Geriatric Medicine Job Description Job Title: GPST 1 and ST2 Specialty: Geriatric Medicine Duration of Post: 4 or 6 months as part of the GP Specialty Training Programme Base: Tameside General Hospital Fountain Street Ashton under Lyne Clinical Supervisors: Dr Shahbaz Ahmed Dr Anjali Prasad Dr Ganeshwaran Yogalingam Dr Abdul Hameed Working Hours: 48 hours (Full time) or as agreed for LTFT On-call: Full shift Outpatient Experience: TIA Clinics, Falls Clinics, General Medicine Learning objectives Comments Care of Elderly patients – Management of Geriatric Giants such as Stroke, Falls, Parkinson’s disease incontinence, immobility, frailty. Ward rounds, teaching both formal and informal, work based assessments(WBA’s),reflection 1
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Geriatric Medicine Job Description
Job Title: GPST 1 and ST2
Specialty: Geriatric Medicine
Duration of Post: 4 or 6 months as part of the GP Specialty Training Programme
Base: Tameside General HospitalFountain StreetAshton under Lyne
Clinical Supervisors: Dr Shahbaz Ahmed
Dr Anjali Prasad
Dr Ganeshwaran Yogalingam
Dr Abdul Hameed
Working Hours: 48 hours (Full time) or as agreed for LTFT
On-call: Full shift
Outpatient Experience: TIA Clinics, Falls Clinics, General Medicine
Learning objectives CommentsCare of Elderly patients – Management of Geriatric Giants such as Stroke, Falls, Parkinson’s disease incontinence, immobility, frailty.
Ward rounds, teaching both formal and informal, work based assessments(WBA’s),reflection
Recognition and Management of Dementia and Delirium as per NICE/RCP/RCGP guidelines
Ward rounds, teaching, ward based assessments (WBA), reflection.
Ortho-geriatrics- as a Geriatric Consultant my special interest is ortho-geriatrics.
Trainees would be encouraged to attend ortho-geriatrics ward rounds on the trauma unit with emphasis on osteoarthritis, osteoporosis, recognition of septic arthritis, fractures. There would be no responsibility of orthopaedics patients from junior doctors perspective
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Stroke/TIA – Subacute Stroke care, stroke rehab and prevention in-patient care and TIA ambulatory care(Supervisor: Dr Ganeshwaran)
Trainee should attend MDT board rounds once a week. See TIA referrals at ambulatory TIA service with direct supervision of consultant. SLEs ( Mini-CEX ) can be done on trainee initiated prior request
Weekly multi-disciplinary Falls and Fracture prevention clinic (Supervisor: Dr Ganeshwaran)
It is mandatory to attend when they are not on the on call rota on a working week for falls management experience and SLEs Mini-Cex and CBD
Management of multiple co-morbidities prevalent in frail elderly population and understanding the concept of frailty
Ward rounds, teaching, work based assessments, reflection, OPD
Mental Capacity assessment and DOLS ,and participation in best interest meetings
Trainee need to complete a SLE ( Mini-CEX for MCA assessment and CBD or Clinical consultation for others )
Nutritional management of older people
Working with dieticians and swallowing therapist with various swallowing functional status and needs
Advanced care planning Able to demonstrate the knowledge, when to initiate , whom to imitate and how to communicate and organize it to be completed in the community
Understanding concept of safe discharge and continuity of care of elderly patients
MDT meetings comprising of physiotherapist, OT, community care teams, social worker
Understanding concept of safe antibiotic prescribing,
Antibiotic ward round on Thursday afternoon by Microbiology Consultant
Departmental Teaching/Audit/Case presentation
Thursday lunchtime- sponsored lunch followed by junior doctor presentation-case/audit/relevant literature review for common elderly care issues
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Duties of the Post
GPST are responsible for: The initial management and primary care of patients referred to the
Department, from GPs directly, from A&E and from Consultant clinics. Including history taking, documentation, arranging initial investigations and starting treatments based on their own independent judgements.
