Domain: Obstetrics and gynaecology



Logbook for the MMed in Family Medicine

2012

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Division of Family Medicine and Primary Care

Registrars Name: _______________________________

Student number: ________________________________

Training complex: _______________________________

Training co-ordinator: ____________________________

Introduction

This logbook should be fully completed during the year and handed in to the University at the end of the year as documentary evidence of your professional experience and clinical competency. It will be required by the University as a pre-requisite for certifying adequate education and training to the HPCSA when you wish to register as a Family Physician. The logbook will become part of your learning portfolio. It is important that you keep your logbook up to date from the beginning. There are 4 sections:

Section 1: Verification of professional experience within the training complex

Section 2: Record of educational meetings

Section 3: Rating of competency in the core clinical skills

Section 4: Annual or end-of-rotation reports

It is important therefore that you complete sections 1, 3 and 4 clearly, accurately and completely at the end of every rotation in the regional hospital or every 6-months at the district hospital or community health centre. In the regional hospital the appropriate section should be signed by the consultant supervising your training and at the district hospital or community health centre by the family physician supervising you. Section 2 should be completed continuously during the programme.

In summary the learning outcomes for Clinical Family Medicine are to:

• Demonstrate competency in all consultations according to the patient-centred clinical method that incorporates effective communication/counselling skills, competent examination skills / investigations, rational decision making, a 3-stage assessment, and a cost-effective, evidence-based and patient-centred management plan.

• Demonstrate competency in emergency, technical and surgical skills necessary for functioning in primary care and the district hospital

• Demonstrate a high degree of professionalism that includes the ability to resolve ethical and medico-legal dilemmas, be aware of one’s own value system, deliver quality care irrespective of one’s own perceptions or prejudices, and the background (with respect to gender, ethnicity, religion or sexual orientation) of your patient and to always deal courteously with patients, colleagues and the public.

MMed students outside South Africa or prior to new HPCSA regulations

While this logbook is designed for the formal training complexes in South Africa the students studying the MMed in other countries or under the old regulations are expected to work in appropriate settings and with suitable supervision – as specified in the programme’s brochure. We have used the term registrar throughout the logbook for simplicity. The sections of the logbook should be completed as follows:

Section 1: By your superintendent, consultant or mentor

Section 2: By your consultant or mentor

Section 3: By your consultant or a senior colleague who works directly with you

Section 4: By your superintendent, consultant or mentor

Section 1 Verification of rotations and professional experience within the training complex

Experience received in primary care or district hospital facilities:

|Date from: |Date to: |Name of institution / facility and |Type of institution / facility |Number of months of |Signed by supervisor |Print supervisors name and give email / telephone|

| | |location |Primary care |full time experience* | |/ cellphone |

| | |Name |District hospital | | | |

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Experience received in a regional, secondary or tertiary hospital:

|Date from: |Date to: |Name of institution / facility and |Name of specialist department where |Number of months of |Signed by supervisor |Print supervisors name and give email or |

| | |location |experience received e.g. internal |full time experience* | |telephone or cellphone |

| | |Name |medicine, general surgery etc. | | | |

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Note: 1 week of full time equivalent = 40 hours, 1 month = 80 hours, during office hours and not counting overtime

Section 2 Record of educational meetings

During the programme the registrar should meet individually with their immediate supervisor and as a group of registrars with their training complex co-ordinator. These meetings can be alternated weekly (i.e. one week with your supervisor one-on-one and the next week as a group) and should last 1-2 hours and be recorded in the logbook. Use the letters below to record the general focus of the meeting and then describe what was done. The meetings could focus on one of the following learning opportunities:

A: Setting a learning agenda (at the beginning and end of a rotation or every 6-months): Reflection on the registrars experience to date, expectations or progress and planning of learning activities and goals for the next period.

B: Intermittent evaluation: For the registrar and trainer to check progress, discuss any difficulties in their relationship or the organization that impede learning or service delivery, make new plans. Feedback can also be given and received on the programme or registrars performance. More detailed notes can be made at the end of this section under the notes page.

C: Clinical / communication skills: Observation/audio/video-review of communication and consultation skills (the division has a specific assessment sheet) and feedback with role-play or simulation. Other clinical skills might also be demonstrated.

