Application for the Approval of a Training Post – Form B (GP)

Please note. This form should be used in seeking post approval for the purposes of GP specialty training only.

Please describe the post:
This is an application for a ST 1 or 2 post in E.N.T (Otolaryngology) and Ophthalmology
Please specify length of the post
6 (3 months in ENT (Otolaryngology) and 3 months in Ophthalmology)
Please indicate intended starting date:
1stAugust 2007
Who will fund the post?
Deanery (50%)
Trust (50%)
Other(please give details)
Please provide the full name, address of the institution(s) e.g. hospital, practice in which the post is based.
Bradford Royal Infirmary, Duckworth Lane, BradfordBD9 6RJ
Please provide name and contact details of the GP specialty programme director (course organiser) who will be responsible for management of the post.
Dr N H Price, 07970 613392,
Dr R Mehay,
Bradford Vocational Training Scheme for General Practice, Field House, Bradford Royal Infirmary
Please provide details of the intended learning outcomes of the post.
Learning outcomes - E.N.T (Otolaryngology)
This post will enable the trainee to acquire the knowledge, skills and attitudes required to provide the delivery of high quality care to patients with E.N.T or eye problems. The learning outcomes are as follows:
  • To be able to make a diagnosis on the elicitation of appropriate symptoms presented by a patient, such as:
  • Hearing loss
  • Otalgia
  • Dizziness
  • Tinnitus
  • Dysphagia
  • Lymph nodes and other neck swellings
  • Speech delay
  • To enhance knowledge of practical investigation, i.e. Otoscopy, Tuning fork tests
  • To understand and be able to explain to the patient about the use of appropriate medications, including commonly used ENT drugs,Topical Anaesthetics, Corticosteroids,
  • To be able to recognise and institute primary management of ENT emergencies and refer appropriately:
  • Septal Haematoma
  • Epistaxis
  • Tonsilitis with Quinsy
  • Otitis Externa if extremely blocked or painful
  • Foreign body
  • Auricular Haematoma or Perichondritis
  • To adopt a person centred approach in dealing with patients suffering from hearing impairment or deafness, e.g. remembering to face the patient and speaking clearly so that they can lip-read, and being able demonstrate effective strategies for dealing with parental concern regarding E.N.T.
  • To develop the confidence to be able to effectively manage the treatment, or refer appropriately, for the following common conditions:
  • Otitis Media (suppurative/secretory); Otitis Externa; Perforated Tympanic Membrane; Cholesteatoma
  • Vertigo; Meniere’s Disease
  • Bell’s Palsy,
  • Pharyngitis; Tonsillitis; Laryngitis; Glandular fever, Oral Candida; Salivary stones; GORD
  • Infective and allergic Rhinitis; Sinusitis, Nasal Polyps
  • Nasal fracture, Haematoma Auris
  • Snoring and Sleep Apnoea
  • Suspected Head and Neck Cancer
  • Unilateral hearing loss in the absence or external ear pathology or obvious cause
  • To develop knowledge of E.N.T presentations of systemic diseases, e.g. GORD, CVA, AIDS
  • To adopt an holistic approach to demonstrate empathy with the patient and appreciate the impact of the condition on a people, e.g. ‘Deafness separates people from people’
Learning outcomes - Ophthalmology
This post will enable the trainee to acquire the knowledge, skills and attitudes required to provide the delivery of high quality care to patients with ophthalmic problems. The learning outcomes are as follows:
  • To be able to make a diagnosis on the elicitation of common conditions presented by a patient, such as:
  • Disorders of the lids and Lacrimal drainage apparatus – Blepharitis, Stye & Chalazion, Basal Cell Carcinoma
  • External Eye disease: Sclera, Cornea and Anterior Uvea – Conjunctivitis, Dry eye syndrome, Episcleritis, Corneal ulcers and Keratitis, Iritis & Uveitis
  • Disorders of Refraction – Cataract, Myopia
  • Disorders of Aqueous drainage – Acute Angle Closure Glaucoma, open angle glaucoma
  • Vitreo-Retinal disorders – Flashes and Floaters, Retinal detachment, retinal vein occlusion, age-related macular degeneration
  • Disorders of the Optic disc and visual pathways – Migraine, Swollen Optic disc
  • Eye movement disorders and problems of Binocularity Amblyopic – Diplopia
  • To enhance knowledge of practical investigation, i.e. undertaking an examination of the eye assessing both structure and function
  • To understand and be able to explain to the patient about the use of appropriate medications, including Mydriatics, Topical Anaesthetics, Corticosteroids, Glaucoma Agents
  • To be able to recognise and institute primary management of ophthalmic emergencies and refer appropriately:
  • Superficial Ocular trauma
  • Arc Eye
  • Severe blunt injury, including hyphaema
  • Severe Orbital injury, including Blow-out fracture
  • Penetrating Ocular injury and Tissue prolapse
  • Retained Intra-ocular foreign body
  • Sudden painless loss of vision
  • Severe Intra-ocular infection
  • Acute angle closure Glaucoma
  • To adopt a person centred approach in dealing with patients with eye problems, in the context of the patient’s circumstances, e.g. appreciating the importance of the social and psychological impact of eye problems on the patient.
  • To be able to demonstrate complete examination of the eye, assessing both structure and function, including:
  • Measurement of visual acuity
  • Pinhole testing
  • Eversion of eyelid
  • Examination of the pupil and assessment of the red reflex
  • Evaluation of extraocular movements
  • Measurement of intraocular pressure
  • Direct Ophthalmoscopy
  • To adopt a comprehensive approach to treatment and management of eye problems allowing for effective and accurate description, explanation, guidance for patients
  • To adopt an holistic approach to demonstrate empathy with the patient and appreciate the impact of the condition on a people, e.g. ‘Blindness separates people from things’

