neurosensory sciences 2012/13 - nhs networks · msc in clinical science can be found in the student...

MODERNISING SCIENTIFIC CAREERS

Scientist Training Programme

Work Based Training

Learning Guide

NEUROSENSORY SCIENCES

2012/13

STP WORK BASED PROGRAMME IN


Contents

SECTION 1: GENERAL INTRODUCTION ................................................................. 4 READERSHIP ............................................................................................................ 5 1.1 Scientist Training Programme (STP) Overview .................................................... 6 1.2 Outcomes of the work based STP ........................................................................ 9 1.3 Key Components of Work Based Training in STP .............................................. 11 1.4 Host Training Departments ................................................................................. 12 1.5 National School of Healthcare Science (NSHCS) and the STP .......................... 16 1.6 The Structure of the Learning Frameworks ......................................................... 17 1.7 Assessment during Work Based Training ........................................................... 18 1.8 Quality Assurance and Quality Management ...................................................... 21

SECTION 2: PROGRAMME OVERVIEW ................................................................ 23

SECTION 3: ROTATIONAL LEARNING FRAMEWORKS ...................................... 30 Introduction to Audiology (A-1) ................................................................................. 32 Introduction to Neurophysiology (N-2) ...................................................................... 40 Introduction to Ophthalmic and Vision Science (O&V-3)........................................... 47 Clinical Assessment and Investigation (CA&I) .......................................................... 56

SECTION 4: PROFESSIONAL PRACTICE LEARNING FRAMEWORK ................. 66 Professional Practice (PP1) ...................................................................................... 69

SECTION 5: ELECTIVE LEARNING FRAMEWORK............................................... 80 Elective (EL) ............................................................................................................. 82

SECTION 6: AUDIOLOGY SPECIALIST LEARNING FRAMEWORK .................... 84 Adult Audiological and Vestibular Assessment (A&VA-5) ......................................... 87 Adult Audiology and Rehabilitation (AA&R-6) ........................................................... 92 Paediatric Audiology and Habilitation (PA&H-7) ...................................................... 98 Epidemiology and Public Health (E&PH-8) ............................................................. 105

SECTION 7: NEUROPHYSIOLOGY SPECIALIST LEARNING FRAMEWORK ... 109 Electromyography and Nerve Conduction Studies and Evoked Potentials (E&NC&EP-5) ......................................................................................................... 112 Paediatric EEG (PEEG-6) ....................................................................................... 121 EEG in the Intensive Care Setting (EEG on ICU-7) ................................................ 126 Sleep and Long-term Monitoring (S&LTM-8) .......................................................... 132

SECTION 8: OPHTHALMIC AND VISION SCIENCE ............................................ 140 Patient Assessment (PA-5) ..................................................................................... 143 Psychophysical Assessment of Vision (PAV-6) ...................................................... 151 Ophthalmic Imaging with Light and Lasers (OILL-7) ............................................... 156 Ultrasonography of Eye and Orbit (UEO-8) ............................................................ 162

Ocular Measurement, Refraction and Biometry (OMRB-9) ..................................... 168 Ocular Movement and Binocular Function (OMBF-10) ........................................... 174 Visual Electrophysiology (VE-11) ............................................................................ 179

SECTION 9: CONTRIBUTORS .............................................................................. 185

SECTION 10: APPENDICES ................................................................................. 187 APPENDIX 1: GLOSSARY ..................................................................................... 188 APPENDIX 2: GOOD SCIENTIFIC PRACTICE ...................................................... 190 APPENDIX 3: FURTHER INFORMATION .............................................................. 197

SECTION 1: GENERAL INTRODUCTION

READERSHIP

This Scientist Training Programme (STP) Learning Guide describes the STP work based

training programmes in the UK:

• Trainees, host departments and managers of services that employ healthcare science staff;

• Work based trainers, which includes all those involved in supervising, coordinating, assessing and delivering education and training;

• Academic and administrative staff within Higher Education Institutions (HEIs);

• Strategic Health Authorities (SHAs), and their successor health and education commissioning bodies;

• Those involved in Modernising Scientific Careers (MSC) accreditation events and reviews.

A glossary of terms used is provided in Appendix 1.

