Saturday, 23 February 2019

Common Competencies

I wrote a summary of what each common competency involved to make sure I linked properly. Here's my summary:

CC1 - History Taking - Risk Factors, Communication Barriers, Time Management, Questionnaire,  conflicting family, assimilate, non-verbal queues, mechanism of injury, no bias in re-attenders, children, interpretor, third parties, notes review

CC2 - Clinical Examination - constraints to overcome them, limitations, targeted, DSH, interpet, mental state, clinical, psychologial, religious, social and cultural factors, adjunctive examinations, ECG, spirometry, ABPI, joints, FAST, echo

CC3  - Therapeutics and safe prescribing
Indications, contraindications, SEs, drug interaction, dose of commonly used drugs, adverse drug reactions, complementary meds, tools for patient safety and prescribing including ID, effects of age, body size, organ dysfunction, concurrent illness on drug distribution and metabolism, regulatory agencies, review long term meds, anticipate and avoid interactions, appropriate drug dose, adjustments, monitoring, concordane, explainations, minimise risk, non-medical prescribers, formulary, info sharing, therapeutic alert
Methadone
Meds from overseas, and translate into UK equivalent,
Children, rapid chemical tranq.
Empathetic for pain. PGD. Drug prescribing audits. Reviews stock. Introduces new drugs.

CC4 - Time management and decision making
Organisation, prioritisation, delegation, techniques for time management, prompt investigation, diagnosis + treatment. Estimate time.  Workload. Work to deadline. Calm in stress.
Manages multiple patients. Quick disposal decisions, CTR... Staff allocation. Team management. Teaching during low demand.
Rota vs patient attendances

CC5 - Decision making + clinical reasoning
Interpret hx + signs. Hypothesis. Expert advice, clinical guidelines + algorithms. Best value + effectivness. Risk assessments. Statistical methodology. Relative + AR, predictive value, sensitivity, specificity.
Recognise critical illness.
Communicate and construct management plan. Risk calculators
Avoid pre-assessment bias


CC6 - Patient central focus of case
Recall health needs to deal with diverse patient groups  - learning disabled, elderly, refugees and non-English speaking. Gives time. Answers questions honestly. Self-management plan. Voice preferences. Acts as advocate.
Time off work. GP letters.
Gillick-competent adolescent. Assess capacity.
Alternative management options. Worried well.
DNAR + end of life decisions
Complaints
Patient survey + local patient groups

CC7 - Patient safety
Safe working environment. Hazards of medical equipment. Med side effects. Risk assessment + management. Safe working practice. Local procedures for optimal practice. NHS and regulatory procedures where concern about performance of team.
Recognise failure to response. Use medical equipment carefully, report faults. Improve understanding of SEs and CIs. Sensitively cousel a collegue following SE or near miss.
Root cause analysis.
High risk patients - nonEnglish speaking, agressive, un-cooperative, clinically brittle
Supports trainees + nursing staff after SUIs
Handover


CC8- Team working _ patient safety
Effective collaboration. Roles + responsibilities. Factors adversely affecting a Drs performance.
Note keeping. Patient lists. Handover. Leadership and management in education & training, deteriorating performance of collegues (stress fatigue), high quality care, effective handover.
Interdisciplinary team meetings. Supervision.
Encourage open environment. Second opinion. Induction. Information sharing. Debrief.

CC9 - Quality and Safety Improvement
Clinical governance, local and national significant event reporting, EBP, local health + safety protocols (fire and manual handling), risk - biohazards, patient early warning systems, national patient safety initiatives - NPSA, NCEPOD, NICE
Surgical checklits. Quality improvement process eg. audit, errors/ discrepancy meetings, critical incident reporting, unit mortality and morbidity, local and national databases.
Reflect regulalrly
No-blame culture.
Audit

CC10 - Infection Control
Prevent infection in high risk groups. Notification in UK. HPA / CCDC / LA in infection control. Potential for infecition. Counsel patients on risk. Local infection control procedures. Antibiotics according to local guidelines. Cross - infection. Aseptic technique.
Atypical common infections.
Not eating on shop floor
Blood cultures, sepsis 6

CC11 - Long term conditions + patient self care
Natural history of diseases that run a chronic course, rehab and MDT, QoL, medical and social models of disability, social services, carers, information, patient advocate. Feedback on referrals. Patient notes. Self-help groups,

CC12 - Patients + Communication
Structure an interview, understand importance of patient's background, rapport, sensitive, manage communication barriers, deliver information compassionately, use and refer to other sources, check understanding, notes, follow up.
Language line, anxious patients.
Acutely disturbed psych patient. Safe and lawful restraint.

CC13 -Breaking Bad news
Stressful. Honest, factual, realistic, empathetic.
Organ donation. Lead resuscitation with relatives present.