D: Case discussions: Reflect on your actual patients through the use of record review, presentation of problem patients or clinical tutorials on specific topics. The study guides for different clinical domains in Clinical Family Medicine also specify what is expected in terms of patient presentations and discussion of clinical scenarios. Reflect on difficult consultations, emotions or ethical dilemmas that arise from your clinical practice or setting.

E: Evidence based practice: Reflect on and critically appraise current journals and original research.

F: Other: For example co-ordination of on-line learning tasks with the on-site professional experience and service priorities i.e. topic for the quality improvement cycle

The logbook at the end of the year should demonstrate engagement with all of the above activities and a minimum of 2-hours formal tuition per month / 24-hours for the year. This minimum standard is needed to fulfil the University requirements, but in normal circumstances the portfolio should show engagement above the minimum standard.

|Date |Group or individual|Code letter from list |Duration (hrs) |Description of content covered / |Signature of |

| |meeting |of activities | |activities / topics |supervisor |

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|23/2/08 |Group |C |2 |Review of 2 audio tapes and breaking bad |R Mash |

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|Date |Group or individual|Code letter from list |Duration (hrs) |Description of content covered / |Signature of |

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|Date |Group or individual|Code letter from list |Duration (hrs) |Description of content covered / |Signature of |

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|Date |Group or individual|Code letter from list |Duration (hrs) |Description of content covered / |Signature of |

| |meeting |of activities | |activities / topics |supervisor |

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Notes

Section 3 Rating of competency in the core clinical skills

1. Domain: Obstetrics and Gynaecology

The following table lists the clinical skills in this domain that should be acquired or consolidated during the 4-year registrar training in Family Medicine. The list is intended to guide the registrar, training complex co-ordinator or other consultant supervisor on what core practical experience and skills training to focus on. The supervisor should evaluate the registrar’s competency at the beginning and end of their rotation at the regional hospital or at least every 6-months (i.e. February and August) at the district hospital / community health centre. Competency in these skills should be acquired and consolidated by a combination of experience and supervision at the regional hospital, district hospital and community health centre.

It is assumed that while learning these specific skills the registrar will be exposed to an appropriate spectrum of patients and will be supervised in clinical assessment, decision making and management. The practical on-site training will also be complemented by the academic on-line learning that targets clinical knowledge, decision making and application of core family medicine principles.

The skills should be rated according to the following definitions from A to D. The rating should be entered in the table below. If the registrar has not been exposed to the domain at all during the year then leave the column blank. Skills listed elsewhere can also be assessed if they are relevant to the rotation.

After making an entry in the table you should also complete and sign the relevant section underneath.

|A: Only Theory: |

|Only theoretical knowledge regarding the skill’s principles, indications, contraindications, performance and complications. |

|B: Seen or have had demonstrated: |

|Have theoretical knowledge regarding the skill and have seen or observed the skill demonstrated by someone else |

|C: Apply/Perform: |

|Have theoretical knowledge regarding the skill and have performed the skill in question under supervision, at least several times. |

|D: Routine/Independent: |

|Have the theoretical knowledge regarding the skill and be competent to perform the skill independently. |

