Special Skills Training Module · 2014-02-12 · INTRODUCTION Ultrasound imaging has become an...
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Royal College of Obstetricians and Gynaecologists Special Skills Training Module Ultrasound Imaging in the Management of Gynaecological Conditions June 2002
Transcript of Special Skills Training Module · 2014-02-12 · INTRODUCTION Ultrasound imaging has become an...
Royal College of Obstetricians and Gynaecologists
Special Skills Training Module
Ultrasound Imaging in theManagement of GynaecologicalConditions
June 2002
Published by the RCOG Pressat the Royal College of Obstetricians and Gynaecologists
Registered Charity No. 213280
© Royal College of Obstetricians and Gynaecologists 2002
Further copies of this module can be obtained from:
Postgraduate Training DepartmentRoyal College of Obstetricians and Gynaecologists27 Sussex PlaceRegent’s ParkLondonNW1 4RG
Telephone: +44 (0) 20 7772 6200Facsimile: +44 (0) 20 7723 0575Website: www.rcog.org.uk
Printed by Manor Press, Unit 1, Priors Way, Maidenhead, Berks. SL6 2EL
CONTENTS
Page
INTRODUCTION 3
Entry criteria 3
Training programme components 3
The logbook 4
TRAINING DETAILS 5
RECORD OF ATTENDANCE 6
CASE REPORTS AND AUDIT 7
BASIC SKILLS 8
EARLY PREGNANCY 12
MENORRHAGIA 18
POSTMENOPAUSAL AND INTERMENSTRUAL BLEEDING 22
PELVIC PAIN/DYSPAREUNIA 26
PELVIC MASS 30
REPRODUCTIVE MEDICINE 34
APPENDIX I: Contents of theoretical course 40
SPECIAL SKILLS TRAINEE REGISTRATION FORM 41
SPECIAL SKILLS REGISTRATION FORM FOR NON-TRAINING GRADES 43
CERTIFICATE OF COMPLETION OF TRAINING PROGRAMME 45
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INTRODUCTION
Ultrasound imaging has become an integral part of the management of many gynaecologicalconditions. This module will help to equip individuals with the knowledge and skills required touse ultrasound imaging within the clinical context. Once trained, a clinician should be able to:
1. Identify the pelvic organs and their orientation.
2. Establish their normality.
3. Correlate the findings with the presenting symptoms or endocrine status.
4. Establish a diagnosis and formulate a plan of action.
5. Effectively communicate the above information to the patient and colleagues.
Entry criteriaAs special skills training should follow the completion of core training, the following criteria mustbe met:
1 The trainee must have passed Part 2 MRCOG or hold an equivalent qualification.
2 The trainee must have satisfactorily completed the Core Logbook requirements.
3 The trainee must have obtained a satisfactory year three RITA.
Registration with the RCOG for special skills training can only be made when the above criteria aremet.
Specialist Registrars with fixed term training appointments (FTTA) who wish to register with theRCOG for special skills training should also fulfil the above criteria.
Training programme componentsThe following are essential components of the training programme, and all of them have to becompleted:
1. Training must be undertaken under the supervision of an identified preceptor for one year. Thepreceptor must be skilled in the use of ultrasound imaging in the management ofgynaecological conditions and will supervise at least one imaging session per week. Thepreceptor should undertake direct supervision of the trainee for the bulk of the module. Onoccasion, the trainee may undertake sessions under the supervision of professionals other thanthe preceptor (for example, bone studies or breast clinics). In these circumstances, it is thepreceptor’s duty to ensure that the professional to whom the duty of training is delegated issufficiently competent, willing and able to teach the trainee. Dual preceptorship is alsoacceptable. Under these circumstances, at least one of the preceptors should hold theMRCOG or FRCOG.
2. Trainees should obtain an application form for special skills training from the PostgraduateTraining Department of the RCOG and get it completed. The special skills training plans of thetrainee should be discussed at the year two RITA. During SpR year three, the trainee shouldobtain the chosen module and application forms from the RCOG Postgraduate TrainingDepartment, make contact with a preceptor in their chosen module, discuss rotations with the
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Deanery Specialist Training Committee (DSTC) and ensure that their application form iscompleted. At the Year Three RITA assessment, the trainee should ask the Chairman of theDSTC to sign the application form in support of the module and send a copy of the completedform to the RCOG.
