cardiology for supervised practitioners

Douglas MillBowling Old Lane

BradfordBD5 7JR

Tel: 01274 237759

http://www.learnonline.nhs.uk/Practitioners+with+Special+Interest/ Dear Applicant

Re: Postgraduate Diploma/Certificate in Cardiology for Supervised Practitioners with a Special Interest

Thank you for your enquiry related to the Postgraduate Diploma/Certificate in Cardiology for Supervised Practitioners with a Special Interest. This document contains information about the above course, an application form for the programme, and information for your future mentor and Primary Care Organisation, should you decide you wish to take this application further.

This Postgraduate Diploma/Certificate is one of a range of courses covering a variety of subjects, and was designed to encourage the development of the specialist practitioner role by establishing collaborative clinical work-based training between the Practitioner and the Consultant. As it comprises a large element of work-based learning, practitioners do not need to be Bradford based to participate in the course.

Your learning will be channelled through NHS Bradford and Airedale, which has seen sustained national achievements for innovation in practice and excellence in training. The Commission for Health Improvement Reports on Clinical Governance gave the Bradford PCTs involved in the development of this course a commendation for their work with PwSIs.

The award made upon successful completion will either be a Postgraduate Diploma, in which case student completes one academic and three clinical modules, or a Postgraduate Certificate, when one academic and one or two clinical modules are taken. The cost for the diploma is £4,500, the cost for the 60 credit certificate is £2,250, and the cost for an individual module is £1,125. The awarding institution is the University of Bradford.

Should you require any further information regarding the programme after you have read this pack, please contact us by email on [email protected] with your query. Should you wish to apply for a place on the course, you should approach a mentor of your choice, and ensure that support from your Primary Care Organisation (PCO) is forthcoming. Your completed application form, together with the letters of support from your chosen mentor and PCO should then be returned to:

Belinda PerfittCourse Co-ordinatorNHS Bradford and AiredaleDouglas MillBowling Old LaneBradfordBD5 7JR

Please note that in order to confirm your place and start date the completed documentation as detailed above would need to be received one month prior to your requested start date. Should you be unsure of whether you meet the requirements to join the programme, please contact the course team on [email protected] for advice.

We look forward to hearing from you in the near future.

Mrs Cathy BurwellEducation Lead (Practitioners with a Special Interest)

July 2009 © NHS Bradford and Airedale

mailto:[email protected]


http://www.learnonline.nhs.uk/Practitioners+with+Special+Interest/

Course Aims and Objectives The programme, which aims to provide a nationally recognised standard of training for Practitioners with a Special Interest, is intended to enable Practitioners to work at a Special Interest level in cardiac care. It aims to contribute to the extension of the role of PwSI, and encourage professional collaboration within this area, in order to develop the most appropriate care pathways for the patient.

On successful completion of this award, you should have the skills and knowledge in the areas defined below, and therefore should be able to:

Subject knowledge and understandingUse current and emerging knowledge to differentiate between the pathophysiologies and epidemiologies of cardiological disease.

Discipline skills Triage and refer appropriately, patients whose symptoms may be due to cardiological disease. Undertake appropriate investigations for patients presenting with cardiological symptoms and interpret the results

accurately. Diagnose and manage patients who present with cardiological symptoms, by means of appropriate lifestyle and

clinical interventions. Evaluate the PwSI/PCPSI role, and its implications for the whole patient pathway and current techniques for

improving the delivery of patient care.

Personal Transferable Skills Work autonomously and collaboratively with consultants and a range of hospital staff or primary care staff. Critically appraise and update their clinical knowledge. Apply information technology as a medium for communication and presentation of data.

Course Dates These are the provisional dates of the teaching and assessment days, and an indication of the time available for your placement. Attendance at the teaching days is mandatory, unless mitigating circumstances prevent it.

Dates Element of course: Location:11 September 2009 IHD Teaching

9.00 am to 5.00 pmManchester

12 September 2010 – 3 March 2010

Work-based placement - one session per week for at least 14 weeks

Locality

January 2010(TBC)

Clinical Skills and Examination Assessment Bradford

4 March 2010 Assessment of IHD9.00 am to 1.00 pm

Manchester

5 March 2010 Arrhythmias and Conduction Disorders teaching9.00 am to 5.00 pm

Manchester

6 March to 8 September 2010


Locality

9 September 2010 Arrhythmias and Conduction Disorders assessment9.00 am to 1.00 pm

Manchester

10 September 2010 Heart Failure Teaching9.00 am to 5.00 pm

Manchester

11 September 2010 – March 2011 (TBC)


Locality

January 2011(TBC)

Clinical Skills and Examination Assessment Bradford

March 2011 (TBC) Heart Failure Assessment Manchester

Further dates will be provided with as much notice as possible.


The Curriculum The Postgraduate diploma consists of four modules, three of which are subject modules which last for 6 months each, and the Clinical Skills and Examination module which runs alongside the subject modules over a period of 18 months. Each module is worth 30 credits and consists of 300 hours to cover lectures, seminars, directed study and other work. The entire programme can be completed in 20 months, but practitioners may stagger the modules over a period not exceeding 3 years, other than in exceptional circumstances, when this could be extended to 5 years. The Postgraduate Certificate consists of the Clinical Skills and Examination module and one or two subject modules. The subject modules taught alongside the Clinical Skills and Examination module in this programme are the following:

Heart Failure and Valvular Disease Arrhythmias and Conduction Disorders Ischaemic Heart Disease

An outline syllabus and learning outcomes for each of the modules is given below.

HEART FAILURE AND VALVULAR DISEASE

Outline syllabusHeart Failure

Diagnosis of heart failure, current issues of access to echocardiography and brain natriuretic peptide Underlying causes of heart failure Treatment of acute heart failure and prevention Services available, occupational therapy, psychological support Palliative approaches National guidelines – National Service framework, NICE Guidelines

Valvular Disease /Cardiomyopathies Clinical manifestations Drug management Criteria for surgery open/closed surgery Prosthetic valve options Anticoagulation Role of clinical review, ensuring best practice

Learning OutcomesIn successfully completing this module, you will be able to:

Knowledge and Understandinga. Synthesise the current evidence of the principles and techniques of echocardiography.b. Differentiate between the pathophysiologies of cardiomyopathies and of pericardial disease.c. Synthesise the varied presentations and pathophysiologies of heart failure and valvular disease

Discipline Skillsa. Interpret clinically a variety of echocardiography reports with an appreciation of the strengths and limitations

of echocardiography techniques. b. Investigate, diagnose and manage (pharmacological / non-pharmacological / device therapy) appropriately

patients with suspected or confirmed valvular disease. c. Investigate, diagnose and manage (pharmacological / non-pharmacological / device therapy) appropriately

patients with suspected or confirmed heart failure.d. Show competency in the classification and appropriate referral of patients to palliative care e. Investigate and diagnose appropriately patients with cardiomyopathies, including an awareness of other

conditions which present in the same way (e.g. pericardial disease).f. Refer patients appropriately for a second opinion in the area of heart failure/ valvular disease/ pericardial

disease.g. Practise evidence based medicine

Personal Transferable Skills a. Practise critical effective problem solving skillsb. Utilise effective team working skills with colleagues and peers.c. Communicate effectively with patients, consultants, other hospital staff, peers and trainers.

ARRHYTHMIAS AND CONDUCTION DISORDER


Outline Syllabus

Normal heart electrophysiology and conduction; Common atrial and ventricular arrhythmias; Aetiology of the development of arrhythmias; Indications, pharmacology and side effects of the common anti-arrhythmic drugs; Indications for cardiac pacemakers and defibrillators and the follow-up of patients with these devices; Understanding of the scope of more specialised electrophysiological investigations and treatments which

should involve a visit to a specialist centre


Knowledge and Understanding Gain a critical appreciation of the pathophysiology of the common cardiac arrhythmias and conduction

disorders; Differentiate the common presentations of cardiac arrhythmias Show a critical understanding of the pharmacology and side effects of antiarrhythmic drugs and the role

each class plays in the management of cardiac arrhythmias Show an advanced awareness of the indications for the use of cardiac pacemakers and defibrillators.