|Clinical topic |Clinical skills |Use one column to grade the registrar and |

| | |add date / comments in box underneath |

| |– aim is D for unshaded skills and C for shaded | |

| |skills |1st 2nd |

|Antenatal care |Antenatal growth chart | | |

| |Assess foetal movement / wellbeing | | |

| |Clinical pelvimetry | | |

| |Obstetric ultrasound | | |

| |Amniocentesis | | |

|Intra-partum care |Examine progress during labour and use partogram | | |

| |Apply and interpret CTG | | |

| |Assess foetal wellbeing during labour | | |

| |Normal vaginal delivery | | |

| |Assisted vaginal delivery / vacuum extraction / | | |

| |forceps | | |

| |Caesarean section (including ability to do | | |

| |sub-total hysterectomy) | | |

| |Episiotomy and suturing | | |

| |Repair of 3rd degree tear | | |

| |Evacuation of uterus | | |

| |Manual removal of placenta | | |

| |External cephalic version | | |

| |Resuscitate a newborn | | |

|Newborn / | | | |

|Post-partum care | | | |

| |Umbilical vein catheterization | | |

| |Assess gestational age at birth | | |

| |Kangaroo mother care | | |

| |Phototherapy | | |

| |Well newborn check | | |

| |Microscopy of vaginal discharge (wet mount, KOH) | | |

|Women’s health | | | |

| |Endometrial biopsy/sampling | | |

| |Dilatation and Curettage | | |

| |Drainage of Bartholin's abscess / cyst | | |

| |Tubal ligation | | |

| |FNAB of breast lump | | |

| |Insertion of IUCD | | |

| |Papanicolau (cervical) smears | | |

| |Culdocentesis | | |

| |Hormone implants | | |

| |Laparotomy for ectopic pregnancy | | |

| |TOP (if no religious/ethical objections) | | |

|Clinical governance |MOU support, the perinatal audit meetings and PPIP | | |

| |programme, the training and audits of the basic | | |

| |antenatal care and perinatal education programmes | | |

| |and intrapartum audits | | |

|Date completed: |

|Comments on the registrar’s progress, clinical performance or professionalism in this domain / any additional skills acquired.|

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|Name of supervisor |

|Signature supervisor |

|Signature student / registrar |

|Column number used |

|Date completed: |

|Comments on the registrar’s progress, clinical performance or professionalism in this domain / any additional skills required |

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|Name of supervisor |

|Signature supervisor |

|Signature student / registrar |

|Email / Telephone |

2. Domain: Adult internal medicine

The following table lists the clinical skills in this domain that should be acquired or consolidated during the 4-year registrar training in Family Medicine. The list is intended to guide the registrar, training complex co-ordinator or other consultant supervisor on what core practical experience and skills training to focus on. The supervisor should evaluate the registrar’s competency at the beginning and end of their rotation at the regional hospital or at least every 6-months (e.g. February and August) at the district hospital / community health centre. Competency in these skills should be acquired and consolidated by a combination of experience and supervision at the regional hospital, district hospital and community health centre.

It is assumed that while learning these specific skills the registrar will be exposed to an appropriate spectrum of patients and will be supervised in clinical assessment, decision making and management. The practical on-site training will also be complemented by the academic on-line learning that targets clinical knowledge, decision making and application of core family medicine principles.

The skills should be rated according to the following definitions from A to D. The rating should be entered in the table below. If the registrar has not been exposed to the domain at all during the year then leave the column blank. Skills listed elsewhere can also be assessed if they are relevant to the rotation.

After making an entry in the table you should also complete and sign the relevant section underneath.

|A: Only Theory: |

|Only theoretical knowledge regarding the skill’s principles, indications, contraindications, performance and complications. |

|B: Seen or have had demonstrated: |

|Have theoretical knowledge regarding the skill and have seen or observed the skill demonstrated by someone else |

|C: Apply/Perform: |

|Have theoretical knowledge regarding the skill and have performed the skill in question under supervision, at least several times. |

|D: Routine/Independent: |

|Have the theoretical knowledge regarding the skill and be competent to perform the skill independently. |

|Clinical topic |Clinical skills |Use one column to grade the registrar and |

| | |add date / comments in box underneath |

| |– aim is D for unshaded skills and C for shaded | |

| |skills |1st 2nd |

|Adult health - general |Femoral vein puncture | | |

| |Lumbar puncture | | |

| |Arterial sampling radial artery | | |

| |Blood culture technique | | |

| |Injections - intra-dermal, subcutaneous, | | |

| |intra-muscular, deep intramuscular, | | |

| |sub-conjunctival, | | |

|Adults- Abdomen |Interpret the AXR in an adult | | |

| |Proctoscopy | | |

|Adults- Chest |ECG - set-up, record and interpret 12 lead ECG | | |

| |Interpret CXR | | |

| |Pleural tap | | |

| |Measure PEF | | |

| |Nebulise a patient | | |

| |Use inhalers and spacers | | |

| |Exercise stress test | | |

| |Perform and interpret office spirometry | | |

| |Pleural biopsy | | |

|Date completed: |

|Comments on the registrar’s progress, clinical performance or professionalism in this domain / any additional skills acquired |

