oncology (2014) - rcog · communication course is recommended genetic counselling training...

Key: Common competency framework competences Medical leadership framework competences Health inequality framework competences

1 GMC Good Medical Practice (GMP) Domains: Domain 1: Knowledge, skills and Performance Domain 2: Safety and quality Domain 3: Communication, Partnership and Teamwork. Domain 4: Maintaining Trust

GMC approved 25 April 2014 © Royal College of Obstetricians and Gynaecologists

Oncology (2014)

Introduction The management of women with suspected or diagnosed gynaecological cancers require specific skills and understanding. This ASTM has been developed to ensure that individuals who wish to pursue a career as the lead in a local gynaecological cancer centre have the required experience and abilities to fulfil the duties of such a position. In this role, communication skills with the (extended) multidisciplinary (MDT) members, the ability to make decisions as part of an MDT and competencies in open and laparoscopic surgery are absolute core requirements. On completion of this ATSM, trainees should be able to:

work in an MDT and have close association with colleagues in the centre – as part of the ATSM, the trainee will gain an understanding of the other specialties that constitute the MDT: pathology, radiology, medical and clinical oncology and palliative care

ensure effective and efficient clinical service and access for women with suspected gynaecological cancers

have a good understanding of gynaecological cancers and their treatment

be clinically competent at recognising symptoms and presentations of gynaecological cancers

be clinically competent at counselling patients with gynaecological cancers

be clinically competent at staging disease and managing gynaecological cancers in accordance with national recommendations

be clinically competent at performing abdominal hysterectomy with and without oophorectomy be clinically competent at performing laparoscopic hysterectomy

be clinically competent at performing surgery to the ovary including post-hysterectomy oophorectomy

be clinically competent at performing other appropriate abdominal procedures including adhesiolysis have a thorough understanding of complications of abdominal surgery, how to manage them and when to involve other specialists

be able to write evidence-based guidelines

have thorough knowledge of ongoing clinical trials be able to undertake quality improvement projects.

Typically, two sessions per week should be dedicated to this ATSM to achieve competencies.

Use of other methodologies (‘OM’) is sometimes required to facilitate competence sign-off during ATSM training. ‘OM’ is not meant to replace exposure to clinical and other direct training opportunities. Detailed advice on use of ‘OM’ for facilitating sign off can be found at: http://www.rcog.org.uk/education-and-exams/curriculum/core-curriculum/guidance-sign-other-methodologies-om

http://www.rcog.org.uk/education-and-exams/curriculum/core-curriculum/guidance-sign-other-methodologies-om




During the course of the ATSM, the trainee must undertake a relevant quality improvement project and make a presentation on a relevant subject to a regional or local meeting.

This ATSM has a work intensity score of 2.0.




Gynaecological cancers Learning outcome:

To develop the knowledge and skills required by an individual to undertake the role of gynaecological oncology unit lead

Knowledge criteria GMP Clinical competency GMP Professional skills and attitudes GMP Training support Evidence/assessment

Broad knowledge of aetiology and differential diagnosis of vulval, cervical, endometrial and ovarian cancer Understanding of risk factors for developing vulval, cervical, endometrial and ovarian cancer Understanding of diagnostic tests, investigations and staging procedures Understanding of genetic predispositions to disease and the role of prophylactic surgery and screening Understanding of trophoblastic disease Knowledge of options for treatment and likely outcomes Knowledge of chemotherapy, radiotherapy and hormonal treatment in gynaecological cancers Knowledge of recent clinical trials and peer-reviewed data Knowledge of rare cancers: vaginal/fallopian tube Knowledge of patterns of disease relapse

1

Clinical evaluation of patients with gynaecological caners Ability to distinguish gynaecological cancers from other malignancies Ability to counsel patients about gynaecological malignancies, their treatment and prognosis Ability to undertake required diagnostic procedures and interpret the results Ability to undertake clinical staging for cervical, vulval and endometrial cancers Agility to undertake surgical intervention for early stage endometrial cancer (in patient cohorts identified in National Cancer Plan) Ability to understand the application of appropriate imaging modalities (CT, MRI, PET-CT) Ability to manage rapid access pathways for suspected gynaecological cancers Awareness of patient pathways and referrals mechanism to the cancer centre

1, 2, 3, 4

Awareness of psychological and emotional implications for patient and family and staff, the role of clinical psychology and psychosexual counselling Realistic recognition of own competence level Use of appropriate external protocols and guidelines Making appropriate tertiary referrals Chairing MDT meetings and teleconferencing or equivalent with cancer centre Collaboration with consultant colleagues and colleagues in other specialties and departments Recognition of dynamics of consultation after ‘bad news’ and ability to offer patients time and support to make decisions