Discipline SkillsIn successfully completing this module, you will be able to:

Assess and identify patients with common cardiac arrhythmias and conduction abnormalities and apply appropriate investigations.

Interpret ECG and 24hr ECG and event recording results with an appreciation of normal variations and limitations of these investigations.

Apply appropriate medical follow up of patients with permanent pacemakers and defibrillators, showing an advanced awareness of common problems which these patients may have.~

Identify and assess appropriately patients who need oral anticoagulation and show competency in their management.

Apply an advanced recognition of the Red Flag signals for patients with cardiac arrhythmias and conduction disorders, and identify those to be referred for more specialist opinion.

Practice evidence-based medicine and apply a critical appreciation of national guidelines in this field.

Personal Transferable SkillsIn successfully completing this module you will be able to Practice critical effective problem solving skills. Utilise effective team working skills. Communicate effectively.

~ does not include pace-maker checks if not part of the role

*in particular the NSF, NICE and Prodigy guidelines

ISCHAEMIC HEART DISEASE

Outline Syllabus Current theories on pathophysiology Incidence and prevalence of ischaemic heart disease, ethnic variations Making the diagnosis –use of ETT, perfusion scans , angiography Revascularisation PTCA vs CABG Secondary prevention including cardiac rehabilitation National Service Framework targets


Knowledge and Understandinga. Differentiate the pathophysiologies of angina, acute coronary syndrome(ACS) and myocardial infarction

(MI).b. Differentiate between the principles of angiography and revascularisation.c. Synthesis the evidence for cardiac rehabilitation.

Discipline Skills


a. Show competency in evaluating patients presenting with chest pain, with an appreciation of the variety of clinical presentations of cardiac chest pain.

b. Investigate, diagnose, manage patients with chest pain.c. Make informed clinical judgments in the selection of patients to be referred for angiography /

revascularisation, with an appreciation of the indications, limitations and complications of these interventions.d. Manage patients on discharge from acute services who have undergone a cardiac event or cardiac

procedure.e. Provide secondary prevention (pharmacological/ lifestyle/ lipid / blood pressure/psychological) management

for patients with ischaemic heart disease f. Refer patients appropriately for a second opinion. g. Practise evidence based medicine.

Personal Transferable Skillsa. Practise critical effective problem solving skillsb. Utilise effective team working skills with colleagues and peers.c. Communicate effectively with patients, consultants, other hospital staff, peers and trainers.


CLINICAL SKILLS AND EXAMINATION

Outline syllabus History taking Examination skills including: Inspection Palpation Percussion Auscultation Diagnosis/differential diagnosis Blood pressure

Physical examination cardiovascular system to include: Breathlessness Chest pain Syncopy Palpitation Hypertension Role of the ECG Investigations Valvular Disease

Learning outcomesIn successfully completing this module, you will be able to:

Knowledge and Understanding Show an advanced critical appreciation of the principles of clinical examination in relation to the

pathophysiology of the heart.

Discipline skills Undertake a detailed cardiological history in order to establish an accurate differential diagnosis. Show competency in the performance of a cardiological examination to include: inspection, palpation,

percussion and auscultation. Auscultate and identify abnormal heart sounds including the eight valvular murmurs (diastolic and systolic in

each valve). Devise a differential diagnosis based on the history and examination for all patients and apply appropriate

investigations. Apply a critical identification of a range of abnormalities as a result of patient examination, and formulate a

cause for them.

Show competency in the classification of patients for referral and second opinion. Practise evidence-based medicine.

Transferable skills Practise critical effective problem solving skills; Utilise effective team working skills; Communicate effectively.

Learning and Teaching Methods A variety of teaching methods is employed in the programme, to enable you to fulfil the varied modular learning outcomes. Your programme of study will start with two teaching days in Bradford, followed by your introductory clinical placement and directed study for approximately eight weeks. At this point you will undertake tuition for your first subject module, in Manchester. This will begin your six month placement (at least 14 weeks of directed study). For your subject modules only, you will return to Manchester after placement for an assessment day, followed by the next subject module teaching day.

A large proportion of your study will be work-based learning. This learning is undertaken on placement in your locality, under the supervision of a clinical mentor. Mentors are GMC registered consultant cardiologists whose names appear on a national register of practitioners. Your clinical mentor will receive a specific Mentor Guide which is included in this pack, as well as advice and support from the course management team.

The tasks for your directed study on placement are as follows: the development and fulfilment of a programme of activities with your mentor, in order to fulfil clinical competence-based learning outcomes; recording your placement cases using a logbook, to reveal your learning progress and learning needs; obtaining essential background information to the module studied to inform your practice and the preparation of assessed work, through guided


reading in the form of lists and website references; discussions concerning your learning needs and possible solutions through scheduled meetings with your mentor (eg. advice, further reading, alteration of elements of your programme).

The Clinical Studies and Examination module involves learning and applying clinical and examinations skills in the placement setting. Directed study comprises researching and reading information, planning, clerking of cases and preparation on assignments.

Peer learning is encouraged through peer contact in Bradford and Manchester, and through participation in “Blackboard” a virtual learning environment accessed through the University of Bradford website.

It is anticipated that you will continue to work in your normal practitioner setting during the period of study, and it is expected that ongoing learning will be applied in this context.

Assessment You will be assessed in a variety of ways, including written case studies and oral presentations; for the Cllinical Skills module, assessed 18 months after the start of this module, there will be an Observed Structured Clinical Examination (OSCE).

For subject and Clinical Skills modules, verification of clinical competence must be indicated by your consultant-mentor's signature on the assessment days. Clinical competence is a pass/fail element, with no mark attached to it. All written work and the critical appraisal presentation must be presented on assessment day, in order for you to progress to the next module. All assessment tasks must be passed by attaining 40% of the full marks. Masters level marking criteria will be made available to you to help you check your work. One opportunity to resubmit work along the same lines as the sessional assessment will normally be allowed.

The standard thresholds of distinction (minimum of 70% overall average) and merit (60-69% overall average) will apply for marked work of an exceptional nature for the award of the Postgraduate Diploma and Postgraduate Certificate. Participants who succeed in one module only, and who do not qualify for one of the above awards, shall be eligible for the award of a Certificate of Continuing Education.

Admission Requirements The application process is divided into two parts: 1. Submission of an application form indicating that you meet the professional/educational criteria. 2. Submission of letters of support showing suitability for you to undertake this course of study. To be accepted onto the Diploma or Certificate, and to benefit from this course of study, you must meet the admission requirements for Masters level, as outlined by the University of Bradford, in addition to those required by NHS Bradford and Airedale. You should be a registered practitioner (NMC or HPC as appropriate) falling within one of the following groups: suitably trained Allied Health Professional; specialist nurse; hospital practitioner; other suitably qualified registered primary care practitioner in cardiology. You must have, and provide evidence of, a Cardiology-related Diploma or equivalent; several years' experience in cardiac care; and 2-3 years post-qualifying practitioner experience. It is desirable for candidates to have experience in Postgraduate education. All applications will be judged on their own merit and prior learning experience.

While making your application for the programme, you must obtain support from your local NHS hospital trust cardiology consultant (GMC Registered) for mentorship and the provision of a placement. Support must also be obtained from your local Primary Care Trust, for approval and direct or indirect support for your training, as it relates to the local setting. Without this evidence of support, you cannot be admitted on to the programme. Should you be unsure of whether you meet the requirements to join the programme, please contact the course team on [email protected] for advice.

We can admit up to 12 participants per clinical module, with entry points in July and January (depending on student numbers).

