Headache
The trainee will be able to assess a patient presenting with headache to produce a valid differential diagnosis, investigate appropriately, formulate and implement a management plan
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Knowledge
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Assessment Methods
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GMP Domains
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Know the presentation of the common and life threatening causes of new onset headache
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E, C, Mi, ACAT
|
1
|
Understand the pathophysiology of headache
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E, C, Mi, ACAT
|
1
|
Recall the indications for urgent CT/MRI scanning in the context of headache
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E, C, Mi, ACAT
|
1
|
Recall clinical features of raised intra-cranial pressure
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E, C, Mi, ACAT
|
1
|
Demonstrate knowledge of different treatments for suspected migraine
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E, C, Mi, ACAT
|
1
|
Skills
|
|
|
Recognise important diagnostic features in history
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E, Mi, C
|
1
|
Perform a comprehensive neurological examination, including eliciting signs of papilloedema, temporal arteritis, meningism and head trauma
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E, D
|
1
|
Order, interpret and act on initial investigations
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Mi, C
|
2
|
Perform a successful lumbar puncture when indicated with minimal discomfort to patient observing full aseptic technique
|
D
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1
|
Interpret basic CSF analysis: cell count, protein, bilirubin, Gram stain and glucose
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E, Mi, C
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2
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Initiate prompt treatment when indicated: appropriate analgesia; antibiotics; antivirals; corticosteroids
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Mi, C
|
1
|
Behaviour
|
|
|
Recognise the nature of headaches that may have a sinister cause and assess and treat urgently
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ACAT, C
|
1
|
Liaise with senior doctor promptly when sinister cause is suspected
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ACAT, C
|
3
|
Involve neurosurgical team promptly when appropriate
|
ACAT, C
|
2, 3
|
Head Injury
The trainee will be able to evaluate the patient who presents with a traumatic head injury, stabilize, assess, appropriate investigate and implement a management plan.
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Knowledge
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Assessment Methods
|
GMP Domains
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Know the anatomy of the scalp, skull and brain, the pathophysiology of head injury (primary and secondary injury) and the symptoms and signs.
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E, C, Mi, ACAT
|
1
|
Know the indications for urgent CT scanning (national guidelines for CT imaging in head injury). Know the appearances of the common head injuries
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E, C, Mi, ACAT
|
1
|
Know the indications for admission following head injury.
|
E, C, Mi, ACAT
|
1
|
Know which patients can be safely discharged.
|
E, C, Mi, ACAT
|
1
|
Skills
|
|
|
Be able to use the ABC approach to the management of a head injury patient, with cervical spine immobilisation.
|
E, D
|
1
|
Be able to demonstrate to use of the GCS and ability to identify those who will need intubation and ventilation.
|
E, MI, ACAT
|
1
|
Elicit the important facts from the history and undertake a full neurological exam to elicit signs of head injury and neurological deficit.
|
E, Mi, C
|
1
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Recognise and initially manage the secondary consequences of head injury (e.g. loss of airway patency, seizures, raised ICP).
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Mi, S, D
|
1
|
Behaviour
|
|
|
Know when to seek senior and anaesthetic, neurosurgical support.
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ACAT, C
|
2
|
Optimise team working between critical care, neurosurgery, emergency and acute medicine.
|
ACAT, C
|
2
|
Jaundice
The trainee will be able to assess a patient presenting with jaundice to produce a valid differential diagnosis, investigate appropriately, formulate and implement a management plan
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Knowledge
|
Assessment Methods
|
GMP Domains
|
Recall the pathophysiology of jaundice in terms of pre-hepatic, hepatic, and post-hepatic causes
|
E, C, Mi, ACAT
|
1
|
Recall causes for each category of jaundice with associated risk factors
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E, C, Mi, ACAT
|
1
|
Recall issues of prescribing in patients with significant liver disease
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E, C, Mi, ACAT
|
1
|
Recall basic investigations to establish aetiology
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E, C, Mi, ACAT
|
1
|
Demonstrate knowledge of common treatments of jaundice
|
E, C, Mi, ACAT
|
1
|
Skills
|
|
|
Take a thorough history and examination to arrive at a valid differential diagnosis
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E, Mi, C
|
1
|
Recognise the presence of chronic liver disease or fulminant liver failure
|
Mi, C
|
1
|
Interpret results of basic investigations to establish aetiology
|
E, Mi, C
|
1
|
Recognise complications of jaundice
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E, Mi, C
|
|
Recognise and initially manage complicating factors: coagulopathy, sepsis, GI bleed, alcohol withdrawal, electrolyte disturbance
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E, C
