopaedic programme. It should be read in conjunction with your curriculum www.iscp.ac.uk/syllabus/overview.aspx. This Handbook is updated annually based on feedback to the Faculty Group from you as a postgraduate doctor and from your Supervisors. Location During your time with us you will be based at Darent Valley Hospital level 3 East Wing The Postgraduate Centre is at the Philip Farrant Centre level 1 West Wing Key People There are several key people who will support you during your time with us. The Director of Medical Education: Dr Ali Bokhari (Ali.Bokhari@dvh.nhs.uk) The Medical Education Manager: Mrs Claire Nottage (Claire.Nottage@dvh.nhs.uk) The College Tutor in Trauma & Orthopaedics: Mr Thilagarajah (Michael.Thilagarajah@dvh.nhs.uk) A list of people directly involved in your Programme e.g. Educational Supervisors, Clinical Supervisors, Administrative Staff, Faculty Group, Deanery Staff, Deanery Careers and Library Knowledge Service Staff with their contact details is given in Appendix A. Local programme administrative arrangements - 1 -

The administrative arrangements for the local management of your programme are managed by the MEM / Faculty Administrator in conjunction with your Programme Lead. The national arrangements for the management of your programme are contained in your e-portfolio (www.iscp.ac.uk). If you experience any local admin issues your first point of contact is the Postgraduate Centre. The Trauma & Orthopaedic Curriculum [Graduate Education and Academic Regulations -GEAR S 1.2; S 1.4; S1.5] The curriculum for Trauma & Orthopaedics can be found at www.iscp.ac.uk/syllabus/overview.aspx?spec=to and a hard copy is also in the PG Centre or Library. The Local Surgical Faculty is responsible for ensuring that the Trauma & Orthopaedic programme is such that it will enable you to meet specific competences required in any given year by your curriculum. The local programme is thus mapped to the national surgical curriculum. This is summarised in the BOA review document 160707 relating to Trauma & Orthopaedics for ST1/2. The Trauma & Orthopaedic Curriculum also includes opportunities for you to work with other health care professionals in pre-assessment, trauma and elective wards and clinics, plaster room and theatres. The aims and objectives of the Orthopaedic & Trauma curriculum [GEAR S 1.4] The aims and objectives of the trauma and orthopaedic curriculum are to: 1. Cover the generic principles of surgery in general 2. Gain skills in the management of trauma, especially ankle and hip fractures 3. Introduce the principles of elective orthopaedics. How you complete the Trauma and Orthopaedic curriculum This curriculum is competency based and ST1/2 leads to the intermediate phase of training (ST3 onwards). You will be supported during your time at Darent Valley by your Programme Lead, the College Tutor and allocated Educational 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 Trauma & Orthopaedic Programme Structure [GEAR S1.4; S 2.3] This Faculty Handbook gives you details of how the national curriculum for T & O is organised here at Darent Valley. It gives you details of your local programme which has been devised to meet the requirements of the curriculum and shows how this works locally. It will 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 Standards of Training of the Postgraduate Medical and Education Training Board (PMETB) and the Gold Guide or Standards for Training in the Foundation Programme. T & O provides daily teaching at Trauma Meetings as well as a formal Thursday lunchtime teaching programme. Masterclasses in common fracture fixation methods will be arranged through the year and weekly Surgical teaching is provided on Tuesdays, at lunchtime You are expected to arrange to meet with your AES at three points through each attachment: 1. Objective setting 2. Interim review 3. Final review An end of year ARCP (Annual Review of Competence Progression) will then take place to review your overall progress. Induction / Handover / Taking Consent - 2 -

[GEAR S1.7; S1.8; S1.9] You will be inducted to the Trust, your Specialty Programme and your Specialty Department. www.dvh.nhs.uk. The policy for handover to ensure patient care is based on a face to face meeting between on call trainees. Patients of note on the ward and admissions through the day will be discussed and the latter documented in the Red Trauma Book. The night time trainee will bring the book to the morning trauma meeting, and enter the details of admissions on the trauma whiteboard in the Orthopaedic Seminar Room. It is the responsibility of the night time trainee to make sure that the first patient on each elective list is prepared for theatre ie. Upto-date bloods, consent, marking. The taking of consent is dependent upon satisfactory understanding and must be confirmed by your respective Consultant. Exams Trainees at ST1/2 are expected to at least attain MRCS Part I and Basic Surgical Skills certification Your Assigned Educational Supervisor (AES) roles and responsibilities [GEAR S1.6] 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 [Gold Guide or Foundation Programme]. The responsibilities of an Educational Supervisor are given in the Gold Guide or Standards for Training in the Foundation Programme / or Operational Framework for Foundation. 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 Supervisors is by direct liaison. 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. The Local Surgical Faculty Group [GEAR S 6.1-6] The Surgical Faculty Group s remit is threefold: to ensure that the local T & O programme is fit for purpose and in line with the ISCP curriculum requirements, to quality control the local T & O programme and to ensure that trainee progression is tracked, supported and audited. The Local Surgical Faculty meets three times a year, in November, March and June. The Local Faculty s work is quality controlled by the KSS Deanery Standards for the Local Faculty Graduate and Education Assessment Regulations [GEAR]. Your Year Group [GEAR S6.10] Each Specialty group needs to meet as a Year Group three times a year, to elect a Year Group Representative and to give feedback to Faculty about the local programme. Your Year Group Representative - 3 -