Student support and guidance The course manual which will be issued to you at the beginning of the programme will support you in all aspects of work-based learning and assessments. Tutor support will be provided by a system of email queries, initially. A telephone seminar/support line may operate at designated times, if needed. Peer support is available to assist you with your clinical questions through participation in the virtual learning environment “Blackboard”. It is anticipated that a significant amount of discussion relating to cases, working arrangements, progress and approaches to study will result from this group. Support you can expect from your mentor is outlined within the mentor guide. The guide also enables mentors to understand the support they will receive automatically, and can gain if required, from the course tutors. You are invited and encouraged to express your opinions about the course structure, materials, process etc throughout your training, and will have a formal feedback opportunity after the first module is completed. Thereafter, participants may nominate a number of student representatives to join the Course Management Committee and they may offer feedback through this committee. Each individual student is also asked to complete paper-based evaluation forms for end of unit (module) and stage (course) evaluation from the University of Bradford.



You are also made aware of your responsibilities in the participant course manual: taking responsibility for organising your own learning, ensuring your placement arrangements are acceptable; returning course forms/assessment submissions on time; attendance at the first teaching day and the concluding assessment day for each clinical module and at the initial teaching day for the core module; patient confidentiality; working to a professional code of conduct; and alerting the course tutors to problems which will affect your training.

Disclaimer Changes in the above specification may be made at any time by NHS Bradford and Airedale, but notification will be made to you as appropriate. Elements of the programme are subject to University conditions including its status as an approved course. The University reserves the right to alter or withdraw these elements at any time, and notification will be made to you by NHS Bradford and Airedale should this occur.

Students with Disabilities

We endeavour to make our course accessible to everyone. Please indicate below if you require any information to be presented in a different format (please specify):


APPLICATION FORMPostgraduate Diploma in Cardiology for Supervised Practitioners with a Special Interest

First name _____________________________________________________________________________

Last name _____________________________________________________________________________

Title ______________________________ Date of birth ______________________________________

Home Address

__________________________________________________________________________________________

__________________________________________________________________________________________

________________________________________________________ Post Code _________________________

Profession _________________________________________________________________________________

Telephone (please specify work or home)

Landline _________________________________________________________________________________

Mobile __________________________________________________________________________________

email address _______________________________________________________________________________

Professional Qualifications ________________________________________________________________

Other relevant Postgraduate Qualification(s) or Experience

____________________________________________________________________________________________

Nursing and Midwifery council PIN or other professional registration number (if relevant) ___________________________________________________________________________________________

Briefly outline your interest in working as a PwSI or in developing specific clinical skills. Include current/planned activities as appropriate. ___________________________________________________________________________________________

___________________________________________________________________________________________

Details of the hospital you will link your clinical training to

Hospital name ____________________________________________________________________________

Address ______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Details of the registered consultant who will act as your mentor


Name __________________________________________________________________________________

Postal address ___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Telephone number _______________________________________________________________________

Email address ___________________________________________________________________________

Details of the PCO from whom you have gained support

Name _________________________________________________________________________________

Address ________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

For invoicing purposes, please note the following:

Contact name: ___________________________________________________________________________

Email address: ___________________________________________________________________________

Telephone number: _______________________________________________________________________

Please circle the programme of study for which you wish to register

A) Diploma: 3 clinical modules and Applied Methodologies (AM) (£4,500)

B) Certificate: 2 clinical modules and AM (£3,375) (see next question)

C) Certificate: 1 clinical module and AM (£2,250) (see next question)

D) Single module (£1,125) (see next question)

For the Certificate or single module only, please circle the module(s) you wish to study

i Heart Failure and Valvular Disease

ii Ischaemic Heart Disease

iii Arrhythmias and Conduction Disorder

iv Clinical Skills and Examination

Indicate your preferred start month (January /July). Please note that we cannot guarantee your start date or the order in which clinical modules are undertaken. Places will be allocated with priority to diploma students.

___________________________________________________________________________________________

Please outline below any information you wish to give to support your application. If you wish to stagger your modules across more than 18 months, please refer to that and the factors influencing your planned study, ie consultant availability, personal circumstances, service delivery commitments.

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________


Non-native English speakers:

As the assessment elements of the postgraduate diploma require a substantial amount of written work at masters level, in accordance with regulations from the University of Bradford we ask that non-native speakers complete an IELTS English Language Exam before they begin their studies.Please indicate here if you have completed the IELTS exam and if so also include your result (further details can be found at www.ielts.org)

___________________________________________________________________________________________

Please indicate where you heard about our course:

Article (please specify which) ________________________________________________________________

Advertisement (please indicate where this was) _____________________________________________________

Website ____________________________________________________________________________________

Other ______________________________________________________________________________________

Please ensure that the following completed letters of confirmation have been attached to this form.

i. Consultant Mentor

ii. PCO

Please note that in order to confirm your place and start date the completed documentation as detailed above would need to be received one month prior to your requested start date. Should you be unsure of whether you meet the requirements to join the programme, please contact the course team on [email protected] for advice.



http://www.ielts.org/

EQUAL OPPORTUNITIES INFORMATION (confidential)

Course applied for:

Start date

1. Please tick the appropriate age range

20 – 30 __

30 – 40 __

40 – 50 __

50 – 60 __

over 60 __

2. Please note your gender __________

3. Please note the number of years you have been qualified _______

4. Please note the number of years you have been practicing _______

5. Please note your ethnicity _______________________________________

6. Do you consider yourself to be disabled? yes/no

7. If you have answered yes to the previous question, please provide further details of your disability______________________________________________________________

8. Please note any further comments you wish to make

______________________________________________________________

______________________________________________________________

______________________________________________________________

______________________________________________________________

______________________________________________________________


Dear Chief Executive

The person presenting you with this letter wishes to be nominated for a Postgraduate Certificate or Diploma in Cardiology for Supervised Practitioners with a Special Interest. In order for them to be selected, they must obtain the support of their local Primary Care Organisation. In addition, they must secure mentorship from a consultant in cardiology at their local NHS hospital.

The PCO is required to offer support in principle, for this individual to train at an advanced level of cardiology as a Practitioner with a Special Interest. This judgement should be made on the basis of your information regarding their professional capability to be trained in this manner and should take due account of the future services you need to provide.

The PCO will be asked to offer time with the candidate to explore the current and future care pathways and patient involvement potential within this specialist area as part of the course. This is in order that the candidate integrates their professional development effectively within the local health system. Coursework based on this research will form part of their final assessment.

The PCO may additionally wish to support the candidate at the level of resources towards the course. A list of costs is attached, as is an indication of clinical time which may require locum cover. Any discussion regarding locum cover and backfill is a matter for local negotiation on an individual basis.

Please give your worthy consideration to this matter and fill in the attached response form accordingly. You may wish to inform the candidate of your response separately.

Yours faithfully

Cathy BurwellEducational Lead - Practitioners with a Special Interest


NOTES AND COSTS

For Primary Care Organisations supportingPractitioners to undertake the course

A Postgraduate Diploma costs £4,500 (all 4 modules)

A 90 credit Postgraduate Certificate costs £3,375 (2 clinical modules and Clinical Skills and Examination)

A 60 credit Postgraduate Certificate costs £2,250 (1 clinical module and Clinical Skills and Examination)

A single 30 credit module costs £1,125

In undertaking this course, the candidate is making a commitment to update their professional knowledge after the course is finished. This will probably occur through the professional appraisal process, and is required by the University to retain a valid award.

TravelFor a full course, this will require 6 trips of two days to Bradford or Manchester, of between half a day and one and a half days (a total of no more than eight days) and a last single day to Manchester. See course days table).

Accommodation For a full course, 3 overnight stays, unless local to Manchester(Possibly 8 if the candidate cannot travel to Manchester to commence a taught day at 9.00am).

