Anyshire Healthcare NHS Trust
Foundation Post in Perinatal Psychiatry
Base: Perinatal Psychiatry, Anytown.
Trainer: Dr Nice
The Service
The Perinatal Psychiatry Service is a busy clinical team dealing with
approximately 100 new referrals per month from across the geographic
county of Anyshire. It includes a tertiary care level Mother & Baby Unit which
is part of the Managed Care Network accepting patients from across the
region. There is also a secondary care level Perinatal Community Team
based in Anytown.
Professional relationships
Dr Nice is the Consultant to the in-patient Mother and Baby Unit and the City
and South of the County and Dr Other, who works half time with the Perinatal
Psychiatry Service, as he is also a Clinical Teaching Fellow, is the Consultant
covering the community patients, largely in the North of the County, but also
for some City patients. Jointly the two consultants provide medical cover for
the whole county; the in-patient service is based on the ward and out-patient
clinics are held at the Anytown Hospital. Dr Nice and Dr Other cover each
other for the purposes of annual and sick leave.
Mrs Manager is the ward manager. There is a Speciality Trainee post in the
team. There are 4.5 WTE CPNs and 1.5 medical secretaries at the base, for
City and South County, and 3.5 WTE CPNs, part-time clinical psychologist for
2.5 sessions/week, and one secretary in the base, for N. Notts.
Job Summary
The trainee will work as an integral part of the multi-disciplinary team,
covering all aspects of Perinatal Psychiatry. This will comprise one clinic per
week, alongside other assessments on the Obstetric/Gynaecology Wards and
Mother & Baby Unit. The trainee will be involved in providing reactive
telephone liaison consultation to other services. The liaison workload is
necessarily unpredictable and the trainee will need to be flexible and work
closely with the team to prioritise both referrals and resources.
The post provides an extremely broad range of clinical experience including
the assessment of well and unwell women throughout the perinatal period,
and supporting colleagues working with psychological difficulties surrounding
delivery.
Page 1 of 16
December 2010
The trainee will be expected to actively participate in psychotherapy through
the training provided at the Psychotherapy Unit (PU) and will be assigned a
Psychotherapy Tutor.
The trainee will participate in the ECT rota at the Hospital and receive direct
supervision and training until considered to be competent in ECT. Dr Extra is
the Consultant responsible for ECT at Hospital. The trainee will be included in
the on-call rota, including exposure to front-door assessments in the
Emergency Department, acute admissions to the psychiatric wards (CAMHS,
Adult, PICU, LD, Old-Age), urgent review of inpatients (inc. Section 5(2)
assessments), and out-of-hours liaison assessments requested by the
Hospitals Trust.
A weekly journal club/case conference is held at the Hospital and the trainee
will be involved in presenting to these meetings once every six months. The
Perinatal Service also has a monthly business meeting which the trainee will
attend where there will be an opportunity to present audit.
Clinical Supervision
Dr Nice provides most of the clinical supervision for this post, but Dr Other is
also available to provide clinical supervision. At the beginning of the post the
trainer will discuss the level of clinical supervision required with the trainee,
but in any case there is a once weekly supervision session with Dr Nice (there
may be room for manoeuvre about times, but at present that slot is on
Tuesday afternoons).
Educational Supervision
The trainee will be expected to continue to see their Educational Supervisor
as planned.