Introduction

1.1 Scientist Training Programme (STP) Overview 1. Healthcare science (HCS) involves the application of science, technology, engineering

and mathematics to health. Good Scientific Practice (GSP) [Appendix 2] sets out the principles and values on which education and training for healthcare science are founded. It makes explicit the professional standards of behaviour and practice that must be achieved and maintained in the delivery of work activities and clinical care for all those who work in healthcare science, the public and healthcare providers.

2. GSP and the Education and Training Standards of the Health and Care Professions

Council (HCPC) are the basis for all MSC training curricula which contextualise the Standards of Proficiency set down by the HCPC in a way that is accessible to the profession and the public.

3. The healthcare science workforce and services have traditionally been grouped into

three broad areas called Divisions, namely: Life Sciences/Clinical Laboratory Sciences, Physical Sciences/Medical Physics and Biomedical Engineering and Physiological Sciences/Clinical Physiology Sciences. Within each Division there are a number of healthcare science specialisms. With advances in scientific technology, changes to the delivery of healthcare scientific services and the development of MSC, the boundaries between these Divisions have been shifting. MSC recognises this important change and to date has identified nine themes within healthcare science for the STP, which enables training across a total of 24 healthcare science specialisms, with curricula for additional specialisms still under development.

4. The STP is designed to provide healthcare scientist trainees with strong science-

based, patient-centred clinical training in a specialist area of healthcare science. Initial rotational training provides a broad base of knowledge, skills and experience across a group of related cognate specialisms reflective of the evolving clinical and scientific changes and requirements followed by specialisation in a single HCS specialism.

5. During the STP programme the scientist trainee is supernumerary but may contribute to the clinical work of the department in which they are training to gain the required clinical experience and competence.

6. The STP is an integrated training programme combining academic study leading to the

award of a specifically commissioned MSc in Clinical Science and a work based training programme. Completion of both will lead to the award of a Certificate of Completion of the Scientist Training Programme (CCSTP) by the National School of Healthcare Science (NSHCS). Graduates are then eligible to apply to the Academy for Healthcare Science for a Certificate of Attainment and will then be eligible to apply to HCPC for registration as a Clinical Scientist.

7. The MSc Clinical Science Learning Outcomes and Indicative Content, and the

associated work based learning outcomes, can be found by following the link www.networks.nhs.uk/nhs-networks/msc-framework-curricula. Further details of the

MSc in Clinical Science can be found in the student handbook from the university with which each trainee is registered.

8. This Introduction to Work Based Learning provides an overview of the work-based

training programme and the guidance provided by the NSHCS for users of the Online Assessment Tool (OLAT) and e-learning Portfolio. All trainees and trainers will have access to the OLAT throughout their training. In addition, The Reference Guide for Healthcare Science Training and Education in England will be published in autumn 2012. This will contextualise the STP within the wider MSC programme.

9. All STP trainees will be registered with the NSHCS for the duration of their training and

will be allocated a National Science Training Number (NSTN). The NSHCS working through its Themed Boards provides oversight and coordination of the STP, communicates with trainees and trainers with respect to national policy and events, liaises with the work based trainers, host employers and the academic providers, reviews progress on assessments and trainee performance including OLAT/ Structured Final Assessment (SFA) and quality assurance of the work place training environment. The School overall has a responsibility to provide confidential reports in accordance with agreed governance and oversight arrangements.

10. The work based training programme has four components each underpinned by the

professional practice curriculum:

•••• Induction;

•••• Rotational Training;

•••• Elective Training;

•••• Specialist Training. 11. It is anticipated that trainees will have a brief induction period in their host employing

organisation prior to commencing the introduction to their MSc in Clinical Science. As the induction period may be up to 6 weeks in some departments the time should be used to begin rotational training as well as the induction period. The subsequent initial academic period is specifically designed to give an overview of the basic science and an introduction to aspects of professional practice relevant to HCS and the STP rotational training. The duration of this first university session will vary, depending on the MSc degree which is undertaken.

12. Details of the work based assessment programme can be found in Section III of this

guide and also by logging onto the online assessment tool. Details of the assessment programme for the MSc in Clinical Science will usually be published in the student handbook provided by each university.