[GEAR S 6.10] This is a key part of the feedback process. This is a member of your cohort who will undertake to meet 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 thrice yearly meetings of the Local Surgical Faculty Group. The feedback loop must be closed as relevant information / responses from the Local Faculty Group need to go back to the cohort. This is the responsibility of the Year Group Rep. The Local Academic Board There is a Local Academic Board 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 Local Faculty Groups. Your Specialty School Details of your Surgical Specialty School can be found at http://cssag.kssdeanery.org How will you 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. Annual Appraisal In this Trust the arrangements for annual appraisal relate to your ARCP Learning Portfolio or E-Learning 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.iscp.ac.uk) How are you assessed? [GEAR S 1.16; 18] This programme is competency based. The assessment tools are Mini cex, DOPS, CBD, Mini PAT, MRCS and BSS. The assessments are recorded in e-portfolios. It is your responsibility to undertake the assessment process in accordance with your specialty curriculum guidance. In this local programme relevant information about the local assessment process is described above in The Trauma & Orthopaedic Programme Structure. What meetings should you know about re: assessment? The signing off process relates to your AES and Surgical Faculty Group meetings as above in The Trauma & Orthopaedic Programme Structure What is the Appeals Process? - 4 -

[GEAR S2.14] The local appeals process follows the South Thames Foundation School appeals process against failure to gain certification for Foundation doctors and the Gold Guide (sections 7.118 7.152) for Specialty Training What if you need help? [GEAR S 2.4; 2.11; 2.12; 2.13] Most Postgraduate Centres operate an Open Door approach and here you can find information about local trust policies e.g. Grievance; Bullying and Harassment and Equal Opportunities. KSS Deanery also offers support for trainees in difficulty. Details of the KSS Deanery Trainees in Difficulty Guide can be found on the KSS Deanery website. Good example included in the Operational Framework for Foundation How can you access 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. The Foundation Faculty has a designated Faculty Careers Lead. Specialty Schools are nominating a careers lead. Locally careers information and support can be accessed from your educational and clinical supervisors. Personal Job Description Includes service commitment, and your job description and rotas all comply, and ensure that training time has been given. Using Educational Resources Library and educational resources in the PGC include IT/computer access. How do you access other educational opportunities? Various opportunities which may be able to be taken during normal working include attending clinics and operating theatre sessions. How about Study Leave? [GEAR S1.13] Allowance should be discussed with the PGC, the College Tutor and Clinical Director in T&O GMC Ethical Guidelines [GEAR S1.19] Contact GMC How about Flexible Training? [GEAR S1.15] We currently have no flexible trainees Useful names & 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 - http://www.mmc.nhs.uk/download_files/gold_guide_290607.doc Add Specialty Links www - as appropriate 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 OUR DEPARTMENT - 5 -

The GMC Survey This is an independent questionnaire performed by all junior doctors to assess their working environment, specifically looking at: - Workload - Support - Educational content - Clinic attendance - Working within your capabilities - Interactions with staff and patients The effects are far reaching for a Department and any criticism is taken very seriously. In order for us to perform well a fair mature judgement is expected. This is particularly the case when negative issues arise, and the questionnaire is designed to gauge your overall experience, not just one or two bad instances in a four or six month placement. If you have any real issues you feel warrant addressing within the Departmental structure then please highlight this at the time, and don t just harbour bad feeling. We are a very open and supportive Department and will always wish to help you enjoy your stay with us. How do you apply for Annual Leave? The rota will likely be under review, as we will in August expand our SHO numbers to eight rather than the present seven. This will, we are sure make your stay with us more enjoyable. One of the current problems we encounter is when multiple SHOs take time off together. We have always supported your leave when you need it, but if numbers are low, please remember that this scenario is likely the outcome of leave and sickness, so bear this in mind when booking leave, and how this will impact on your colleagues. Locum cover is often very hard to arrange these days, so although the intention may be there, there is no guarantee it can be fulfilled. Days off are provided after a week of nights Half days are periodically incorporated into your seven week rota Any leave must be discussed with: Mr Butt Mr Moftah Mr Thilagarajah (if educationally related - ie courses etc) - 6 -