Trainee Timetable
Monday
am
9:00 – 11:00 PU
Case Discussion
Journal Club/ Case
Conference
pm
13:30 – 17:00
Follow-up OPC -
Tuesday
Wednesday
Thursday
WARD ROUND –
(Mother & Baby Unit)
Liaison Assessments
9:00 – 12:30 – MDT
Referral / Allocation /
Supervision With
CPNs –
Ward Review
Obstetric Liaison
/ Home Visits
Urgent Assessments
Admin
Friday
Ward work
Foundation Teaching
Programme
Ward Work
16:00 – 17:00
Supervision
Page 2 of 16
December 2010
Admin
Trainer timetable
am
Monday
Tuesday
Wednesday
9:00 – 10:00 Admin
10:00 – 12:00NOON
New patient clinic
WARD ROUND –
(Mother & Baby Unit)
ON CALL PPS
URGENTS
Journal Club/ Case
Conference
pm
13:40 – 17:00
FOLLOW-UP CLINIC
–
ON CALL PPS
URGENTS
POSTGRAD
MEETING
2:00 – 3:00 ADMIN –
3:00 - 4:00
SUPERVISION OF
SpR
4:00 – 5:00
Supervision of SHO
ON CALL PPS
URGENTS
2:00 – 5:00 SPA –
ON CALL PPS
URGENTS
Thursday
Friday
9:00 – 12:30 – MDT
REFERRAL /
ALLOCATION /
SUPERVISION WITH
CPNs –
WARD REVIEW ON CALL PPS
URGENTS
13:30 – 17:00 (1ST &
3RD) Outpatient
Clinic –
12:30 – 2:00 2ND
Business Mtg
12:30 – 2:00 4TH
Perinatal Clinical /
Audit
15:00 – 17:00 Urgent
Assessments (2nd
and 4th)
Admin / Obstetric
Liaision –
ON CALL PPS
URGENTS
Duties and opportunities
The duties of the post, performance criteria and the learning opportunities
available are set out following the structure of the UK Foundation Programme
Curriculum (March 2010), which in turn, is based on the headings of the
GMC’s Good Medical Practice (2006).
1 Professionalism
The trainee will be expected to practise with professionalism including:
integrity, compassion, altruism, continuous improvement, aspiration to
excellence, respect of cultural and ethnic diversity, regard to the principles of
equity, ethical behaviour, probity and show leadership.
1.1 Behaviour in the workplace
The trainee will be expected to work within the level of their own competence
and there is access to immediate supervision by telephone if not face-to-face.
It is expected that their assessments will take account of factors pertaining to
the patient’s age, colour, culture, disability, ethnic or national origin, gender,
lifestyle, marital or parental status, race, religion or beliefs, sexual orientation,
or social or economic status
Given the wide range of services (both statutory and voluntary) involved in the
care of our patients, the trainee will be expected to manage confidential
information appropriately whilst maintaining necessary communication under
Trust guidance and policy. They will be aware of their responsibilities as
regards child protection and how this relates to confidentiality. Appropriate
Page 3 of 16
December 2010
feedback of any concerns is encouraged in the teams at University Hospitals.
The trainee is expected to complete appropriate multi-source feedback.
Assessment: MSF, CBD, probity declaration and supervisor’s report.
1.2 Health and handling stress and fatigue
The trainee will expected to be aware of the impact of ill-health and stress on
their work. There will be an opportunity to seek support through weekly
supervision with their clinical supervisor or separately through their
educational supervisor.
Assessment: MSF, supervisor’s report and health declaration.
1.3 Time management and continuity of care
The job can be busy at times with conflicting responsibilities to the inpatient
Mother & Baby unit, community service and liaison assessments. The trainee
will be expected to prioritise this work appropriately and seek support from
colleagues when this becomes difficult. Likewise, there will be times when the
trainee receives multiple requests out-of-hours, and with the supervision of
the ST/Consultant colleague will prioritise this appropriately.
The trainee will be expected to produce timely and clear written
communication to colleagues, both within and without the service. This may
include legal reports where these are requested such as those under the
Children’s Act (but only with senior supervision).
Assessment: MSF, supervisors report, feedback form and survey
receipts.
2 Good Clinical Care
Outcome: demonstrates the knowledge, attitudes, behaviours, skills and
competences to be able to take a history and examine patients, prescribe
safely, keep an accurate and relevant medical record and use medical
devices safely.