3. Trainees should attend a theoretical course that should provide the essential knowledgecomponent of training for this module. It is expected that trainees will also supplement theirknowledge by reading standard textbooks and other literature. The theoretical course can beattended at any time after registration.
4. The practical component will involve attendance at clinics where patients are referred forultrasound imaging as part of the management of their gynaecological conditions (earlypregnancy clinics, gynaecological evaluation clinics, menstrual disorder clinics, pelvic massclinics etc.). Gynaecology outpatient clinics where ultrasound imaging is immediatelyavailable are also appropriate. The trainee must attend at least 30 such sessions andattendance must be documented in the appropriate section of the logbook. At least ten of thesesessions should be in a dedicated early pregnancy clinic.
5. Trainees should complete ten referenced case reports and a clinical audit on a subject relatedto the menopause. These should be completed to the preceptor’s satisfaction.
Training will be deemed to be complete when all the components have been completed to thesatisfaction of the preceptor. The Completion of Training Certificate should be signed by the trainee,preceptor and chairman of the DSTC and sent to the Postgraduate Training Department at theRCOG.
The logbookThis logbook defines the skills required to use ultrasound imaging in the management ofgynaecological conditions. The diagnoses are grouped pragmatically in order to prevent repetition.It is intended that the trainee will adopt a clinical rather than pathological or anatomical approachto the ultrasound examination. Moreover, trainees should develop a systematic method so that a fullpelvic assessment is undertaken.
Completion of the logbook will allow the preceptor and trainee to monitor progress and identifydeficiencies over the course of training. It is important to note that the logbook is a record ofcompetence rather than experience. The preceptor and trainee will review the progress of trainingevery two months. Competence will be documented by the preceptor signing the appropriatesections of the logbook. The levels of competence are:
Level 1 performed the exercise under direct supervision
Level 2 performed the exercise independently.
In addition to the recording of competence, the logbook also contains sections for the recording ofultrasound images and basic clinical details of patients seen by the trainee. The ultrasound imagesshould be of high quality and demonstrate aspects of the ultrasound scan which are pertinent to theclinical case, and should have been obtained by the trainee. The trainee should review suitableimages with the preceptor prior to attaching them to the logbook. This provides an opportunity forthe trainee and preceptor to discuss the management of the case summarised under the images.
It is imperative that all participants appreciate that the trainee’s progress has to meet standardsthat satisfy the preceptor. At the end of the training programme, the preceptor has to certify thatthe skills attained by the trainee are to his/her satisfaction.
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TRAINING DETAILS
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Trainee name:
Address:
National Training Number:
Preceptor:
Address:
Date of commencement of training:
Date of attendance at theoretical course:
Date of completion of training:
RECORD OF ATTENDANCE
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Date and type of clinic (at least 10 in early Number of scanspregnancy clinic) Supervised Independent
CASE REPORTS AND AUDIT
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Case report Date completed Preceptor’s signature
1
2
3
4
5
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10
Audit
BASIC SKILLS
In order to document the acquisition of basic skills, images of the uterus and ovaries should beplaced on the following pages as specified.
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Skill Level 1 Level 2 Preceptor to sign and date Supervised Independent when competence achieved
Machine set-up
Counselling for scan
Decide transabdominal vs. transvaginal route
Choice of probe
Patient positioning
Orientation
Identify normal endometrium
Identify normal myometrium
Identify normal ovaries
Measure cervical length
Recording images
Note keeping
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Longitudinal view of normal uterus (including measurement of endometrial thickness)
Transverse view of normal uterus at the fundus
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Transverse view of normal ovary with measurement (I)
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Longitudinal view of normal ovary with measurement (II)
Transverse view of normal ovary with measurement (II)
EARLY PREGNANCY
Ultrasound images from ten separate patient examinations from the above conditions should beattached on the following pages. The trainee should try to avoid repetition and aim to cover asmuch of the spectrum above as possible. For each examination, the patient’s hospital number,indication for scan and management plan should be recorded in the boxes below the image.
