Job Description for General Practice Training Post in Ortho-Geriatric
May 2015

Educational support: Orthopaedic Surgeon: Mr Swaminathan

Consultant Geriatrician:Dr Ahmed

Clinical Supervisor:Mr Raja Swaminathan Orthopaedic Surgeon

Location:Orthopaedic Wards, A&E, Clinic 10 and Theatres, Tameside General Hospital, Fountain Street, Ashton-Under-Lyne, Lancashire

Out Patient Skills

Week 3 of an 8 week rota. During this week you have flexi time to spend in clinics of your choice

Purpose of the post:

The intention of this post is that on completion, the doctor is able to fulfil the responsibilities of a GP, with regard to the assessment and treatment of patients with musculoskeletal problems and injuries, falls and osteoporosis in the acute and General Practice setting. The post holder will develop a broad knowledge of common medical disorders and in recognising signs of serious illness. The importance of rehabilitation, common mental health issues and the support of community services to a safe discharge home will be fully appreciated.

The post provides easily accessible opportunities to cover several MRCGP Curriculum statements:

2.02 Patient safety and quality of care

2.03 The GP in the Wider Professional Environment

3.03 Care or acutely unwell patients

3.05 Care of older adults

3.20 Care of people with musculoskeletal problems

MANAGING COMPLEX CARE

3.10 Care of people with mental health problems

Important objectives will be:-

  • To recognise and manage common medical conditions (both acute and chronic) in an orthopaedic setting.
  • To become competent in the diagnosis, assessment and management of common orthopaedic conditions in primary and secondary care.
  • To develop an understanding of orthopaedic surgical techniques.
  • To gain an understanding of the factors that lead to falls and what can be done to prevent them.
  • To recognise and treat osteoporosis.
  • To manage pain effectively.
  • To understand rehabilitation from a multidisciplinary perspective and appreciate the role of a doctor within a rehabilitation setting.
  • To appreciate and understand the rehabilitative and support services available to older adults in the community including intermediate care and domiciliary therapy/ support.
  • To understand what to do when a person can no longer be supported safely in their own home.
  • To learn to communicate often complex issues effectively with patients, relatives and all relevant disciplines.
  • To make timely referrals on behalf of patients to other specialist services.

Objectives and how to achieve them:

What / Where / When / How / comment
Assess common T&O conditions / On wards, and in clinics / On ward rounds and in clinics. Plan is to allocate two clinics a month.
Month 1: Fracture clinic
Month 2: Shoulder clinic
Month 3: Knee and hip Clinic
Month 4: Orthopaedic clinic / Bed side teaching / Case based discussion. It is the Doctors responsibility to attend these allocated clinics. The doctors can perform observe and learn the techniques of shoulder and knee joint injections – ( DOPS for assessment) and CBD for clinical case presentation and build their portfolio.
Competence based assessment for clinical examination of Spine, shoulder, wrist and hand and hip and knee and ankle joint.
Orthopaedic Surgical techniques / In Theatre / During week 3 of rota, late shifts helping in theatre / Observation and practicing sutures and injection techniques / On the doctors own initiative and during their Thursday off on GP teaching
Assess common medical conditions / On wards / On ward rounds and on rounds with Dr Ahmed. / Bed side teaching / Case based discussion and building their portfolio.
Recognise and treat osteoporosis / On wards, in clinic and in trauma meeting / On ward rounds and in clinic and in meeting / Observation and participation / Cases based discussion and build their portfolio.
Pain management / On wards / On ward rounds / In liaison with pain team / Doctors are encouraged to discuss pain management with pain team and build their portfolio.
Rehabilitation / On ward / Multidisciplinary meeting / Observation and participation. / Doctors are encouraged to attend at least one MDT in the four month period and build their portfolio.

Educational content:

  • The post holder will be expected to attend orthopaedic educational meetings.
  • An appraisal will be made at the commencement of the Post and at least 8 Clinics will be timetabled to provide Educational teaching in Common Orthopaedic conditions of the Shoulder, Back, Hip, Knees and Hands.
  • There will be opportunity to learn Joint injections.
  • The post holder will be entitled to study leave in accordance with national and local guidelines.
  • Proviso will be made for Trainees to attend GP ST1/2 Teaching
  • The department has requested that all Workplace Based Assessments are carried out by consultants rather than middle grade colleagues
  • Study leave should, where possible, not be taken on weeks on call (weeks 1 and 2 of rota, see below)

Work Timetable

There is an 8 week duty rota, which the GP trainees will rotate through twice during their 4 month attachment. These include

  • 4 weeks ward based work, co-supervised by Care of Elderly and Orthopaedic staff
  • 1 week of nights on call for orthopaedics
  • 1 week of days on call for orthopaedics (responsibilities shared between clinic 10 and A&E). Juniors can get consultant opinions about A&E cases during the day.
  • 1 week of late shifts for theatre cover to learn surgery skills (11:00 until 7:00pm)
  • Six weekends in every eight are free. One weekend in eight is for night on call. One in eight is for day time on call.
  • The rota complies with European Working Time Directives, and averages just less than 48 hours a week
  • GPST trainees will be on the same rota, but at different points, so they will cover the same wards for alternate 4 week blocks. Handover between the trainees is essential.