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|Name of supervisor |

|Signature supervisor |

|Signature student / registrar |

|Email / Telephone |

|Date completed: |

|Comments on the registrar’s progress, clinical performance or professionalism in this domain / any additional skills acquired |

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|Name of supervisor |

|Signature supervisor |

|Signature student / registrar |

|Email / Telephone |

3. Domain: Adult surgery

The following table lists the clinical skills in this domain that should be acquired or consolidated during the 4-year registrar training in Family Medicine. The list is intended to guide the registrar, training complex co-ordinator or other consultant supervisor on what core practical experience and skills training to focus on. The supervisor should evaluate the registrar’s competency at the beginning and end of their rotation at the regional hospital or at least every 6-months (e.g. February and August) at the district hospital / community health centre. Competency in these skills should be acquired and consolidated by a combination of experience and supervision at the regional hospital, district hospital and community health centre.

It is assumed that while learning these specific skills the registrar will be exposed to an appropriate spectrum of patients and will be supervised in clinical assessment, decision making and management. The practical on-site training will also be complemented by the academic on-line learning that targets clinical knowledge, decision making and application of core family medicine principles.

The skills should be rated according to the following definitions from A to D. The rating should be entered in the table below. If the registrar has not been exposed to the domain at all during the year then leave the column blank. Skills listed elsewhere can also be assessed if they are relevant to the rotation.

After making an entry in the table you should also complete and sign the relevant section underneath.

|A: Only Theory: |

|Only theoretical knowledge regarding the skill’s principles, indications, contraindications, performance and complications. |

|B: Seen or have had demonstrated: |

|Have theoretical knowledge regarding the skill and have seen or observed the skill demonstrated by someone else |

|C: Apply/Perform: |

|Have theoretical knowledge regarding the skill and have performed the skill in question under supervision, at least several times. |

|D: Routine/Independent: |

|Have the theoretical knowledge regarding the skill and be competent to perform the skill independently. |

|Clinical topic |Clinical skills |Use one column to grade the registrar and |

| | |add date / comments in box underneath |

| |– aim is D for unshaded skills and C for shaded | |

| |skills |1st 2nd |

|Adult health - general |Wound care and dressings | | |

| |Lymph node excision biopsy | | |

|Adults- Abdomen |I&D of perianal haematoma | | |

| |Proctoscopy | | |

| |Appendicectomy | | |

| |Interpret barium swallows | | |

|Adults-Urology |Penile block | | |

| |Reduce a paraphimosis | | |

| |Circumcision | | |

| |Drain hydrocoele | | |

| |Insert a urinary and suprapubic catheter | | |

| |Hydrocoelectomy | | |

| |Interpret IVP for renal colic | | |

| |Vasectomy | | |

| |Orchidectomy and anchoring of torted testis | | |

|ENT |Drain a peritonsillar abscess | | |

| |Tonsillectomy / adenoidectomy | | |

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|Skin |Excise sebaceous cyst (other lumps-bumps) | | |

| |Skin biopsy (punch and fusiform), skin scrapes | | |

| |Wide Needle Aspiration Biopsy lymph node in HIV | | |

| |Cryotherapy/cauterization | | |

| |Skin graft | | |

| |Phenol ablation of ingrown toenail | | |

| |Inject keloids | | |

|Emergency |Give a blood transfusion | | |

| |Gastric lavage | | |

| |Debride wounds or burns | | |

| |I&D abscesses | | |

| |Laparotomy for initial damage control in stabbed | | |

| |abdomen | | |

|Date completed: |

|Comments on the registrar’s competency or professionalism in this domain / any additional skills acquired |

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|Name of supervisor |

|Signature supervisor |

|Signature student / registrar |

|Email / Telephone |

|Date completed: |

|Comments on the registrar’s competency or professionalism in this domain / any additional skills acquired |

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|Name of supervisor |

|Signature supervisor |

|Signature student / registrar |

|Email / Telephone |

4. Domain: Orthopaedics

The following table lists the clinical skills in this domain that should be acquired or consolidated during the 4-year registrar training in Family Medicine. The list is intended to guide the registrar, training complex co-ordinator or other consultant supervisor on what core practical experience and skills training to focus on. The supervisor should evaluate the registrar’s competency at the beginning and end of their rotation at the regional hospital or at least every 6-months (e.g. February and August) at the district hospital / community health centre. Competency in these skills should be acquired and consolidated by a combination of experience and supervision at the regional hospital, district hospital and community health centre.