A broad overview of the STP is shown in the diagram overleaf:

Modernising Scientific Careers: Scientist Training Programme (STP): Diagrammatic representation of employment-based, pre-registration 3 year

NHS commissioned education and training programme

1.2 Outcomes of the work based STP

13. On successful completion of the work based STP trainees will have clinical and specialist expertise in a specific healthcare science specialism, underpinned by broader knowledge and experience within a healthcare science division or theme. They will undertake complex scientific and clinical roles, defining and choosing investigative and clinical options, and making key judgements about complex facts and clinical situations. Many will work directly with patients and all will have an impact on patient care and outcomes. They will be involved, often in lead roles, in innovation and improvement, research and development and education and training. Some will pursue explicit academic career pathways, which combine clinical practice and academic activity in research, innovation and education. On successful completion of the work-based training programme which forms part of the MSC STP, trainees will possess the essential knowledge, skills, experience and attributes required for their role and should demonstrate:

• A systematic understanding of clinical and scientific knowledge, and a critical awareness of current problems, future developments, research and innovation in health and healthcare science practice, much of which is at, or informed by, the forefront of their professional practice in a healthcare environment;

• Clinical and scientific practice that applies knowledge, skills and experience in a healthcare setting, places the patient and the public at the centre of care prioritising patient safety and dignity and reflecting NHS/health service values and the NHS Constitution;

• Clinical, scientific and professional practice that meets the professional standards defined by GSP and the regulator (HCPC);

• Personal qualities that encompass self-management, self-awareness, acting with integrity and the ability to take responsibility for self-directed learning, reflection and action planning;

• The ability to analyse and solve problems, define and choose investigative and scientific and/or clinical options, and make key judgements about complex facts in a range of situations;

• The ability to deal with complex issues both systematically and creatively, make sound judgements in the absence of complete data, and to communicate their conclusions clearly to specialist and non-specialist audiences including patients and the public;

• The ability to be independent self-directed learners demonstrating originality in tackling and solving problems and acting autonomously in planning and implementing tasks at a professional level;

• A comprehensive understanding of the strengths, weaknesses and opportunities for further development of healthcare and healthcare science as applicable to their own clinical practice, research, innovation and service development which either directly or indirectly leads to improvements in clinical outcomes and scientific practice; alternative;

• Conceptual understanding and advanced scholarship in their specialism that enables the graduate to critically evaluate current research and innovation methodologies and develop critiques of them and, where appropriate, propose new research questions and hypotheses;

• Scientific and clinical leadership based on the continual advancement of their knowledge, skills and understanding through the independent learning required for continuing professional development.

14. Once registered as a Clinical Scientist, a range of career development options will be available including competitive entry into Higher Specialist Scientist Training (HSST). Alternatively, others may choose to undertake further career development in post through a structured programme of Continuing Professional Development (CPD), provided by Accredited Expert Scientific Practice or pursue a clinical academic career. Clinical Scientists who successfully complete HSST, or who can demonstrate equivalence to its outcomes, will be eligible to compete for available Consultant Clinical Scientist posts.

1.3 Key Components of Work Based Training in STP

The Trainee 15. The trainee is at the centre of the STP, supported on the one hand by the national

oversight role taken by the NSHCS, working closely with local quality monitoring and performance processes currently undertaken by SHAs and on the other by the day-to-day delivery of training in the workplace, facilitated by the underpinning and integrated MSC in Clinical Science programme. This Guide contains important information which will help the trainee understand how the work based programme operates and its key elements.

16. At the core of successful work based training is appropriate educational supervision,

facilitation and feedback. Each trainee will be allocated to a clinical training supervisor or training officer1 from within the employing host department. Trainees should ensure that a planned schedule of meetings with their training officer is agreed early in training, commencing with a meeting during the first week. Conversations between trainees and trainers are confidential, unless patient safety is at risk. When the trainee is following a rotational module a trainer from the host department will act as their main contact whilst they are away from their host department.

17. The local training departments, supported by the NSHCS working with others, are responsible for ensuring that trainees have access to training opportunities to enable the achievement of the learning outcomes of the STP. In return trainees are expected to take responsibility for:

• ensuring that they fulfill their obligations to their employer and to patients

(especially with regard to patient safety and confidentiality) as healthcare professionals;

• engaging as active adult learners by initiating work based assessments; contributing to learning activities; taking into account feedback received from their trainers and assessors and; giving considered and constructive feedback on their experience of their training;

• meeting the requirements of the academic MSc Clinical Science programme. 18. Critical reflection on progress and performance is an integral part of both the STP and

of being a professional. Trainees should therefore regularly critically reflect on their progress and performance, enabling them to develop skills in self-evaluation and action planning.