Managing their time in order to deliver the most effective care to the most unwell of patients, recognising their own limitations and asking for help where appropriate
Preparing information for ward rounds Attending ward rounds and undertaking any necessary tasks as directed
by senior medical colleagues Arranging for the follow-up of patients - Reviewing investigations
performed and the taking of appropriate action Transmission of relevant clinical information on patients to other staff
involved in the patients care. Maintenance of adequate and proper records on patients for both clinical
and audit purposes and for the furnishing of letters, reports and other documentation as required for medical, legal and statutory purposes
Attending outpatient clinics and consulting under supervision Instruction of nursing staff, FY1, FY2 and, from time to time, medical
students under training within the Department Careful handover of care at change of shifts, with communication of
details about patients at significant risk of serious deterioration The preparation of discharge summaries and other information to be
communicated to primary care services Dictation of outpatient letters Communication of care plans and diagnoses to patients and their
relatives
Clinical Governance
Undertake induction and mandatory training, as provided by the Department of Medicine
Draw up an educational agreement with the medical department Take part in clinical audit Report significant events where the delivery of care has placed patients at
risk Participate in the improvement of services as directed by the medical
consultant Adhere to departmental clinical protocols as directed by the medical
department
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Encourage and allow feedback on personal performance and critically review your own work
Teaching and Mentoring
Offer opportunities to medical students, attached to the team, to learn about the management of acutely unwell patients
Participate in the preparation and delivery of teaching at departmental events
Educational Content of the Post
The post provides easily accessible opportunities to cover several MRCGP Curriculum statements:
2.02 Patient safety and quality of care2.03 The GP in the Wider Professional Environement3.03 Care or acutely unwell patients3.04 Care of children and young people3.05 Care of older adults3.06 Womens health3.07 Mens health3.09 End of life care3.12 Cardiovascular health3.13 Digestive Health3.14 Care of people with ENT, oral and facial problems3.16 Care of people with eye problems3.17 Care of people with Metabolic problems3.18 Care of people with Neurological problems3.19 Respiratory Health3.20 Care of people with musculoskeletal problems3.21 Care of people with skin problems
MANAGING COMPLEX CARE3.10 Care of people with mental health problems3.11 Care of people with intellectual disability3.14 Care of people who misuse drugs and alcohol
At the end of the post the GP-Trainee should: Be able to manage a wide range of presentations of acute illness Be able to recognise and manage a wide range of common diagnoses Be able to effectively problem solve and manage rare or unique
presentations of acute illness and diagnoses
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Understand the principles of Chronic Disease management and national
protocols for common conditions Develop a range of practical skills needed to manage acutely unwell
patients Understand the need for a range of skills to manage patients with chronic
disease Communicate diagnoses, and management plans with patients and their
relatives Be able to work effectively in teams and coordinate care Weigh up different courses of action taking account of
o Patient safetyo the appropriateness of interventions according to patients’ wishes, o the severity of the illness o co-morbidities and the patients pre- admission state of healtho the patients capacity to understand their treatment
Be able to make rapid mental state and mental capacity assessments in order to direct care appropriately
Accept responsibility for action, at the same time recognising any need for involvement of more experienced members of the team
Be aware of the resources needed to treat patients, and deliver care in a cost effective and efficient manner
Understand the need to follow agreed national or local protocols but be confident to deviate from them, and justify these actions when faced with unique clinical scenarios.
Plan discharge and hand over to primary care services appropriately taking account of the capacities and competencies of primary care
Understand the importance of helping patients make lifestyle changes, in order to improve their health, and know common ways this can be facilitated
(See appendix for educational check list to check progress of learning)
Educational Organisation
Most education should occur during the delivery of acute care, by a mixture of supervision, personal reflection, personal study and team discussions.
The post holder will have a named clinical supervisor who is accountable for the overall educational experience of the job.
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The post holder will attend educational meetings organised by the General Practice Primary Care Medical Educator and local TARGET sessions
The post holder will participate in a continuing programme of education within the hospital department.
