Colour key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Labour Ward Lead (2018)– approved by GMC on 10 July 2017 and implemented by RCOG on 1 April 2018
Aim
To prepare for labour ward lead at consultant level for the care of both low and high-risk women.
Prerequisites
The Advanced labour Ward ATSM must be completed before the Labour Ward Lead ATSM can be awarded. The two ATSM may be undertaken one after the other or in parallel.
Completion an obstetric emergency training course e.g. MOET or equivalent
Key components
The ATSM is divided into 4 Advanced Skills Modules (ASM). All 4 ASM are required for the awarding of the ATSM for CCT. Outwith CCT, individual ASM may be recognised separately as part of continuing professional development towards your CPD programme.
ASM 18. Intensive and High Dependency Care - Maternal.
ASM 19. Intensive and High Dependency Care - Neonatal.
ASM 20. Communication and Governance skills for Labour Ward Lead.
ASM 21. Clinical leadership on the labour ward.
Educational Support
Attendance at a suitable Management of the Labour Ward Course such as the annual RCOG/BMFMS Labour Ward Lead Course is a compulsory component of the course. Attendance at the course must be after registering for the ATSM and no more than three years prior to completing the module.
TOG, STRATOG and e-portfolio support is provided by the RCOG.
Clinical Support
The ATSM should be undertaken under the supervision of an identified Obstetrician, who must be in a position to directly supervise and assess competence as well as approve appropriate professionals to train for the wider curriculum components.
An average of least two sessions per week is required to work towards the targets.
Additional, specific themed sessions are listed in the module.
Work intensity
For pre-CCT trainees the ATSM has been allocated a work intensity score of 2.0. If taken alongside the Advanced Labour Ward ATSM then their combined work intensity score remains at 2.0.
ASM 18 Intensive and high-dependency care – maternal clinical competency
Clinical competency /GMP
/Knowledge criteria
/ GMP / Professional skills and attitudes /GMP
/Training support
/Evidence/
assessment
(18.01) Appropriate delivery of high-dependency care on the delivery suite.(18.02) Appropriate transfer to dedicated High Dependency Unit.
(18.03) Assessment of the critically ill patient. / 1,2
1,2
1,2 / (18.01-18.02)
Understand the structure and organization of high dependency, intensive care and outreach teams.
Review the indications for high dependency and intensive care in obstetrics.
Review the methods of invasive monitoring for oxygenation, acid-base balance, intra-arterial pressure, cardiac output, preload and contractility.
Understand the supportive therapies that can be employed for multi-organ failure. / 1,2
1,2
1,2
1,2 / (18.02)
Be able to rapidly assess the seriousness of the clinical situation.
Appropriately investigate and construct a differential diagnosis.
With support, plan the acute care and neonatal delivery.
Liaise fully with the MDT.
Debrief providing accurate information including details on future risks. / 1,2
1,2
1,3
1,3,4
1,2,3,4 / (18.01-18.03)
RCoA/RCOG/OAA/ ICNARC joint report (2009) Female admissions to adult, general critical care units in England, Wales and Northern Ireland, reported as currently or recently pregnant.
MOET Course / (18.01-18.13)
Evidence for this section should include a short placement on a High Dependency Unit. To gain adequate experience it is expected that your evidence will include non-pregnant cases to supplement any cases in pregnancy.
Record whether you have been able to witness the insertion of Central Venous Pressure line, endotracheal intubation, insertion of an arterial line / PA catheter.
Reflective Practice
Feedback from clinical skills drills.
OSAT
CBD
(18.04) Assessment of compromised respiratory function.
(18.05) Assessment of compromised cardiac function.
(18.06) Assessment of impaired renal function.
(18.07) Assessment of fluid balance.
(18.08) Assessment of haemodynamic status
(18.09) Assessment of severe maternal sepsis / 1
1
1
1
1
1 / (18.04-18.09)
Review the symptoms and signs of severe respiratory, cardiac and renal compromise and how they may present in pregnancy and postpartum.