1, 3, 4

Attendance at suitable theoretical course Attendance at MDT and regional network meetings Local/regional protocols RCOG Green Top Guideline: http://www.rcog.org.uk/womens-health/clinical-guidance/ovarian-masses-premenopausal-women-management-suspected-green-top-62 Useful websites: - www.bgcs.org.uk - www.bsccp.org.uk - www.cancerbacup.org.uk - www.macmillan.org.uk - www.ncri.org.uk - www.nice.org.uk - www.dh.gov.uk/PolicyAndGuidance/HealthAndSocialCareTopics/Cancer/fs/en

Case logbook CbD Audit projects Certificates of course attendance MDT attendance Attendance at relevant national meetings Team observation

http://www.rcog.org.uk/womens-health/clinical-guidance/ovarian-masses-premenopausal-women-management-suspected-green-top-62






http://www.bgcs.org.uk/

http://www.bsccp.org.uk/

http://www.cancerbacup.org.uk/

http://www.macmillan.org.uk/

http://www.ncri.org.uk/

http://www.nice.org.uk/

http://www.dh.gov.uk/PolicyAndGuidance/HealthAndSocialCareTopics/Cancer/fs/en






Knowledge criteria GMP Clinical competency GMP Professional skills and attitudes GMP Training support Evidence/assessment

Knowledge of palliative care aspects of management, including the role of interventional procedures to relieve symptoms

Ability to discuss different modalities of treatment confidently and advise patients appropriately Ability to inform and counsel patients about clinical trials for treatment options Understand the role of follow-up and ability to diagnose disease recurrence Understand the role of and manage patients with ascitic drains

Patient support websites: - www.jostrust.org.uk - www.ovacome.org.uk http://www.rcog.org.uk/womens-health/clinical-guidance/ovarian-cysts-menopause-information-you Attendance at advanced communication course is recommended Genetic counselling training opportunities through local network or postgraduate courses Observation of chemotherapy being delivered Observation of radiotherapy planning Attendance at palliative care clinics/assessments and MDT meetings Observation of paracentesis StartOG

http://www.jostrust.org.uk/

http://www.ovacome.org.uk/

http://www.rcog.org.uk/womens-health/clinical-guidance/ovarian-cysts-menopause-information-you








Gynaecological cancer surgery Learning outcome:

To understand and demonstrate knowledge, skills and attitudes in relation to abdominal gynaecological surgery

Knowledge criteria GMP Clinical competency GMP Professional skills and attitudes GMP Training support Evidence/assessment Understand the anatomy and innervations to the genital tract Knowledge of equipment, instrumentation and theatre set-up Understand the principles of diathermy Awareness of potential risks and complications of abdominal surgery and laparoscopy (including anaesthesia) Understand the principles and management of major haemorrhage Knowledge of emergency hysterectomy procedures, complications and risks Appropriate assessment of suitability of woman for laparoscopic hysterectomy and the ability to undertake a laparoscopic hysterectomy using a recognised technique and an understanding of suitable alternatives Recognition of initial and late complications such as haemorrhage or damage to adjacent viscera

1

Ability to perform: - abdominal hysterectomy +/- bilateral salpingo-oophorectomy (BSO) - oophorectomy - ovarian cystectomy - adhesiolysis - cystosocpy - post-hysterectomy oophorectomy Ability to control major haemorrhage Ability to recognise damage to bowel and bladder Recognition of intraoperative complications and management Recognition and management of postoperative complications Ability to perform diagnostic laparoscopy (with biopsy) for the assessment of stage in gynaecological cancer Awareness of clinical scenarios where emergency hysterectomy is necessary Proficient in undertaking laparoscopic hysterectomy Ability to manage haemorrhage and initial treatment of damage to adjacent viscera. Recognition of late complications. Initiation of immediate treatment and summoning the appropriate help.

1, 2,3,4

Ability to provide counselling regarding abdominal surgery and laparoscopy, complications and alternatives Ability to select patients appropriately for abdominal surgery Ability to perform abdominal procedures in a fluent and safe manner Ability to repair bladder and rectal injuries as appropriate Appreciation of the role of other specialists Awareness of long-term complications of abdominal surgery Ability to perform laparoscopy in a fluent and safe manner Ability to undertake a laparoscopic hysterectomy using a recognised technique Appropriate clinical skills

1, 3, 4

Observation of techniques and then practising them with assistance from supervisor Surgical update courses Practical courses in individual units www.nice.org.uk Tailored clinical experience and practice Tutorials and lectures

Relevant OSATS Audit of cases Case logbook Mini-CEX CbD

http://www.nice.org.uk/




Section 1: Vulval Cancer

Competence level Not required

Level 1 Level 2 Level 3

Date Signature Date Signature Date Signature

Examination of vulva (vulvoscopy)

Excision biopsy of vulval lesion

Tumour staging (clinical)