Attendance at a range of medical outpatient clinics is strongly encouraged and is a legitimate use of study leave
The post holder GPST 1 & 2 trainees are eligible for 30 days study leave per year. 12 days of study leave will be used for the GP Structured Educational Programme which is based at Werneth House .The trainees can use the remaining 9 days per 6 month post according to their own educational needs. It is recommended that some of this time is spent as a day in General Practice with their Educational Supervisor. Study leave is discretionary and needs to be approved by the Clinical Supervisor, the Educational Supervisor, and the final approval will be by the Programme Director who will record progress in their e-portfolio.
The post holder will meet with their Educational Supervisor (GP-Trainer) at least twice during this post
The post holder will direct necessary DOPs, CBDs and Mini-Cex assessments as appropriate.
General Medicine or Care of Elderly postsGP Curriculum at TGH
Abbreviation KA Know
aboutHave some knowledge about this area and know about some of the skills needed.Need to improve your knowledge and skills base to be able to manage patients safely
KH Know how Have a good knowledge of this area and know the appropriate skills.Would need advice and support to manage a patient independently
CD Can do Have a track record of managing the patient. Have used your knowledge and skill base in this area to bring benefit to the patient
Learning Area KA KH CDManagement of unsorted medical symptoms Chest pain
Cardiac arrest
Shock and anaphylaxis
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Convulsions
Acute confusion (especially in the elderly)
Falls ?cause
Chronic confusion
Unconsciousness
Acute Breathlessness
Chronic Breathlessness
Haemoptysis
Cough
Wheeze
Increased sputum production
Collapse ?cause
Palpitations
Septicaemia
Acute neurological weakness
New Murmurs
Weight loss
Acute Diarrhoea
Abdominal pain
Vomiting
Constipation
Dyspepsia
Haematemesis
Malaena
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Jaundice
Acute anaemia
Acites
Organomegaly
Abdominal masses
Anaemia
Tremour
Headache
Polyuria
Marked lethargy/fatigue
Urinary retention
Management of acute diagnosed medical conditions KA KH CDAcute coronary syndrome
Serious arrhythmias causing cardiac insufficiency
Acute onset atrial fibrillation
Acute asthma attack
Diabetes emergencies (HONK and DKA)
Hypertension
Meningitis and/or septicaemia
Acute drug intoxication
Alcohol withdrawal
Pulmonary embolism
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Pulmonary oedema
Pneumonia and bronchitis
Exacerbation of COPD
Influenza
Acute epileptic seizure
CVA and TIA
Acute limb ischaemia
Acute renal failure
Addisons
Gastroenteritis
Clostridium Difficile infection
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Assessment and management of chronic diagnosed medical conditions
KA KH CD
Ischaemic heart disease
Post-acute cardiac syndrome management
Atrial fibrillation
Hypertension
Diabetes Monitoring Assessment of end organ damage
Impaired fasting glycaemia
Impaired glucose tolerance
Thromboembolic events and the use of anti-coagulation
Medical complications of chronic alcohol use
Heart failure
Peripheral vascular disease
Epilepsy
Parkinson’s disease and other types of tremor
Valvular heart disease
Hyperlipidaemia
Gout
Recurrent UTIs
Pulmonary tuberculosis
Occupational lung disease
COPD
Asthma
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Hypothyroidism
Hyperthyroidism
Morbid obesity
Parathyroidism
Chronic renal failure stage III
Chronic renal failure stage IV or V
Coeliac Disease
Malabsorption syndromes
Diverticular disease
Gallstones
Gastro-oesophageal reflux disease
Stomach ulcers
Duodenal ulcers and H. Pylori infection
Crohn’s disease
Ulcerative colitis
Irritable bowel syndrome
Chronic liver disease Alcohol Hepatitis B Hepatitis C Autoimmune
Pancreatitis
Chronic fatigue syndrome
Chronic headache (all types)
Recurrent drug or age induced constipation
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Pressure sores
Anaemia of chronic disease
Anaemia due to B12 or folate deficiency
Myeloproliferative disorders
Lung cancer
Brain tumour
Upper GI cancers
Lower GI cancers
Renal cancerSkills (beyond basic communication and examination) KA KH CDMisc. skillsFemale and male catheterisation
Intramuscular, intradermal and sub-dermal immunisation
Intravenous and arterial access
How to calculate a BMI and measure waist circumference
How to assess a patient for peripheral neuropathy