Wk / Mon / Tue / Wed / Thu / Fri / Sat / Sun
1
On call duties / B
20:30 09:00 / B
20:30 09:00 / B
20:30 09:00 / B
20:30 09:00 / Zero Hours
2
On call duties and clinic 10 / A
08:00 20:30 / A
08:00 20:30 / A
08:00 20:30 / A
08:00 20:30 / Zero Hours
3
Out-Patient Skills / D: Late
11:00 19:00 / D: Late
11:00 19:00 / D: Late
11:00 19:00 / D: Late
11:00 19:00 / B. On Call
20:30 09:00 / B On Call
20:30 09:00 / B On Call
20:30 09:00
4 / Zero Hours / Zero Hours / Zero Hours / Zero Hours / A On call
08:00 20:30 / A On Call
08:00 20:30 / A On Call
08:00 20:30
5
Ward Based Work / Stnd Day
08:30 16:30 / Stnd Day
08:30 16:30 / Stnd Day
08:30 16:30 / Stnd Day
08:30 16:30 / Stnd Day
08:30 16:30
6
Ward Based Work / Stnd Day
08:30 16:30 / Stnd Day
08:30 16:30 / Stnd Day
08:30 16:30 / Stnd Day
08:30 16:30 / Stnd Day
08:30 16:30
7
Ward Based Work / Stnd Day
08:30 16:30 / Stnd Day
08:30 16:30 / Stnd Day
08:30 16:30 / Stnd Day
08:30 16:30 / Stnd Day
08:30 16:30
8
Ward Based Work / Stnd Day
08:30 16:30 / Stnd Day
08:30 16:30 / Stnd Day
08:30 16:30 / Stnd Day
08:30 16:30 / Stnd Day
08:30 16:30

Timetable for ward work (4 out of 8 weeks) :

Monday AM / Ward Round and then Fracture Clinic Mr Thalava
Monday PM / Ward Round Dr Ahmed of T&O patients 2pm
Tuesday AM / Ward Round Dr Htin of T&O patients 1030am
Tuesday PM / Ward round / Trauma Theatre on alternate weeks/ RT Ortho clinic
Wednesday AM / Ward work 1000hr MDT Dr Ahmed then Ward Round
Wednesday PM / Ward Work
Thursday AM / Ward work Ward Round Dr Htin 1030am
Thursday PM / Ward Work
Friday AM / Ward work
Friday PM / Ward Round Dr Ahmed 2pm

There will be some flexibility in the timetable dependent on educational and service needs

Learning Outcomes

Core Curriculum 15.9 Rheumatology and Conditions of the Musculoskeletal System (including Trauma)

Common and/or important conditions:

  • Acute back/neck pain
  • Chronic back/neck pain
  • Shoulder pain
  • Knee pain
  • Osteoarthritis
  • Osteoporosis
  • Common injuries.

Investigation:

  • Indications for plain radiography, ultrasound, CT and MR scan
  • General rules of X-ray interpretation

Treatment:

  • Knowledge of when joint injections and aspirations are appropriate in general practice and the ability to perform when appropriate, e.g. shoulder and knee joints and injections for tennis and golfer’s elbow

Examination:

  • Demonstrate complete examination of the following areas:
  • The neck and back
  • The shoulder, elbow, wrist and hand
  • The hip, knee and ankle.

Core Curriculum 9 Care of Older Adults

  • Skills in acute, chronic, preventative, palliative and emergency care
  • Skills to effectively liaise and cooperate with the many different disciplines and persons in primary, intermediate and secondary care
  • Ensuring that the provision of care promotes the patient’s sense of identity and personal dignity, and that the patient is not discriminated against as a result of their age
  • Understanding of the concept of co-morbidity in an elderly patient
  • Skills to manage the concurrent health problems
  • Understanding the variety of possible approaches
  • Understanding the complex nature of health problems of older patients

Orthopaedic Geriatric Job

Educational tick list

Management of common joint problems

Foot and Ankle (Mr. Ebiezie’s clinic – Wednesday PM)

Examine the foot and ankle

Identify differential diagnoses which cause pain or limp

Understand and advise non-surgical management of

  • Plantar Fasciitis
  • Bunions
  • Metatarsalgia
  • Ankle sprains
  • Hooked toes
  • In-rolling of foot in adults and children
  • Achilles tendon pain and swelling
  • Gait problems in children
  • Gout
  • Ganglions of the foot

Understand the need for investigations

The use of Steroid injections

Understand the indications for and the limitations of common surgical procedures

Understand the likely rehabilitation time after common surgical procedures

Knee (RT clinic Tuesday AM and PM/ MO clinic Tuesday or Thursday)