1 For the purposes of this document Training Officer has be used however the title may vary between departments and may be

subject to a title change in England as part of developments for the whole of the professional healthcare workforce. In essence this

is the person in the host department who is responsible for the training of each trainee for the duration of the 3 years.

1.4 Host Training Departments 19. The third key component for successful training in the STP is the employing host

department and other service units facilitating work based training. The success of the training and the trainee experience requires the commitment and enthusiasm of those in the work base who provide the training.

20. Host departments should therefore ensure that they are fully familiar with the four

components of the work based training programme, namely: induction, rotational, elective and specialist; the underpinning professional practice curriculum and be aware of how the academic MSc in Clinical Science degree integrates with work based training.

21. All trainees must have a designated training officer who will have responsibility for:

• provision of support, guidance and mentoring for the duration of the programme, in the host department and related training environments;

• provision of a timetable which enables an appropriate balance of work and learning for the trainee;

• ensuring adequate support during periods of training outside the host department;

• ensuring that the programme of work based assessment is understood and that its outcomes for individual trainees is documented through the use of OLAT;

• ensuring that the e-learning Portfolio is discussed with the trainee and that there is clarity and agreement about its use;

• ensuring that clinical practice is well supervised for the safety of patients and the trainee, so that the acquisition of clinical competence is facilitated;

• ensuring that other contributors to the assessment process are fully aware of the requirements and the use of the OLAT.

Organisation of the Training Programme

22. The host department is responsible for organising the training programme for each

of its trainees. This may involve liaising with other departments to facilitate necessary work based learning and other contributors to the associated assessment requirements. Whilst the NSHCS will provide support, host departments need to be satisfied that they are providing a training environment of appropriate quality including appropriately trained staff and facilities. Furthermore, host departments are required to engage in the quality assessment management process established by the NSHCS and provide information as necessary to enable the NSHCS to fulfil this critical function. Details of the NSHCS quality assessment management policy for work based training provider departments can be found at:www.nshcs.org.uk.

23. Induction At the start of the STP training programme and of each new placement, trainees should be provided with an induction programme explaining trust and departmental arrangements. Initial work based induction in the host department should include an overview of the:

• hospital/healthcare setting and local policies including health and safety, confidentiality, data protection etc relevant to the placement;

• range of services provided by the department; • range of people who use the services provided by the department; • function, operation and routine and corrective maintenance requirements of

equipment appropriate to the section(s) of the department in which the trainee will be working.

Moreover, the host department should ensure that the trainee has access to:

• Host Trust IT systems including the library and knowledge service as necessary;

• On-line Assessment and Personal Management System.

Induction should include an early discussion (within the first week) between the trainee and his/her training officer so that the curriculum, assessment and placement arrangements can be discussed. In addition, trainers should provide trainees with copies of:

• Good Scientific Practice; • The STP work based Learning Guide; • The OLAT learning guide; • Links to the NSHCS (see section III for details of the role of the NSHCS in

relation to STP training).

24. Rotational Training

During rotational training each trainee will undertake four rotations which will include a rotation in the area in which they will subsequently specialise. Trainees must successfully achieve all of the learning outcomes. Each rotational placement should be of approximately 12 weeks duration. It is the responsibility of the host department to organise this rotational programme and to liaise with the trainers in the rotational placement departments on the requirements of work based training and supervision and the use of the online assessment tool. The NSHCS and the SHA MSC leads (and successors) will help to facilitate rotational placements for small specialisms or where there are local issues in respect of access to particular training elements.

The host department is responsible for setting the timetable for each of the 4 rotations, which will depend on local availability and may require some time to be spent out with your locality to ensure that the learning outcomes in totality can be achieved. In agreeing the rotational training the host department will need to consider the periods of time the trainee will be required to attend the University or undertake academic activities for the MSc within the work place.

The host department must be familiar with the content, delivery and assessment programme of the MSc in Clinical Science which the trainee is undertaking at university and ensure that the departments where the trainee is placed for rotational placements are also familiar with the expected outcomes of each period of training and are trained in the assessment methods. The training officer in the host department should maintain contact with the trainee and should liaise with the person taking overall responsibility for the trainee whilst they are undertaking the rotation. Supervision meetings between the training officer and the trainee should continue whilst they are on their rotational placements.

