Emergency Medicine Job Description
Job Title:GPST1 and ST2
Specialty:Emergency Medicine
Duration of Post:4 or 6 months as part of the GP Specialist training programme
Base:Tameside General Hospital
Responsible to: Emergency Medicine Consultant
Working Hours:48 hours
On-call:Full shift
Duties of the Post
GPSTs are responsible to the Consultants and the Trust for:
Theinitialmanagement andprimary care of patients presenting in the
Department
Arranging for the follow-up of patients they treat in the Department - including
the follow-up of any investigations performed and the taking of appropriate
action in accordance with the results of these.
Management of personal time in order to deliver the most effective care to the most unwell of patients, recognising personal limitations and asking for help where appropriate
Transmission of relevant clinical information on patients to other medical, technical and nursing staff either within the Department, within or without the hospital or at any other hospital, regarding patients under care or those referred to other places for further treatment or follow-up.
Initial management of fractures including reduction and immobilisation
The performing of minor surgical procedures and operations
Joint working with nursing staff in matters relating to the treatment of Patients
Maintenance of adequate and proper records on patients for both clinical and
audit purposes (including data input into the computer system) and for the
furnishing of letters, reports and other documentation as required for medical,
legal and statutory purposes.
Instruction of nursingstaff, FY1, FY2 and, from time to time, medical students and ambulance personnel under training within the Department.
Coding diagnostics and treatment of patients on the information system
Preparing clear, accurate and timely reports to General Practice
Communication of care plans and diagnoses to patients and their relatives
Clinical Governance
Undertake induction and mandatory training, as provided by the Department of Medicine
Draw up an educational agreement with the medical department
Take part in clinical audit
Report significant events where the delivery of care has placed patients at risk
Participate in the improvement of services as directed by the medical consultant
Adhere to departmental clinical protocols as directed by the medical department
Encourage and allow feedback on personal performance and critically review your own work
Teaching and Mentoring
Offer opportunities to medical students, attached to the team, to learn about the management of acutely unwell patients
Participate in the preparation and delivery of teaching at departmental events
Educational Content of the Post
Note: This post is the most likely to provide educational exposure to acute eye problems encountered in Primary Care. The department encourages education in ophthalmology.
The post provides easily accessible opportunities to cover several MRCGP Curriculum statements:
2.02 Patient safety and quality of care
3.03 Care or acutely unwell patients
3.04 Care of children and young people
3.05 Care of older adults
3.06 Womens health
3.07 Mens health
3.09 End of life care
3.12 Cardiovascular health
3.13 Digestive Health
3.14 Care of people with ENT, oral and facial problems
3.16 Care of people with eye problems
3.17 Care of people with Metabolic problems
3.18 Care of people with Neurological problems
3.19 Respiratory Health
3.20 Care of people with musculoskeletal problems
3.21 Care of people with skin problems
MANAGING COMPLEX CARE
3.10 Care of people with mental health problems
3.11 Care of people with intellectual disability
3.14 Care of people who misuse drugs and alcohol
At the end of the post the GP-Trainee should:
Be able to manage a wide range of presentations of acute illness
Be confident in managing life threatening illness
Be able to recognise and manage a wide range of common acute diagnoses and flare ups of common chronic illnesses
Be able to effectively problem solve and manage rare or unique presentations of acute illness and diagnoses
Develop a range of practical skills needed to manage acutely unwell patients
Communicate diagnoses, and management plans with patients and their relatives
Be able to work effectively in teams and coordinate care
Weigh up different courses of action taking account of
oPatient safety
oThe appropriateness of interventions according to patients’ wishes,
oThe severity of the illness
oCo-morbidities and the patients pre- admission state of health
oThe patients capacity to understand their treatment
Be able to make rapid mental state and mental capacity assessments in order to direct care appropriately
Accept responsibility for action, at the same time recognising any need for involvement of more experienced members of the team
Be aware of the resources needed to treat patients, and deliver care in a cost effective and efficient manner
Understand the need to follow agreed national or local protocols but be confident to deviate from them, and justify these actions when faced with unique clinical scenarios.
Plan discharge and hand over to primary care services appropriately taking account of the capacities and competencies of primary care
(See appendix for educational check list to check progress of learning)
Educational Organisation
Most education should occur during the delivery of acute care, by a mixture of supervision, personal reflection, personal study and team discussions.
The post holder will have a named clinical supervisor who is accountable for the overall educational experience of the job.
The post holder will attend educational meetings organised by the General Practice Primary Care Medical Educator and local TARGET sessions
The post holder will participate in a continuing programme of education within the hospital department.
Attendance at ophthalmology outpatient clinics is strongly encouraged and is a legitimate use of study leave
The post holder will be entitled to study leave in accordance with national and local guidelines. (15 days in a 6 month post, 10 days for a 4 month post)
The post holder will record progress in their e-portfolio.
The post holder will meet with their Educational Supervisor (GP-Trainer) at least twice during this post
The post holder will direct necessary DOPs, CBDs and Mini-Cex assessments as appropriate.
Accident and emergency
GP Curriculum at TGH
AbbreviationKA / Know about / Have some knowledge about this area and know about some of the skills needed.
Need to improve your knowledge and skills base to be able to manage patients safely
KH / Know how / Have a good knowledge of this area and know the appropriate skills.