Examine the knee

Identify differential diagnoses

Understand and advise non-surgical management of

  • Osteoarthritis of the knee
  • Bursitis
  • Acute knee injuries before imaging or arthroscopy
  • Anterior knee pain in children
  • Osgood schlatters syndrome
  • Muscle wastage in the elderly

Understand the need for investigations

The use of Steroid injections

Understand the indications for and the limitations of common surgical procedures

Understand the likely rehabilitation time after common surgical procedures

Hip (RT Clinic Tuesday AM and PM)

Examine the hip

Identify differential diagnoses

Understand and advise non-surgical management of

  • Trochanteric Bursitis
  • Mild OA of the hip
  • Groin strain
  • Hip pain in children

Understand the need for investigations

The use of Steroid injections

Understand the indications for and the limitations of common surgical procedures

Understand the likely rehabilitation time after common surgical procedures

Lumbar spine (Any clinic)

Examine the lower back, including a brief neurological examination

Identify differential diagnoses

Understand and advise non-surgical management of

  • Acute musculoskeletal lumbar spine pain
  • Chronic lumbar spine pain
  • Sciatic nerve symptoms
  • Piriformus muscle spasm

Understand the need for investigations

The use of Steroid injections

Understand the indications for and the limitations of common surgical procedures

Understand the likely rehabilitation time after common surgical procedures

Shoulder (BNM clinics)

Examine the shoulder

Identify differential diagnoses

Understand and advise non-surgical management of

  • Painful arc syndrome
  • Acute injuries to the shoulder
  • Impingement syndrome
  • Acromio-clavicular joint pain
  • Mid scapular and rhomboid muscle pain
  • Gleno-humoral joint pain

Understand the need for investigations

The use of Steroid injections and common approaches to injecting the shoulder

Understand the indications for and the limitations of common surgical procedures

Understand the likely rehabilitation time after common surgical procedures

Cervical spine and neck (Any Clinic)

Examine the neck

Identify differential diagnoses

Understand and advise non-surgical management of

  • Acute whiplash injuries
  • Painful neck movements and stiffness in the elderly
  • Headaches caused by neck problems
  • Trapesius and supraspinatus muscle spasm

Understand the need for investigations

The use of Steroid injections

Understand the indications for and the limitations of common surgical procedures

Understand the likely rehabilitation time after common surgical procedures

Elbow (RS clinic)

Examine the elbow

Identify differential diagnoses

Understand and advise non-surgical management of

  • Lateral and medial epicondyl pain syndromes
  • Olecranon bursitis

Understand the need for investigations

The use of Steroid injections

Understand the indications for and the limitations of common surgical procedures

Understand the likely rehabilitation time after common surgical procedures

Wrist and hand (RT Clinics and RS clinic)

Examine the wrist and hand

Identify differential diagnoses

Understand and advise non-surgical management of

  • Carpal tunnel syndrome
  • Teno-synovitis
  • Ganglions
  • Thumb osteoarthritis

Understand the need for investigations

The use of Steroid injections including carpal tunnel injection

Understand the indications for and the limitations of common surgical procedures

Understand the likely rehabilitation time after common surgical procedures

Acute fracture trauma management, including common lengths of time off work

Surgical skills (When they have OT placement)

Aseptic technique for joint injection and principles of its use

Minor surgical techniques

  • Stitching of skin wounds
  • Skin Biopsy
  • Removal of sebaceous cysts – (Gen – surgery)
  • Ellipse incisions around skin lesions
  • Shave excision – (Not T & O )
    Wound management – (On the Wards)

Post-surgical wound management

Traumatic wound management

The management of pressure sores

Pressure care, waterlow scoring and the benefit of nutrition post op

The wider team for joint problems

The use of foot orthotics

The role of surgical appliances in managing common orthopaedic problems

The use of medical certificates to be off work, and the use of the ‘fit note’ to facilitate return to work.

The use of community Falls prevention services and the MDT approach to making high risk people safe in their own homes

The role of Rehabilitation services in the community

Common Walking aids and how to make a simple assessment for a patient

How to access a wheel chair from the community

Inflammatory and other arthritis (Rheumatological clinics)

Common presentations of acute inflammatory joint conditions and the ability to differentiate from other joint pathology. With a knowledge of when to refer to rheumatology

The principles of screening for and managing Osteoporosis

The use of DMARDS (methotrexate, sulphasalazine, gold, azathioprine, hydroxychloroquine)

The recognition of Gout and its management

Pain management(on wards with pain management of patients in T&O)

Acute and chronic pain management, including the use of:

  • Opiates,
  • Neuropathic pain modulators
  • TENS
  • Acupuncture
  • Nerve stimulators
  • Epidural and para-spinal injections
  • Rubrificants including capsacin

Medical management of unwell patients on the ward (On ward with Medical team – Mon, Wed, Fri)

Medical management or new presentations or exacerbations of

  • Chest pain
  • Thrombo embolism
  • Diabetes
  • Pneumonia
  • Atrial fibrillation
  • CVA and TIA
  • Wound infections

Thrombo-embolism prophylaxis and the management of anti-coagulation during operations

Renal failure management during operations

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