Full Attribute Guide

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Full Attribute Guide Powered By Docstoc
					  Developed by
  Dr. Julian Page
  Research Fellow                                                         The Joint Committee on
  Department of Postgraduate Medicine & Dentistry,                        Postgraduate Training for
  University of Manchester                                                General Practice
  Dr. Malcolm Valentine
  Assistant Director of Postgraduate GP Education,
  North/North East Scotland Deanery

                  Instructions, Feedback Forms & Attribute Guide
                           Section                                                            Page
                           Guidance on how to complete the SHO Report                           1
                           Summary of Process                                                 2-3
     Section 1:            12 Point Rating Scale                                                5
                           360 Reviews                                                          5
    Guidance               360 Degree SHO Assessment (Colleague)                                6
                           Patient SHO Assessment                                               7
                           The RITA / VTR/2 forms                                               8
                           Generic Attributes                                                9 – 13
                           Accident & Emergency & Dermatology                                  15
     Section 2:            ENT & Medicine                                                      17
     Attribute             Obstetrics & Gynaecology & Ophthalmology                            19
      Guide                Paediatrics                                                         21
                           Palliative Care                                                     23
                           Psychiatry & Rheumatology                                           25

Section 1: Guidance on how to complete the SHO Report for General

General Guidelines
The guidance for completing the SHO Report for General Practice is produced in this document. The log
books should be kept by the SHOs and brought to each meeting with their Educational Supervisors. The
Educational Supervisors are advised to photocopy the document after their final review and retain
it for future reference.

Study Leave
Study leave uses a considerable amount of resources of both time and money, it should be used
appropriately and evaluated. For doctors who intend to direct their career towards General Practice it is
important that their study leave can be used to promote this aim even though it may not be related to their
current specialty.
A typical solution is as follows:-
                 Course                   Use study leave in the following specialty
                 Resuscitation            Medicine or Accident & Emergency
                 Family Planning          Obstetrics & Gynaecology
                 Child Development        Paediatrics
                 Minor Surgery            Any

                             Summary of Process

    Objectives from
       last post                              Study Leave
    Attribute Guide            Review         Initial PDP
    Relevant to Speciality

                             360 degree
    Attribute Guide            Review
    Relevant to Speciality                    Study Leave
      12 Point                Review          Continuing
     Rating Scale                               PDP

    Attribute Guide                          Evaluation of
         review                                learning
    Relevant to Speciality
                                Final        Feedback on
       12 Point                Review           post
     Rating Scale
                                             passed on to
                                               next post
                              VTR/2 RITA
                                                                          Attribute Guide & Instructions     3

                                                                                                                 Summary of Process
                                      Summary of Process

First Review: @ 2 weeks
The first introductory session with the SHO should be arranged in the first two weeks, it is mainly a
“getting to know you session.”

                   Areas to cover                                         Objectives to set
•   A review of progress from the previous post         •   Setting of any general or specific educational
•   A review of the relevant section of the Attribute       objectives
    Guide                                               •   Agreement on the use of study leave
                                                        •   Arranging the date for the mid-point review

Mid-point Review: Mid-point
This is the main review meeting, the Educational Supervisor must ensure that the SHO is progressing
satisfactorily and have the 360 degree forms available for discussion. If there are concerns then please
seek advice from the Vocational Course / Scheme Organiser or Clinical Tutor.

                   Areas to cover                                          Objectives to set
•   A review of the relevant section of the Attribute   •   Assess that the doctor is progressing
    Guide                                                   satisfactorily
•   Give feedback on the doctor’s performance           •   Setting of any general or specific educational
    using the “12 point SHO rating scale”.                  objectives
•   A discussion of the results from the 360 review     •   Decide the appropriate use of study leave
    assessments from colleagues and patient             •   Monitor working conditions
    assessments                                         •   Provide pastoral support
                                                        •   Arranging the date for the final review

The 12 Point Rating Scale should be supported by “360 review assessments” by colleagues and patients,
performed at least annually. Forms are provided on pages 6 & 7 and can be downloaded from the web
site and

Final Review: @ Last 2 weeks
The final review is to ensure that the SHO has performed satisfactorily and to evaluate the learning

                   Areas to cover                                         Objectives to set
•   Discuss the self-assessment forms and identify      •   Assess that the doctor’s performance has been
    areas of further learning                               satisfactory
•   Give feedback on the doctor’s performance           •   Evaluate the learning achieved
    using the “12 point SHO rating scale”.              •   Monitor working conditions
                                                        •   Consider any learning objectives to be passed
                                                            on to the next post
                                                        •   Complete the VTR/2 / RITA form

                                                                                    Attribute Guide & Instructions          5

The 12 Point SHO Rating Scale
This rating scale should be used jointly by the SHO and Educational Supervisor in the mid-point and final
review sessions. It covers the main points of Good Medical Practice. The three examples of performance
relate to the scores 1, 5 and 9. Intermediate scores may be given using the scale below. A small section
is provided for evidence, further space is available on the opposite page. Constructive comments are
encouraged for all SHOs, but much more evidence is required if performance is below standard, scoring 1
or 2. SHOs with a borderline score 3 should also have more details recorded.