2.1 Eliciting a history & 2.2 Examination
Competences
This job allows Foundation Trainees to demonstrate competencies in taking
histories of both acute (e.g. affective, anxiety, puerperal psychosis) and
chronic disorders (e.g. bipolar and schizoaffective disorders). The trainee will
be involved in the assessment of women pre-conceptually, ante-natally and
post-natally, and as such will experience the distinctive features of illness in
the perinatal period. They will undertake new assessments on outpatients,
liaison referrals from obstetric and gynaecology wards (primarily at the
Hospital and City Hospital) and review patients on the specialist regional
Mother & Baby Unit. This will include the range of conditions affecting adults
but also specifically the assessment of patients who may be suffering normal
psychological changes in the perinatal period as well as those with mood
Page 4 of 16
December 2010
disorders (including puerperal psychosis), OCD and relapses of
Schizophrenia. It will be necessary to consider a range of personal, social
and cultural factors including family dynamics. Assessments will also
consider parenting competence as affected by illness. In assessing the need
for treatment, the trainee will routinely consider the risks and benefits of
medication in pregnancy and breastfeeding and be able to relate this to the
development of the foetus/neonate. The trainee will also develop a general
understanding of the physical problems that may arise during pregnancy and
the puerperium through exposure, primarily on the Mother & Baby Unit.
The on-call rota will also provide experience of the assessment of a diverse
range of presentations including CAMHS, LD, Adult and Old-Age Psychiatry.
They will develop an awareness of safeguarding children (Levels 1 and 2) and
vulnerable adults and, under supervision, refer appropriately to safeguarding
services.
There will be access to supervision from a senior colleague following all new
assessments (which may be via telephone where this is urgent). All
assessments will be documented and the trainee will provide written
communication to all relevant allied professionals.
Assessment: mini-CEX and CBD.
2.3 Diagnosis and clinical decision making
Following all assessments the trainee will be expected to formulate cases in
terms of current operational classifications systems, including main,
subsidiary and alternative diagnoses. Given the particular circumstances of
this patient group, the trainee will be encouraged to additionally formulate
cases in broader social/psychological perspective. There will be an
opportunity to discuss diagnostic dilemmas and difficult formulations in
supervision. It is expected that all formulations will be documented and the
trainee should be able to present these verbally when asked to do so.
The trainee will arrange appropriate basic laboratory tests and other
investigations and negotiate a treatment plan with patients and allows patients
to make informed treatment choices.
The ward and community environments will provide rich opportunity to
formulate a range of cases, as above, including at times complex and
disputed cases. The post-holder will be expected to listen and take into
account other perspectives in coming to their ultimate conclusions on any
case and this will involve liaising broadly, within the teams described above
and outside to agencies in primary care, allied services and psychotherapy. A
high standard of referral is encouraged and it is a joint responsibility between
the trainer/clinical supervisor and the post-holder that this is achieved.
The trainee will work across interfaces in Psychiatry, Primary Care,
Community Midwifery, Health Visiting, Childcare Social Services and
Obstetrics & Gynaecology. They will also liaise with services across area
boundaries (such as liaising with services in Othershire) where less
Page 5 of 16
December 2010
specialised services are available. They will be expected to prioritise and
manage referrals and to work within the multidisciplinary team across the
County. There is an opportunity to further discuss cases at the weekly MDT
meeting.
The Service also works with well women who have a predictable risk of illness
post-natally, to try to prevent relapse; pathways are in place to facilitate this.
Assessment: mini-CEX and CBD.
2.4 Safe prescribing
The service works with women throughout pregnancy and the first postnatal
year. Consequently, when prescribing medication the trainee will need to
consider the pharmaco-kinetic and pharmaco-dynamic alterations occurring in
pregnancy and the early puerperium, as well as the impact on breastfeeding.
Supervision from senior colleagues regarding this will always be available.
They will develop their knowledge of the effects of patient (e.g. pregnancy and
breast feeding, cultural/religious beliefs) and disease factors (e.g. hepatic,
renal) on prescribing and an awareness of NICE, SIGN and local guidelines.
