The Foundation Programme at a Glance

Providing an overview of the formative years of a junior doctor's career, The Foundation Programme at a Glance consolidates the generic and condition-specific skills required to excel in this stage of training. Taking a simple and holistic approach to providing support for junior doctors, it integrates text and image content to suit all learning styles. Sections include advice on making the most of your training, tips on good clinical practice, communication, and common presentations and conditions. Edited by the National Director and Deputy National Director of the UK Foundation Programme, each section is written by experts in their respective fields, presenting insights into the programme with unrivalled authority. The Foundation Programme at a Glance: •Uses diagrams, line drawings and flow charts to clearly illustrate concepts •Follows the current Foundation Programme curriculum •Integrates theory and practice This comprehensive and practical volume contains all the vital information you need to reach excellence during the foundation years, and to get the most out of your time on the programme. The Foundation Programme at a Glance Contents List of contributors Preface Acknowledgements List of abbreviations How to use your textbook 1 Shadowing and induction Shadowing and induction Clinical placements Student assistantships Learning how to do your first F1 job Shadowing Induction What you need to know Who else should you meet? 2 The e-portfolio – how to plan, manage and evidence your learning What is the e-portfolio for? Who has access to my e-portfolio? What do I put in it? Planning and recording your learning Recording your meetings with your clinical and educational supervisors Supervised learning events and assessments Reflection Additional evidence Sign-off at the end of F1 and F2 3 Supervised learning events and assessments Supervised learning events (SLEs) What are SLEs? When and how do you record a SLE? What is DOPS? What is mini-CEX? What is CBD? What is developing the clinical teacher? Assessments How will you be assessed? What is TAB? How are core procedural skills assessed? What are the supervisor’s reports? How to use feedback 4 Reflective learning What is reflection? Why is it important? Using the e-portfolio to help your reflective practice A model for reflection What examples can you use in your reflective log 5 Managing your medical career What should I aim for in my medical career? Career discussions and where to find career support Exploring options in the foundation programme Other career issues and changes to plan 6 Applying to specialty training Exploration of the options Career structure of your chosen specialties Application process timelines Interview/selection process Applicant etiquette Less than full time (LTFT) training Myths about speciality training applications 7 Quality improvement and clinical leadership What is quality improvement? Improving healthcare for the benefit of patients Leading and implementing changes 8 Quality improvement projects Plan, do, study, act (PDSA) Plan Do Study Act Audit Stage 1 – what problemwould you like to fix? Stage 2 – what are you seeking to achieve? Stage 3 – how are you going to gather and analyze the data? Stage 4 – what changes or improvements need to be made? Stage 5 – how will you demonstrate that you have made a difference? 9 Breaking bad news and handling complaints Breaking bad news Handling complaints 10 Assessing capacity and informed consent What is mental capacity? Principles Supporting patients to make decisions Two-stage test of mental capacity Stage 1 – diagnostic test Stage 2 – functional test Acting in the patient’s best interests 11 Handover and communicating with colleagues Effective communication with colleagues Safe handover Leadership and communication Dealing with poor performance in others Dealing with your own difficulties 12 Communication between primary and secondary care Written communication Discharge letters Referral letters and internal referrals Clinic letters 13 Introduction to evidence-based medicine What is evidence-based medicine? Why is it important? How to practice EBM – the five steps Step 1 – how to ask structured clinical question Step 2 – how to access (search for) the best available evidence Step 3 – how to critically appraise the evidence Step 4 – how to apply the evidence in practice Step 5 – how to assess your performance 14 Critical appraisal of randomized controlled trials What is critical appraisal? Is the RCT applicable and valid? Are the results important? Is it a poor quality study or a poorly reported study? 15 Critical appraisal of systematic reviews and meta-analyses Question – does it ask a clearly focused question? Find – did it find all the best evidence? Appraise – were the studies critically appraised? Synthesis – were the results appropriately combined? What could you tell your patient? 