An example of the first point in the rating scale

  1a        History taking and examination
        1                      2        3        4       5        6        7              8                    9
Jumbled, confusing history taking,    Clear history taking, appreciates the       Accomplished and concise history taker;
cannot get patient co-operation for   importance of clinical, psychological and   including clinical, psychological and
examination, technique poor           social factors, performs adequate and       social factors. Skilled examination
                                      appropriate examinations                    technique

     This “example of poor              This “example of average                    This “example of excellent
     performance” relates                 performance” relates                        performance” relates
         to a score of 1                      to a score of 5                             to a score of 9
                             Score                                        Evidence

Mid-point Review

   Final Review

One important issue is that if GP registrars who have failed summative assessment could have had
concerns about their poor performance identified earlier in their training, then remedial action could have
been taken and failure possibly prevented. It should increase the rigor of the assessment made prior to
the completion of the VTR/2 / RITA forms, identify doctors who need a greater degree of support and also
provide the educational supervisor with a medico-legal record. The Educational Supervisor should thus
ensure that the rating scales are completed before signing the VTR/2 and RITA forms. If he/she considers
that the SHO is below standard or has concerns a copy of the form should be sent to the Vocational
Course / Scheme Organiser and the Regional Director of GP Education.

The 360 Review and Patient Assessments
More evidence gathered from colleagues and patients must back up the 12 point rating scale using this or
other similar 360 degree processes. The GMC require this to be completed at least annually (before the
mid point review). The forms are available on the following pages and can also be downloaded from the
web ( and

The Educational Supervisor should distribute the 360 Degree SHO Assessment form (Colleague) to ward
Sisters, Consultants and other relevant medical staff who have worked with the SHO. The SHO should
ask several patients whom they have cared for to complete the Patient SHO Assessment form. The
outcome should be discussed at the mid-point review.

                                              360 Degree SHO Assessment (Colleague)
360 Degree SHO Assessment

                            SHO:                                                                                                 Please return the form to:-

                            Completed by:

                                                              Please circle the appropriate level of performance
                            Problem solving / making a diagnosis / management plans
                                     1                      2                3       4        5       6        7             8                      9
                            Unable to make decisions, or even make         Can make a sound diagnosis, and          Plus - shows intelligent interpretation of
                            a working diagnosis. Fails to involve          produce safe, appropriate management     available data to form an effective
                            patients in decision making. Unaware of        plans. Involves patients in decision     hypothesis, understands the importance
                            own limits                                     making. Good recognition of own limits   of probability in diagnosis

                            Emergency Care
                                     1                      2                3       4        5       6        7             8                      9
                                                                           Responds quickly to emergency            Shows ability in evaluating the
                            Does not respond to emergency
                                                                           calls, works well within the team,       emergency situation calmly and
                            calls, chaos and panic in emergency
                                                                           appropriate management of                intelligently, establishes priorities
                            situations. Inability to do CPR and
                                                                           situation. Proficient in CPR and basic   correctly, organises assistance and
                            basic life support
                                                                           life support                             treatment promptly

                            Working within limits of competence
                                     1                      2                3       4        5       6        7             8                      9
                            No self-confidence, seeks help all
                                                                                                                    An able doctor with a clear
                            the time, does not make any
                                                                           Aware of own skill and competency        understanding of own competency,
                            decisions. Over-confidence in ability,
                                                                           level, seeks assistance appropriately    but still seeks advice when
                            with no insight to a level that may
                            harm patients

                            Attitude to and relationship with patients
                                     1                      2                3       4        5       6        7             8                      9
                                                                           Courteous & polite, communicates         Excellent bedside manner, able to
                            Discourteous, inconsiderate of
                                                                           well with patients, shows appropriate    anticipate patient’s emotional and
                            patients views, dignity & privacy.
                                                                           level of emotional involvement in the    physical needs and plans to meet
                            Unable to reassure, subject of
                                                                           patient and family. Respects privacy     them. Explains clearly and checks
                            repeated complaints
                                                                           & dignity                                understanding.