Through experience they will become aware of the difference between
prescribing by brand name and by generic name and be aware of
circumstances when brand names should be used (e.g. Lithium Priadel).
As part of their assessment of patients, the trainee will be expected to take an
accurate drug history, including self-medication, use of herbal products and
enquiry about allergic and other adverse reactions.
The trainee will review both inpatients and outpatients to monitor therapeutic
effects and adjusts treatments and dosages appropriately, under supervision.
Assessment: CBD.
2.5 Medical record-keeping and correspondence
The trainee will maintain accurate and timely records of assessments and
management plans. The trainee will dictate and sign letters to GPs and
colleagues in the general hospital as well as liaising with other professionals if
necessary. The trainee will also be responsible for admission, case and
discharge summaries. It will be expected that the post-holder brings examples
of letters and summaries to supervision to develop this skill.
2.6 Safe use of medical devices
The trainee will be expected to utilise equipment on the inpatient wards to
monitor basic physical observations including blood pressure, pulse and
oxygen saturation. They will recognise the limitations of providing physical
healthcare on psychiatric inpatient units and refer/seek advise appropriately.
Assessment: mini-CEX, DOPs, log book and CBD.
Page 6 of 16
December 2010
3 Recognition and management of the acutely ill patient
Outcome: achieve competence in the early management of emergency
patients and of those with acute illness superimposed on a background of
chronic disease. Competences are context-dependent and so will not
necessarily be at the same level in all acute situations. For example,
foundation doctors will not be expected to have the same level of competence
to manage seriously ill children as that expected with adults.
3.1 Promptly assesses the acutely ill or collapsed patient
The trainee will be competent in basic hospital life support. A refresher
course is available within the Trust. During working hours they will deal with
pregnant women and will be able to physically examine and refer on those
who become acutely unwell. Whilst on-call they may be asked to physically
assess and appropriately manage patients on general adult, old-age and
learning disability units. They will recognise the limitations of providing
physical healthcare on psychiatric inpatient units.
3.2 Identifies and responds to acutely abnormal physiology
The trainee will be expected to investigate causes of abnormal vital signs
within an appropriate timeframe.
3.3 Not applicable
3.4 Reassesses ill patients appropriately after starting treatment
Where a physically unwell patient is suitable to be managed on a psychiatric
unit, the trainee will reassess the patient as appropriate to the condition. They
will provide clear guidance to medical and nursing colleagues about further
monitoring and calling criteria and consider psychiatric/psychological aetiology
(e.g. deliberate self harm).
Where a psychiatrically unwell patient is being managed, such as through
rapid tranquilisation, the trainee will reassess the patient as appropriate (in
accordance with guidelines). They will consider the possibility of physical
causes affecting the presentation (e.g. head injury).
3.5 Undertakes a further patient review to establish a differential
diagnosis
They will recognise the importance of iterative review and that the acute
illness may be an acute exacerbation of a chronic disease. The trainee will
undertake focused further history-taking in difficult circumstances and/or when
the patient is unable to co-operate. This will commonly be in admission
and/or on-call situations.
3.6 Not applicable
3.7 Not applicable
Page 7 of 16
December 2010
3.8 Uses common analgesic drugs safely and effectively
The trainee will prescribe analgesia appropriately for inpatients. However,
they will be expected to consider the underlying aetiology and refer/seek
advice where appropriate from medical/surgical colleagues.
3.9 Understands and applies the principles of managing a patient with
acute mental disorder including self harm
In this post the trainee will develop their knowledge of a range of psychiatric
conditions affecting adults including normal psychological changes in the
perinatal period as well as mood disorders (including puerperal psychosis),
OCD and relapses of Schizophrenia. Their involvement in the on-call rota will
also provide experience of the assessment of a diverse range of
presentations including CAMHS, LD, Adult, Old-Age and Liaison Psychiatry.
They will have extensive experience of mental state assessments and will
understand the potential risks to self and others.