25. Elective Training Each trainee must undertake elective training and successfully achieve all of the learning outcomes. The host department should agree the timing and content of the elective training period with the trainee and should then inform the NSHCS of the plans for the elective by completing the appropriate form and submitting it to the School. The aim of the elective is to facilitate a wider experience of health care and/or the practice of healthcare science in a cultural and/or clinical setting that is different from the usual training environment. This may involve health care or healthcare science in a different area of the health service and may involve study abroad or pursuit of a particular clinical or research interest. The elective period can be taken any time during the specialist training, and may comprise a single period of 4–6 weeks or a series of shorter periods of elective training. It is important that the trainee is able to express their preferences for the elective period which is designed to provide a broader experience and for these to be fully taken into consideration.

26. Specialist Training

The host department will plan the timetable for specialist training. This will usually be in a single health care science specialism (except for Gastrointestinal Physiological and Urodynamic Science who share modules in the specialist training period, and Immunogenetics and Histocompatibility who share some specialist modules with Clinical Immunology). Each trainee must successfully achieve all of the learning outcomes in the specialist training modules including, by the end of the training programme, all of the professional practice learning outcomes. If the host department itself is unable to provide the necessary work based training to enable the trainee to complete all of the required learning outcomes, it will need to arrange training in other training departments and environments.

27. Supervision

STP clinical and educational supervision should promote learning, reflective practice and support the trainee to produce action plans to address identified learning needs. It will need to ensure that the trainee learns specific skills and competencies, helping them to develop self-sufficiency and self-awareness in the ongoing acquisition of skills and knowledge. At every stage, patient safety must be paramount. Supervision will require the provision of pastoral care for some trainees. Supervision may, at times during the programme, be provided by other healthcare professionals outside of healthcare science who will be appropriately trained e.g. medical colleagues.

The first supervision meeting should be set up during the first week of the training programme. At this meeting the training officer should ensure that the trainee is undertaking an induction programme that includes the hospital and department. It is recommended that following areas should be explored and agreement reached at the first meeting with respect to the:

• expectations of the training officer and trainee; • responsibilities of the training officer and trainee; • boundaries between the training officer and trainee; • confidentiality; • frequency and duration of planned supervision meetings; • methods of communication and responsibility for arranging meetings; • level of support and arrangements for communications between meetings; • models of reflection and action planning; • record keeping; • content of the work based training programme; • the approach to assessment and the use of the assessment tools and the

online system; • sources of help and support.

1.5 National School of Healthcare Science (NSHCS) and the STP

28. The NSHCS provides a national coordinating and oversight function to support trainees and host departments in the delivery of training. It is responsible for:

• national recruitment into STP, enabling a transparent and robust selection of the very best science graduates;

• providing national oversight of STP trainees throughout their training by managing and monitoring their progress through the OLAT, supporting trainees in difficulty as well as co-ordinating national structured assessments both during and at the end of STP training;

• evaluation of ongoing work based assessment outcomes through the OLAT, enabling the School to benchmark training programme delivery for early identification of programme issues which may need to be addressed and resolved and reporting these as part of agreed MSC governance arrangements;

• liaising with each HEI’s MSc Clinical Science programme director to ensure the integration and coordination needed to deliver the academic and work based programmes that form the STP;liaising with MSC SHA leads (and education and quality leads in the future arrangements) on local issues and problems and their resolution;

• working closely with work place training departments and providing support as appropriate;

• organising national ‘Train the Trainer’ programmes to ensure common standards of delivery and content and recommending on-going training activities to support the continuing professional development of work based trainers.

Professional Leads in each of the scientific divisions within the NSHCS will provide help and support with respect to organising rotations and/or specialist training that might require national coordination. In order to optimise the educational benefit and value of OLAT and the e-learning Portfolio, Professional Leads will also work with and support training departments in its use.

The School can be contacted on the following email [email protected] and at www.nshcs.org.uk .