                            Working with colleagues
                                     1                      2                3       4        5       6        7             8                      9
                            Unable / refuses to communicate                Listens to colleagues– accepts the       Able to bring together views for a
                            with colleagues. Can’t work to                 views of others. Flexible– ability to    common goal. Team goal is put
                            common goal, selfish, inflexible               change in the face of valid argument     before personal agenda

                            Probity: Has a responsible and professional attitude and approach to their work, in the
                            following areas:- • Trustworthy          • Ethics             • Punctuality
                                               • Honesty             • Dress code         • Time management
                                               • Confidentiality     • Manners
                                     1                      2                3       4        5       6        7             8                      9
                            Poor attitude / approach in above areas,                                                Excellent attitude / approach in
                            possible concerns……
                                                                           Reasonable attitude / approach in        above areas, a credit to the
                            Fails to make care of patient first concern,
                            own beliefs prejudice care, abuses             above areas, a good doctor               profession. Patient care is the
                            position as a doctor                                                                    priority

                            Health issues that may effect fitness to practice
                            Are there any health issues that are affecting or may affect the junior Doctors fitness to practice?          YES / NO

                                                                     If you have any more comments please add overleaf
                                                           Attribute Guide & Instructions     7

                                                                                                  Patient SHO Assessment
             Patient SHO Assessment
SHO:                                                                Please return the form to:-

Completed by:

As part of guidance from the General Medical Council we need to assess how you were
treated by the junior doctor you have just seen or who has been looking after you while
in hospital. Please think about your consultation with the doctor and circle the
appropriate level of performance.

How thoroughly did the doctor ask you about your symptoms?

        Unsatisfactory               Satisfactory                   Very good

How well did the doctor listen to what you had to say?

        Unsatisfactory               Satisfactory                   Very good

How well did the doctor put you at ease during your physical examination?

        Unsatisfactory               Satisfactory                   Very good

How well did the doctor explain your problem or your treatment?

        Unsatisfactory               Satisfactory                   Very good

Was the doctor concerned for your welfare?

        Unsatisfactory               Satisfactory                   Very good

Do you have any other comments on the doctor.

The VTR/2 RITA Forms
The SHO Report has a joint VTR/2 / RITA form. The RITA form is required by the Deanery and the VTR/2
by the Joint Committee on Postgraduate Training for General Practice (JCPTGP). The Educational
Supervisor will have to certify either:-

VTR/2 / RITA C: Satisfactory Completion
This denotes satisfactory completion indicating that the SHO has reliably achieved a good standard of
clinical care, has maintained good medical practice, has demonstrated adequate communication skills
and team working, has shown trust and probity and respect for patients
The RITA C does not guarantee career progression and career advice might be required

VTR/2 / RITA D: Satisfactory Completion “with minor concerns”
This denotes satisfactory completion and will be accepted by the JCPTGP. However specific and
relatively minor weaknesses have been identified which require attention during the next period of
training. It is to be expected that a proportion of SHOs will require this targeted training. The RITA D is a
means to ensure that this is provided. The SHO should not see this as a failure but as an opportunity to
address those needs.
The RITA D may be endorsed by the Educational Supervisor to indicate that the trainee has satisfactorily
completed less than the full training period. The number of months of satisfactorily completed training
must be given.
After receiving a RITA D the SHO and Educational Supervisor should consult with the Director of
Postgraduate Medical Education / Postgraduate Clinical Tutor / Speciality Tutor / Scheme Organiser to
produce the Personal Development Plan for the SHO and indicate how it can be implemented in the next
post. The Educational Supervisor should then complete the referral form, it should accompany form D.

RITA E: Unsatisfactory Completion
This indicates that there are more substantial areas of concern that require further exploration prior to the
SHO starting the next post. The Educational Supervisor should complete the referral form explaining the
reasons, it should accompany form E. A RITA E is not acceptable to the JCPTGP.
After receiving a RITA E the SHO and Educational Supervisor must consult with the Deanery to consider
the way forward.

Deanery RITA Process
It should be completed after the final review and a copy sent to the local Clinical Tutor to be forwarded on
to the Deanery.

JCPTGP Process
The completed VTR/2 forms (either a RITA C or D) will be needed to obtain your certificate of satisfactory
completion of GP Training. Keep them safe. The Joint Committee on Postgraduate Training for General
Practice will only accept the original forms. Photocopies of blank forms then completed are acceptable
but photocopies of signatures are not. The hospital stamp is also needed.

At the beginning of your GP Registrar year remove the centre pages and send the original VTR/2’s to
your local Director of Postgraduate General Practice Education for countersignature. We would
recommend you retain a copy of your forms in case of loss or dispute. Your Director will then return them
to you.