Any commitments must be addressed and appropriate cover arranged 6 Week notice is mandatory, and once the form has been handed to Mr Moftah s secretary, it is good practice to advise Heidi Cooper (rota manager) of your intended absence. FY2 You must attend your compulsory weekly teaching in the Phillip Farrant Centre as this is equivalent to your study leave allowance. Please note, you consequently have limitation on attending other, out of hospital courses, but are free to use your annual leave if you like. This is your responsibility if you are unable to attend due to any conflicting commitments, you must inform me and your supervisors, to ensure you can be released. You will be encouraged to work alongside and in a similar fashion to your CT colleagues. The FY2 doctors are responsible for attendance at the OrthoGeriatrcian s ward rounds with Dr Colin Weekes. This is an excellent teaching / business ward round, and you should ensure that the respective Orthopaedic Teams are updated with regard to any new management plans, which may impact on their patients. You should ensure that during your absence, appropriate support for the ward round is provided by your colleagues. CT 1 + 2 A surgical teaching programme runs in the Phillip Farrant Centre please confirm with your CT rep. You are requested to make contact with Mr Richard Dickson Lowe (richard.dickson-lowe@nhs.net), a current General Surgical Registrar who will support and mentor you, as well as represent you at discussions at Senior / College Tutor level. Further teaching is organised within the Orthopaedic Department led by Mr Chettiar. Please liaise directly with him. OrthoGeriatrics - 7 -

We have a full time OrthoGeriatician Consultant working with us with two juniors. The intention is that #NOF patients will be formally taken over by them at 48 to 72 hours postsurgery. A #NOF proforma must be used for these particular patients, and within it, a formal transition summary exists, which needs to be completed containing the following: - Wound state - Weight bearing status - Ongoing medical issues - Confirmation of up to date EDN Ortho SHOs will work together with OG doctors when necessary Ortho FY doctors will specifically have a greater involvement in the medical liaison of in-patients and be supported by their more senior SHO colleagues Admissions We do not admit patients purely for social reasons BUT if the incapacity is due to a new Orthopaedic injury eg. Pubic ramus / neck of humerus fracture then the patient should be our responsibility, providing no overriding medical issue exists. Head injuries are NOT usually admitted under Orthopaedics discuss with your Registrar Cellulitis is NOT usually admitted under Orthopaedics discuss with your Registrar IF IN DOUBT ASK THE MIDDLE GRADE ON CALL Ward work Juniors are allocated to Consultant Firms and must familiarise themselves with their respective regime for DVT prophylaxis, Antibiotics etc. Despite this allocation, juniors ARE expected to share the workload if necessary. We are very fortunate in having excellent Elderly Medicine support from Dr Weekes and it is a priority that one SHO always attends his ward round. When covering another doctor, you are expected to familiarise yourself with that Consultant s timetable and attend appropriately, and you are to carry both your usual bleep and the bleep of the doctor you are covering. An important responsibility of being a Doctor, is being contactable. Always remember the Secretaries are very knowledgeable. Discharge from the ward - 8 -

Discharges are completed electronically (EDN) for all in-patients and presently on paper in day surgery (although some Consultants prefer EDN). It is important to provide adequate information regarding their hospital stay including complications encountered, drugs on discharge and follow up arrangements made. A summary complication/pmh is included in the EDN. This is best done in real time as things occur. Note Keeping Daily entries are required for all in-patients with legible: Date / Time Dr ID legible name and bleep number The name of the on-call Consultant you represent that day, if seeing patients on call A working diagnosis and plan Elderly patients need MMS and social history HANDOVER This is done on the Registrar Room Computer and printed out daily. An updated specific weekend and bank holiday version is to be used to ensure all patients have summaries and plans for the on-call team. Integrated Care Pathways ICPs exist for Total Hip Replacement, Total Knee Replacement and Fractured Neck of Femur. These follow the patient from initial assessment through to discharge. Please ensure post-operative x-ray forms are completed immediately post op, as delays result in delayed discharge. Neck of Femur Fracture Pathway We have a proforma for the care of these patients which MUST be completed. Specifically: BE PROACTIVE Front page if not completed by nursing staff Blood results - 9 -