The trainee will follow-up patients in clinic and demonstrate the ability to
develop professional and therapeutic relationships with their patients. When
working with well women at risk of postnatal illness there is a need to remain
positive whilst engaging in preventative strategies at what is an emotional and
stressful time of life. They will be supervised to manage complex mental
capacity assessments in the acute hospital including emergency situations
such as around delivery.
Risk of suicide and its relation to the perinatal period has been a significant
driver in the development of perinatal services through the influence of the
Confidential Enquiries into Maternal Deaths, NICE and SIGN guidelines.
Assessments of all women, including those currently well will involve
assessment of the risk of deliberate self-harm/suicide. Under supervision,
they will liaise and work with other teams, such as the crisis team, as
appropriate to manage risk.
Through liaison referrals, outpatient referrals and inpatients on the Mother &
Baby Unit, the trainee will have experience of a variety of emergency
situations. This will include managing patients who pose a risk of harm to
themselves, those at risk of exploitation/neglect and behavioural disturbance
due to acute medical disorders. They will be expected to use both
pharmacological and environmental means of managing risk, with senior
advice always available.
Risk posed to others is especially important in perinatal psychiatry and the
trainee will be expected to assess the risk to children. Under supervision,
they will work with colleagues and other services (such as Childcare Social
Services) to minimise these risks.
3.10 Ensures safe continuing care of patients on handover between
shifts, on-call staff or with “hospital at night” team by meticulous
attention to detail and reflection on performance
Page 8 of 16
December 2010
The trainee will be expected to inform on-call colleagues of patients who are
unwell, disturbed or in need of review out-of-hours (as appropriate). The oncall rota incorporates a one-hour overlap between shifts to complete work and
to provide verbal handover where required. The trainee will be expected to
document out-of-hours assessments and provide timely written
communication to GPs where patients are not admitted.
Through liaison assessments they will have experience of assessing patients
with impaired level of consciousness, agitated behaviour and self-harm.
Senior supervision via the ST4-6 and Consultant on-call will always be
available.
They will be aware and experience the use of Mental Health and Mental
Capacity legislation both in a psychiatric and general hospital setting.
4 Resuscitation
Outcome: demonstrates the knowledge, competences and skills to be able to
recognise critically ill patients, take part in advanced life support, feel
confident to initiate resuscitation, lead the team where necessary, and use the
local protocol for deciding when not to resuscitate patients.
4.1 Resuscitation
The trainee will be trained in life support as part of the Foundation
Programme.
Assessment: MSF, CBD and ILS/ALS/equivalent course.
4.2 Discusses Do Not Attempt Resuscitation (DNAR) orders/advance
directives appropriately
Whilst on-call it is likely that the trainee will see a small number of patients,
most likely in Old-Age Psychiatry who have existing DNARs and advance
directives. They will be aware of the effect of these and how they stand within
legislation.
There will be an opportunity to discuss these issues in
supervision.
Assessment: MSF and CBD.
5 Discharge and planning for chronic disease management
Outcome: demonstrates the knowledge and skills to care for patients with
chronic diseases during their in-patient stay. Plans discharge for all patients,
starting from the point of admission and encourages patients in self-care
where appropriate.
Many patients seen by the Perinatal Psychiatry Service do not have a chronic
or enduring health problem. However there will be a proportion with severe
and enduring mental illness (such as Bipolar Disorder or Schizophrenia) as
well as those with chronic physical illness.
Page 9 of 16
December 2010
The trainee will be expected to prescribe long-term medications (contacting
primary care to confirm where necessary) and to have an awareness of new
complications of long-term illnesses. They will recognise the need for
occupational therapy for inpatients and will be involved in the planning of
discharge from the time of admission (including early referral to the
appropriate members of the multidisciplinary team).