You should sign the forms yourself and then send them to the JCPTGP, 14 Princes Gate, Hyde Park,
London SW7 1PU (Tel 020 7581 3232) with your VTR/1 and other VTR2 forms, a copy of your GMC
registration certificate. (VTR/1 for the GP Registrar year and VTR/2 for hospital experience). Please
enclose a letter quoting your full name and address for correspondence.

Please refer to the JCPTGP’s web site ( for full and up to date guidance, in particular to
the JCPTGP’s Application Checklist.
                                                                             Attribute Guide & Instructions    9

Section 2: Attribute Guide for General Practice
This booklet has been produced to help SHOs who are directing their career towards General Practice. It
comprises two parts, a “Trainers Report” and this “Attribute Guide.” This guide is split into generic and
speciality specific attributes. The origin of the speciality sections is listed in the text and, where possible,
they are based on the statements produced by the Royal College of General Practitioners (RCGP) in
collaboration with other medical royal colleges. It is intended to promote reflection and notes pages are
included to encourage this. This is a key document in SHOs evolving portfolio of personal and
professional development. There are many other elements that contribute to reflective practice.
The JCPTGP sees this as an evolving document that will be subject to further development and iterative
review. It is not intended as a replacement for other documents which also meet the needs of doctors in
training within the context Good Medical Practice. The RCGP is undertaking a major piece of work
developing a definitive GP training curriculum. Further details of these developments are available from, and As the procedures may change, you
must refer to the JCPTGP’s web site ( for up to date guidance and further copies can be
downloaded from that site. The JCPTGP and the authors would welcome feedback.
Before each review with the Educational Supervisor, the SHO should consider the attributes in the
generic section and the relevant speciality section and note the areas that he/she feels may need more
attention. Notes can be made on the opposite side of the page. These points can then be brought out in
the discussion and be incorporated into the learning plan. They can be documented in the SHO Report
for General Practice.

                                         Generic Attributes

                                                                                                                   Generic Attributes
Good Medical Practice
History & Examination
•   Takes a proper clinical history
•   Carries out a proper clinical examination
•   Is proficient in the use of basic diagnostic tools, for example: stethoscopic examination of the heart,
    chest and abdomen, use of the sphygmomanometer, otoscope, ophthalmoscope. peak flow meter
    and electronic thermometer
•   Understands basic communication theory and consultation models
•   Understands body language and cues
•   Understands physical, social and psychological influences on illness behaviour
•   Can assess accurately what the patient does and doesn’t know
•   Can communicate bad news sensitively and effectively
•   Can communicate effectively with patients and relatives

• Can initiate and arrange appropriate investigations
• Has a thorough understanding of the appropriate use of investigative techniques such as:-
               Indications for and interpretation of ECGs
               The use of chest and abdominal X-rays
               The range and scope of laboratory investigations
               The scope and use of ultrasound and various imaging techniques

Problem solving / making a diagnosis / management plans
• Has good problem solving skills
• Has an understanding of how doctors think and work
• Can cope with uncertainty
• Reflects formatively on accuracy and inaccuracy in diagnosis
• Can assess existing provision, future need and initiate provision of: physiotherapy, occupational
   therapy, homecare, social and financial support, day care / respite, use of voluntary agencies &
   housing assessment
• Can assess the implications of the patients social context including effects of: retirement,
   bereavement, isolation, polypharmacy, need for palliative care & support for carers

                                                                         Attribute Guide & Instructions 11

                                                                                                             Generic Attributes - Continued
• Has a thorough understanding of the principles of prescribing and therapeutics including drug side
   effects, interactions and contra-indications
• Is committed to generic prescribing
• Understands prescribing in children the elderly and pregnancy
• Is aware of prescribing costs in the hospital and community
• Understands the purpose and use of drug formularies
• Understands the role of the pharmacist

Record Keeping
• Understands the structure of the clinical record
• Keeps regular, appropriately detailed, accurate records
• Understands medico-legal and risk management aspects of record keeping

Emergency Care
• Understands how emergency medical care is organised in hospital and in primary care
• Understands how unplanned care is organised and integrated including the role of the GP, NHS
  Direct/24 and other systems and structures
• Can understand the presentation of, accurately assess and initiate a management plan for medical
• Can fully assess a patient in collapse / arrest, initiate and manage basic CPR, life support and use of
  the defibrillator
• Proficient in the assessment of the unconscious and/or very ill patient, stabilising them and initiating
  an action plan
• Proficient in establishing venous access and venous blood sampling

Works within limits of confidence
• Is aware of available and relevant guidelines, evidence and protocols
• Engages appropriately in critical self-appraisal
• Can engage team support appropriately
• Understands the nature of departmental senior staff support and engages this appropriately