It is assumed that while learning these specific skills the registrar will be exposed to an appropriate spectrum of patients and will be supervised in clinical assessment, decision making and management. The practical on-site training will also be complemented by the academic on-line learning that targets clinical knowledge, decision making and application of core family medicine principles.

The skills should be rated according to the following definitions from A to D. The rating should be entered in the table below. If the registrar has not been exposed to the domain at all during the year then leave the column blank. Skills listed elsewhere can also be assessed if they are relevant to the rotation.

After making an entry in the table you should also complete and sign the relevant section underneath.

|A: Only Theory: |

|Only theoretical knowledge regarding the skill’s principles, indications, contraindications, performance and complications. |

|B: Seen or have had demonstrated: |

|Have theoretical knowledge regarding the skill and have seen or observed the skill demonstrated by someone else |

|C: Apply/Perform: |

|Have theoretical knowledge regarding the skill and have performed the skill in question under supervision, at least several times. |

|D: Routine/Independent: |

|Have the theoretical knowledge regarding the skill and be competent to perform the skill independently. |

|Clinical topic |Clinical skills |Use one column to grade the registrar and |

| | |add date / comments in box underneath |

| |– aim is D for unshaded skills and C for shaded | |

| |skills |1st 2nd |

|Orthopaedics |Measure shortening of the legs | | |

| |Aspirate and inject the knee | | |

| |Inject tennis elbow / golfers elbow | | |

| |Inject the shoulder (ACJ, subacromial, GHJ) | | |

| |Inject trochanteric bursitis | | |

| |Interpret x-rays of joints | | |

| |Apply finger and hand splints | | |

| |Apply POP (upper and lower limbs) | | |

| |Closed reductions (hand, forearm,tib-fib) | | |

| |Set up traction (skeletal and skin) | | |

| |Reduce elbow dislocation | | |

| |Reduce hip dislocation | | |

| |Reduce shoulder dislocation | | |

| |Reduce radial head dislocation | | |

| |Excise a ganglion | | |

| |Inject carpal tunnel syndrome | | |

| |Inject de Quervains tenosynovitis | | |

| |Amputations-fingers/toes and lower limb | | |

| |Apply club foot POP | | |

| |Debridement of open fractures | | |

| |Fasciotomy | | |

|Date completed: |

|Comments on the registrar’s competency or professionalism in this domain / any additional skills acquired |

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|Name of supervisor |

|Signature supervisor |

|Signature student / registrar |

|Email / Telephone |

|Date completed: |

|Comments on the registrar’s competency or professionalism in this domain / any additional skills acquired |

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|Name of supervisor |

|Signature supervisor |

|Signature student / registrar |

|Email / Telephone |

5. Domain: Anaesthetics

The following table lists the clinical skills in this domain that should be acquired or consolidated during the 4-year registrar training in Family Medicine. The list is intended to guide the registrar, training complex co-ordinator or other consultant supervisor on what core practical experience and skills training to focus on. The supervisor should evaluate the registrar’s competency at the beginning and end of their rotation at the regional hospital or at least every 6-months (e.g. February and August) at the district hospital / community health centre. Competency in these skills should be acquired and consolidated by a combination of experience and supervision at the regional hospital, district hospital and community health centre.

It is assumed that while learning these specific skills the registrar will be exposed to an appropriate spectrum of patients and will be supervised in clinical assessment, decision making and management. The practical on-site training will also be complemented by the academic on-line learning that targets clinical knowledge, decision making and application of core family medicine principles.

The skills should be rated according to the following definitions from A to D. The rating should be entered in the table below. If the registrar has not been exposed to the domain at all during the year then leave the column blank. Skills listed elsewhere can also be assessed if they are relevant to the rotation.