Time: Locum cover / backfill costs for at least 14 clinical sessions per module, and two days attendance per clinical module and one for introduction/AM module. Personal study above these sessions is an issue for local agreement and the module descriptors give information regarding time allocation for study.


PCT - RESPONSE OF SUPPORTPlease fill in the form below and send to:

Belinda PerfittEducation Programmes Team PwSINHS Bradford and AiredaleDouglas MillBowling Old LaneBradfordBD5 7JR

I (name and position):………………………………………………………………..

of the (name of PCT) :………………………………………………………………..

am willing to support (candidate's name):…………………………………….………

for participation in the Postgraduate Diploma/Certificate in Cardiology for Supervised Practitioners with a Special interest

For the module (s):

Clinical Skills and Examination

Arrhythmias and Conduction Disorders

Heart Failure and Valvular Disease

Ischaemic Heart Disease

Please indicate level of support below (delete as appropriate):

i) We hereby commit financial support for the above candidate (once accepted onto the course) in the sum of: (please circle the appropriate amount)

£4,500£3,325£2,250£1,125

ii) We do not commit financial support for the above candidate, but are supportive in principle of his/her undertaking this training in relation to enhancing services within the PCT area.

iii) We do not offer support to this candidate and understand this will prevent them from gaining a place on the course.

Any further comments (please indicate any further support offered, appropriate information about the candidate etc)

Signed:……………………………………………… Date…………………………PCO stamp/authenticating ma


Dear Consultant

Re: Postgraduate Diploma / Certificate for Supervised Practitioners with a Special Interest in Cardiology

The practitioner presenting you with this letter wishes to apply for the above-named course. It is mainly a competence-based course and seeks to extend the training of the Practitioner with a Special Interest (PwSI) to an advanced level. This complies with developments and guidance issued through the Modernisation Agency and the Royal College of General Practitioners and advice from the Royal College of Physicians. In order for the practitioner to be selected, he/she must undertake to work with a named mentor, who is a cardiology consultant at their local NHS trust hospital. In addition, the candidate must obtain proof of support from their local PCO in order to proceed. They have chosen you to mentor them for the duration of the course, and you must therefore understand the commitment you are undertaking, if you choose to support them.

You should consider whether you are prepared in principle to support this individual for training at a more advanced level in cardiology. If you know them already, this judgment should be made on the basis of your information regarding their professional capability to be trained in this manner. If you do not know them, you may wish to speak to them about their professional background, current cardiology interests and future plans.

Two qualifications are currently available. The first is Postgraduate Diploma or Certificate for Practitioners with a Special Interest in Cardiology; geared towards GPs and advanced practitioners whose roles involve a more independent style of working, eg nurse consultants. The second is Postgraduate Diploma or Certificate for Supervised Practitioners with a Special Interest; this is geared towards specialist nurses, physicians, extended scope allied health professionals, who require clinical examinations skills, and whose role determines a more supervised style of working. This pack is for the Supervised Practitioner’s qualification.

During their training, you will engage in creating a programme of activities with them. This will identify their learning needs and permit them to acquire the knowledge and experience, and perform the skills required for their work-based learning in cardiology. The practitioner has a copy of the syllabus and learning outcomes for the modules they plan to undertake, as well as a mentor guide, a copy of which you should receive. For the clinical skills and examination module, the candidate will learn and then apply skills in subject module areas on placement over 18 months. For each subject module the candidate will need at least one session per week to train in the work-based placement within the hospital over a minimum of a 14 week period. During this time, as a mentor, you and members of your team will be observing the candidate's work with patients, offering advice, support and opportunities for learning by reflection. Time to discuss problems and to offer constructive feedback should be part of this process. During and at the end of the training, you will assess the clinical and professional competence of the candidate. Your signature of competence against the modular learning outcomes and the agreed programme will carry great weight in the overall assessment of the candidate. Together with the outcome of their course work, he or she will pass or fail the course on this signature. Ultimately, the benefits of working in this mentoring relationship will affect your service directly, as patient access in cardiology is improved.

Please give your worthy consideration to this matter and fill in the attached response form accordingly. You may wish to inform the candidate of your response separately.

Yours faithfully

Cathy BurwellEducation Lead for Practitioners with a Special Interest


CONSULTANT RESPONSE OF SUPPORTPlease complete the form below and send to:

Belinda PerfittEducation Programmes Team PwSINHS Bradford and AiredaleDouglas MillBowling Old LaneBradfordBD5 7JR

I (name) ………………………………………………………………………………………………………………………….

GMC Number ……………………………………………………………………………………………………………….….

of the (name and address of hospital) ………………………………………………………………………………………..

…………………………………………………………………………………………………………………………………....

…………………………………………………………………………………………………………………………………....

Telephone contact number .……………………………………………………………………………………………………

Email address …………………………………………………………………………………………………………………..

am willing to support (candidate's name):………………………………….…………………………………………………

and recognise their suitability for participation in the Postgraduate Diploma/Certificate in Cardiology for Supervised Practitioners with a Special Interest, having discussed their clinical experience and their experience/training in diagnosis, clinical history taking and physical examination,

(Please ensure the candidate is in an environment where he/she will gain sufficient exposure to patient assessment in all the areas ticked below. Please see Mentor Guide for learning outcomes in all modules.)

for the module (s):

Clinical Skills and Examination (mandatory for Certificate and Diploma)


Ischaemic Heart Disease Arrhythmias and Conduction Disorders

I am willing to engage in the creation of the learning programme, to offer mentor observation, advice, support and opportunities for learning by reflection, and to assess the clinical competence of the candidate.

Signed:……………………………………………………………….…. Date:……………………………………………

Hospital


Information To Advanced Level Nurses regarding:POSTGRADUATE AWARDS FOR SUPERVISED PRACTITIONERS WITH A SPECIAL INTEREST (Manchester)

The following advice is available to help direct your study options.

Pre-Entry Advice:

1. You will need to be working at a level of advanced practice in order to be able to clinically assess patients to achieve the competencies.

Entry Advice

1. Please discuss with your mentor, whether you can gain sufficient experience in modular areas outside your specialism to be able to take the diploma. Often, specialist nurses may find it difficult to attend clinics outside their specialist area. As there may be restrictions to your whereabouts in your own specialist area, please negotiate your placement carefully. To help this process, a letter is available to give to your nurse manager, in order to establish if an agreement can be obtained for you to visit and work outside your clinic for placement sessions. This agreement should be established at the outset, so that you are not in difficulties with your studies during the course.

2. You may also wish to obtain designated support in the form of free time/designated study time. Without this, there can be pressures on studying due to catching up ordinary workloads.

3. Where you are expecting to study more than one clinical module, you should plan for studies in future modules, whilst you are studying your first clinical module. This will require talking to colleagues within those areas and asking the mentor to negotiate suitable clinics.

4. To make the most of your programme of study, you are likely to need negotiation skills, and to be pro-active in your approach. You will need to ensure that placement session times are made available and that support with workload is received.

5. The Diploma programme can be extended to a Master of Science award. Any successful graduate from the Diploma programme, is eligible to undertake this programme of study, providing other entry criteria can be met. Please email us on [email protected] for more information.



Letter for Nurse Managers:

Nurse Managerc/o Nurse applicant for Postgraduate Diplomain Cardiology for Supervised Practitioners with a special interest

Dear Sir/Madam

Re: Postgraduate Certificate/Diploma for Supervised Practitioners with a Special Interest

We are glad to accept the application for your Practitioner onto our Postgraduate Certificate and Diploma programme.

For a successful training experience, nurses require the following:

Time out of their own clinic/work to undertake the mandatory one session per week on “placement” within the hospital and other appropriate clinics for a minimum of 14 sessions per clinical module.

