nmrcgp for consultants

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O&G (Women's Health)

This is what our GP trainees need to achieve during their time at your department. We've classified them under the six main compentency domains for general practice..

1. PRIMARY CARE MANAGEMENT

• Demonstrate knowledge of women's health problems, conditions and diseases
• Understand how practice management issues impact on the provision of care to women including choice and availability of female doctors
• Maintain patient records that are accurate, facilitate continuity of care, and respect the patient's confidentiality (particularly in relation to family issues, domestic violence, termination of pregnancy, and contact tracing);
• Be familiar with local support services, referral services, networks, and groups for women (e.g. Family Planning, Breast Cancer Nurses, domestic violence resources)
• Understand the importance of informing patients of results of screening, and ensuring follow up

The knowledge base

Symptoms
• breast pain, breast lumps, nipple discharge,
• pruritis vulvae, vaginal discharge
• dysparunia, pelvic pain, endometriosis
• amenorrhoea, menorrhagia, dysmenorrhoea, inter-menstrual bleeding, irregular bleeding patterns, post menopausal bleeding, pre-menstrual syndrome, menopause, menopausal problems
• infertility - primary and secondary
• urinary malfunction: dysuria, urinary incontinence
• faecal incontinence
• emotional problems, including low mood and symptoms of depression

Common and/or important conditions
• abnormal cervical cytology,
• vaginal and uterine prolapse
• fibroids
• gynaecological infections including Bartholin’s abscess and sexually transmitted diseases (covered in detail in the RCGP Curriculum Statement on Sexual Health)
• gynaecological malignancies
• miscarriage & termination of pregnancy
• ectopic pregnancy
• trophoblastic disease
• normal pregnancy and pregnancy problems including hyperemesis, back pain, symphysis pubis dysfunction, multiple pregnancy, growth retardation, pre-eclampsia, ante-partum haemorrhage and abruption, premature labour, polyhydramnios, abnormal lies, placenta praevia, deep vein thrombosis and pulmonary embolism, post dates, reduced movements, intrauterine infection, intrauterine death, foetal abnormality
• sexual dysfunction including psychosexual conditions
• mental health issues including anxiety, depression, suicide and the relationship between these, pregnancy and the menopause

Investigations
• Pregnancy testing
• urinalysis, MSU and urine dipstick
• blood tests including renal function tests, hormone tests
• bacteriological and virology tests
• knowledge of secondary care investigations including colposcopy and sub fertility investigations

Treatment
• primary care management of the conditions listed above. (note sexually transmitted disease and contraception are dealt with in depth in the Curriculum Statement on Sexual Health)
• menopause management including Hormone Replacement Therapy
• knowledge of specialist treatments and surgical procedures including: laparoscopy, D&C, hysterectomy, oopherectomy, ovarian cystectomy, pelvic floor repair, medical and surgical termination of pregnancy, sterilisation
• understand the risks of prescribing during pregnancy
• palliative care, including management of pain, vomiting, anxiety

Emergency care
• bleeding in pregnancy
• suspected ectopic pregnancy
• domestic violence

Prevention
• health education regarding lifestyle and sexual and mental health
• pre pregnancy issues discontinuing contraception, folic acid, family & genetic history and lifestyle advice
• pregnancy care including health promotion, social and cultural factors, smoking and alcohol, age factors, previous obstetric history, diabetes and obesity, rhesus problems and use of anti d, hypertension and other medical problems, anaemia, acid reflux, leg ache and varicose veins, haemorrhoids, rubella testing and immunisation
• risk assessment, screening and management of osteoporosis

2. PERSON CENTRED CARE

• Communicate sensitively with women about sexuality and intimate issues (particularly in recognising the impact of past sexual abuse)
• Recognise the prevalence of domestic violence and question sensitively where this may be an issue.
• Recognise that many women consult for lifestyle advice, and that GPs should not over-medicalise these issues
• Recognise the issues of gender and power, and the patient-doctor relationship, and know how to prevent these issues adversely affecting women's health care
• Understand the importance of confidentiality and informed consent
• Understand the issues relating to the use of chaperones

3. PROBLEM SOLVING SKILLS

The knowledge base

Emergency care
• bleeding in pregnancy
• suspected ectopic pregnancy
• domestic violence

Specific problem-solving skills
• Recognise and intervene immediately when patients present with a gynaecological emergency
• Intervene urgently with suspected malignancy and have a low threshold for the referral of breast lumps
• Demonstrate an understanding of the importance of risk factors in the diagnosis and management of women’s problems
• Understand the importance of promoting health and a healthy lifestyle in women, and in particular the impact of this on the unborn child, growing children and the family

4. COMPREHENSIVE APPROACH

• Outline screening strategies relevant to women (e.g. cervical, breast, other cancers, postnatal depression) and discuss their advantages/disadvantages;
• Outline prevention strategies relevant to women (e.g. safe sex, pre-pregnancy counselling, antenatal care, immunisation, osteoporosis)
• Understand the impact of other illness, in both the patient and her family on the presentation and management and of women’s health problems.

5. COMMUNITY ORIENTATION

• Understand the issues of equity and access to health information and services for women
• Evaluate the effectiveness of the primary care service you provide from the female patient’s point of view.
• Appraise the role of well-woman clinics in primary care.

6. HOLISTIC APPROACH

• Discuss the psycho-social component of women's health and the need, in some cases, to provide women patients with additional emotional and organisational support (e.g. in relation to pregnancy options, hormone replacement therapy, breast cancer, and unemployment)
• Understand the impact of culture and ethnicity on womens’ perceived role in society and their attendant health beliefs, and tailor healthcare accordingly

All these 6 domains have a

7. Contextual Aspect

• Be familiar with legislation relevant to women's health (e.g. termination of pregnancy, contraception for minors)

8. Attitudinal Aspect

• Discuss their own values, attitudes and approach to ethical issues (e.g. termination of pregnancy, contraception for minors, consent, confidentiality, cosmetic surgery)

9. Scientific Aspect

• Being aware of tensions between science and politics of screening
• Understand and implement the key national guidelines that influence healthcare provision for women’s problems (and note that the documents will vary across the UK following devolution)