After making an entry in the table you should also complete and sign the relevant section underneath.

|A: Only Theory: |

|Only theoretical knowledge regarding the skill’s principles, indications, contraindications, performance and complications. |

|B: Seen or have had demonstrated: |

|Have theoretical knowledge regarding the skill and have seen or observed the skill demonstrated by someone else |

|C: Apply/Perform: |

|Have theoretical knowledge regarding the skill and have performed the skill in question under supervision, at least several times. |

|D: Routine/Independent: |

|Have the theoretical knowledge regarding the skill and be competent to perform the skill independently. |

|Clinical topic |Clinical skills |Use one column to grade the registrar and |

| | |add date / comments in box underneath |

| |– aim is D for unshaded skills and C for shaded | |

| |skills |1st 2nd |

|Anaesthetics |Ring block | | |

| |Administer oxygen | | |

| |Check Boyle's machine | | |

| |Control airway – mask and ambu bag | | |

| |General anaesthetic | | |

| |Inhalation induction | | |

| |Intravenous induction | | |

| |Intubate & ventilate patient | | |

| |Ketamine anesthesia | | |

| |Monitor patient during anaesthetic | | |

| |Recover patient in recovery room | | |

| |Reverse muscle relaxation (mix drugs) | | |

| |Set airflows – Magill, Circle, T-piece | | |

| |Spinal anaesthetic | | |

| |Sterilize your equipment | | |

| |Bier's block | | |

| |Brachial block | | |

| |Conscious sedation – basic | | |

| |Epidural | | |

|Date completed: |

|Comments on the registrar’s competency or professionalism in this domain / any additional skills acquired |

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|Name of supervisor |

|Signature supervisor |

|Signature student / registrar |

|Email / Telephone |

|Date completed: |

|Comments on the registrar’s competency or professionalism in this domain / any additional skills acquired |

| |

| |

| |

| |

| |

| |

| |

| |

| |

|Name of supervisor |

|Signature supervisor |

|Signature student / registrar |

|Email / Telephone |

6. Domain: Paediatrics

The following table lists the clinical skills in this domain that should be acquired or consolidated during the 4-year registrar training in Family Medicine. The list is intended to guide the registrar, training complex co-ordinator or other consultant supervisor on what core practical experience and skills training to focus on. The supervisor should evaluate the registrar’s competency at the beginning and end of their rotation at the regional hospital or at least every 6-months (e.g. February and August) at the district hospital / community health centre. Competency in these skills should be acquired and consolidated by a combination of experience and supervision at the regional hospital, district hospital and community health centre.

It is assumed that while learning these specific skills the registrar will be exposed to an appropriate spectrum of patients and will be supervised in clinical assessment, decision making and management. The practical on-site training will also be complemented by the academic on-line learning that targets clinical knowledge, decision making and application of core family medicine principles.

The skills should be rated according to the following definitions from A to D. The rating should be entered in the table below. If the registrar has not been exposed to the domain at all during the year then leave the column blank. Skills listed elsewhere can also be assessed if they are relevant to the rotation.

After making an entry in the table you should also complete and sign the relevant section underneath.

|A: Only Theory: |

|Only theoretical knowledge regarding the skill’s principles, indications, contraindications, performance and complications. |

|B: Seen or have had demonstrated: |

|Have theoretical knowledge regarding the skill and have seen or observed the skill demonstrated by someone else |

|C: Apply/Perform: |

|Have theoretical knowledge regarding the skill and have performed the skill in question under supervision, at least several times. |

|D: Routine/Independent: |

|Have the theoretical knowledge regarding the skill and be competent to perform the skill independently. |

|Clinical topic |Clinical skills |Use one column to grade the registrar and |

| | |add date / comments in box underneath |

| |– aim is D for unshaded skills and C for shaded | |

| |skills |1st 2nd |

|Child |Assess growth and classify malnutrition | | |

| |Assess child abuse (sexual/non-sexual) | | |

| |Assess child abuse (sexual/non-sexual) | | |

| |Capillary blood sampling - finger, heel | | |

| |CXR in a child | | |

| |Developmental assessment | | |

| | | | |

| |How to do and interpret Tine test and Mantoux tests| | |

| |Intra-osseous line | | |

| | | | |

| |IV access in a child | | |

| |Lumbar puncture | | |

| |Suprapubic bladder puncture | | |

| |Venepuncture - upper limb, extn jugular vein | | |

| | | | |

|Date completed: |

| |

|Comments on the registrar’s competency or professionalism in this domain / any additional skills acquired |

