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Foundation (F2) Curriculum

INTRODUCTION:

During general professional training all SHOs require skills that are regardless of the specific training post and ‘generic’ to all physicians. Many of these issues and others are outlined in the GMC document ‘Good Medical Practice’ [1]. During the SHO years there is an exciting opportunity to build upon skills already established as an undergraduate and Pre-registration House Officer. To give SHOs and trainers guidance to recognise opportunities for learning, to reflect on clinical practice and to become self-critical in these vital areas, learning objectives, knowledge, skills and attitudes are outlined for the following ‘generic skills’:

Good Clinical Care:

History taking, examination and note keeping

Time management and decision making

Basic life support

Communication Skills

Maintaining Good Medical Practice:

Learning

Evidence, audit and guidelines

Ethics and legal issues

Maintaining Trust

Professional behaviour

Patient education and disease prevention

Working with Colleagues

Teaching and Training

These objectives should not restrict learning, they do however, outline the minimum requirements for satisfactory completion of general professional training.

AIMS:

To provide SHOs with the knowledge, skills and attitudes to provide high standard care to patients with general medical problems. Throughout the educational process positive attitudes to lifelong learning will be encouraged. At the end of the process SHOs will be equipped with knowledge and skills to prepare them for Higher Specialist or General Practice Training.

1. GOOD CLINICAL CARE

A) HISTORY, EXAMINATION & NOTEKEEPING SKILLS:

Objective: To provide the SHO with the knowledge and skills and attitudes to be able to take a history and examine patients, as well as keep an accurate medical record.

Subject	Knowledge	Skills	Attitudes
History	Symptom patterns Alarm symptoms	Identify and synthesise problems Take a history in difficult circumstances e.g.: · when English is not the patient’s first language · confused patients · deaf patients How to formulate a differential diagnosis	Recognise the impact of physical problems on psychological and social well being
Examination	Patterns of clinical signs	Explain examination procedure and minimise patient discomfort Elicit signs and use instruments appropriately	Recognise patient dignity Use chaperones appropriately
Note keeping, letters etc	Structure of: · medical notes · discharge letters · discharge summaries · outpatient letters	Record accurately and legibly in the medical notes including: · history · examination · summary · differential diagnosis · initial investigation and management plan · investigation results and action taken · conversations e.g. between team members and patient / relatives Date and sign each entry (with time of first contact) Mouse and keyboard skills and ability to use email and the internet	Ensure that notes are accessible to all members of the team and patients /relatives under certain circumstances Timely dictation and cost-effective use of medical secretary time Recognise the benefits of: · prompt communication with primary care · new technology e.g. fax, email etc

B) TIME MANAGEMENT AND DECISION MAKING

Objective: To provide SHOs with the knowledge, skills and attitudes to manage time and problems effectively.

Subject	Knowledge	Skills	Attitudes
Time management	Which patients / tasks take priority	Start with the most important tasks Work more efficiently as clinical skills develop Recognise when he/she is falling behind and re-prioritises or calls for help	Have realistic expectations of tasks to be completed by self and others Consult and work as part of a team
Decision making	Clinical priorities for investigation and management	Analyse and manage clinical problems	Be flexible and willing to change

C) BASIC LIFE SUPPORT:

Objective: To provide SHOs with the knowledge skills and attitudes to perform basic life support.

Subject	Knowledge	Skills	Attitudes
Basic life support	Elements of basic life support	How to assess a collapsed patient Maintain an adequate airway and perform effective cardiopulmonary resuscitation	Keep calm

2. COMMUNICATION SKILLS:

Objective: To provide the SHO with the knowledge, skills and attitudes to be able to communicate effectively with patients and colleagues in the circumstances outlined below.

Circumstance	Knowledge	Skills	Attitudes
Within a consultation	How to structure the interview to identify the patient’s: · concerns / problem list · expectations · understanding · acceptance	Listen Use open questioning followed by appropriate closed questions Avoid jargon and use familiar language Use interpreters appropriately Give clear information and feedback to patients and share information with relatives when appropriate	Recognise the importance of: · involving patients in decisions · offering choices · respecting patients views
Breaking bad news	How to structure the interview and where it should take place Normal bereavement reactions Awareness of organ donation procedure and role of local transplant co-ordinators	Avoid jargon and use familiar language Encourage questions Avoid conveying unrealistic optimism	Act with empathy, honesty and sensitivity
Complaints	Awareness of the local complaints procedure	Deal with dissatisfied patients / relatives	Act with honesty and sensitivity

3. MAINTAINING GOOD MEDICAL PRACTICE

A) LEARNING:

Subject	Knowledge	Skills	Attitudes
Life long learning	Define continuing professional development Understand the role of appraisal	Recognise and use learning opportunities Maximise the potential of study leave	Be: · eager to learn · willing to learn from colleagues

B) EVIDENCE, AUDIT AND GUIDELINES:

Objective: To provide SHOs with the knowledge, skills and attitudes to use evidence, guidelines and audit to benefit patient care.