Recognition that even within their specialist area, there will be need to observe and be involved in other related areas to gain a breadth of experience, also necessitating cover for their ordinary work

Consultant supervision/observation of nurses working “hands on” with patients in areas within, but particularly outside their specialism. This enables nurses to gain the experience required for Postgraduate level, to demonstrate clinical competence in diagnosis, investigation and management of other conditions, rather than be judged by what their service may require.

Other elements of support which would significantly enhance the training opportunity would include time given for the nurse to pursue supporting academic studies (preparation of written clinical cases, guided reading and journaling, and the preparation of presentation of clinical papers), and for discussion with the supervising consultant specialist.

As line manager to this applicant, would you discuss with him/her the possibilities of ensuring the above as they relate to the programme of study undertaken.

By all means, contact me by email on [email protected] in order to discuss issues surrounding the viability of study or the best approach to it.

Yours sincerely

Cathy BurwellEducation Lead (Practitioners with a Special Interest)



Hospital Manager - RESPONSE OF SUPPORT (for secondary care nurses)Please fill in the form below and send to:

Belinda PerfittEducation Programmes Team PwSINHS Bradford and AiredaleDouglas MillBowling Old LaneBRADFORDBD5 7JR

I (name and position):…………………………………………………………………………………………………….……..

of the (name of Hospital) :………………………………………………………………………………………………………

am willing to support (candidate's name): …………………………………….………………………………………..……

for participation in the Postgraduate Diploma/Certificate in Cardiology for Supervised Practitioners with a Special interest

For the module (s):

Clinical Skills and Examination (mandatory)


Ischaemic Heart Disease Arrhythmias and Conduction Disorders

We hereby commit support time for study and practical clinical experience as is necessary for the above candidate (once accepted onto the course) to complete the Postgraduate Award.

Further comments (please indicate any further support offered, information about the candidate etc)

Signed:………………………………………………………………. Date…………………………

Hospital stamp/authenticating mark


MENTOR GUIDE

POSTGRADUATE DIPLOMA FORSUPERVISED PRACTITIONERS WITH A SPECIAL INTEREST

“Enabling Practitioners to work at a special interest level in collaboration with the local network of care”

List of Contents Page no.Section 1 Why have a course?

Collaborative ApproachBenefits to you

1

Section 2 What we ask of youRoles of mentor and assessor

3

Section 3 What is in the course 4

Section 4 Establishing the learning programmeFour stage process Clinical competence forms

5

Section 5 Student learning, reflection and discussion 10

Section 6 Hands on work and the organisation of clinicsExamples of clinic arrangements

11

Section 7 Assessing clinical competenceHow to sign a student off

15

Section 8 What we can do for youBradford-based supportContact details

17


SECTION ONE

Why have a course?

IntroductionThank you for your interest in being a mentor for a student Practitioner with a Special Interest. This course is one of a series of NHS run courses offering nationally recognised Postgraduate awards, which provide competence based training for Practitioners with a Special Interest. This guide has been revised following visits to mentors and students on the programme to help steer both parties through the programme. If you require further information about the course, your student has a comprehensive manual. Alternatively, contact us by email: [email protected]. This course is a new programme, for Supervised Practitioners with a Special Interest in Cardiology. It provides an 18 month module for the development of clinical skills and examination methods (teaching and placement-based), and up to three other subject modules (Arrhythmias and Conduction Disorders, Heart Failure and Valvular Disease, Ischaemic Heart Disease).Your feedback about the course is very valuable to us, and will be welcomed in any form throughout the programme.

BackgroundOnly recently has the idea of “GP specialists” been formalised. Certain procedures, which have historically been undertaken in hospitals and often learnt by clinical assistants, are now being undertaken in the local general practice by GPs with a special interest. Emphases such as the importance of sharing care appropriately between secondary and primary services to develop better patient care pathways, and enabling those who have skills to work at their level within their area of care, have brought about a shift in current practice, which requires formal training and recognition.

Dr Peter Mills, of the SAC for cardiology, at the Royal College of Physicians, sees this shift and the aims of the Postgraduate Diploma as compatible with the work and rigorous standards set by consultants in their speciality: "The PwSI shift and this course are about helping consultants rationalise their care. They have time with the patients who need their specialist care, rather than all the other elements, which can be done at PwSI level. The patient should be satisfied that the person speaking to them (at whatever level of care) knows what they are talking about."

In the light of the emergence of GPs with a Special Interest and other Practitioners with a Special Interest (generically termed PwSI), we have provided courses which we believe will contribute significantly to the training of the PwSI and their safe and effective practice within their local healthcare network.

Statement on Collaboration (Training and Future Work of PwSIs)We believe that the training and continued development of PwSIs is a collaborative venture. Consultants and PCTs must be given proper opportunity to input and be aware of those being trained. This has determined the structure used within these courses.

As a consultant your help is needed to ensure that your PwSI student, who will learn locally in your hospital, is adequately trained to an agreed level of competence. It is our expectation that following the course, the PwSI will continue to work in collaboration with a specialist in their local network of healthcare. This course will provide a background for those collaborative relationships to be established or extended, in order to provide safe and effective services to patients in the future.

Whether by telephone or in person, the relationship between consultant (mentor) and PwSI will be in place in order to:

exchange information and answer clinical questions concerning patients; reinforce learning; communicate new learning for continuous updating; continue to share good practice; affect the dynamic development of local services involving PwSIs, GPs and hospitals.

February 2008 © NHS Bradford and Airedale


Benefits to You

There are many direct benefits from this programme for consultants who agree to undertake mentorship for a PwSI trainee:

1 Significant assistance with your workload, in appropriate areas of work.

2 The opportunity to shape the training landscape within your specialism and specifically to train the PwSI for their future role.

3 The opportunity to develop a mutually beneficial working relationship which will inform future local healthcare developments

4 Assistance in keeping up to date in your specialist area of work

5 Evidence for your own appraisal, section 5 Teaching and Training.


The student will gain: familiarity with you and

your team’s way of working within your specialism.

knowledge and skills which you consider to be essential and which may relate directly to your local situation.

understanding and the ability to function within specialist healthcare in your area.

You will gain familiarity with the student, how they think and work, and how much they know.

SECTION TWO

What we ask of you

You will have two roles within the programme. Mentor Assessor

Mentor roleWe anticipate that all mentors for the course will be GMC registered specialists as appropriate to the course, and that you have been through a recognised body for training to undertake mentorship. We draw your attention to the fact that whilst you are called upon to direct and assess the overall programme, other consultants and hospital staff members may be involved with the provision of training activities for the student.

Your role will operate as a dynamic teaching relationship with the student, whenever time is spent together. You are in the position to set the level of trust and openness for this relationship and to gauge the student’s learning needs and how to address these.

There are four main tasks as mentor:

1 Establish and oversee a learning programme with the PwSI trainee based on mandatory learning outcomes and the student’s learning needs.

2 Encourage the PwSI trainee to develop their skills and knowledge by reflection, reading and discussion about cases, with you and other hospital colleagues.

3 Provide time in which to discuss cases and reflect on learning4 Provide opportunity for hands-on work for the PwSI trainee

Assessor role This role requires you to:

1 Assess the student’s clinical competence given the appropriate opportunities.

All of these roles are outlined with examples in the next sections.


SECTION THREE

What is in the course?

The AwardThe Postgraduate Diploma for Supervised Practitioners with a Special Interest is a masters level award. The candidate can gain credits for each module undertaken towards a full award (Diploma), a semi-award (Certificate) or a credited transcript of work. The value of each module is 30 masters level credits. This approximates to 300 hours total learning time for the participant per module, 70 hours or more of which is undertaken on practical placement in clinic across a minimum of 14 sessions.

The ModulesThere are four modules on the diploma course. Three of these are concerned with clinical competence based on a series of learning outcomes which are listed below, and will be undertaken the student’s locality on placement in your hospital. Each takes six months to complete. The fourth module (Clinical Skills and Examination is a module relating to service improvement and is studied throughout an 18 month period. This module starts before the other subject modules, and is examined separately in Bradford, particularly by OSCE, at the end of 18 months.