Understand the principles upon which transfer to high dependency is indicated when there is a need for intensive monitoring and supportive measures.
Review each system in terms of the impact upon the pregnancy and whether delivery is appropriate. Consider the place of termination of pregnancy for maternal health concerns compared to prolonging the pregnancy for delivery at fetal viability. / 1,2
1,2
1,2 / (18.04-18.09)
Construct a differential diagnosis for compromised function of each organ system to include breathlessness, tachypnoea, acute hypoxemia, renal failure and signs of sepsis.
Arrange and interpret appropriate investigations & fetal monitoring refer to respiratory physicians / intensivists for further assessment / treatment.
Plan delivery and postnatal care in liaison with anaesthetists and physicians.
Recognise and act promptly if there are signs of deterioration.
Arrange and interpret appropriate investigations, formulate, implement and where appropriate modify a multi-disciplinary management plan with appropriate liaison where necessary.
Understand how the MDT may be effective in optimising the outcome and underpinning effective supportive measures. / 1,2
1,2
1,2,3
1,2
1,2,3
1,2,3 / (18.04-18.09)
Ward rounds and MDT meetings on ITU/HDU, Obstetric anaesthesia reviews.
RCOG Green top guideline No.64 Sepsis in pregnancy.
No.64b Sepsis following pregnancy.
(18.10) Run clinical skills drill for obstetric collapse including cardiopulmonary resuscitation.
(18.11) Run clinical skills drill for massive obstetric haemorrhage. / 1,2
1,2 / (18.10-18.11)
Understand the principles of resuscitation and how these relate to pregnancy collapse and massive postpartum haemorrhage. / 1 / (18.10-18.11)
Be able to construct skills drills for resuscitation in pregnancy and make use of constructive feedback. / 1,2,3 / (18.10-18.11)
RCOG Green top guideline No.56 (2011) Maternal collapse in pregnancy and the puerperium.
(18.12) Participate in a MDT serious untoward event investigation (maternal).
(18.13) Formulate recommendations following root cause analysis (maternal). / 1,2,3
1,2,3 / (18.12-18.13)
Understand the Governance structure within the obstetric department and how serious untoward events are investigated and acted upon within the department and Trust.
Understand how to escalate concerns and how to progress new guidelines, protocols and new innovations. / 1,2
1,2 / (18.13)
Be able to construct a timeline for root cause analysis and how this can assist in making future recommendations. / 1,2 / (18.12-18.13)
STRATOG Advanced, Generic Skills Case Studies eLearning (2015) Serious incident requiring investigation.
ASM 18 Intensive and high dependency care – maternal clinical competency / Part of the Labour Ward Lead ATSM
Logbook / Competence level Not required
Level 1 / Level 2 / Level 3
ASM 18: Intensive and high dependency care – maternal clinical competency / Date / Signature / Date / Signature / Date / Signature
Clinical skills
Appropriate delivery of high dependency care on the delivery suite.
Appropriate transfer to dedicated High dependency unit.
Assessment of the critically ill patient.
Assessment of compromised respiratory function.
Assessment of compromised cardiac function.
Assessment of impaired renal function.
Assessment of fluid balance.
Assessment of haemodynamic status
Assessment of severe maternal sepsis
Leadership skills
Run clinical skills drill for obstetric collapse including CPR.
Run clinical skills drill for massive obstetric haemorrhage.
Governance and risk management skills
Participate in a MDT serious untoward event investigation (maternal).
Formulate recommendations following root cause analysis (maternal).
Training Courses or sessions
Title
/Signature of educational supervisor
/ DateAuthorisation of signatures (to be completed by the clinical trainers)
Name of clinical trainer (please print) / Signature of clinical trainer
Completion of ASM 18: Intensive and high-dependency care – maternal clinical competency
/ Date / SignatureExperience gained of serious multisystem maternal illness, supplemented by sessions within ITU and HDU. Aware of own limitations and timely liaison with anaesthetists, HDU/ITU, tertiary care and the wider MDT as required.