1.6 The Structure of the Learning Frameworks 29. The work-based programme is divided into modules, with each module following a

standard format. The aim and scope of the module are described followed by:

• Learning outcomes – high level descriptors of required achievements for module;

• Clinical Experiential Learning – the learning activities that will facilitate learning and achievement of stated outcomes;

• Competences – further, outcome based statements for each Learning Outcome;

• Knowledge and Understanding as APPLIED to appropriate competences. All of the above are focused on service need, patient care/pathway and continuous service improvement

1.7 Assessment during Work Based Training

Trainee Assessment 30. The work-based assessment is designed to promote learning, skill development and

competence within the specialist healthcare context. Trainees will be able to identify areas for development and improvement.

The assessment programme is designed to enable both trainee and trainer to obtain regular feedback on progress and achievement. It aims to nurture the trainee by providing professional educational support and encouraging critical reflection and generating regular feedback about progression. The programme embeds assessment tools to enable trainees to learn and develop but also to generate evidence so that judgments about progression can be made and areas identified for trainee improvement based on supportable evidence. The work-based education and training programme should offer a constructive environment where a trainee understands that he/she is still developing and the assessment tools are intended for use in this context. As part of each assessment, the work-base assessor will facilitate a discussion in which the trainee is encouraged to reflect on his/her performance and identify his/her strengths and areas that could be improved, setting an action plan to achieve that improvement.

31. The structure of the work based assessment programme.

There are distinct elements of the work-based assessment programme for all trainees: • Assessment Tools, see Table 1 overleaf; • Competency Log; • Online Assessment and Personal Learning Management System (OLAT); • Exit assessment – Objective Structured Final Assessment (OSFA).

Assessment Tools

32. The assessment programme utilises a range of work-based assessment tools, designed to promote continuous assessment and generate feedback throughout training. The assessment promotes student centred feedback to enable the trainee to gain skills in self-assessment. There is a requirement for each trainee to engage with the assessment process and to complete a defined number and range of assessments to successfully complete each module. These are set out in OLAT.

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STP_LG Neurosensory Sciences Final Version (4.0)

Table 1 Summary of the STP Work Based Assessment Tools

Assessment

Tool

Direct observation of

practical skills (DOPS)

Observed clinical

event (OCE)

Case based discussion

(CbD)

Multi source feedback

(MSF)

Purpose

To assess a practical skill or procedure which may include interaction

with a patient. Feedback is generated, learning

needs identified and an action plan generated.

To assess a clinical encounter.

To assess the trainee’s ability to apply their

knowledge and understanding of an

aspect of an activity for

example the underpinning science, aspects of

professional practice .

To provide a sample of attitudes and opinions of

colleagues on the performance and

professional behaviour of the trainee. It helps to

provide data for reflection on performance and gives useful feedback for self-

evaluation.

Method The assessor observes a practical activity and

facilitates student centred feedback either during or immediately

following the observation. The

trainee then generates an action plan.

The assessor observes a clinical activity and

facilitates student centred feedback either during or immediately following the observation. The trainee then generates an action

plan.

The assessor facilitates a discussion with the

trainee about a clinical case with which the

trainee has been involved. This may

include a report, record, result or an aspect of professional practice arising from the case.

Following the discussion the trainee generates an

action plan.

Using an on-line system the trainee gains feedback from

a range of people (8–10) who work with them and the

trainee also rates themselves. On completion

the report generated is reviewed in a discussion between the trainee and trainer and using critical reflection an action plan generated by the trainee.

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S T P _ L G N e u r o s e n s o r y S c i e n c e s F i n a l V e r s i o n ( 4 . 0 )

33. Competences

All trainees are required to provide evidence to demonstrate that they have completed each competence which should then, at the request of the trainee, be signed off by a trainer. Trainees will gain competence at their own pace, but in line with the overall delivery of the relevant modules. Each competence may link directly to a specific learning outcome and some competences may be linked to more than one learning outcome, therefore successful completion cannot be achieved until demonstrated for all learning outcomes. All of the competences are contained within a competency log within the OLAT. Completion of the competency log is essential for progression within the programme and in order to exit from the programme. The expectation is that as the trainee progresses the competency log will demonstrate an evidence base of achievement.

34. Online Assessment and Personal Management Tool (OLAT)

The achievement of competences and all work based assessments are recorded on OLAT. OLAT is customised for each specialism and contains all the above assessment tools as well as the full list of competences for each programme and a reflective log. NSHCS will provide trainees with the information to allow them to register on OLAT at the start of their programme. As part of their registration they must nominate their training officer, even though others may contribute during the total period of work base training to the assessment process. Short film clips which explain the principles of the assessment process and how to use each of the assessment tools are available on OLAT.