In addition to work-based learning, the course includes teaching and assessment days in Manchester at the beginning and end of every module, guided reading lists to support learning and an interactive email group for students to exchange peer knowledge.

The Training ProgrammeOn placement with you, the student will develop, run and evidence their training programme. The training programme is based on a series of mandatory learning outcomes to which you and the student will attach appropriate activities. There is a set of training programmes for each module studied.

The ProceduresWorking at a distance most of the time requires students and mentors to adhere to certain strict procedures, in order to validate the training students receive, and to ensure students across the country are receiving provision of the same standard.

All the procedures relating to establishing the learning programme are shown in Section Four. This includes the use of the clinical competence forms.


Learning Outcomes

The Curriculum The Postgraduate diploma consists of four modules, three of which are clinical modules which last for 6 months each, and the clinical skills module which runs alongside the clinical modules over a period of 20 months. Each module is worth 30 credits and consists of 300 hours to cover lectures, seminars, directed study and other work. The entire programme can be completed in 20 months, but practitioners may stagger the modules over a period not exceeding 3 years, other than in exceptional circumstances, when this could be extended to 5 years. The Postgraduate Certificate consists of the clinical skills module and one or two clinical modules. The clinical modules taught alongside the clinical skills module in this programme are the following:

Heart Failure and Valvular Disease Arrhythmias and Conduction Disorders Ischaemic Heart Disease

An outline syllabus and learning outcomes for each of the modules is given below.

HEART FAILURE AND VALVULAR DISEASE

Outline syllabusHeart Failure

Diagnosis of heart failure, current issues of access to echocardiography and brain natriuretic peptide

Underlying causes of heart failure Treatment of acute heart failure and prevention Services available, occupational therapy, psychological support Palliative approaches National guidelines – National Service framework, NICE Guidelines

Valvular Disease /Cardiomyopathies Clinical manifestations Drug management Criteria for surgery open/closed surgery Prosthetic valve options Anticoagulation Role of clinical review, ensuring best practice

Learning OutcomesIn successfully completing this module, students will be able to:

Knowledge and Understandinga. Synthesise the current evidence of the principles and techniques of echocardiography.b. Differentiate between the pathophysiologies of cardiomyopathies and of pericardial disease.c. Synthesise the varied presentations and pathophysiologies of heart failure and valvular disease

Discipline Skillsa. Interpret clinically a variety of echocardiography reports with an appreciation of the strengths and

limitations of echocardiography techniques. b. Investigate, diagnose and manage (pharmacological / non-pharmacological / device therapy)

appropriately patients with suspected or confirmed valvular disease. c. Investigate, diagnose and manage (pharmacological / non-pharmacological / device therapy)

appropriately patients with suspected or confirmed heart failure.d. Show competency in the classification and appropriate referral of patients to palliative care e. Investigate and diagnose appropriately patients with cardiomyopathies, including an awareness of

other conditions which present in the same way (e.g. pericardial disease).f. Refer patients appropriately for a second opinion in the area of heart failure/ valvular disease/

pericardial disease.g. Practise evidence based medicine

Personal Transferable Skills


a. Practise critical effective problem solving skillsb. Utilise effective team working skills with colleagues and peers.c. Communicate effectively with patients, consultants, other hospital staff, peers and trainers.

ARRHYTHMIAS AND CONDUCTION DISORDER Outline Syllabus

Normal heart electrophysiology and conduction; Common atrial and ventricular arrhythmias; Aetiology of the development of arrhythmias; Indications, pharmacology and side effects of the common anti-arrhythmic drugs; Indications for cardiac pacemakers and defibrillators and the follow-up of patients with these

devices; Understanding of the scope of more specialised electrophysiological investigations and treatments

which should involve a visit to a specialist centre.

Learning OutcomesIn successfully completing this module, students will be able to:

Knowledge and Understandinga. Gain a critical appreciation of the pathophysiology of the common cardiac arrhythmias and

conduction disorders;b. Differentiate the common presentations of cardiac arrhythmiasc. Show a critical understanding of the pharmacology and side effects of antiarrhythmic drugs and the

role each class plays in the management of cardiac arrhythmiasd. Show an advanced awareness of the indications for the use of cardiac pacemakers and

defibrillators.

Discipline Skillsa. Assess and identify patients with common cardiac arrhythmias and conduction abnormalities and

apply appropriate investigations.b. Interpret ECG and 24hr ECG and event recording results with an appreciation of normal variations

and limitations of these investigations.c. Apply appropriate medical follow up of patients with permanent pacemakers and defibrillators,

showing an advanced awareness of common problems which these patients may have.~d. Identify and assess appropriately patients who need oral anticoagulation and show competency in

their management. e. Apply an advanced recognition of the Red Flag signals for patients with cardiac arrhythmias and

conduction disorders, and identify those to be referred for more specialist opinion.f. Practice evidence-based medicine and apply a critical appreciation of national guidelines in this

field.

3. Personal Transferable Skillsa. Practice critical effective problem solving skills.b. Utilise effective team working skills.c. Communicate effectively.

~ does not include pace-maker checks if not part of the role

*in particular the NSF, NICE and Prodigy guidelines

ISCHAEMIC HEART DISEASE

Outline Syllabus Current theories on pathophysiology Incidence and prevalence of ischaemic heart disease, ethnic variations Making the diagnosis –use of ETT, perfusion scans , angiography Revascularisation PTCA vs CABG Secondary prevention including cardiac rehabilitation National Service Framework targets

Learning Outcomes


In successfully completing this module, students will be able to:

Knowledge and Understandinga. Differentiate the pathophysiologies of angina, acute coronary syndrome (ACS) and myocardial

infarction (MI).b. Differentiate between the principles of angiography and revascularisation.c. Synthesis the evidence for cardiac rehabilitation.

Discipline Skillsa. Show competency in evaluating patients presenting with chest pain, with an appreciation of the

variety of clinical presentations of cardiac chest pain.b. Investigate, diagnose, manage patients with chest pain.c. Make informed clinical judgments in the selection of patients to be referred for angiography /

revascularisation, with an appreciation of the indications, limitations and complications of these interventions.

d. Manage patients on discharge from acute services who have undergone a cardiac event or cardiac procedure.

e. Provide secondary prevention (pharmacological/ lifestyle/ lipid / blood pressure/psychological) management for patients with ischaemic heart disease

f. Refer patients appropriately for a second opinion. g. Practise evidence based medicine.

Personal Transferable Skillsa. Practise critical effective problem solving skillsb. Utilise effective team working skills with colleagues and peers.c. Communicate effectively with patients, consultants, other hospital staff, peers and trainers.


SECTION FOUR

Establishing the learning programme

This section covers the Development, Running and Evidencing of the training programme.

The use of clinical competence forms

These forms are used to plan, and later assess the learning which has taken place for your student. There is one clinical competence form for each learning outcome to be undertaken on placement within the six month module. These are also outlined on the module descriptors.

There are two types of forms: Clinical competence training programme forms Clinical competence evidence forms

There is one for each learning outcome. All your activities are to be recorded by the student on the training programme form. Towards the end of the module, students will complete their evidence forms to show how their learning programme has been achieved.

With your student, you will agree a training programme for his/her placement sessions, to be documented on each form. The forms are then used as an active training document to inform the initial and continued training programme whilst on placement and as such, must always be made accessible to you, as mentor, and to any relevant clinician with whom your student is working.

The evidence form is to be used to document the ways in which the training programme has been fulfilled. Here, comments and signatures will be required from you as mentor and other members of staff to authenticate the training under each learning outcome.

Finally, you will decide whether to sign the student off as 1) competent, 2) not yet competent and requiring an extension of time or 3) not competent, despite having had opportunity to become so. This will be based on your and others’ experience and assessment of working with the student. These forms provide the greatest part of the student’s summative assessment for the module, because on this element alone they can pass or fail the module.