ASM 19: Intensive and high-dependency care – neonatal clinical competency
Clinical competency /GMP
/Knowledge criteria
/ GMP / Professional skills and attitudes /GMP
/Training support
/Evidence/
assessment
(19.01) Basic neonatal resuscitation. / 1 / (19.01)Understand the principles of neonatal resuscitation.
Understand how the neonate may be compromised by antenatal and intrapartum factors.
Understand the requirements for neonatal admission. / 1
1,2
1 / (19.01)
Understand how to provide basic neonatal resuscitation and when to ask for help. / 1,2,3 / Attendance at: resuscitations
Neonatal intensive care ward rounds neonatal follow- up clinics.
ALSO Course / The practical skills should be acquired during a short placement on the neonatal unit.
Suitable evidence includes:
Reflective practice
Log of cases
Feedback from skills drills
ALSO course or similar certification
Uploaded evidence such as for case reviews or adverse outcomes should not include patient identifiable information.
(19.02) Delivery of advanced neonatal resuscitation as part of the neonatal team / 1,3 / (19.02)
Know how to assist in advanced neonatal life support, interpret cord gases and assess acid-base balance.
Be able to follow the admission process of a neonate to their intensive care unit. / 1,2
1,3 / (19.02)
To have the basic skills so that you may advance to be proficient at neonatal resuscitation in more challenging circumstances as part of the neonatal team. / 1,2,3
(19.03) Interpret neonatal acid base balance / 1 / (19.03)
Understand neonatal acid-base physiology and blood gas interpretation. Understand how to monitor it and the corrective measures that can be taken.
Understand how intrapartum factors can influence neonatal acid base balance. / 1,2
1,2 / (19.03)
Develop an understanding of how to minimise the risk of acid-base disturbances both intrapartum and during any initial resuscitation. / 1
(19.04) Counsel parents about the neonatal risks of prematurity.
(19.05) Counsel parents about the outcomes following prematurity
(19.06) Counsel parents about the outcomes of Hypoxic ischaemic encephalopathy / 1,3,4
1,3,4
1,3,4 / (19.04-19.05)
Understand the morbidity and mortality associated with prematurity and the impact of birthweight alongside gestational age. If available review these figures in the context of local outcome data.
(19.06)
Understand how best to diagnose hypoxic ischaemic encephalopathy.
Understand the short and long term consequences of hypoxic ischaemic encephalopathy. / 1,2
1
1 / (19.04-19.06)
With support, counsel women and their partners on the specific long and short-term neonatal risks in a manner that is easy to understand.
Debrief and formulate a suitable management plan for future pregnancies. / 1,3,4
1,3,4 / (19.04-19.06)
RCOG Scientific impact paper No.41 (2014) Perinatal management of pregnant women at the threshold of infant viability.
RCOG Scientific impact paper No.33 Preterm labour, antibiotics and cerebral palsy.
RCOG Scientific impact paper No.29 (2011) Magnesium sulphate to prevent cerebral palsy following preterm birth.
RCOG Green top guideline No.7 (2010) Antenatal steroids to reduce preterm morbidity.
(19.07) Run clinical skills drill for basic neonatal resuscitation.
(19.08) Participate in a MDT serious untoward event investigation (fetal/neonatal).
(19.09) Formulate recommendations following a root cause analysis (fetal/neonatal). / 1,2,3
1,2,3
1,2,3 / (19.08-19.09)
Understand the Governance structure within the neonatal department and how serious untoward events are investigated and acted upon within the department and Trust.
Understand how to escalate concerns and how to progress new guidelines, protocols and new innovations. / 1,2
1,2,3 / (19.07)
Be able to run a neonatal resuscitation skills drill for delivery suite staff across a range of scenarios. Collate and make use of constructive feedback.