They will be expected to liaise with family and carers to obtain collateral
information and to find out about family dynamics and socio-economic factors
influencing success of discharge (such as child-care arrangements). The
trainee will dictate and sign letters to GPs and colleagues in the general
hospital as well as liaising with other professionals (such as Health Visitors)
as necessary.
Assessment: CBD and MSF.
Knowledge
6 Relationship with patients and communication skills
Outcome: demonstrates the knowledge, skills, attitudes and behaviours to be
able to communicate effectively with patients, relatives and colleagues in the
circumstances outlined below.
6.1 Within a consultation
The trainee will be expected to communicate effectively and sensitively and
bear in mind the particular issues for women with mental illness, including
their fears of stigma and the fear of consequences of sharing information
regarding their illness. This includes common fears that their children will
automatically be removed by Social Services.
6.2 Breaking bad news
Pregnancy is a time of high expectations and the risk and/or development of a
severe mental illness can be devastating for both the patient and her family.
Under supervision as necessary, the trainee will communicate information
about diagnosis, prognosis and treatment.
Assessment: CBD and MSF
7 Patient safety within clinical governance
Outcome: demonstrates a clear commitment to maintaining patient safety
and delivering high-quality reliable care. Understand that clinical governance
is the over-arching framework that unites a range of quality improvement
activities to safeguard standards and facilitate improvements in clinical
services.
7.1 Treats the patient as the centre of care
It is expected that the trainee will work to the Recovery Model, emphasizing
the right of the patient to make choices about their care and recovery. The
Page 10 of 16
December 2010
trainee will manage confidential information appropriately whilst maintaining
necessary communication under Trust guidance and policy.
Senior
colleagues will involve the trainee in clinical governance issues. This will
include participation in the annual accreditation by the Perinatal Quality
Network.
Assessment: CBD and MSF.
7.2 Makes patient safety a priority in own clinical practice
The trainee will work within care pathways developed by the Managed Care
Network. They will comply with information governance standards of
confidentiality and data protection and complete the mandatory IG training.
Through supervision they will have opportunities to discuss how to deal with
real or hypothetical complaints.
Assessment: CBD and MSF.
7.3 Promotes patient safety through good team-working
The trainee will routinely work with colleagues in General Practice,
Community Midwifery, Health Visiting, Childcare Social Services and
Obstetrics & Gynaecology. They may be asked to attend case conferences
typically arranged either on the Mother & Baby Unit or by Social Services. At
times there will be divergent views which will need managing. Along with
input from senior colleagues, the trainee will bring a specialist understanding
of the mother’s mental illness and its prognosis to these meetings and relate it
to the ability to parent (thus promoting the safety of mother and child).
Assessment: CBD and MSF.
7.4 Understands the principles of quality and safety improvement
The trainee will demonstrate knowledge of how and when to report adverse
events and ‘near misses’ to local and, where appropriate, national reporting
systems. They will experience the role of the Managed Care Network and
Perinatal Quality Network in setting standards for quality services.
Assessment: CBD and MSF.
7.5 Complaints
In situations where patients are unhappy with aspects of care, the trainee will
seek to remedy concerns with help from senior colleagues and/or other
members of the multidisciplinary team. Within supervision they will discuss
how complaints are managed and investigated locally.
Assessment: MSF and supervisor’s report.
8 Infection control
Outcome: demonstrates the knowledge, skills, attitudes and behaviours to
reduce the risk of cross-infection.
Page 11 of 16
December 2010
The trainee will be expected to consistently use hand hygiene appropriately in
clinical settings and to adhere to policy regarding the disposal of sharps and
clinical waste. They will follow local guidelines/protocols for antibiotic
prescribing which are available through Pharmacy.
Assessment: MSF, logbook and DOPS.
9 Nutritional care
Outcome: demonstrates the knowledge, skills, attitudes and behaviours to
assess patients’ basic nutritional requirements and the use of procedures to
ensure adequate nutrition.
The trainee will be aware of the need to ensure adequate nutrition, especially
as it pertains to pregnant and postpartum women.