16 Making the most of guidelines and protocols What is the difference between a guideline and protocol? How to find guidelines and protocols How to critically appraise a guideline or protocol How to use guidelines and protocols 17 Running a teaching session and presentation skills Maximising learning Choosing the right media PowerPoint Printed material Audio Videotape Practical/simulation Length Emphasize key messages 18 Assessment and feedback Assessment methodology Assessment tools Miller’s pyramid of clinical competence (Fig. 18.1) Assessment demonstrating cause for concern Feedback Principles of feedback Giving feedback 19 Assessing and managing the acutely ill patient Identifying the unwell patient Approaching the acutely ill patient Initial assessment Airway Breathing Circulation Disability When should I call for help? 20 Rational prescribing First steps Prescribing Treatment Compliance External effects on prescribing Drug reactions What to report 21 Medical record keeping Why keep medical records? What is included in medical records? Who contributes to medical records? What information should be recorded? What should not be recorded in the notes? Confidentiality Who can view medical records? 22 Time management How can I maximize my time? Ward rounds Preoperative assessments Ward work On call Protected time Reference 23 Fluid management Normal body fluids Abnormalities of fluid balance Assessment of the volume state Management of abnormalities of fluid balance Administration and monitoring of fluid replacement Volume overload Maintenance fluids’ 24 Blood transfusion Blood transfusion Risks of transfusion Managing transfusion reactions Prescribing blood products Avoiding transfusion errors Sampling Setting up a transfusion Reference 25 Discharge planning Why is discharge planning important? What is discharge planning? What is the foundation doctor’s role in discharge planning? How is a discharge planned? Early supported-discharge teams Who can discharge a patient? 26 Nutrition Specific malnutrition (vitamin and mineral deficiencies) Nutritional support Indications Therapeutic diets 27 Health promotion and public health Alcohol Smoking Drugs Diet and nutrition Wider public health issues 28 Do not attempt CPR decisions Ethical and legal considerations When to consider making a DNACPR decision Discussions about CPR What if a person lacks capacity? What if there is a disagreement? Practical Issues 29 Palliative care Pain Assessment Treatment (Fig. 29.1c) Terminal phase of illness 30 Certifying death How to complete a MCCD When to inform the coroner or procurator fiscal What does the coroner or procurator fiscal need to know? What happens next? 31 The unconscious patient History Examination Airway Breathing Circulation Disability Examination/Everything Else Investigations Management 32 Stridor What is stridor? What you see History Management What to do while waiting for help to arrive Ongoing management 33 Anaphylaxis Mechanism Triggers Presentation/range of symptoms What questions to ask the patient? Examination/anything else to look for? Practical management Investigations 34 Asthma Definition Epidemiology Aetiology Pathology Assessment Severe uncontrolled asthma Prognosis 35 Pneumothorax and pulmonary embolism Pneumothorax Definition Classification Assessment Management Pulmonary embolism Definition Risk factors Pneumothorax and pulmonary embolism (continued) Clinical features Investigations Treatment (Fig. 35.2) 36 Chronic obstructive pulmonary disease Definition Aetiology Pathology Clinical features Investigations Management 37 Community-acquired pneumonia Classification Epidemiology Risk factors Clinical features Investigations Severity assessment Management 38 Acute chest pain Key points Differential diagnosis Heart and aorta Lung Oesophagus, stomach and abdominal disease Chest wall Important diagnostic features Ischaemic chest pain Pulmonary embolism Pleuritic pain Aortic dissection Pericarditis Oesophageal pain Musculoskeletal pain The acute coronary syndromes Key investigations ECG Cardiac troponin Other blood tests Chest X-ray CT scanning Echocardiography 39 Palpitations Key points Differential diagnosis: what is the patient describing? Irregular heart beat Paroxysmal tachycardia (Fig 39.1) Abnormal or increased awareness of the normal heartbeat Important diagnostic features Supraventricular tachycardias Ventricular tachycardia Paroxysmal atrial fibrillation Key investigations ECG Holter (ambulatory) ECG recorders Invasive electrophysiology study 40 Hypotension Definitions Blood pressure Hypotension Symptoms and signs Causes Acute hypotension Chronic hypotension Management Evaluate Acute hypotension Chronic hypotension 41 Severe sepsis Definitions Systemic inflammatory response syndrome (SIRS) Sepsis Severe sepsis Incidence and risk factors Management Early management (1st