(19.08-19.09)
Be able to construct a timeline for root cause analysis and how this can assist in making future recommendations. / 1,2,3
1,2 / (19.08)
STRATOG Advanced, Generic Skills Case Studies eLearning: Serious incident requiring investigation case study (2015).
(19.09)
RCOG Clinical Governance Advice No.1c Producing a clinical practice guideline.
No.2 Improving patient safety. Risk management for maternity and gynaecology.
ASM 19 Intensive and high dependency care – neonatal clinical competency / Part of the Labour Ward Lead ATSM
Logbook / Competence level Not required
Level 1 / Level 2 / Level 3
ASM 19: Intensive and high dependency care – neonatal clinical competency / Date / Signature / Date / Signature / Date / Signature
Clinical skills
Basic neonatal resuscitation.
Delivery of advanced neonatal resuscitation as part of the neonatal team
Interpret neonatal acid base balance
Counsel parents about the neonatal risks of prematurity
Counsel parents about the outcomes following prematurity
Counsel parents about the outcomes of Hypoxic ischaemic encephalopathy
Leadership skills
Run clinical skills drill for basic neonatal resuscitation.
Governance and risk management skills
Participate in a MDT serious untoward event investigation (fetal/neonatal).
Formulate recommendations following a root cause analysis (fetal/neonatal).
Training Courses or sessions
Title
/Signature of educational supervisor
/ DateAuthorisation of signatures (to be completed by the clinical trainers)
Name of clinical trainer (please print) / Signature of clinical trainer
Completion of ASM 19: Intensive and high-dependency care – neonatal clinical competency
/ Date / SignatureExperience gained of early neonatal resuscitation and care on the neonatal unit, supplemented by sessions within a tertiary neonatal unit setting and follow up clinics.
ASM 20: Communication and Governance Skills for Labour Ward Lead
Clinical competency /GMP
/Knowledge criteria
/ GMP / Professional skills and attitudes /GMP
/Training support
/Evidence/
assessment
(20.01) Communicate effectively with the MDT for maternal concerns. / 1,2,3,4 / (20.01)Understand effective techniques for communication. Learn how best to coordinate a discussion allowing all present to participate and have their opinions recognised. / 1,3,4 / (20.01)
Demonstrate effective communication with colleagues.
Demonstrate good working relationships with colleagues and the ability to work in clinical teams.
Respect confidentiality.
Follow appropriate local and national guidelines if patient safety concerns are raised. / 3,4
3,4
3,4 / (20.01)
STRATOG
Core training (2016) Communication skills. / These are largely non-technical skills and the supporting evidence should reflect this. Learning from adverse events is key to the safe running of delivery suite.
These communication and Governance skills should be supported by real case examples wherever possible.
Please ensure patient identifiable material is not uploaded to your ePortfolio.
NOTTS
T01 forms
OSATS
(20.01-20.2, 20.06) OSATS of Management of the deliver suite
Reflective Practice
Record of eLearning
(20.02) Recognise and positively influence a dysfunction team or clinical scenario. / 1,3,4 / (20.02)
Understand how to create a positive work environment. Be able to use language in an assertive but respectful and positive manner.
Understand the role of human factors for a variety of labour ward clinical scenarios and team dynamics. / 1,3,4
1,3,4 / (20.02)
Be able to assess basic competencies of different members of staff.
Be able to set objectives and assess against these objectives.
Be able to deal with difficult team members. / 1,3
1,3
1,3,4 / (20.02)
STRATOG
Non-technical skills (2015) Human factors.
GMC (2012)
Leadership and Management for all doctors
(20.03) Debrief parents / family following adverse pregnancy outcome (maternal).
(20.04) Debrief parents /family following adverse pregnancy outcome (fetal). / 1,3,4
1,3,4 / (20.03-20.04)
Understand the bereavement reaction, how people react often to bad news and how best to approach difficult and challenging consultations.