The forms may be typed but must have actual signatures against activities.

This process is undertaken in four stages, as described below.

Stage One: Induction/Preparation

1 Explain the practical hospital details affecting the student, in particular lines of communication / your whereabouts and procedures in case of emergency situations.Please cover appropriate aspects of: • occupational health and safety

• indemnity cover• dealing with emergencies• patient confidentiality

2 The student will prepare suggested activities for the training programme.

Stage Two: First meeting

1 Meet with the student to discuss the learning outcomes and his/her proposals for training activities to fulfil those, using the clinical competence (training programme) forms.

2 Together, devise a programme of activities covering each learning outcome which is satisfactory to you and your student, and which covers the essential requirements stated above.


3 These activities should include:

The types of clinic to be attended The types of patient cases to be seen Other types of input eg. Meetings, visiting or shadowing relevant staff;

external input; tutorials by a mentor or hospital team member etc

(Note: for Clinical Skills and Examination, a variety of contexts should be sought for learning, particularly before students embark on their subject modules. Students will benefit from a tutorial style approach to diagnosis also).

4 The student should write up the proposed activities on the forms and should send a copy of the form to the student coordinator, by post within 2 weeks of commencement.

5 Plan when and where (eg specialist clinic) the student will start their placement, and when and where you can be located. You should expect to meet most clinic sessions and the student should certainly be adequately supervised when you are not available.

NB Students may work with more than one consultant colleague but for the purposes of the course, they should consider only one consultant to be their mentor, and this is the individual whose name appears on your initial letter of support, and who will sign their clinical competence (evidence) forms.

Stage Three: Once activities have started

Your oversight will be required for the following student activities:

1 Practical activities as they work through their training programme2 Recording cases of note in their clinical learning diary.3 Seeing you and/or another team member as appropriate, each session4 Obtaining signatures/comments as appropriate for work done.5 Obtaining evidence (copies or originals) as appropriate for work done.

Stage Four: Evidencing the learning outcomes

When a learning outcome has been completed, the task of writing up evidence is to be undertaken by the student, with you present.

1 Using the clinical competence evidence form for each learning outcome, ensure that the following evidence is included by the student to show they have fulfilled their learning activities:

A list showing which clinical conditions have been seen and how many patients for each one.

Reference to other areas of the activities shown on the student’s initial training programme which have been fulfilled.

Description of other activities undertaken to support the student’s learning not listed on the initial training programme.

Where activities from the student’s initial training programme have not been fulfilled, justification or explanation: where these are rarer conditions which have not been seen, you should indicate clearly your opinion of the student’s ability to manage such a condition.

Special note: OSCEsWhen you sign off a student’s activities on the evidence form please be aware that students can only pass the course once they have attended and been successful in their Observed Structured Clinical Examination (month 18/20). All “pass” signatures remain provisional until that point.


CLINICAL COMPETENCE FORM TRAINING PROGRAMMEMODULE NAME

Name: TO BE COMPLETED BY STUDENT

Learning Outcome: AS PER THE MODULE DESCRIPTOR

Self Developed Learning Outcome (optional): TO BE COMPLETED BY STUDENT

Training programme outline:

TO BE COMPLETED BY STUDENTS

To includeCLINICSCLINICAL ACTIVITIESOTHER ACTIVITIES

Confirmation that this training programme outline aims to fulfil the above learning outcomePlease sign only when this programme is confirmed between student and mentor:

Mentor name: Mentor signature Date:

YOUR NAME YOUR SIGNATURE

For use by BCtPCT only: checked by ……………………………………………. Date…………………………………………..


EVIDENCEMODULE NAME

Name: TO BE COMPLETED BY STUDENT

Learning outcome: AS PER THE MODULE DESCRIPTOR

Evidence of activities undertaken for this training programme listed below (see handbook section 4 for instructions on completion)Activity Type of patient No of patient cases Reading materials eg guidelines

TO BE COMPLETED IN YOUR PRESENCE

To be completed by mentor onlyI am satisfied that in the above learning outcome ……………………………………………………………….……… (student’s name)

Signature of Mentor (please sign one box only)A

Is competentYOUR SIGNATURE IN ONE BOX ONLY Mentor’s Name (please print)

Brequires and extension of time to become fully

competentYOUR SIGNATURE IN ONE BOX ONLY

PRINT YOUR NAME HERE

Date:C

Is not competent YOUR SIGNATURE IN ONE BOX ONLY ……………………………………………

For use by BCtPCT only: checked by ……………………………………………. Date…………………………………………..


SECTION FIVE

Student learning, reflection, and discussion about cases

1 Aims of your discussions- structured time for the student to discuss cases/problems arising in clinic;- regular constructive feedback for the student;- encouragement to self-appraisal, helping the student to reflect on his/her practice and the relevant evidence base- confidential and focussed discussion of professional experiences, pertinent to the student's learning.

2 When to discussBased on the experience of mentors and students in previous programmes,learning through discussion can occur at various points, but should be an intentional part of the student’s training programme.

Some examples include: - during consultation: formative discussion held in consultant’s office about diagnosis and choice of management of

patients during clinic;- during the moments before the next patient comes in;- regular planned debriefing of 10 minutes to half an hour every session or every fortnightly session, at the end of

each clinic;- pre-arranged discussions at other times;- specially organised tutorial sessions.

3 What to talk about:

This is time dependent, but would include: - the student’s evidence of observation and clinical evidence as a basis for discussing progress; also use the

student's logbook and clinical competence form to further inform feedback on progress; - feedback which develops the participant's learning. You may change the learning activities as appropriate and

ensure these are recorded on the participant's clinical competence training programme forms; - issues arising out of cases seen or observed in hospital;- issues arising out of practice;- interesting cases seen by consultant;- learning from wider reading or new clinical updating;- in depth learning about a topic which requires more input;- encouraging the student to complete their learning diary (here they must record a minimum of 12 cases which

provide learning and/or action points) as soon after clinical experience as they can and to focus on their understanding, knowledge and skills, and identify how these are changing.

4 Guided readingStudents will mainly read around their immediate coursework / assessed work requirements. Please make your student aware of wider areas of knowledge from the reading list, or your own sources.

5 Student AssignmentsIt is a very worthwhile exercise to look through the prepared assignments that your student has to submit for their coursework. This provides an overview to you of their current level of understanding, and may be a topic for further discussion with them.

SECTION SIX

Hands on work and the organisation of clinic

A few key points:

1 Exposure to hands onObservation is valuable, and should normally be used early in the module, as necessary. Gradually, increasing responsibility should be given for hands-on work.

2 Exposure to follow upsGive consideration to the ways in which students may see follow-up patients, as well as new cases.

3 SpaceCan a PwSI trainee access space to see their own patients?


8 THINGS MENTORS AND STUDENTS SAY ABOUT PLACEMENT

1 Every student visited on placement during said that the most effective form of training was hands-on experience. This was expressed by very experienced practitioners, and those with less clinical experience.

2 All mentors visited made efforts to select the most appropriate patient cases for trainees to see.

3 Mentors want trainees to see them in between every, or most patients with proposed diagnoses and management plans.

4 PwSIs want to see their mentor for every patient/most cases due to the learning opportunity this represents and in light of their own understanding that their knowledge is limited.

5 PwSIs want to be entrusted with patients in order to gain confidence, and recognise where the limitations of their knowledge lie.

6 Mentor and PwSI discussion about patients highlights gaps in PWSI knowledge.

7 The availability of a room in clinic to enable the PwSI to see patients can require creative problem solving, if training is to be effective.