|
1
|
Behaviour
|
|
|
Exhibit non-judgmental attitudes to patients with a history of alcoholism or substance abuse
|
ACAT, C, M
|
4
|
Consult seniors and gastroenterologists promptly when indicated
|
ACAT, C
|
3
|
Contribute to the patient’s understanding of their illness
|
ACAT, PS
|
4
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Recognise the importance of a multi-disciplinary approach
|
ACAT, C, M
|
3
|
Limb Pain & Swelling - Atraumatic
The trainee will be able to assess a patient presenting with atraumatic limb pain or swelling to produce a valid differential diagnosis, investigate appropriately, formulate and implement a management plan
|
Knowledge
|
Assessment Methods
|
GMP Domains
|
Recall the causes of unilateral and bilateral limb swelling in terms of acute and chronic presentation
|
E, C, Mi, ACAT
|
1
|
Recall the different causes of limb pain. Recall the pathophysiology for pitting oedema, non-pitting oedema, thrombosis and peripheral ischemia
|
E, C, Mi, ACAT
|
1
|
Recall the risk factors for the development of thrombosis and recognised risk scoring systems
|
E, C, Mi, ACAT
|
1
|
Recall the indications, contraindications and side effects of diuretics and anti-coagulants
|
E, C, Mi, ACAT
|
1
|
Demonstrate awareness of the longer term management of DVT
|
E, C, Mi, ACAT
|
1
|
Differentiate the features of limb pain and/or swelling pain due to cellulitis, varicose eczema, critical ischaemia and DVT
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E, C, Mi, ACAT
|
1
|
Skills
|
|
|
Perform a full and relevant examination including assessment of viability and perfusion of limb and differentiate pitting oedema; cellulitis; venous thrombosis; compartment syndrome
|
E, D
|
1
|
Recognise compartment syndrome and critical ischaemia and take appropriate timely action
|
E, Mi, C
|
2
|
Order, interpret and act on initial investigations appropriately: blood tests, Doppler studies, urine protein
|
E, Mi, C
|
2
|
Practise safe prescribing of initial treatment as appropriate (anti-coagulation therapy, antibiotics etc)
|
Mi, C
|
2
|
Prescribe appropriate analgesia
|
MI, C, AA
|
2
|
Behaviour
|
|
|
Liaise promptly with surgical colleagues in event of circulatory compromise (e.g. compartment syndrome)
|
ACAT, C
|
3
|
Recognise importance of thromboprophylaxis in high risk groups
|
ACAT, C, AA
|
2
|
Neck pain
The trainee will be able to evaluate the patient who presents with neck pain, produce a valid differential diagnosis, appropriate investigation and implement a management plan.
|
Knowledge
|
Assessment Methods
|
GMP Domains
|
Outline the common and serious causes of neck pain including meningeal irritation, trauma, musculoskeletal inflammation, local infection and vascular causes.
|
E, C, Mi, ACAT
|
1
|
Understand the investigations required to make a diagnosis
|
E, C, Mi, ACAT
|
1
|
Skills
|
|
|
Take a full history including recent trauma and appropriate physical examination.
|
E, Mi, D
|
1
|
Identify those patients with meningism and consult senior early.
|
Mi, C
|
1
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Order, Interpret and act on initial tests
|
Mi, C
|
1
|
Be able to prescribe appropriate analgesia and antibiotics
|
Mi, C, AA
|
1
|
Behaviour
|
|
|
Ask for senior advice appropriately
|
ACAT, C
|
2
|
Oliguric patient
The trainee will be able to produce a differential diagnosis, establish safe monitoring, investigate appropriately and formulate an initial management plan when assessing a patient with a low urine output.
|
Knowledge
|
Assessment Methods
|
GMP Domains
|
Understand the principal causes of a low urine output in the critically ill patient, and be able to identify the principal sub causes (pre-renal, renal and post renal), including but not limited to: hypotension and inadequate renal perfusion renal tract obstruction nephrotoxic drugs and contrast media
|
E, C, Mi, ACAT
|
1
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Understand current terminology and classification of acute kidney injury
|
E, C, Mi, ACAT
|
1
|
Understand appropriate monitoring of the patient with a low urine output, including but not limited to: clinical assessment Urinary catheterisation cardiovascular monitoring including pressure and flow monitoring techniques (see principles of monitoring cardiac output) arterial blood gases
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E, C, Mi, ACAT
|
1
|
Understand the methods of assessment of renal function including but not limited to: blood tests assessment of renal excretion. Imaging of the GU tract
|
E, C, Mi, ACAT
|
1
|
Outline immediate management options including but not limited to: Fluid resuscitation Increased cardiovascular monitoring Administration of vasoactive drugs and inotropes The role of diuretics
|
E, C, Mi, ACAT
|
1
|
Understand the role of renal replacement therapy in the oliguric patient
|
E, C, Mi, ACAT
|
1
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Be able to safely prescribe for patients in renal failure
|
E,C, Mi, ACAT
|
1
|
Skills
|
|
|
Make a rapid and immediate assessment including appropriate clinical examination
|
Mi, C
|
1
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Initiate appropriate immediate management
|
MI, C
|
1
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Prioritise, order, interpret and act on simple investigations appropriately
|
Mi, C
|
1
|
Initiate early (critical) management (e.g. fluid administration) including requesting safe monitoring
|
Mi, C
|
1
|
Behaviour
|
|
|
Recognise need for immediate assessment and resuscitation
|
ACAT, C
|
1
|
Assume leadership role where appropriate
|
ACAT, C
|
2,3
|
Involve appropriate senior help to facilitate immediate assessment and management
|
ACAT, C
|
3
|
Involve appropriate specialists to facilitate immediate assessment and management or decreased renal function (e.g. imaging, intensive care, surgeons, renal physicians)
|
ACAT, C
|
3
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