Maintaining Good Medical Practice
•   Enthusiastically participates in and effectively contributes to learning opportunities
•   Has a good ability to access and appraise medical literature
•   Accepts and values constructive criticism
•   Effectively participates in and contributes to the departmental training programme
•   Commits whenever possible to parallel training programmes eg GP modular programmes
•   Understands audit opportunities in primary care and the hospital
•   Understands and is able to set quality standards
•   Understands how audit feeds into quality assurance
•   Ensures completion of agreed audit work

Working relationship with colleagues
•   Understands the roles of the wider health care team both in the hospital and the community
•   Respects and engages all team members knowledge and skills
•   Communicates accurately and effectively with team members
•   Effectively engages with the whole medical team to ensure best outcomes for patient care
•   Appropriately delegates and participates in care management
•   Is committed to maximising team work between GPs and hospital doctors
•   Has a competent telephone manner
•   Constructs good quality letters – both for admission, referrals and discharge
•   Communicates accurately and effectively with primary care colleagues, especially keeping them
    informed about their patients

                                                                                     Attribute Guide & Instructions 13

                                                                                                                          Generic Attributes - Continued
Relationship with patients
•   Has a good basic understanding of human rights
•   Understands basic personal needs of patients and relatives, respects their dignity and minimises
•   Can illustrate patience and tolerance
•   Copes with and defuses confrontation
•   Uses language appropriate to patient and relatives understanding
•   Takes appropriate responsibility for initiating communication with patients and relatives
•   Has a basic understanding of ethnic influences on patient care

Teaching and Training
•   Willing to participate in departmental teaching and training responsibilities
•   Willing to develop basic training skills and attributes
•   Appropriately supervises/mentors more junior staff and can motivate others
•   Provides honest feedback on colleagues when requested

•   Understands what constitutes acceptable and unacceptable ethical practice
•   Understands and maintains professionalism at all times
•   Seeks help early if concerned about their own performance or that of others
•   Understands how to handle complaints
•   Understands the legal requirements and how to handle: death certification, The Mental Health Act,
    fitness to Ddive, child protection & notifiable conditions
•   Understands and is committed to medical confidence
•   Understands rights regarding access to information
•   Ensures punctuality and availability when on duty
•   Understands principles of time management
•   Understands the need for high levels of honesty and trustworthiness in medicine including when
    financial transactions are involved
•   Ensures that information relating to medical services is given clearly and objectively
•   Never exploits patient vulnerability especially in terms of financial issues
•   Always declares and withdraws from issues with conflict of interest

•   Is aware of health issues that may effect ability to work safely as a doctor
•   Is aware of work issues that might affect personal health
•   Understands stress effects on doctors, patients and carers.
•   Manages personal causes and effects of stress
•   Has an awareness of strategies for coping with stress
•   Understands and tolerates other personality types
•   Maintains as high a level of personal health and fitness as possible
•   Has an awareness of the scope of Occupational Health services

Based on a series of General Professional Training Curricula, developed by Dr. Malcolm Valentine, Assistant Director of
Postgraduate GP Education, North/North East Scotland.

                                                                               Attribute Guide & Instructions 15

                                            A & E Attribute Guide

                                                                                                                   Accident & Emergency
Clinical Acute Presentation & Management
Cardiac Resuscitation                  Adult major trauma              Acute general surgery
Acute Medicine                         Orthopaedic trauma              Gynaecology
Problems in the elderly                Soft tissue injury              ENT conditions
Paediatric medicine & surgery          Wound management                Eye conditions
Paediatric trauma                      Maxillo-facial trauma           Psychiatry
Pain control X-ray interpretation      Dealing with difficult patients
Legal / ethical issues                 Dealing with distresses/bereaved relatives

Clinical Skills- Resuscitation
Basic life support                     Needle cricothyroidotomy        Intraosseuos access*
Oral airway                            Heimlich manoeuvre              Needle thoracocentesis*
Nasopharyngeal airway                  Defibrillation                  Chest drain*
Bag & mask ventilation                 IV access in adults             Central venous line*
Intubation                             IV access in children*

Clinical Skills- Trauma
Fracture reduction            Spinal immobilisation                    Log-rolling
Dislocated shoulder reduction Limb splinting                           Plaster backslab
Wound assessment, cleaning & debridement                               Steristrips
Suturing                      Wound glue                               Dressings

Clinical Skills- Other Skills
Digital nerve block*                   Femoral nerve block*            Abscess I & D
Joint aspiration                       Bladder catheterisation         Nasal packing*

* The above criteria are less relevant for general practice

Reproduced from the North West Training Record for SHO’s in Accident & Emergency Medicine.