10 Health promotion, patient education and public health
Outcome: demonstrates the knowledge, skills, attitudes and behaviours to be
able to educate patients effectively.
10.1 Educating patients
There will be opportunities to do this during routine weekly practice including
educating patients on treatment options such as commencing new medication
and seeing patients consented for ECT. There will be opportunities to be
observed doing this by senior colleagues.
The trainee will be aware of the higher rates of physical ill health in patients
with enduring mental illness and their shorter life expectancy. They will
explain to patients, as appropriate, the possible effects of lifestyle, including
the effects of diet, nutrition, smoking, alcohol and drugs (separately and in
combination) and be prepared to advise on smoking cessation and
appropriate drinking levels or cessation.
Assessment: mini-CEX, CBD and MSF.
10.2 Environmental, biological and lifestyle risk factors
Knowledge
The trainee will demonstrate a knowledge of the risk factors for disease
including: genetics, diet, obesity, exercise, social deprivation, occupation,
substance misuse and abuse, child/vulnerable person abuse and of possible
pregnancy complications in women of child-bearing age.
10.3 Smoking
The trainee will demonstrate knowledge of the effects of smoking on health of
smoker, others (including the unborn child) and on psychotropic medication.
They will have an awareness of smoking cessation strategies.
Page 12 of 16
December 2010
10.4 Alcohol
The trainee will demonstrate knowledge of the effects of alcohol on
pregnancy, on the health and psycho-social well-being of the patient and
family members, and the availability of local support groups/agencies.
10.5 Epidemiology and screening
All women in Anyshire are screened at booking for a history of mental illness.
The trainee will experience the effectiveness and limitations of this approach
in identifying at risk women.
11 Ethical and legal issues
Outcome: demonstrates the knowledge and skills to cope with ethical and
legal issues that occur during the management of patients with general
medical problems.
11.1 Medical ethical principles and confidentiality
The trainee will ensure privacy when discussing sensitive issues, seek timely
advice where patient abuse is suspected, and modify patients’ management
plans in accordance with the principles of patients’ best interests, autonomy
and rights. They will be aware of the limits of confidentiality, especially as
regards safeguarding.
Assessment: CBD, MSF and supervisor’s report.
11.2 Valid consent
The trainee will be expected to obtain consent from patients in a variety of
settings including investigations, medical treatment and correspondence.
There will be opportunities to observe senior colleagues consenting patients
to ECT. The trainee will develop their knowledge of the legal framework
surrounding consent and capacity both within the Perinatal Psychiatry Sevice
and on-call.
11.3 Legal framework of medical practice
In supervision, the trainee will be made aware of local child protection
procedures. They will have direct experience of the use of the Mental Health
Act and Mental Capacity Act and will be responsible for making Section 5(2)
assessments whilst on-call. They will recognise the need for restraint of some
patients with mental illness according to the appropriate legal framework
(commonly the Mental Health Act).
Assessment: CBD and supervisor’s report.
11.4 Relevance of outside bodies
In this post the trainee will experience the relevance of the Royal College of
Psychiatrists (particularly through its Centre for Quality Improvement), NICE
Page 13 of 16
December 2010
(Antenatal and Postnatal Mental Health Guidelines) and a number of other
services including the Local Authority and Surestart.
12 Maintaining good medical practice
12.1 Lifelong learning
Outcome: demonstrates the knowledge, attitudes, behaviours, skills and
competences needed to start self-directed lifelong learning.
The aim will be to inspire or encourage a life-long interest in learning. The
trainee will also be encouraged during supervision sessions to develop
systems of learning, such as making time each week to review relevant
journals.
The clinical supervisor will undertake WPBAs with the trainee to support their
development and to feedback on progress.
Assessment: CBD and MSF.
12.2 Research, evidence, guidelines and care protocols
Outcome: demonstrates the knowledge, skills, attitudes and behaviours to
use evidence and guidelines that will improve patient care.