Subject	Knowledge	Skills	Attitudes
Evidence based medicine (EBM)	Principles of EBM Types of clinical trial	Critical appraisal of evidence Competent use of databases e.g. Medline, the library and the internet	Keen to use evidence to support patient care
Audit	The audit loop Data sources for audit	Involvement in on-going audit and undertake at least one Gain informed consent from patients for audit	Recognise the relevance of audit to: · benefit patient care · clinical governance
Guidelines	Problems and benefits of guidelines Methods of determining best practice	Ability to use local guidelines Be involved in guideline generation and evaluation	Recognise individual patient needs when using guidelines

C) ETHICS AND LEGAL ISSUES:

Objective: To provide SHOs with the knowledge and skills to cope with ethical and legal issues which occur during the management of patients with general medical problems.

Subject	Knowledge	Skills	Attitudes
Informed consent	Process for gaining informed consent	Give appropriate information in a manner patients understand and be able to consent patients	Recognise the patient’s needs as an individual
Confidentiality	Strategies to ensure confidentiality Awareness of the ‘Caldicott Guardian’	Use and share all information appropriately Avoid discussing one patient in front of another	Respect the right to confidentiality
Legal issues, particularly those relating to: · death certification · role of the Coroner / Procurator Fiscal · mental illness · advance directives and living wills	Legal responsibilities of completing death certificates Types of deaths to be referred to the Coroner / Procurator Fiscal Process for section under the mental health act	Completion of death certificates Liaison with the Coroner / Procurator Fiscal Check whether the patient has an advance directive or living will	Show attention to detail and recognise pressures of time Respect living wills and advance directives Act with compassion at all times

4. MAINTAINING TRUST

A) PROFESSIONAL BEHAVIOUR

Objective: To ensure that SHOs develop the knowledge, skills and attitudes to act in a professional manner at all times.

Subject	Knowledge	Skills	Attitudes
Continuity of care	Relevance of continuity of care	Ensure satisfactory completion of reasonable tasks at the end of the shift/day with appropriate handover Make adequate arrangements to cover leave	Recognise the importance of: · punctuality · attention to detail
Doctor-patient relationship	Aspects of a professional relationship	Avoid unnecessary personal comments Ensure all discussion / examination is relevant Deal with inappropriate behaviour in patients, e.g. aggression, violence, sexual harassment	Adopt a non-discriminatory attitude to all patients and recognise their needs as individuals
Recognises own limitations	Extent of own limitations and when to ask for advice	Summarise cases and ask relevant questions when seeking advice from others	Willing to consult and have respect for colleagues
Stress	The effects of stress	Develop coping mechanisms for stress	Recognise the manifestations of stress on self & others
Relevance of outside bodies	The relevance to professional life of: · The Royal Colleges · GMC · Postgraduate Dean · Defence unions · BMA		Be open to constructive criticism Accept professional regulation

B) PATIENT EDUCATION AND DISEASE PREVENTION:

Objective: To provide the SHO with the knowledge, skills and attitudes to be able to educate patients effectively.

Subject	Knowledge	Skills	Attitudes
Educating patients about: · disease · investigations · therapy	Natural history of common diseases Investigation procedure Possible alternatives / choices Strategies to improve adherence to therapies	Ability to give information to patients clearly Encourage questions Negotiate individual treatment plans including action to be taken if patient deteriorates or improves	Involve patients in developing mutually acceptable investigation and treatment plans Encourage patients to access: · further information · patient support groups
Environmental & lifestyle risk factors	Risk factors for disease including: · diet · exercise · social deprivation · occupation · substance abuse	Advise on lifestyle changes Involve other health care workers as appropriate	Have a non-judgemental approach
Smoking	Effects of smoking on health Implications of addiction Smoking cessation strategies	Advise on smoking cessation and supportive measures Identify ‘ready to quit’ smokers	Recognise the importance of support during smoking cessation
Alcohol	Effects of alcohol on health and psychosocial wellbeing Local support groups /agencies	Advise on drinking cessation	Suggest patient support groups as appropriate
Epidemiology & screening	Data collection methods and their limitations Notifiable diseases Principles of 1^o& 2^o prevention & screening	Assess an individual patient’s risk factors Encourage participation in appropriate disease prevention or screening programmes	Recognise the: · positive & negative aspects of prevention · importance of patient confidentiality Respect patient choice

5. WORKING WITH COLLEAGUES:

Circumstance	Knowledge	Skills	Attitudes
Interactions between: · members of a team · hospital & GP · hospital & other agencies e.g. social services	Roles and responsibilities of team members How teams work effectively	Delegate, show leadership and supervise safely Safe Handover	Be conscientious Respect colleagues Recognise own limitations

6. TEACHING AND TRAINING:

Objective: To provide SHOs with the knowledge, skills and attitudes to become life-long learners and teachers.

Subject	Knowledge	Skills	Attitudes
Teaching	How adults learn Learner-centred approach	Communicate and share information one-to-one and in small groups Always seek feedback	Recognise all opportunities for teaching Demonstrate willingness, enthusiasm and patience to teach
Formal presentations	Features of an effective presentation	Presentation skills to small groups e.g. journal club Present material in different presentation media	Be confident and not intimidated when presenting Embrace new technology

Source: RCGP 2000

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Foundation (F2) Curriculum

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