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Skill Level 1 Level 2 Preceptor to sign and date Supervised Independent when competence achieved
Confirm viability
Date pregnancy
Diagnose corpus luteum cyst
Diagnose multiple pregnancy
Determine chorionicity/zygosity
Identify retroplacental haematoma
Diagnose anembryonic pregnancy
Diagnose missed miscarriage
Diagnose retained products of conception
Counselling for failed pregnancy
Diagnose ectopic pregnancy
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Hospital number Indication Management plan
Image description:
Hospital number Indication Management plan
Image description:
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Hospital number Indication Management plan
Image description:
Hospital number Indication Management plan
Image description:
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Hospital number Indication Management plan
Image description:
Hospital number Indication Management plan
Image description:
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Hospital number Indication Management plan
Image description:
Hospital number Indication Management plan
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Hospital number Indication Management plan
Image description:
Hospital number Indication Management plan
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MENORRHAGIA
Ultrasound images from six separate patient examinations from the above conditions should beattached on the following pages. The trainee should try to avoid repetition and aim to cover asmuch of the spectrum above as possible. For each examination, the patient’s hospital number,indication for scan and management plan should be recorded in the boxes below the image.
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Skill Level 1 Level 2 Preceptor to sign and date Supervised Independent when competence achieved
Identify submucous fibroid
Identify intramural fibroid
Identify subserous and pedunculated fibroid
Identify correctly placed IUCD
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Hospital number Indication Management plan
Image description:
Hospital number Indication Management plan
Image description:
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Hospital number Indication Management plan
Image description:
Hospital number Indication Management plan
Image description:
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Hospital number Indication Management plan
Image description:
Hospital number Indication Management plan
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POSTMENOPAUSAL ANDINTERMENSTRUAL BLEEDING
Ultrasound images from six separate patient examinations from the above conditions should beattached on the following pages. The trainee should try to avoid repetition and aim to cover asmuch of the spectrum above as possible. For each examination, the patient’s hospital number,indication for scan and management plan should be recorded in the boxes below the image.
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Skill Level 1 Level 2 Preceptor to sign and date Supervised Independent when competence achieved
Measure endometrial thickness
Identify atrophic endometrium
Identify hyperplastic endometrium
Identify endometrial polyps
Identify functional ovarian tumours
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Hospital number Indication Management plan
Image description:
Hospital number Indication Management plan
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Hospital number Indication Management plan
Image description:
Hospital number Indication Management plan
Image description:
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Hospital number Indication Management plan
Image description:
Hospital number Indication Management plan
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PELVIC PAIN/DYSPAREUNIA
Ultrasound images from six separate patient examinations from the above conditions should beattached on the following pages. The trainee should try to avoid repetition and aim to cover asmuch of the spectrum above as possible. For each examination, the patient’s hospital number,indication for scan and management plan should be recorded in the boxes below the image.
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Skill Level 1 Level 2 Preceptor to sign and date Supervised Independent when competence achieved
Diagnose ovarian cyst torsion
Diagnose ovarian cyst rupture
Diagnose ovarian cyst haemorrhage
Identify endometrioma
Identify hydrosalpinges
Diagnose residual ovary syndrome
Identify fixed retroverted uterus
Identify encapsulated fluid collection
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Hospital number Indication Management plan
Image description:
Hospital number Indication Management plan
Image description:
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Hospital number Indication Management plan
Image description:
Hospital number Indication Management plan
Image description:
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Hospital number Indication Management plan
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Hospital number Indication Management plan
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PELVIC MASS
Ultrasound images from six separate patient examinations from the above conditions should beattached on the following pages. The trainee should try to avoid repetition and aim to cover asmuch of the spectrum above as possible. For each examination, the patient’s hospital number,indication for scan and management plan should be recorded in the boxes below the image.
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Skill Level 1 Level 2 Preceptor to sign and date Supervised Independent when competence achieved
Identify mass as uterine
Identify unilocular ovarian mass
Identify multilocular ovarian mass
Identify solid and cystic ovarian mass
Identify mass as non-gynaecological
Identify ascites
Correlate ultrasound appearances with pathology for uterine and ovarian masses
Knowledge of relevant further investigations
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Hospital number Indication Management plan
Image description:
Hospital number Indication Management plan
Image description:
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Hospital number Indication Management plan
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Hospital number Indication Management plan
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Hospital number Indication Management plan
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REPRODUCTIVE MEDICINE
Ultrasound images from ten separate patient examinations from the above conditions should beattached on the following pages. The trainee should try to avoid repetition of conditions and aim tocover as much of the spectrum above as possible. For each examination, the patient’s hospitalnumber, indication for scan and management plan should be recorded in the boxes below theimage.