Ability to assess patients at risk of pressure sores
Ability to assess chronic wound severity
Ability to assess nutritional status
Ability to assess swallowing reflex
Medical test resultsUnderstanding of sensitivity and specificity of medical tests (inherent inaccuracies)and how this alters patient management
The communication of uncertainty about the results of medical test results
Interpretation of results
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ECG 24 hour ECG BP and ambulatory BP Venous Doppler (ABPI) echocardiogram Gastroscopy H. Pylori tests Duodenal biopsy results FOBs Bone density studies Nerve conduction tests
Interpretation of blood tests cardiac enzymes and trop T results thyroid results, TSH, T4 and Thyroid antibodies FBC, B12, Folate Ferritin blood sugar results and the diagnostic criteria for diabetes, IFG and
IGTT HbA1c Uric acid results Liver function tests Clotting tests lipids renal blood tests, including U&E and FBC in renal disease
Interpretation of urine results MSSU Renal disease Diabetes management
Understanding x-ray results Plain x-rays CT and MRI results USS results Barium enemas Barium swallow
Use of and interpretation of medical equipment Taking a BP (automated and manual) Spirometry (with and without reversibility) Serial PEFRs nebuliser therapy all types of inhalers Defibrillator
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ECG Near patient blood sugar testing Ophthalmoscopy
Special Respiratory skills
How to assess someone for long term oxygen
How to assess someone for nebuliser therapy
How to take blood gases
How to produce an asthma self-management plan
How to check inhaler technique
Understanding when to refer for pulmonary rehabilitation
Ability to differentiate between co-existing respiratory and cardiac disease symptoms
Special CVD/diabetes skills
How to calculate CVD and/or CHD risk
To know when to use ambulatory BP measurements
How to dose anticoagulants
How to calculate renal disease staging
Research and national guidance
Understand how to find high quality EBM information to direct patient care
The use of NICE and NSF guidance in patient care
Use of local antibiotics guidelines
EBM use of antibiotics
Use of the BTS guidance for asthma and COPD management
Understanding two week cancer referral process for lung cancer, renal cancer, brain cancer, upper and lower GI cancers
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Social skillsUnderstanding the medical conditions which affect ability to drive and knowing how and when to refer to the DVLA
Understand the criteria for DLA and how to apply for it
Ways to help people stop smoking
How to help people reduce their weight
CommunicationHow to assess patient mental capacity and autonomy. Mini mental state examination Geriatric Depression Scale Consent to treatment procedures in ‘incompetent patients’ Understanding when to ask for a formal mental health assessment
How to communicate risk of future disease
Ability to take a history from confused or elderly patients where third part evidence is important, using relatives or other health workers including GPs
Ability to alter the pace of communication to take into consideration the needs of the patient, i.e. learning difficulty and elderly
Medicines useAbility to alter medicines doses in the elderly (or those with renal/liver disease)
Understanding the dangers of polypharmacy and the ability to reduce patient medicine use
Ability to review long term medication use
Skill to recognise common drug interactions
To recognise patients who may have difficulties with compliance and take steps to improve medicines use
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Teamwork. Understanding the roles of: KA KH CDCoroner
Social Services
Podiatry
People who assess gait and provide walking aids
Respiratory nurse specialist
Macmillan nurse
Dietician
Intermediate care services
Diabetes nurse specialist
Speech Therapist
Attitude Ability to accept and explore the reasons for patients who decide to decline urgent medical care
Being able to recognise and take responsibility for patients who are at significant risk of self-neglect or self-harm
Being aware of how to manage risk of personal harm (emotional and physical)
The importance of interventions which support and monitor patients with chronic diseases in order to prevent re-admission to hospital
Working with patients to create self-management plans
Awareness that social and environmental changes can provide health benefits which can be more effective than medical treatments