• Renal medicine – with the focus on CKD in primary care, skills in this area are increasingly valuable to GPs

• Rheumatology – 20% of GP consultations tackle rheumatological issues

• Medical on call at CIC – providing experiential learning of acute medical care

When not undertaking the medical on call component of the job, the working week is planned as follows:

Alternatively, 2 months in renal medicine and 2 months in rheumatology.

This work pattern is overridden by the on-call rota. Deviations from the work pattern to fulfil educational objectives or for operational reasons are negotiated by the GP registrar with the clinical supervisors in each specialty. The majority of educationally useful work in rheumatology occurs in the first half of the week.

Each department will provide:

• A named clinical supervisor
• Induction
• Departmental teaching appropriate to the GP curriculum

Learning opportunities in this post

Educational objectives for this post

Educational objectives in renal medicine component of the post

• Teamwork in relation to chronic disease management, and understanding the roles of team members.
• Coordination of care between primary and secondary care
• Local and systemic manifestations of renal disease
  • Acute renal disease
  • Chronic renal disease
• Common and/or important conditions, and renal manifestaions of chronic disease eg hypertension, diabetes.
• History and examination relating to renal disease
• Investigation and treatment of renal disease, and the prevention of complications. The use of immunosupressive therapy and the principles of dialysis.
• A holistic approach to the care and management of patients with renal disease, developing appropriate communication skills.

Educational objectives in rheumatology component of the post

• Teamwork in relation to chronic disease management, and understanding the roles of team members.
• Coordination of care between primary and secondary care
• Local and systemic manifestations of rheumatological disease
• Common and/or important conditions:
  • Acute back/neck pain
  • Chronic back/neck pain
  • Shoulder pain
  • Knee pain
  • Soft-tissue disorders
  • Osteoarthritis
  • Osteoporosis
  • Somatisation/fibromyalgia and allied syndromes
  • Pain management
  • Acute arthropathies
  • Chronic inflammatory arthropathies
  • Polymyalgia rheumatica and allied conditions
  • Awareness of rare diseases
  • Chronic disability
  • Common injuries
• History and examination of the musculoskeletal system
• Investigation and treatment of rheumatological disease, and the prevention of complications, including joint and soft tissue injections and DMARD therapy.
• A holistic approach to the care and management of patients with rheumatological disease, developing appropriate communication skills.

Educational objectives in acute medical care component of the post

• The use of teamwork when managing patients with acute illness.
• Recognition and management of the acutely ill patient.
• Developing a differential diagnosis and management plan.
• Managing complexity, coping with uncertainty, level or urgency and responsibility.
• A holistic approach to the care and management of patients with acute illness, developing appropriate communication skills.
• Triage skills.
• Resuscitation skills
• Symptoms
  • Cardiovascular – chest pain, haemorrhage, shock.
  • Respiratory – wheeze, breathlessness, stridor, choking.
  • Central nervous system – convulsions, reduced conscious level, confusion.
  • Mental health – threatened self-harm, delusional states, violent patients.
  • Severe pain.
• Common and/or important conditions
  • Shock (including no cardiac output), acute coronary syndromes, haemorrhage (revealed or concealed),
  • ischaemia, pulmonary embolus, asthma.
  • Dangerous diagnoses eg
  • myocardial infarction
  • pulmonary embolus
  • subarachnoid haemorrhage
  • limb ischaemia
  • meningitis
  • aneurysms
• common problems that may be expected with certain practice activities eg anaphylaxis after immunisation

Created by BC on 8/2/08