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Knowledge of: Preceptor to sign and date when target achieved
Ovulation induction
Sonohysterography
Hysterocontrast sonography
Ultrasound guided egg collection
Congenital genital tract anomalies
Ultrasound examination of the renal tract
Skill Level 1 Level 2 Preceptor to sign and date Supervised Independent when competence achieved
Identify postmenstrual endometrium
Identify periovulatory endometrium
Identify luteal phase endometrium
Identify natural follicle
Identify stimulated ovary
Identify hyperstimulated ovary
Identify polycystic ovary
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Hospital number Indication Management plan
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Hospital number Indication Management plan
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Appendix I
Contents of theoretical courseAttendance at a theoretical course is mandatory and can be undertaken at any time after enrolment.The contents of the theoretical course should include at least the following, in addition to coveringthe subjects outlined in the syllabus above:
● Physics, instrumentation and safety
● Normal pelvic anatomy and examination technique
● Selection of transabdominal or transvaginal ultrasound examination
● Normal pregnancy development in the first trimester
● Management of pregnancies of unknown location
● Congenital uterine anomalies
● Drug effects on the endometrium
● Diagnostic criteria and models for the diagnosis of ovarian cancer
● Screening for ovarian cancer
● Organisational arrangements in providing a gynaecological ultrasound assessment service
The theoretical course need not include any hands-on component, which should be undertakenlocally. Course organisers should ensure that the audiovisual facilities are of a high calibre andvideo recordings of examinations demonstrating salient features should be used.
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To be completed and returned to the:Special Skills Secretary,Postgraduate Training Department, RCOG, 27 Sussex Place, Regent’s Park, London NW1 4RG.
Please complete both sides of the form in block letters in black ink.
TO BE COMPLETED BY TRAINEE
SURNAME: .....................................................................................................................................................
OTHER NAMES: .............................................................................................................................................
RCOG REG NO: (V)NTN:__ __ __/__ __ __/__ __ __/__ MALE ■■ FEMALE ■■
ENTRY CRITERIA: (you must have possession of the MRCOG)
Date obtained MRCOG: __ __/__ __/__ __
NAME AND ADDRESS OF TRAINING CENTRE:
........................................................................................................................................................................
........................................................................................................................................................................
DATE OF COMMENCEMENT OF TRAINING: __ __/__ __/__ __
I WILL/HAVE ATTEND(ED) THE APPROVED THEORETICAL COURSE:
If you have attended please give date: __ __/__ __/__ __
Would you like to receive information on the approved theoretical course: YES ■■ NO ■■
Trainee’s signature: ........................................................................Date: .........................................................
Please complete overleaf
Please insert name of module:
Royal College of Obstetricians and Gynaecologists
SPECIAL SKILLS TRAINEE REGISTRATION FORM
TO BE COMPLETED BY PRECEPTOR(S)
Name of preceptor(s) in charge of training:
1. Name: .................................................................. 2. Name: ..................................................................
Post: ......................................................................... Post: .........................................................................
Department address: Department address:
................................................................................. .................................................................................
................................................................................. .................................................................................
................................................................................. .................................................................................
I agree to provide the training necessary for the completion of this Special Skills Module.
Preceptor name (1): Preceptor name (2):
................................................................................. .................................................................................
Date: ........................................................................ Date: ........................................................................
TO BE COMPLETED BY THE RCOG COLLEGE TUTORI confirm that the trainee can undertake this module of Special Skills Training under the supervision of thepreceptor(s) listed above.
Please print name:
................................................................................. Signature: .................................................................
Date: ........................................................................
TO BE COMPLETED BY THE CHAIRMAN OF THE DEANERY SPECIALISTTRAINING COMMITTEEI confirm that the trainee has completed core training and that the Deanery Specialist Training Committee hasapproved the training module for the trainee, preceptor(s) and programme of training.