hour) Monitoring and reassessment (1–4 hours) Advanced management (1–6 hours) 42 Oliguria – including acute kidney injury Presentation Prevention History Examination Investigations Management Immediate management for all patients If you suspect hypovolaemia . . . If the patient has urinary obstruction . . . Ongoing management 43 Electrolyte derangement–hyperkalaemia Hyperkalaemia Presentation History Examination Investigations Management 44 Electrolyte derangement – hyponatraemia Hyponatraemia Presentation History Examination Investigations Management 45 Diabetic ketoacidosis Recognition and management of DKA Pathophysiology Aetiology Mortality and morbidity Treatment Rationale for best practice Patient care Resolution phase 46 Hypoglycaemia Recognition of hypoglycaemia Spontaneous hypoglycaemia Causes of hypoglycaemia in diabetes Risk factors for hypoglycaemia in diabetes Treatment Follow on care 47 Abdominal pain History Examination Investigations Red flag conditions Ruptured abdominal aortic aneurysm Ectopic pregnancy Perforated viscus Appendicitis 48 Gastrointestinal bleeds Causes History Initial assessment and management: the ABC approach 49 Back pain and large joint pain Back pain Differential diagnosis Investigations Treatment Large joint pain Polyarthritis Monoarthritis Investigations Treatment References 50 Fractures and dislocations Causes Shape and direction of injury History Examination Investigation Classification of fractures Growth plate fractures in children Management Complications Osteotomies 51 Coma Causes Assessment of the level of consciousness Priorities History Examination Urgent investigation of the unconscious patient Further management 52 Seizures Stop the seizure First line: benzodiazepines Second line: benzodiazepines Third line: anticonvulsants Fourth line: sedation and intubation After the seizure: the post-ictal period Search for a cause Was it a seizure? Seizure vs pseudoseizure Causes, triggers and auras Examination Investigations Who can go home? 53 Meningitis and encephalitis Meningitis Bacterial meningitis Viral meningitis Other causes of meningitis Encephalitis Cerebral abscess 54 Stroke/acute onset of focal neurological signs Clinical assessment Investigations Stroke Stroke subtypes: clinical syndromes Stroke mimics Treatment Transient ischaemic attack 55 Acute visual impairment Vascular occlusion Retinal vein occlusion Retinal artery occlusion Non-arteritic anterior or posterior ischaemic optic neuropathy Cerebrovascular accident Acephalgic migraine Vitreous haemorrhage Management Retinal detachment Management 56 Depression How to diagnose a major depressive episode What are the risk factors for depression? What are the risks associated with depression? What else could it be? How to manage patients with a depressive episode What is the prognosis? 57 Psychosis What is psychosis? Schizophrenia How to assess for psychosis Differential diagnosis for schizophrenia How to manage a patient with schizophrenia Prognosis and risk Assessing and managing aggressive patients Recognizing aggression History from others Assessment of the patient Management Follow-up 58 Anxiety disorders Anxiety disorders Epidemiology Aetiology (Fig. 58.1) Panic disorder Generalized anxiety disorder (GAD) 59 Harmful drinking and alcohol dependence Screening for harmful use/alcohol dependence Detailed assessment Management of assisted alcohol withdrawal Alcohol withdrawal in hospital 60 Child abuse and protection Cause for concern – the child’s injury Parental responsibility History Examination Distinguishing accidental from non-accidental injuries Action Referral to social services In an emergency Pitfalls in diagnosis Reference 61 The febrile child, and recognizing the seriously ill child (including UTI and meningitis) Detection of fever Assessment Remote assessment, e.g. telephone Assessment by the non-paediatric practitioner, e.g. GP Assessment by the paediatric specialist service Further clinical assessment of the child with fever Symptoms and signs of specific illnesses 62 Cough and wheeze Is it asthma? Initial assessment For a child with a high probability of asthma For a child with a low probability of asthma For a child with an intermediate probability of asthma Managing acute asthma in children Children under 2 years Children over 2 years Long-term management of stable asthma Reference 63 Diarrhoea, vomiting and constipation in young children Diarrhoea and vomiting (D&V) Diagnosis Children at greater risk of dehydration or recurrence Fluid management Antibiotic therapy in gastroenteritis Constipation Assessment and diagnosis Management of idiopathic constipation References 64 Confusion, dementia and delirium Delirium Dementia Risk factors Diagnosis Treatment 65 Fits, faints and falls Check History Treatment in fits and faints Implications of a diagnosis of epilepsy Prevention of falls Next steps Index