| |

| |

| |

| |

| |

| |

| |

| |

| |

|Name of supervisor |

|Signature supervisor |

|Signature student / registrar |

|Email / Telephone |

|Date completed: |

|Comments on the registrar’s competency or professionalism in this domain / any additional skills acquired |

| |

| |

| |

| |

| |

| |

| |

| |

| |

|Name of supervisor |

|Signature supervisor |

|Signature student / registrar |

|Email / Telephone |

7. Domain: Emergencies, Communication, ENT, Eye, Skin and miscellaneous

The following table lists the clinical skills in this domain that should be acquired or consolidated during the 4-year registrar training in Family Medicine. The list is intended to guide the registrar, training complex co-ordinator or other consultant supervisor on what core practical experience and skills training to focus on. The supervisor should evaluate the registrar’s competency at the beginning and end of their rotation at the regional hospital or at least every 6-months (e.g. February and August) at the district hospital / community health centre. Competency in these skills should be acquired and consolidated by a combination of experience and supervision at the regional hospital, district hospital and community health centre.

It is assumed that while learning these specific skills the registrar will be exposed to an appropriate spectrum of patients and will be supervised in clinical assessment, decision making and management. The practical on-site training will also be complemented by the academic on-line learning that targets clinical knowledge, decision making and application of core family medicine principles.

The skills should be rated according to the following definitions from A to D. The rating should be entered in the table below. If the registrar has not been exposed to the domain at all during the year then leave the column blank. Skills listed elsewhere can also be assessed if they are relevant to the rotation.

After making an entry in the table you should also complete and sign the relevant section underneath.

|A: Only Theory: |

|Only theoretical knowledge regarding the skill’s principles, indications, contraindications, performance and complications. |

|B: Seen or have had demonstrated: |

|Have theoretical knowledge regarding the skill and have seen or observed the skill demonstrated by someone else |

|C: Apply/Perform: |

|Have theoretical knowledge regarding the skill and have performed the skill in question under supervision, at least several times. |

|D: Routine/Independent: |

|Have the theoretical knowledge regarding the skill and be competent to perform the skill independently. |