Review by the night SHO on evening of surgery- and you should therefore, go straight to theatre when you start your shift to see what operations were done on the trauma list. You should then see these post op patients, and fill in the findings as per the proforma. Theatre time is at a premium, and you should be aware of what operating lists are available the next day, and discuss with your Registrar on call, who to starve. Inform the night Anaesthetic SHO who should review before morning. Trauma lists occur daily through the week in the afternoon, and in addition on Wednesday morning. Occasionally additional space is available on elective lists, so check what s expected on the following day s operating lists. Optimise your patients urgently. Reasons for cancellation of surgery. Plan of action whilst waiting for surgery. Please liaise with Sister Michelle Yeadon (Trauma Sister) who will advise you regarding any issues relating to the management of NOFs and trauma patients. She is very experienced in Orthopaedics and is always willing to help. We are keen for Trainees to learn how to perform Ilio-Fascial nerve blocks for pain relief current Miss Amy Garner leads the training of this, with the help of Mr Shoib Mahmood (Registrars) Bridging Team Nurse and Physiotherapy support for Orthopaedic Patients in the community following discharge. On Call Absolute priority must be given to seeing patients in A+E when requested. Keep the computer based daily handover sheet up to date - Details of all patients admitted or seen need to be entered in this document and referred to in handover and Trauma Meetings. It is the responsibility of the night time doctor to be aware of what trauma cases are outstanding and whether there is the possibility of doing them on the morning list in which case they need to be starved from midnight. - 10 -

When seeing any patient in A&E, you are representing the Consultant on-call that day - as such, any advice given or decisions made will be the responsibility of that Consultant. If you have had contact with A&E regarding any patient, YOU MUST ensure that it is presented in the next trauma meeting and any follow up advice is directed to THAT Consultant's Fracture Clinic, not any random clinic. You are responsible for patients you are involved with and this includes their follow up plan. If a patient goes home, to be discussed the next morning with a view to admission the next day, please fill in the Surgical Admissions Lounge (SAL) next day admission form, available on ADAGIO, and communicate the information to the Bed Bureau and SAL. Starve appropriately. TRAUMA CALLS Orthopaedics is officially at Secondary Survey stage. The Trauma Calls are specifically run by the A&E seniors, the Surgical Registrar, with support from Anaesthetics, who all have the appropriate ATLS abilities to run the process. You are expected to attend however, and must liaise quickly with your registrar on call. If you feel you have been placed in a position of responsibility beyond your capabilities, you must highlight this immediately. Know your limitations and never work beyond them. The GMC and your indemnity body will not support you if you do this. Failure to do this, results in failure to progress in your training. Morbidity & Mortality - Include a summary from the medical records and appropriate x-rays. Documentation and discussion of this information is a professional duty. The department encourages an open and honest, no blame environment. Information should be entered in the Black Book (M&M) as soon as cases arise. All consultants expect their cases to be discussed. Audit Audit projects are presented monthly and are co-ordinated by Mr J Smith. Failure to complete or make appropriate arrangements for presentation will result in that doctor not being signed up for their attachment. This will on occasion include a journal club. Aim for a presentation at the Hospital Audit Competition. - 11 -

Teaching sessions - Orthopaedic seminar room A compulsory teaching seminar is held by Mr Chettiar and Mr Norris on Friday at 11.00 please liaise directly with them regarding timetable and any variation. This includes trainee led teaching, surgical technique discussion, etc. Prompt attendance is expected. A daily Trauma meeting is held: Mon - 8.00 review of weekend trauma and plan for pm trauma list Tue - Mr R Singh / Mr Rashid (locum) 8.00 Wed - Mr K Chettiar / Mr J Smith 8.00 Thur - Mr M Thilagarajah / Mr M Norris 8.00 Fri - Mr Sait / Mr Neen (locum) 8.30 / 8.00 These meetings are for teaching also, so please feel free to ask any questions. Appendix A Here is a list with contact details of Education and Clinical Supervisors in the Trust who will be working with you. MEM Dr Ali Bhokari x 8740 Surgical Tutor Mr Mark Watson College Tutor (T&O) Mr M Thilagarajah Assigned Educational Supervisors Mr M Thilagarajah x 8463 Mr J Smith x 8465 Mr S Sait x 8461 Mr F Moftah x 8462 Mr R Singh Mr K Chettiar Mr M Norris Clinical Supervisors Mr H Ghozlan Dr Jameel Mr F Butt Mr K Papakostas Mr M El-Kadafi Mr I Mohamed Mr N Patsiogiannis - 12 -

Rotating SpRs Surgical Juniors Representative Richard Dickson-Lowe Surgical Faculty Group Mr Watson Mr Thilagarajah Mr Bhardwaj Mr Hanek Mr Dickinson Mr Ademek Library Mr Millgate x 8549 Clinical Director Mr F Moftah Surgical Manager Alex Tan Bleep 149 Wards Maple (trauma) x4992 Cherry (elective) x8874/76 Willow (childrens) x8997/55 Main Theatres x8643 Day Surgery x8261 Bridging Team x8717 Direct Paging System 78 bleep number ext Bed Bureau All admissions must go via this office x8193/4/6 and 4902 When closed go through the site manager - 13 -