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

     

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