Please print name:
................................................................................. Signature: .................................................................
Date: ........................................................................
IT IS THE RESPONSIBILITY OF THE TRAINEE TO OBTAIN THE REQUIRED SIGNATURES FOR THISFORM BEFORE FORWARDING TO THE COLLEGE
To be completed and returned to the:Special Skills Secretary,Postgraduate Training Department, RCOG, 27 Sussex Place, Regent’s Park, London NW1 4RG.
Please complete both sides of the form in block letters in black ink.
TO BE COMPLETED BY DOCTOR
SURNAME: .....................................................................................................................................................
OTHER NAMES: .............................................................................................................................................
RCOG REG NO:........................................................................ MALE ■■ FEMALE ■■
ENTRY CRITERIA: (you must have possession of the MRCOG)
Date obtained MRCOG: __ __/__ __/__ __
NAME AND ADDRESS OF TRAINING CENTRE:
........................................................................................................................................................................
........................................................................................................................................................................
DATE OF COMMENCEMENT OF TRAINING: __ __/__ __/__ __
I WILL/HAVE ATTEND(ED) THE APPROVED THEORETICAL COURSE:
If you have attended please give date: __ __/__ __/__ __
Would you like to receive information on the approved theoretical course: YES ■■ NO ■■
Doctor’s signature: ........................................................................Date: .........................................................
Please complete overleaf
Please insert name of module:
Royal College of Obstetricians and Gynaecologists
SPECIAL SKILLS REGISTRATION FORM FOR NON-TRAINING GRADES
TO BE COMPLETED BY PRECEPTOR(S)
Name of preceptor(s) in charge of training (please print name):
1. Name: .................................................................. 2. Name: ..................................................................
Post: ......................................................................... Post: .........................................................................
Department address: Department address:
................................................................................. .................................................................................
................................................................................. .................................................................................
................................................................................. .................................................................................
I agree to provide the training necessary for the completion of this Special Skills Module.
Preceptor signature (1): Preceptor signature (2):
................................................................................. .................................................................................
Date: ........................................................................ Date: ........................................................................
TO BE COMPLETED BY THE CLINICAL DIRECTORI confirm that the doctor can undertake this module of Special Skills Training under the supervision of thepreceptor(s) listed above.
Please print name:
................................................................................. Signature: .................................................................
Date: ........................................................................
TO BE COMPLETED BY THE CHAIRMAN OF THE DEANERY SPECIALISTTRAINING COMMITTEEI confirm that the trainee has completed core training and that the Deanery Specialist Training Committee hasapproved the training module for the doctor, preceptor(s) and programme of training.
Please print name:
................................................................................. Signature: .................................................................
Date: ........................................................................
IT IS THE RESPONSIBILITY OF THE DOCTOR TO OBTAIN THE REQUIRED SIGNATURES FOR THISFORM BEFORE FORWARDING TO THE COLLEGE
Royal College of Obstetricians and Gynaecologists
NOTIFICATION OF COMPLETION OF TRAINING MODULE(To be completed by preceptor)
I certify that
has completed the training module in ultrasound imaging in the management ofgynaecological conditions to my satisfaction. I confirm that I have had regular assessmentsessions with the trainee and each of the required skills in the logbook has been attained.
Date of commencement of practical training: __ __/__ __/__ __
Date satisfactorily completed theoretical course: __ __/__ __/__ __
Trainee name: ..................................................................................................................................................
Trainee signature: ..................................................................... Date: .........................................................
Preceptor(s) in charge of training.
Preceptor name (1): Preceptor name (2):
................................................................................. .................................................................................
Preceptor name (1): Preceptor name (2):
................................................................................. .................................................................................
Date: ........................................................................ Date: ........................................................................
Department address: Department address:
................................................................................. .................................................................................
................................................................................. .................................................................................
................................................................................. .................................................................................
Authorised by the Chairman of the Deanery Specialist Training Committee
Please print name:............................................. Signature: .........................................................................
Date: .................................................................
This certificate of completion of training should be sent to the
Special Skills Secretary, Postgraduate Training Department, RCOG, 27 Sussex Place, Regent’s Park, London NW1 4RG.