                                     Dermatology Attribute Guide

Dermatological Conditions
Eczema                                 Seborrhoeic dermatitis          Scabies and lice
Psoriasis                              Hyperkeratosis and icthyoses    Fungal infections
Acne vulgaris                          Rosacea                         Herpes simplex and zoster
Pigmented lesions and                                                  Warts and molluscum contagiosum
malignant melanoma                     Bullous conditions
Basal cell carcinoma                   Alopecia                        Pityriasis versicolor
Squamous cell carcinoma                Urticarias                      Pityriasis rosea
Solar keratosis                        Pruritis                        Lichen planus

Dermatological Skills
Dermatological examination             Skin scapings etc               Excision biopsy
Examination with Wood's light          Skin (punch) biopsy             Shave biopsy
Curretage and cautery                  Crytocautery

Thanks to Dr. Mike Pollard for developing this guide.

                                                                                     Attribute Guide & Instructions 17

                                            ENT Attribute Guide

•   Knowledge of basic anatomy, physiology and pathology of the Ear, Nose & Throat
•   Be able to use- a head mirror, nasal and aural speculae, tuning fork, indirect mirror examination of the
    larynx and postnasal space, audiometer.
•   Be competent to examine and recognise normal and abnormal ears, noses, throats and necks.

Be able to recognise and manage the following common conditions:-
Otitis media                          Vertigo                                Tonsillitis
Otitis externa                        Nasal polyposis                        Epiglotitis & croup
Discharging ears                      Epitaxis                               Hoarseness
Ear wax                               Allergies of the nose & throat         Neck lumps
Glue ear                              Sinusitis
Deafness                              Foreign bodies in noses & ears

Be able to perform:-
Nasal packing, anterior and posterior
Nasal cautery
Aural toilet and dressing

Be able to relate and communicate with:-
Patients                         Colleagues and co-workers
The deaf                         Post laryngectomy patients
Patients with treatment for malignancy to the head & neck
This guide was developed from the Chelmsford Vocational Training Scheme Logbook

                                         Medical Attribute Guide

Be able to recognise and manage the following common conditions:-
Myocardial Infarction                 Insulin and Non-Insulin                Asthma
Cardiac Arrest (CPR)                  Dependant Diabetes                     COAD
Angina                                Uncontrolled Diabetes &                Pneumonia
Heart Failure                         Ketoacidosis                           Bronchial Carcinoma
Common Arrhythmias                    Hypoglycaemia                          TB
Hypertension                          Hypo / Hyperthyroidism                 Pneumothorax
DVT & Pulmonary Embolism
                                      Headaches/Migraine                     Rheumatoid Arthritis
Dyspepsia, Peptic                     CVA & TIA                              Osteoarthritis
Ulceration                            Meningitis & septicaemia               Acutely Inflamed Joint
Acute GI bleeding                     Epilepsy & Status
Diarrhoea                             Epilepticus                            Palliative care
Jaundice                              Confusion / Dementia                   Metastatic carcino ma
Inflammatory Bowel                    Coma                                   Pain control
Disease                               Acute Confusional state
                                      Multiple Sclerosis                     Overdoses
Renal Failure                         Parkinson’s Disease                    Anaphylaxis
Urinary Tract Infections
                                  Anaemia                       Alcohol
Anticoagulation                   Disturbed & Violent Behaviour
Hypothermia                       Falls, “Gone off legs”        Pressure Sores
Managing patients with poor vision and/or poor hearing          Urinary Incontinence
Effective discharge of patients into the community              Faecal Incontinence
Managing the elderly with multiple pathologies and poly-pharmacy

This is based on a Core Curriculum for SHO’s in General (Internal) Medicine and the Medical Specialities, the Royal College
of Physicians, with advice from Dr. Mike Cheshire, Consultant Physician, Manchester Royal Infirmary

                                                                                    Attribute Guide & Instructions 19

                          Obstetric & Gynaecology Attribute Guide

                                                                                                                             Obstetrics & Gynaecology
The routine procedures used in modern antenatal care
Be able to assess women for hospital, shared or GP care
Parent education for pregnancy, childbirth & care of the new born
Recognise early labour                   Management of normal labour Induction of labour
Foetal monitoring in labour              Management of 3 stage of labour
Suture epesiotomies                      Breast feeding
Immunisation (Rubella & Anti-D)          Record keeping
Routine examination of the new born

To be able to communicate with women in labour in order to be aware of their wishes and fears so they
can be active participants in the decisions concerning its management, so they can understand the
procedures proposed for their own safety and that of their babies.