Understand how the complaints procedure operates within the Trust. / 1,3
1 / (20.03-20.04)
Be able to provide honest, informative and balanced clinical information in a way that is easy to understand.
Be able to advise upon the local support available and the options for further discussion.
Know when to ask for assistance and how to offer a second opinion if required. / 1,3,4
1,3,4
1,3,4 / (20.03-20.04)
STRATOG
Non-technical skills eLearning: Communication skills and Communicating with patients.
(20.05) Support staff following adverse pregnancy outcome. / 1,3,4 / (20.05)
Understand when and how best to support staff after an adverse event. Understand the role of the Labour Ward Forum, risk management meeting and critical incident review.
Understand how the department and Trust manage serious untoward incidents (SUI) or ‘never events’. / 1,2,3,4
1,2,3,4 / (20.05)
Develop good listening skills. Respect confidentiality and be to discuss clinical scenarios in an open, honest, and informative manner. / (20.05)
STRATOG non-technical skills eLearning: Communication skills,
Mentoring scenarios.
GMC (2015) Building a supportive environment.
(20.06) Formulate and communicate effective intrapartum care plans to the midwifery, anaesthetic and obstetric teams. / 1,3,4, / (20.06)
Understand the principles of shared decision-making.
Understand how best to document and communicate intrapartum care plans.
Understand how to respond appropriately to and incorporate advanced directives and strongly held beliefs that might impact upon intrapartum care. / 1,2,3,4
1,3
1,2,3,4 / (20.06)
Lead on ward rounds and handover.
Delegate appropriately and ask for assistance as necessary. / 3,4
1,3,4 / RCOG/The Health Foundation. (2015) Safer births through better team working.
STRATOG non-technical skills eLearning: Communication skills, communicating with colleagues.
(20.07) Produce a relevant Audit, Guideline or other Quality Improvement Project (attach supporting evidence). / 2 / (20.07)
Department of Health (2000) An Organisation with a Memory.
(20.08) Lead Labour Ward forum
(20.09) Lead Risk Management case review. / 1,2,3,4
1,2,3,4 / (20.08-20.09)
Understand the Governance meeting’s structure within the Trust and Department.
Understand how to escalate concerns and how to progress new guidelines, protocols and new innovations. / 1,2,3
1,2,3 / (20.08-20.09)
Participate in risk management meetings.
Investigate a critical incident by reviewing the case and taking appropriate statements, construct a time line.
Perform a root cause analysis to assess future risks.
Formulate recommendations write a case review report and provide appropriate feedback to both staff and families. / 2,3,4
1,2,3
1,2
1,2,3
ASM 20: Communication and Governance Skills for Labour Ward Lead / Part of the Labour Ward Lead ATSM
Logbook / Competence level Not required
Level 1 / Level 2 / Level 3
ASM 20: Communication and Governance Skills for Labour Ward Lead / Date / Signature / Date / Signature / Date / Signature
Communicate effectively with the MDT for maternal concerns.
Recognise and positively influence a dysfunction team or clinical scenario.
Debrief parents / family following adverse pregnancy outcome (maternal).
Debrief parents /family following adverse pregnancy outcome (fetal).
Support staff following adverse pregnancy outcome.
Formulate and communicate effective intrapartum care plans to the midwifery, anaesthetic and obstetric teams.
Governance
Produce a relevant Audit, Guideline or other Quality Improvement Project (attach supporting evidence).
Lead Labour Ward forum
Lead Risk Management case review.
Collate information and draft a response letter to a complaint.
Demonstrate awareness of own limitations, when to refer and how best to share care and monitoring.
Training Courses or sessions
Title
/Signature of educational supervisor
/ DateAuthorisation of signatures (to be completed by the clinical trainers)
Name of clinical trainer (please print) / Signature of clinical trainer
Completion of ASM 20: Communication and Governance Skills for Labour Ward Lead