The trainee will be expected to partake in journal club sessions during each
semester, to develop critical appraisal of papers. The post-holder will also
have a half-day release to attend the Foundation teaching programme. They
will be encouraged to use evidence based medicine and understand the
limitations of evidence base in field such as Perinatal Psychiatry.
The team has been involved in research such as the national collaborative
BISMARC outcomes in perinatal psychiatry study. The Perinatal Section of
the Royal College of Psychiatrists is working to develop a national perinatal
research network and it is intended that Anytown will be involved. Trainees
would be welcome to assist in future projects.
Assessment MSF, CBD and mini-CEX.
12.3 Audit
Outcome: demonstrates the knowledge, skills, attitudes and behaviours to
use audit results to improve patient care.
The trainee will be involved in the audit process of the team and will have the
opportunity to develop their own topics and present them at the monthly
business meeting.
Assessment: audit project review and e-portfolio.
13 Teaching and training
Outcome: demonstrates the knowledge, skills, attitudes and behaviours to
undertake a teaching role.
Page 14 of 16
December 2010
The trainee will be involved in the monthly team development meeting, with
opportunities to teach colleagues. They will also be expected to assist with
the clinical exposure and teaching of medical students in Perinatal Psychiatry.
Under supervision, there may also be opportunities to be involved in the
teaching of Midwifes and Health Visitors.
Assessment: Developing the clinical teacher.
14 Working with colleagues
Outcome: demonstrates effective teamwork skills within the clinical team and
in the larger medical context.
14.1 Communication with colleagues and teamwork for patient safety &
14.2 Interface with different specialties and with other professionals
The trainee will routinely work with colleagues in General Practice,
Community Midwifery, Health Visiting, Childcare Social Services and
Obstetrics & Gynaecology. The trainee will be given the opportunity to act as
a leader. Trainees with representative roles in Trust management committees
will be supported. The department’s involvement in PQN (Perinatal Quality
Network) provides the trainee with the opportunity to be involved with peer
audit and accreditation of services and experience of how standards can drive
development.
The ward and community environments will provide rich opportunity to
formulate a range of cases, as above, including at times complex and
disputed cases. The post-holder will be expected to listen and take into
account other perspectives in coming to their ultimate conclusions on any
case and this will involve liaising broadly, within the teams described above
and outside to agencies in primary care, allied services and psychotherapy. A
high standard of referral is encouraged and it is a joint responsibility between
the trainer/clinical supervisor and the post-holder that this is achieved. There
is an opportunity to further discuss cases at the weekly MDT meeting.
Assessment: MSF and CBD.
Learning in acute care
This post will provide opportunities for the assessment of competence of
foundation doctors managing adult patients with the following complaints:
Psychiatric/behavioural problems, including:
• situations where the safety of the patient, self or others may be at risk,
including underlying mental illness (e.g. depression)
• violence and aggression with particular regard to child and elder abuse
• patient suffering from:
• overdose/self harm
Page 15 of 16
December 2010
• substance abuse
• delirium or acute confusional state
• psychosis.
Investigations & procedures
Outcome: routinely arranges and correctly interprets basic laboratory and
radiological investigations in the context of the particular patient with
understanding of applicability and limitations.
The trainee will be expected to request common investigations appropriate for
patients’ needs and the clinical context and to discuss the results with the
patient. They will interpret results of laboratory tests taking into account the
effect of pregnancy and recent delivery, and act accordingly.
Assessment: mini-CEX and CBD.
Practical procedures
Outcome: performs the common practical procedures listed below. These are
needed to diagnose and manage adult patients who present acutely.
Foundation doctors who care for children will also learn how to do some of the
following common procedures for them.
In this post it is expected that on occasion the trainee will be required to
perform venepuncture, blood cultures (peripheral), perform and interpret an
ECG and may be required to perform urethral catheterisation (in adult males
and females).
Dr AJ Cairns, June 2011.
Page 16 of 16
December 2010