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 Tuesday Wednesday Thursday Friday am 9:00 – 11:00 PU WARD ROUND – Liaison 9:00 – 12:30 – Ward Review Case Discussion (Mother & Baby Assessments MDT Referral / Unit) Allocation / Admin Supervision With CPNs – Journal Club/ Ward work Case Conference pm 13:30 – 17:00 Ward Work Obstetric Liaison Urgent Follow-up OPC - Foundation / Home Visits Assessments Teaching 16:00 – 17:00 Programme Supervision Admin

Page 2 of 16 December 2010 Trainer timetable

Monday Tuesday Wednesday Thursday Friday am 9:00 – 10:00 WARD ROUND – ON CALL PPS 9:00 – 12:30 – WARD REVIEW - Admin (Mother & Baby URGENTS MDT REFERRAL / ON CALL PPS 10:00 – Unit) ALLOCATION / URGENTS 12:00NOON ON CALL PPS SUPERVISION New patient URGENTS POSTGRAD WITH CPNs – clinic MEETING

Journal Club/ pm 13:40 – 17:00 2:00 – 3:00 2:00 – 5:00 SPA 13:30 – 17:00 Admin / Obstetric FOLLOW-UP ADMIN – – (1ST & 3RD) Liaision – CLINIC – ON CALL PPS Outpatient Clinic ON CALL PPS 3:00 - 4:00 URGENTS – URGENTS SUPERVISION OF 12:30 – 2:00 2ND SpR Business Mtg 4:00 – 5:00 12:30 – 2:00 4TH Supervision of Perinatal SHO Clinical / Audit ON CALL PPS 15:00 – 17:00 URGENTS Urgent

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 disorders (including puerperal psychosis), OCD and relapses of Page 4 of 16 December 2010 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 specialised services are available. They will be expected to prioritise and manage referrals and to work within the multidisciplinary team across the Page 5 of 16 December 2010 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.

3 Recognition and management of the acutely ill patient Page 6 of 16 December 2010 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

3.8 Uses common analgesic drugs safely and effectively

Page 7 of 16 December 2010 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 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 on- call rota incorporates a one-hour overlap between shifts to complete work and Page 8 of 16 December 2010 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. 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

Page 9 of 16 December 2010 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 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. Page 10 of 16 December 2010 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. 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.

Page 11 of 16 December 2010 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.

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.

Page 12 of 16 December 2010 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 (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

Page 13 of 16 December 2010 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. 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.

Page 14 of 16 December 2010 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 • substance abuse • delirium or acute confusional state • psychosis. Investigations & procedures

Page 15 of 16 December 2010 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.

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