|Clinical topic |Clinical skills |Use one column to grade the registrar and |

| | |add date / comments in box underneath |

| |– aim is D for unshaded skills and C for shaded | |

| |skills |1st 2nd |

| |CPR adult advanced support | | |

|Emergency | | | |

| |CPR child advanced support | | |

| |Choking | | |

| |Primary survey | | |

| |Intubate and manage airway | | |

| |Cricothyroidotomy | | |

| |Give oxygen | | |

| |Insert chest drain | | |

| |Relieve tension pneumothorax | | |

| |IV cutdown | | |

| |Secondary survey | | |

| |Measure the GCS | | |

| |Insert NGT | | |

| |Interpret x-rays in trauma | | |

| |Immoblise spine | | |

| |Transport critically ill | | |

| |Remove a splinter, fish-hook | | |

| |Suture lacerations | | |

| |Manage snake bite | | |

| |Administer rabies prophylaxis | | |

| |Selecting emergency equipment for doctors bag or | | |

| |emergency tray | | |

| | | | |

| |Calculate % burnt | | |

| |Certifying patient under mental health care act | | |

| |Relieve cardiac tamponade | | |

| |Peritoneal lavage | | |

| |Suturing lip with tissue loss from human bite | | |

| |Tracheostomy | | |

|Consultation |Patient-centred consultation (all ages) | | |

| |Holistic (3-stage) assessment and management | | |

| |Motivate behaviour change | | |

| |Break bad news | | |

| |Counselling skills for HIV, TOP, after rape | | |

| |Assess and consult couples, families | | |

| |Conduct a family conference | | |

| |Mini mental examination | | |

| |Support / consult with PHC nurse | | |

| |Use genogram and ecomap | | |

| |Use problem-orientated medical record | | |

| |Develop and use flowcharts for chronic care | | |

| |Cope with language barriers | | |

|ENT |Remove a foreign body from the ear | | |

| |Remove a foreign body from the nose | | |

| |Syringe, dry swab an ear | | |

| |Take a throat swab | | |

| |Manage epistaxis (cautery, packing) | | |

| |Assess hearing loss | | |

| |Suture a pinna, lobe | | |

| |Reduce a fractured nose | | |

| |Interpret audiogram | | |

|Skin |Skin patch testing | | |

|Admin |Work assessment and DG forms | | |

| |Making appropriate referrals and letters | | |

| |Completing sick certificates | | |

| |Completing death certificates | | |

| |Manage a clinic for chronic care (e.g. HIV, | | |

| |diabetes) | | |

|Forensic |Completing J88 | | |

| |Assess, manage and document sexual assault | | |

| |Assess, manage and document drunken driving | | |

| |Assess, manage and document interpersonal violence | | |

|Palliative care |Counselling of dying patient | | |

| |Hypodermoclysis (subcutaneous infusion) | | |

| |Set up a syringe driver | | |

|Eyes |Fundoscopy (diabetes, hypertension), visual fields,| | |

| |visual acuity | | |

| |Instill drops or apply ointment | | |

| |Remove a foreign body in the eye, eversion of | | |

| |eyelid | | |

| |I&D a chalazion | | |

| |Suture an eyelid | | |

| |Test for squint | | |

| |Washout of eye (chemical burns) | | |

| |Subconjunctival injections | | |

| |Use a Schiotz tonometer | | |

|Date completed: |

|Comments on the registrar’s competency or professionalism in this domain / any additional skills acquired |

| |

| |

| |

| |

| |

| |

| |

| |

| |

|Name of supervisor |

|Signature supervisor |

|Signature student / registrar |

|Email / Telephone |

|Date completed: |

|Comments on the registrar’s competency or professionalism in this domain / any additional skills acquired |

| |

| |

| |

| |

| |

| |

| |

| |

| |

|Name of supervisor |

|Signature supervisor |

|Signature student / registrar |

|Email / Telephone |

|Date completed: |

|Comments on the registrar’s competency or professionalism in this domain / any additional skills acquired |

| |

| |

| |

| |

| |

| |

| |

| |

| |

|Name of supervisor |

|Signature supervisor |

|Signature student / registrar |

|Email / Telephone |

Section 4: Annual or end-of-rotation reports

(This should be completed confidentially and faxed to the Division at +27 21 931 1257 and can be obtained electronically from the website sun.ac.za/fammed. A separate report is required for each rotation or facility. Please complete assessment below and any additional comments on page 2)

|Name of registrar: |

1. At the end of this year/rotation this registrar’s ability to work well with other colleagues and professions was (select one):

Poor Barely adequate Average Good Excellent

Poor: Colleagues would generally refuse to work with him / her

Barely adequate: There was a pattern of conflict and tension with colleagues and other co-workers

Average: He / she worked well and had no major problems in relating to colleagues and co-workers

Good: He / she promoted team work and contributed significantly to co-operation among colleagues and co-workers

Excellent: He / she showed significant leadership qualities and was seen as an example to follow by colleagues and co-workers

2. Did this registrar elicit any significant complaints by patients, staff or community members or was he / she the subject of any formal disciplinary proceedings?

Yes / No: If yes, please elaborate below with a brief description of the problem(s) and any action taken (on notes page):

3. The registrars's approach towards medico-legal and ethical issues was:

Poor Barely adequate Average Good Excellent

Poor: Was the cause of medico-legal and ethical problems. No insight.

Barely adequate: Showed some serious errors of judgement. Little insight.

Average: Showed a reasonable working knowledge of medico-legal and ethical standards. Had insight into deficiencies and addressed them.

Good: Demonstrated high medico-legal and ethical standards and contributed towards the improvement of these standards in the workplace

Excellent: Was looked towards as a source of advice and help by colleagues in solving medico-legal and ethical dilemmas

4. What is your global assessment of the registrar’s clinical performance?

|Poor – significant concerns|Below average – |Average – borderline / |Good –achieved all /most of|Excellent – achieved more |

|regarding their clinical |did not achieve most of the|achieved some of the |the learning outcomes |than the learning outcomes|

|competency |learning outcomes |learning outcomes | | |

| | | | | |

|Name Date Signature |

| |

| |

|Cellphone/ telephone/email: |

Section 4: Annual or end-of-rotation report: Additional comments or notes:

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