8 As students work in the hospital longer, they know staff better so hospital mechanisms work better.

STANDARD STUDENT HANDS-ON MODEL

Generally, our PwSI students recognise the limitations of their own knowledge and skills base, but all believe that hands-on learning and discussion with the mentor generates their most effective learning opportunity whilst on placement. Hands-on work with the following model will allow more patients to be seen in the same amount of time:

STUDENT OBSERVATION OF CONSULTANT

Observation is best used in the early stages of the PwSIs training or to focus him/her on a specific area of learning.

STANDARD STUDENT OBSERVATION MODEL

The examples below indicate successful uses of student observation of the consultant and the hands on model operating within this PwSI training course.

PRE-OBSERVATION MODEL

For candidates who need further background information before starting observation and hands-on work, a possible model is shown as model F.


Student sees patient alone

Student leaves patient and presents initial findings to mentor

Mentor explores student’s diagnosis and management plan

Student delivers agreed diagnosis and management plan to patient

Consultant sees patients

Student observes consultant

Consultant debriefs student after patient; student raises questions

CLINICS FOR HANDS-ON MODEL

A.

Benefits: The easiest clinic to arrange. Consultant is on hand for all cases, running his/her own clinic next door.Drawbacks: There is no certainty that the student will see suitable cases to cover their learning outcomes. Prior

selection of cases may be necessary. The best cases usually come up as follow-ups.

B.

Benefits: Patients seen are particularly relevant to PwSIs training needs. Consultant is on hand running their own clinic side by side.

Drawbacks: Takes mentor time initially to arrange.

C.

Benefits: PwSIs get strong teaching tutorial input. Cases offered appropriately where possible.Drawbacks: Requires at least two other clinicians to work. Consultant must be willing not to see any patients

him/herself.


General clinic for new patients (consultant led)

PwSI mini-clinic: specially arranged.(new patients and selected follow-ups)

Teaching clinic

Consultant waits in central room and is available all session to select patients for students, and give students teaching on cases between patients

PwSI students &SHOs see all the patients

D.HYBRID BETWEEN OBSERVATION AND HANDS-ON MODEL

Benefits: Good mechanism for easing students into hands-on work.Drawbacks: Slows down the clinic.

E.OBSERVATION MODEL

Benefits: Excellent follow-through of patient cases increasing wider understanding of care.Drawbacks: Appointments for selected follow up patients must be made to coincide with PwSI time in hospital.

F.PRE-OBSERVATION MODEL


Consultant-run general follow-up clinic

Consultant sees first two patients. Student observes.

Student sees next two patients, and consultant observes.

Consultant-run follow up clinic

Student observes patients in outpatient clinic

Student follows same patients on ward round the following week.

Student follows patient to theatre the following week.

Student undertakes reading, based on known weaknesses in knowledge & competence.

Student shadows staff in various areas of hospital to gain broad knowledge (See model E.)

Student observes consultant or registrar and asks questions in debriefing time.

Student moves onto hands on work in model D when appropriate.

SECTION SEVEN

Assessing clinical competence

Continuous Assessment Assessment is continuous throughout the placement. The intention to help the participant succeed should underpin all the meetings which take place between you and the student.

Assessing learning outcomes individuallyEach learning outcome must be assessed during the placement. This covers both clinical and transferable key skills. Please refer to the student's Clinical Competence Forms for details.

Ongoing sign-off of competencePlease check comments and signatures from other members of staff who may have signed off clinical competence for individual activities.Please also check the evidence being presented by the student to support his/her competence, before you sign him/her off. You can also sign off clinical activities, but only you may sign for the final satisfaction of clinical competence in a given learning outcome (see overleaf).It is likely that sign-off will occur throughout the placement rather than just at the end, as individual outcomes are completed.

Methods of assessingContinuous assessment can be done in many ways. Some examples are listed below:

observation and note taking discussion about cases/perspectives/the fulfilment of learning needs looking at the clinical competence form (comments & signatures from other staff etc) examples of evidence and clinical pieces of work presented by the student reference to the learning diary

Progress You and the student will be contacted separately by email to establish if there are any anticipated problems in the student’s progress. The student will also be required to submit cases to the course tutors during the clinical skills module.

Learning diary sign-off Please sign the learning diary which records a minimum of 12 cases seen. This can be signed throughout placement following your discussions and at the end of placement when the record is complete.

Information about other student assessed workDuring the placement students will prepare a set number of written case studies and a presentation which they will submit/present at the assessment day following placement. An OSCE will be undertaken at month 18 in Bradford also.


Final sign-off (verification) of clinical competence

You may sign off a student in three ways. The three options shown on each clinical competence evidence form are explained below.

Option 1 Competent.

You have observed the student undertaking appropriate activities relating to this outcome and are satisfied that they are competent within this area.

Option 2 Requires an extension of time to become fully competent.

This option should be used for students who are clearly capable, but who, through lack of opportunity or other mitigating circumstances, require more time to fulfil their learning outcomes adequately. This extension will be for 8 weeks in the first instance, but can be reviewed thereafter, as long as progress continues to be made.

Option 3 Is not competent.

This option should be used for students who have had sufficient opportunity to demonstrate clinical competence, but who have failed to do so within a certain element. Any student in this category will automatically receive 8 further weeks to redeem their situation. Thereafter they will be deemed to have failed the module, and unless it is their final module, they will fail the course and be unable to progress.(Failing the final subject module would make them eligible for a Postgraduate Certificate, based on success in prior modules).

Please note: The participant passes or fails the course on the basis of your signature for each outcome, once the OSCE result is known.


Please note that competence should be assessed purely on the student’s ability as you record it from extensive and appropriate observation of them on placement. Following the course, continued competence will rely on the nature of the working arrangement within the healthcare network. This Postgraduate programme emphasises the need for practitioners to continue to work within a team to deliver healthcare, once in service as a PwSI. (See the Statement on Collaboration page 2.)

SECTION EIGHT

What we can do for you

Our support to you

Please use this manual as guidance to assist you in making the training process smooth for both you and the participant. Nonetheless, it is possible that you have questions you may wish to refer to us. Please direct these by email in the first instance to the student coordinator. Matters requiring a telephone conversation will be followed up confidentially from tutors in Bradford, from this email address.

As you and the participant will be operating at a distance from the Bradford setting, it is you as mentor who will be called upon by the participant, in the first instance, to handle their enquiries.

Problems which arise for the participant and which may affect their training, the fulfilment of competency criteria or their performance, should be addressed to the participant in question first. Please take appropriate steps to avert or resolve the problem at this level. (You may wish to make a record of the issue for your final comment, if appropriate.)

In the event that these issues cannot be resolved, or if serious concerns are raised eg. about professional misconduct or incompetent practice, please contact the course coordinator as above. As you know, the participant's training is also subject to the support they have from the PCT, and in serious cases, the PCT may also become involved. We would anticipate, however, that this will occur very infrequently.

Contact details The Education lead and the course tutors can be contacted in the first instance at [email protected]. The Student Coordinator will forward all clinically based requests to the appropriate tutor.The postal address for course returns is: Mrs Ellen Goodison, PwSI [specialism] course, NHS Bradford and Airedale, Douglas Mill, Bowling Old Road, Bradford, BD5 7JR.

Definitions The following terms are explained below:Competence: skill demonstrated by the participant in fulfilling a task effectively and safely Verification of competence: proof of the above skills, indicated by mentor signature Student: candidate who has been accepted onto the courseMentor: consultant specialist in local hospitalCourse Tutor: clinical tutor based in Manchester, responsible for the delivery of this moduleEducation Lead: Manager (Bradford) overseeing course delivery

Schedule overview

Preparation for placement Week 1 Weeks 1- 26 End of module

Complete and send mentor agreement letterSet date for the week following your student’s clinical teaching session in Bradford to plan the training programme.

Meet with student to plan the training programme(learning for the clinical competencies).

Training fully underway.You will be contacted at various points by email (as will the student) regarding progress and with information for you.

Clinical competency sign off.


cardiology for supervised practitioners

Documents