Please provide a timetable of service and educational commitments.
Please see attached timetable.
What are the arrangements for educational supervision in the post?
Educational supervision will be provided by Mr. Ian Smith (ENT) and Mrs. Anita Reynolds (Ophthalmology)
What are the arrangements for clinical supervision in the post?
Clinical supervision will be provided by Mr. Ian Smith (ENT) and Mrs. Anita Reynolds (Ophthalmology)
What arrangements are in place for access to GP training release scheme?
ENT :GP trainees have permission to attend the half day release Tuesday afternoon GP training meeting, following the regular ENT lunchtime teaching. In exceptional circumstances they may be required to cover clinical duties.
Ophthalmology: The timetable allows for attendance at the half-day release Tuesday afternoon meeting. Occasionally leave arrangements require cross-cover.
What arrangements are there to participate in out-of-hours care?
ENT : There is a shift system operating for the trainees, the GP trainee does day and evening shifts (4pm till 11pm) but does NOT do any night shifts (as this would involve cross cover with plastic surgery and maxillo facial surgery
Ophthalmology: inclusion in 1st on call 1:5 rota
Please provide details of the GP training programme of which the post will form part.
This post will form part of a variety of training programmes for General Practice Specialist Training. Posts will be arranged in combinations to meet the General Practice Registrar’s educational needs and to comply with PMETB Certificate of Completion of Training (CCT) Training Programme guidance (
The post will form part of 10 different Programmes for GP Specialist training, each of which is responsible to the Yorkshire Deanery. Each Programme will have posts available which enable individual doctors to follow a balanced 3 year or shortened training programme according to their individual learning needs and comprising both 12-18 months of general practice experience and 18-24 months of hospital experience in approved posts. Whilst the particular programmes followed by individuals will be different, and determined according to their needs and preferences, each individual programme will enable the GP Specialist Trainee to complete the curriculum prescribed by the Royal College of General Practitioners and to fulfil the requirements of PMETB.
Each programme fulfils the standards of the Yorkshire Deanery but, naturally, there is some local variation between them allowing an interesting and worthwhile diversity of experience for GP Specialist Trainees.
Please describe the arrangements for the ongoing evaluation of the post.
Each post will be evaluated by the post-holder on an iterative basis. The post will be discussed between post-holder and Programme Director of the local Specialist Training Scheme for General Practice. The post-holder will also complete a Quality Assurance form at the midpoint of their post. If there are any deficiencies or problems with the post then these will be discussed between the Programme Director and the responsible Consultant. The Programme Director will liaise with the Consultant in terms of dealing with any concerns, recognising good practice and providing ongoing monitoring. The Programme Director is responsible to a named Associate Director of the Yorkshire.
The Associate Director responsible for the area or ‘patch’ will have made an initial visit to each new general practice post and assessed this in terms of the quality of the learning environment and experience; this is according to standards laid down by the Yorkshire Deanery and conforms with those prescribed formerly by the JCPTGP. The post will be visited after 1 year by a Programme Director and GP trainer from an adjacent GP training Programme to ensure that these high standards continue to be met. I have attached an example of the paperwork used when inspecting the Hospital and interviewing the relevant Consultant/s. In addition, the GP Specialist Trainee in post will be interviewed using a structured interview format to determine their experiences of the post.
The following will also apply in this post:
  • There will be continuous evaluation of educational progress throughout the post.
  • Methods of assessment will be discussed between the General Practice Registrar and their educational supervisors at the start of the post.
  • There will be continuous evaluation of educational progress throughout the post. Methods of assessment will be discussed between the trainee and their educational supervisor at the start of the post. The will be midpoint, 360 degree and end point appraisals in line with current RITA process.

