Educational objectives

Be able to demonstrate an understanding of the components of effective verbal and non verbal communication skills with relevance to obstetrics and gynaecology

Obstetrics

The GP Registrar should:

• Be able to take a relevant obstetric history and perform an obstetric examination.
• Be able to give pre-conceptual advice.
• Be aware of the routine management of normal pregnancy, appreciating the preventative role of all procedures.
• Be able to understand the principles of of antenatal screening including screening for structural defects,chromosomal abnormalities and haemoglobinopathies and the effects upon fetus and neonate of relevant infections during pregnancy
• Be able to undertake the initial management of common and life-threatening emergencies in early pregnancy.
• Be aware of peri-conceptional care, antenatal care and maternal complications of pregnancy.
• Be aware of substance misuse, psychiatric illness, problems of pregnancy at extreames of age.
• Be aware of domestic violence in relation to pregnancy.
• Should have a thorough understanding of the epidemiology of maternal and perinatal morbidity and mortality.
• Should understand the principles of counselling a woman faced with possible or real problems of foetal malformation.
• Should understand the management of common conditions in which pregnant woman are admitted to hospital, e.g. premature labour, pre-eclampsia, multiple pregnancy, foetal growth, ante-partum haemorrhage and maternal disease, and understand their own role and other members of the health team in the management of obstetrics.
• Should have an understanding of all obstetric emergencies.
• Should have a good understanding of common medical disorders and the effect that pregnancy may have on them, and also their effect, in turn, upon the pregnancy. E.g. diabetes, thyroid disease, kidney disease, heart disease
• Be aware of the indications and methods of induction of labour and be confident in and understand the principles of managing normal labour and emergency complications eg cord prolapse.
• Know when a pregnant woman requires referral for specialist opinion and be capable of intial management of intrapartum problems in a community setting
• Have appropriate knowledge of regional anaesthesia, analgesia and operative vaginal delivery including caesarean section.
• Understand the indications for maternal immunisation with anti D and rubella vaccine and the importance of confirming its efficacy. The importance of polio, diphtheria, hepatitis A&B, varicella, and rashes during pregnancy.

Intranatal and postnatal care

GP Registrar should

• Be able to demonstrate appropriate knowledge of process of normal labour
• Recognise the abnormalities that may occur in labour necessitating transfer to specialist care, e.g. foetal distress, haemorrhage, delay in labour, abnormal presentation, etc.
• Have an understanding of the investigations and management of immediate neonatal problems including neonatal resuscitation.
• Know how to:
  • resuscitate a shocked mother
  • deal with secondary PPH
  • resuscitate a shocked baby.
• Be aware of special arrangements needed for home confinements.
• Understand local arrangements for intrapartum care in the setting of general practice.
• Be able to take an appropriate history and perform an appropriate examination on a postpartum woman.
• Recognise and understand the management of physical and psychological problems of the mother in the post-natal period, e.g. peurperal depression, psychosis, fever.
• Understand the normal involutional processes in the postpartum period and be able to conduct a full post-natal examination. Be able to demonstrate appropriate knowledge, management in relation to postpartum maternal problems including the normal and abnormal puerperium, secondary postpartum haemorrhage,, therapeutics, perineal care, infant feeding and breast problems.
• Be able to advise and provide suitable methods of family planning

Gynaecology

The GP Registrar should:

• Understand the role of the general practitioner in and techniques used in general practice:
  for health education and sex education in children, adolescents and older women.
  for the prevention of gynaecological disease, e.g. cervical carcinoma, genital infection.
• Be able to take a gynaecological history, carry out a full and appropriate examination and conduct appropriate investigations on patients of all ages.
• Be able to advise and provide suitable methods for family planning. Have a thorough understanding of indications, contraindications, complications, mode of action and efficacy of all reversible and irreversible contraceptive methods.
• Be able to demonstrate knowledge and attitude in relation to management of abortion and should be familiar with the accompanying laws related to abortion and consent.
• Understand the principles involved in counselling patients with psychosexual problems.
• Be able to demonstrate appropriate knowledge and attitude in relation to sub-fertility including epidemiology, aetiology, management and prognosis of male and female fertility problems. Have a broad based knowledge of investigations and management of the infertile couple in the primary care setting and appropriate knowledge on assisted reproductive techniques.
• Be aware of clinical features, investigations and management of conditions leading to early pregnancy loss; miscarriage(including recurrent), ectopic pregnancy and molar pregnancy. Be aware of the physical and psychological aspects of early pregnancy loss.
• Be aware of clinical features and make appropriate referral of patients suspected with ectopic pregnancy and abdominal pain ex. Due to tortion of ovarian cyst.
• Be able to manage the common gynaecological problems relating to menstruation, e.g. amenorrhoea, dysmenorrhoea, menorrhagia, polymenorrhoea, premenstrual syndrome, fibroids, endometriosis, PCO syndrome
• Understand the management of patients suffering from infections of the genital tract including HIV/AIDS and be familiar with their modes of transmission and clinical features and principles of contact tracing.
• Be aware of the basis of national screeing programmes their limitations and their local implementation through local care pathways. Be familiar with clinical features, investigations and management of pre-malignant and malignant conditions of the female genital tract, including postmenapausal bleeding.
• Understanding the options available for palliative and terminal care including relief of symptoms and community support available.
• Know the steps required for the early diagnosis of neoplasia of the genital tract and the general practitioner`s role in the management.
• Understand the physiology and management of the menopause including HRT.
• Understand the diagnosis and management of incontinence of urine, genital prolapse in women, pelvic pain, endocrine problems and paediatric and adolescent gynaecological problems.
• Be aware of ethical and legal aspects of gynaeological problems e.g. chaperoning,age of consent, assault, sexually transmitted disease.
• Be able to demonstrate an understanding of commonly performed gynaecological surgical procedures including their complications and issues surrounding consent for such procedures.
• Be able to interpret pre-operative investigations and be aware of the principles involved in appropriate pre and post operative care including detection of post-operative complications and infection control.
• Understand diagnosis and management of vulval conditions

Learning opportunities

Educational contract

THE GP REGISTRAR

1. Has a responsibility to fulfill the educational objectives that have been defined for the post.
2. Will participate fully in all educational sessions.
3. We expect a professional attitude to the job and that you will take full advantage of work and educational opportunities.
4. The GP Registrar is entitled to appropriate study leave to be organised with the agreement of the Consultant trainer.

CONSULTANT TRAINER:

1. Will arrange and run an appropriate teaching programme that achieves the educational objectives as defined for the post.
2. Will provide regular assessment of the trainees progress while in post.
3. Will be available for informal help and teaching.
4. Will allow trainees to arrange appropriate study leave.

Updated by BC on 24/2/08