Counselling for parents with possible or real foetal malformations
Epidemiology of maternal & perinatal morbidity & mortality
Detection of congenital malformations
The initial management of common obstetric conditions and emergencies
Management of common problems for which pregnant women are admitted to hospital
Management of abnormal labour- twins, breech, shoulder dystocia
Recognise problems in labour requiring intervention
Resuscitate a shocked mother and/or baby
Psychological problems post-natally
Special requirements of home delivery

Health education and prevention of gynaecological conditions
Gynaecological history, examination & investigations Infections of the genital tract
Early diagnosis of genital neoplasia
The menopause and HRT                    Family planning                  Psychosexual counselling
Incontinence and prolapse                Infertility                      Abortion/ miscarriage
Problems with menstruation               The role of other team members
Ethical and legal implications- chaperoning, age of consent, assault, STD
Based on the training objectives for Obstetrics & Gynaecology from the booklet General Practitioner Vocational Training in
Obstetrics & Gynaecology

                                  Ophthalmology Attribute Guide
Be able to perform:-
External examination of eye           Indirect ophthalmoscopy               Visual field testing
Direct ophthalmoscopy                 Slit lamp examination

Be able to recognise and manage the following common conditions:-
Eye Injuries and Foreign Body         Vascular Haemorrhages           Chalazion incision and curettage
Conjunctivitis                        and Occlusions                  Repair of entropion
Blepharitis                           Amaurosis Fugax                 Repair of ectropion
Styes and Meibomian Cysts             Papilloedema and Optic Neuritis
Corneal Ulcers and Keratitis          Hypertensive Retinopathy        Orthoptic report
                                      Diabetic Retinopathies          Fluroscein angiograhpy
Episceritis and Scleritis             Vitreous and Retinal            Ultrasonography and biometry
Iritis and Uveitis                    Detachment                      Optometric methods
Uveitis investigations
Closed/acute Glaucoma                 Open/chronic Glaucoma                 Cataract

Thanks to Dr. Mike Pollard for developing this guide

                                                                                    Attribute Guide & Instructions 21

                                       Paediatric Attribute Guide
•   Ability to relate to children in illness and health, and to their parents, including parental anxiety and
•   Prescribes safely and appropriately for children
•   Examine the new-born, recognise abnormalities and problems and take appropriate action.
    Experience dealing with still birth and neo-natal death
•   Awareness of developmental milestones and experience in developmental assessment. Knowledge
    of childhood handicap and services available.
•   Knowledge of normal growth and physical development and deviation from this. Awareness of the
    principals of nutrition and infant feeding. Ability to assess stages of puberty
•   Recognise limitations of parents’ ability to cope with illness and recognise deterioration
•   Confidently differentiate – a well child, a well ill child and an ill child and take appropriate action
•   Knowledge of vaccination schedules and ability to advise appropriately
•   Awareness of functions of health visitors and social services and appropriate laws appertaining to
•   Awareness of family interaction and dynamics
•   Ability to communicate with other doctors and other health professionals regarding the care of
    children at home and in hospital
•   Awareness of genetic principles and relevance to general practice

Good working knowledge of the common and/or important childhood complaints
Asthma                            Recurrent abdominal pain                  Child abuse
Eczema                            Allergy                                   Diarrhoea & vomiting
Infections: Exanthemata           Behavioural problems                      Failure to thrive
URTI (Croup, otitis media, tonsillitis)                                     Diabetes
Convulsions                       Undescended testicles                     Heart murmur

Awareness of less common conditions
Autism                         Dsylexia                                     Cerebral palsy
Learning and allied problems Cot deaths                                     Muscular dystrophies
Congenital heart disease       Malignancy in children

Awareness of and ability to treat paediatric emergencies
Asthma                        Removal of foreign bodies                     Convulsion
Injuries & poisioning         Unconcious child                              Epiglottitis / stridor
Meningitis                    Dehydrated child                              Acute abdomen
Diabetic come & hypoglycaemia                                               Torsion of testis

Able to resuscitate children and neonates

Based on “The Paediatric Component for Vocational Training for General Practice.” The Royal College of General
Practitioners and The Royal College of Paediatrics and Child Health

                                                                                     Attribute Guide & Instructions 23

                                                                                                                             Palliative Care
                                   Palliative Care Attribute Guide
Multiprofessional assessments and patient-led problems
Anticipating problems and developing management plans
Evaluation of treatment benefits/burdens in the light of changing prognosis
Quality of life and its measurement