Would need advice and support to manage a patient independently
CD / Can do / Have a track record of managing the patient. Have used your knowledge and skill base in this area to bring benefit to the patient
Learning Area / KA / KH / CD
Management of unsorted medical symptoms
Chest pain
Cardiac arrest
Shock and anaphylaxis
Convulsions
Acute confusion
Unconsciousness
Acute Breathlessness
Acute severe wheeze
Collapse ?cause
Septicaemia
Acute neurological weakness (inc CVA)
Severe abdominal pain
Acute haemorrhage
Haematemesis
Gynaecological
Rectal
Wound
Severe Acute Headache
Urinary retention
Eye lid swelling
Red eye
Painful eye
Acute visual loss and disturbance
Acutely swollen joints
Back pain
Common fractures and acutely swollen joints of:
Hand
Wrist
Arm
Chest
Face
Skull
Pelvis
Hip
Leg
Foot
Management of acute diagnosed medical conditions / KA / KH / CD
Acute coronary syndrome
Serious arrhythmias causing cardiac insufficiency
Acute asthma attack
Diabetes emergencies (HONK and DKA)
Meningitis and/or septicaemia
Acute drug intoxication
Alcohol withdrawal
Pulmonary oedema
Pneumonia and bronchitis
Acute epileptic seizure
CVA and TIA
Acute limb ischaemia
Overdose
Pancreatitis
Gallstones
Eye lid problems
Blepharitis and styes
Entroprion and ectroprion
Naso lacrimal obstruction
Red and painful eye
Conjunctivitis
Dry eye syndrome
Foreign bodies
Scleritis and episcleritis
Corneal ulcers and keratitis
Iritis and uvitis
Acute trauma to the eye and surrounding structures
Visual loss
Acute glaucoma
Retinal detachment
Vitreous Haemorrhage
TIA
Gout
Acute flare up of rheumatoid arthritis
Acute flare up of SLE
Acute tendon rupture of knee, ankle, shoulder
Assessment and management of chronic diagnosed medical conditions / KA / KH / CD
Eyes
Cataract
Chronic angle glaucoma
Myopia and astigmatism
Diabetic retinopathy
Dry eye syndrome
Blepharitis
Strabismus
Registering of short sightedness and blindness
Rheumatoid arthritis
SLE
Gout
Psoriatic Arthritis
Viral arthritis
Osteoarthritis of
Hand
Shoulder
Neck and spine
Hip
Knee
Hip fracture
Skull fracture
Asthma, prevention of re-admission
Skills (beyond basic communication and examination) / KA / KH / CD
Misc. skills
Female and male catheterisation
Intramuscular, intradermal and sub-dermal immunisation
Ability to assess patients at risk of pressure sores
Ability to assess chronic wound severity including burns
Ability to assess nutritional status
Ability to assess swallowing reflex
Fundoscopy
External eye examination with flurosceine
Visual acuity measurement
Visual field examination
Application of eye drops
Medical test results
Understanding of sensitivity and specificity of medical tests (inherent inaccuracies)and how this alters patient management
The communication of uncertainty about the results of medical test results
Interpretation of results
ECG
BP
Temperature charts
Glasgow Coma Scale
Interpretation of blood tests
cardiac enzymes and trop T results
thyroid results, TSH, T4 and Thyroid antibodies
FBC
blood sugar results
Liver function tests
Clotting tests
renal blood tests
Interpretation of urine results
MSSU
Diabetes management
Understanding x-ray results
Plain x-rays
CT and MRI results
USS results
Understanding Eye exam tests
oOptic pressures
oVisual acuity results
oVisual field testing
oOptic disc measurements
o
Use of medical equipment
Taking a BP (automated and manual)
PEFRs and interpretation of results
nebuliser therapy
all types of inhalers
Defibrillator
ECG
Near patient blood sugar testing
Ophthalmoscopy
Proctoscope
How to assess someone for nebuliser therapy
How to take blood gases
How to produce an asthma self-management plan
How to check inhaler technique
Special Ophthalmology skills
How to remove a foreign body from the eye
Research and national guidance
Understand how to find high quality EBM information to direct patient care
The use of NICE and NSF guidance in patient care
Use of local antibiotics guidelines
EBM use of antibiotics
Use of the BTS guidance for asthma and COPD management
Basic Life support
Social skills
Ways to help people stop smoking
Understanding the rules about rest, time off work after injury
Issuing of sick notes
Knowledge of support groups for arthritis
Rules about registration for partial sightedness and blindness
Communication
How to assess patient mental capacity and autonomy.
Mini mental state examination
Consent to treatment procedures in ‘incompetent patients’
Understanding when to ask for a formal mental health assessment
Ability to take a history from confused or elderly patients where third part evidence is important, using relatives or other health workers including GPs
Ability to alter the pace of communication to take into consideration the needs of the patient, i.e. learning difficulty and elderly
How to communicate with intoxicated patients
Medicines use
Ability to alter medicines doses in the elderly (or those with renal disease)
Skill to recognise common drug interactions
Teamwork. Understanding the roles of: / KA / KH / CD
Social Services
Macmillan nurse
Intermediate care services
Cara Team
Health visitors
District nurses
Opticians
Eye Casualty
Physiotherapy (after acute injury)
Mental Health Liaison Nurses
Approved Social Worker (ASW)
Attitude
Ability to accept and explore the reasons for patients who decide to decline urgent medical care
Being able to recognise and take responsibility for patients who are at significant risk of self-neglect or self-harm
Being aware of how to restrict personal harm, physical or emotional
Deal with intoxicated or aggressive patients with sensitivity and respect
Ability to explore the reasons for recurrent presentation.
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