Patient counselling

Patient referral

Radical vulval cancer surgery




Section 2: Cervical Cancer




Examination of the cervix

Diagnosis of cervical carcinoma

Biopsy of tumour

Tumour staging

Patient counselling

Patient referral

Observation of radical hysterectomy




Section 3: Endometrial cancer




Diagnosis of endometrial carcinoma

Tumour staging

Patient counselling

Patient referral

Surgical management of endometrial cancer




Section 4: Ovarian cancer




Assessment of possible ovarian cancer

Use of risk of malignancy index (RMI)

Ascitic fluid tap/paracentesis

Patient counselling on genetic risk/screening

Patient counselling on disease and therapy

Patient referral

Observation of ovarian cancer surgery

Laparoscopic oophorectomy




Section 5: Gynaecological cancer surgery




Diagnostic cystoscopy

Diagnostic laparoscopy for the assessment of gynaecological

cancer +/- perform biopsies

Abdominal hysterectomy +/- BSO

Oophorectomy

Ovarian cystectomy

Post-hysterectomy oophorectomy

Adhesiolysis (including bowel)

Emergency hysterectomy

Laparoscopic hysterectomy




Authorisation of signatures (to be completed by the clinical trainers)

Name of clinical trainer (please print) Signature of clinical trainer




Training courses or sessions

Title

Signature of Educational Supervisor

Date

Completed Quality improvement project

Title

Signature of Educational Supervisor

Date




APPENDIX TO ONCOLOGY: Details of knowledge criteria Broad knowledge of aetiology and risk factors for gynaecological cancers:

VIN, CIN, BRCA1/2 genes, HNPPC, HPV-16, HPV-18, obesity, diabetes, Tamoxifen.

Relationship with other cancers, i.e. breast cancer, colon cancers. Family history and risk.

Extensive knowledge of investigations in gynaecological cancers:

Serum tumour markers: CA125, CEA, CA19.9, BHCG, inhibin, estrogen – in presentation and follow-up.

Imaging techniques and their use: CT/MRI dcans, ultrasound and radiation effects. Histopathology: tumour types and relevance of tumour grade, lymph vascular space invasion.

Cytology: basic utility of cytology in cervical smear and fluids. The role of investigations in follow-up and relapse.

In-depth knowledge of clinical presentation, diagnostic tests and appropriate management of gynaecological cancers:

Vulval cancer: clinical presentation disease staging (FIGO) importance of disease size, site and histopathology o imaging requirements: role of CT, MRI, CXR surgical and non-surgical therapies disease relapse: patterns of relapse, investigations.

Cervical cancer: clinical presentation disease staging (FIGO) imaging requirements: role of CT, MRI, IVU, CXR ole of surgery fertility-preserving surgery o chemo-radiotherapy disease relapse: patterns of relapse, investigations.

Endometrial cancer: clinical presentation disease staging (FIGO) role of ultrasound and risk of malignancy o role of CT, MRI, CXR identification of low- and high-risk patients according to histopathology o triaging patients according to ultrasound postmenopausal bleeding (PMB) clinics and their function o disease relapse: patterns of relapse,

investigations.




Ovarian cancer: clinical presentation: role of ultrasound , CT, MRI, CXR o disease

staging (FIGO) transvaginal scan: features of malignancy on scan serum blood tests: CA125, CEA, CA19.9, BHCG, AFP o risk of

malignancy index disease relapse: patterns of relapse, investigations.

Trophoblast disease:

clinical presentation: molar pregnancy, partial molar pregnancy, choriocarinoma, risk factors o BHCG and follow-up, use of contraceptive, timing of pregnancy

specialty centres disease relapse: patterns of relapse, investigations.

Good knowledge of options available for treating gynaecological cancers, and palliation of symptoms:

The role of surgical and non-surgical interventions, complications, sequelae.

Fertility preservation procedures available in cervical cancer: trachalectomy, pelvic lymphadenectomy, the role of cold knife biopsy, pregnancy complications and outcomes. Fertility preservation in endometrial cancer.

Fertility preservation in ovarian cancer.

Chemotherapy in ovarian cancer: platinum-based therapy, IV and IP treatments, second-line therapies, disease response rates. Chemo-radiotherapy in cervical cancer and vulval cancer.

The role of radiotherapy in endometrial cancer: in primary and adjuvant settings.

Palliative care: introduction of service, do not resuscitate criteria, methods of analgesia, radiotherapy/chemotherapy in palliation. Role of surgery, tumour excision, bowel diversionary procedure, paracenthesis, pleuridesis.

Rarer gynaecological cancers: vaginal cancer – risk, presentation, basic management; fallopian tube carcinomas – clinical presentation, basic management. Genetic risk/screening: principles of screening, BRCA1 and 2 genes, evaluation of risk from family history. HNPCC and risk of ovarian and endometrial cancer. Implications of genetic

screening.

Understanding of management issues in the provision of gynaecological cancer unit services:

staffing facilities and equipment

referral patterns and triage

managing a rapid access clinic

patient pathways and time constraints external support

training

clinical protocols




risk management

audit and research.

oncology (2014) - rcog · communication course is recommended genetic counselling training...

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