CC14: Complaints and Medical error
Local complaints procedure. Factors likely to lead to complaints. Deal with disasatisfied patients. Honest. Apologise. Review. Support junior ED staff in responding.

CC15: Communication with collegues + cooperation
MDT + team dynamics. Inter-professional collaboration. Communicate accurately, clearly, promptly. Use whole MDT. Hospital at night. Behavioural management skills with collegues.
Healthy work / life balance for whole team. Confidentiality. Accept additional duties. Handover. Manages shift to ensure breaks. Respect for nursing staff.

CC16: Health promotion and public health
Incidence and prevalence of communication conditions - biological, social, cultural and economic. Lifestyle on health. Screening. Smoking, obseity. Globalisation. Substance misuse, gambling. Ill health and disease. Lifestyle changes.
Registered with Dr. Encourages alcohol, drug, smoking. Discourages high risk.
Display local information.


CC17: Medical ethics + confidentiality
GMC on confidentiality. Data Protection Act + FOI Act. Caldicott Guardian. Caldicott approval. Patient consent - desirable but not required eg. communicable diseases. Consent. Confidentiality following death. Problems by disclosure in public interest. Factors influencing ethical decision making. DNR. MCA.
Confidential waste, no password sharing, doesn't take notes home, anonymisation, DNAR


CC18: Valid Consent
Consent is a process that may culminate in a consent form. Consider understanding and mental state. Balanced view. Autonoy. Scope of authority. Don't withold information. Seek advance directives. 2nd opinion.
STEMI/ stroke thrombolysis
Patient advocacy


CC19: Legal framework
Best interest of the patient. Legislative framework - death certification and role of coroner/ procurator fiscal. Safeguarding children. Mental health legislation. Advanced directives. Living Wills. Withdrawaing and witholding treatment. Resus decisions. Surrogate decision making - organi donation + retention. Communicable disease notification. Medical risk + driving. Data protection + FOI Act, continuing care.
Differences in legislation in 4 countries of UK. Disciplinatry processes. Role of medical practitioner in relation to personal health + substance misue including what to do ?abuse.
Report to Coroner.


CC20: Ethical Research
Good practice in research. Audit vs research. Understand how guidelines produced. Knowledge of research principles. Formulate research question. Comprehend principal qualitative, quantitative, bio-statistical and epidemiological research methods. Funding.
Critical appraisal skills
Write scientific paper. Ethical research, literature databases, good verbal + written presentation skills Popuation based assessment + unit-based studies and evaluate outcomes.
Complete a BestBET. CTR.


CC21: Evidence and Guidelines
Application of statistics in scientific medical practice. Different style methodologies. Critical appraisal. Level of evidence + quality. Advantages and disadvantages of guidelines. NICE and SIGN process. Search medical literature. Address clinical question. Limits of research.

CC22: Audit
Data for audit. Role + steps. Local + national. Local / national audit meetings.

CC23: Teaching and training
Adult learning principles, identification of learning methods. Educational objectives. Questinoning tecnhiques. Teaching format and stimulus. Literature. Appraisal interview. Bodies in med ed. Appraisal vs assessment. WBPA knowledge. Define learning objectives and outcomes.
Failing trainee.
Vary teaching format and stimulus. Feedback. Appraisal.
Demonstrate effective lecture, presentation, small group + bedside teaching sessions. Career advice. Improve patient education. Departmental teaching programmes, failing trainee. Has discussion. Formal tuition in medical education. Personal development as a role model.
PowerPoint. Small group teaching. Simple feedback. Supevision. WBPA.Teaces med students. Supervises things. Medical student programme.

CC24: Personal Behaviour
Inappropriate patient and family behaviour. Respect rights of children, elderly, physical, mental, learning or communication difficulties. Eliminate discrimination. Honesty and probity. Honesty and sensitivity. Ethical reasoning. Value-based practice. Royal Colleges, JRCPTB, GMC, Postgraduate Dean, BMA, specialist societies, medical defence organisations
Practice with integrity, compassion, altruism, continuous improvement, excellence, respect for cultural and ethnic diversity, equity
Rotas. Utilise resources. Specialist support. Press + media.
Clinical leadership + management
Mentor, educator and role model. Accept mentoring. 360 feedback.
Annual departmental stragetic vision.


CC25: Management and NHS Structure
GMC management guidelines. Understand local NHS structure. Structure and function of healthcare systems. Understand NHS debates and changes in the NHS. Local demographic data.
Clinical coding, EWTD, NSF, health regulatory agencies, NHS structure + relationships, NHS finance and budgeting, consultant contract + contracting process, resource allocation, independent sector. Managerial meetings. Technology.

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