Symptom Management
                    General Principles                                     Nausea, Vomiting & Constipation
Diagnosis of causes of symptoms                                 Anti-emetics and their different actions
Appropriate use of disease modifying treatments                 Management of malignant bowel obstruction
Frequent review of symptoms and adverse effects                 Management of constipation
of treatment                                                    Constipation
Choosing appropriate routes for drug                                                Fungating lesions
administration                                                  Medical management of malodour
Psychological approaches                                                                 Dyspnoea
                  Causes of symptoms                            Pharmacological, physical and psychological
Pain – basic mechanisms of pain and its perception              interventions
Nausea and vomiting                                             The use of sedating drugs in terminal respiratory
Dyspnoea                                                        failure
                            Pain                                Emergencies in palliative care
WHO analgesic ladder                                            Superior vena caval compression
Different opioids and their use                                 Acute pain
Adjuvant analgesic drugs                                        Hypercalcaemia
Role of surgery & radiotherapy                                  Spinal cord compression
Role of nerve blocks, TENS, acupuncture                         Haemorrhage
             Managing the last days of life                     Acute confusional states
Dealing with terminal agitation
Appropriate use of syringe drivers

Psychological Issues
Imparting information and communicating with patients and families
Current thinking in bereavement care
Recognising and treating anxiety and depression in severely ill patients
Caring for dying patients and their families from different faiths and cultural groups

Ethical Issues in Advanced Disease
Cardiopulmonary resuscitation
Hydration & feeding

Based on Continuing Professional Development, A Palliative Medicine Curriculum for Specialists in other fields and General
Practitioners. Produced by a working party of the Association for Palliative Medicine of Great Britain & Ireland

                                                                                     Attribute Guide & Instructions 25

                                      Psychiatry Attribute Guide
•   Understand the doctor-patient relationship & its therapeutic value
•   Factors leading to mental illness
•   Emotional, intellectual & social development
•   Recognise deviations from the expected norms of development- mental handicap, dyslexia,
    behavioural and personality disorders
•   The roles of other health professionals in mental illness
•   Liaison with social services
•   Impact on family of mental illness
•   Mental Health Act, Children’s Act & Misuse of Drugs Regulations

Clinical skills
Taking a psychiatric history          Mental state examination                        Advising relatives
Consultation skills- listening,       Prescribing drug treatment                      Planning interviews to
recognising clues & providing         Formulating the psychodynamics                  modify behaviour
explanation                           of a case, including a care                     Referral for specialist advice
                                      programme approach

Knowledge and understanding of mental and emotional disorders
Acute life threatening disorders and appropriate management
Schizophrenia                     Substance abuse               Bereavement / grief reactions
Early depression                  Mental handicap               Enuresis
Postnatal depression              Dementia                      School refusal
Manic-depression illness          Phobias
Knowledge of psychological aspects of physical illnesses and of medical and surgical treatments

Pharmacology of drugs used in psychiatry
Non-pharmacological treatments available for psychiatric disorders
Understand the placebo effect
Based on the training objectives for the psychiatric component of GP vocational training, from the booklet General
Practitioner Vocational Training in Psychiatry

                                   Rheumatology Attribute Guide

Good working knowledge of the common and/or important complaints
Osteoarthritis                        Acute neck pain                       Fibromyalgia
Rheumatoid arthritis                  Chronic neck pain                     Chronic fatigue syndrome
Ankylosing spondylitis                Acute low back pain
Reactive arthritis                    Chronic low back pain                 Acute shoulder pain
Psoriatic arthritis                                                         Rotator cuff syndrome
Infectious arthritis                  Gout                                  Adhesive capsulitis
Osteoporosis                          Pseudogout                            Epicondylitis
Osteomalacia                          Chondrocalcinosis                     Plantar fasciitis
Pagets disease                                                              Tendonitis
                                      Vasculitis                            Carpal tunnel syndrome
PMR and temporal arteritis                                                  Bursitis

Awareness of less common conditions
SLE                                   Sjogrens syndrome                     Ankylosing spondylitis
Poly- and dermato-myositis            Scleroderma                           Systemic sclerosis

Practical skills: Joint injections
1st CMC (base of thumb)           Shoulder                                  Medial epicondylitis
Knee (including joint aspiration) Acromio-clavicular                        Lateral epicondylitis
Plantar fasciitis
Based on A Core Curriculum for Senior House Officers in General Medicine (RCP) and Learning Guide for General
Practitioners and General Practice Registrars on Musculoskeletal Problems (ARC). Developed by Dr. Mike Pollard

        Attribute Guide & Instructions 27


This log book has been derived from the Vocational Training Record for General Practice, produced by the North
West Deanery and a series of General Professional Training Curricula produced by the NHS Education for Scotland,
GP Unit. Feedback and comments are most welcome. (Via: or

We would like to thank Dr. John Toby, Chairman JCPTGP, Dr. Justin Allen, Secretary JCPTGP and Dr. Stephen
Field, Postgraduate Dean, West Midlands for their assistance.
Dr. Julian Page
Dr. Malcolm Valentine