Please describe the arrangements for the ongoing quality control of the post.
Quality control will take place as follows:
The Associate Director of the Yorkshire Deanery with responsibility for the patch will meet at least quarterly with the team of Programme Directors in order to discuss the quality of teaching and learning experience within the relevant posts. Additionally, the Quality Assurance questionnaire completed by the GP Specialist Trainee at the midpoint of their attachment will be sent to the Yorkshire Deanery, for the attention of the Associate Director. If there are any problems or difficulties, the Associate Director would visit the practice concerned. If changes were needed, there would be a suitable time frame for these and this would be monitored by the local Programme Director, liaising with the Associate Director. If standards were not met within the agreed time, then the Patch Director would report to the Executive Committee of the Yorkshire Deanery and ultimately a decision would be taken to request that PMETB withdrew approval of the post.
The programmes of which the posts form part are visited on a rotational basis; formerly approved by the JCPTGP. Future compulsory quality assurance will be implemented by the Yorkshire Deanery, in consultation with representatives of the Royal College of General Practitioners.
Also in this post the following will apply:
  • The PMETB National Survey of Trainee Doctors will provide feedback to the Deanery (this survey will replace the Deanery’s own Assessment of Posts questionnaire).
  • We will be working with Daniel Smith (PMETB) over the next six months to incorporate questions into the survey that are more relevant to General Practice and Innovative Training.

Declarations
Lead Clinical Supervisor
I agree to provide the educational supervision required by the post described above.
Name: Dr Ian Smith
Signature:
Clinical supervisor(s)
Name: Dr. A. Reynolds
Name:
GP specialty programme director (course organiser)
I agree to manage this post as a component part of the GP training scheme described above.
Name: Dr Nicholas Price
Signature

GP Director
I have reviewed this application and in my opinion this is a suitable post for inclusion in a GP training programme.
Name: Dr Sheena McMain
Signature / Date

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Timetable

Post Reference:ENT and Opthalmology

Post Title:ST post for General Practice in ENT and Ophthalmology

Scheme / Units:Bradford General Practice Specialist Training Programme / Bradford Royal Infirmary / Monday / Tuesday / Wednesday / Thursday / Friday / Out of Hours
Unit / Activity / Unit / Activity / Unit / Activity / Unit / Activity / Unit / Activity / Unit / Activity
a.m. / Assessment clinic cover / ward work / General clinic observation
(Mr. Atkinson) / Retinal clinic observation
(Mr. Ghanchi) / Research / Teaching / Study / Admin / Research / Teaching / Study / Admin / There is a shift system operating for the trainees, the GP trainee does day and evening shifts (4pm till 11pm) but does NOT do any night shifts (as this would involve cross cover with plasitic surgery and maxillo facial surgery
Lunch / Structured teaching programme
p.m. / Urgent Referral Clinic with SpR / General Practice training release scheme / Urgent Referral Clinic with SpR / Retinal clinic observation
(Mr. Ghanchi) / Urgent Referral Clinic with SpR

When not on evening duties (which are one week in 6) then trainee is expected to attend clinics and occasional theatre sessions.

Day time urgent referral clinic duties every one week in 6

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