35. Objective Structured Final Assessment

At the end of training trainees will be assessed using an Objective Structured Final Assessment (OSFAs). This is a performance based assessment used to measure trainees across a number of different stations encompassing scientific, clinical and professional practice. The NSHCS, in partnership with the professional bodies and supported by the NSHCS Themed Boards, will design and deliver the OSFA and the Academy for Healthcare Science will provide external Quality Assurance All trainees will have the opportunity to undertake an OSFA mid-programme to provide formative experience of this assessment.

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1.8 Quality Assurance and Quality Management Quality Assurance of work based training 36. All host and training departments are responsible for the delivery of the work

based training quality standards detailed in the Learning and Development Agreement (LDA) agreed with and issued by with the local Strategic Health Authority (SHA) and their successor bodies. All host and training departments providing training for trainees on the STP must also be MSC approved and accredited.

37. MSC work-based accreditation is carried out by the NSHCS on behalf of MSC.

38. The NSHCS provides oversight of the quality management and quality control of the STP work based training environments as agreed by the appropriate MSC governance arrangements and to be maintained into the future.

39. The NSHCS works in partnership with the professional bodies through its Themed Boards and the SHAs/LETBs to deliver a robust Quality Assessment Management (QAM) programme for the work based education and training programme. This QAM programme is UK wide and independent from the direct delivery of education and training. The purposes of the QAM programme are to:

• all STP training environments are accredited to deliver work based training; • ensure that all training settings are working to the agreed standards; • create an open and transparent culture where issues and concerns can be

raised, investigated and resolved; • ensure that trainees receive a high quality educational experience wherever

their training takes place; • Identify and share examples of good practice; • provide evidence of the quality of work based education and training

environments to those who regulate and register the profession; • provide evidence of the high standard of work based education and training

and assurance that these standards are robustly managed.

40. Details of the quality management approach is available from the NSHCS (Ref NSHCS Policy 03), in summary, the quality framework includes:

• Receipt, analysis, review and response with respect to:

o annual self assessment progress reports from each work base; o trainee feedback questionnaires; o assessment progress reports; o ad hoc reporting of exceptions or changes to programmes; o individual work based education and training timetables for each

trainee;

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• A mechanism for receiving and reviewing reports with respect to the STP programme from trainees, trainers, patients or other stakeholders;

• Visit Programme including: o a five year rolling visit programme to each work base; o adhoc visits to departments as required.

41. The NSHCS monitors the progress of each trainee and provides support for

trainees in difficulty (Trainees in Difficulty Ref NSHCS Policy 04). Staff in the NSHCS also regularly review the STP programmes using information from the OLAT and other sources through the Themed Boards (See NSHCS Policy 01)

42. The QAM processes, established jointly by the MSC governance arrangements

involving all current SHAs and the NSHCS, do not absolve the training provider from responsibility for continuously managing and maintaining the quality of its own provision. Local training departments are responsible for ongoing quality control and local education providers should therefore ensure that a high quality education and training environment is maintained.

The following sections of this Learning Guide include an overview of the STP work based programme for the specialisms within this theme. This is followed by the Learning Frameworks for the Rotational, Elective, Specialist and Professional Practice components of the programme. Further information can be found in Appendix 3.

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SECTION 2: PROGRAMME OVERVIEW


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STP WORK BASED TRAINING PROGRAMME IN AUDIOLOGY

The diagram below provides an overview of the programme each trainee in Audiology will follow:

Modernising Scientific Careers: Scientist Training Programme (STP): Diagrammatic representation of employment based, 3-year NHS

commissioned, pre-registration Education and Training programme

PROFESSIONAL PRACTICE This module spans the whole of the 3-year training programme, underpinning both work based training and the MSc in Clinical Science.

INDUCTION COMPONENT At the start of the training programme and of each new placement all trainees will complete an induction programme.

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ROTATIONAL COMPONENT

Trainees must then successfully complete the following rotations: Rotation 1 (A-1)

Introduction to Audiology

Rotation 2 (N-2)

Introduction to Neurophysiology

Rotation 3 (O&V-3 ) Introduction to Ophthalmic and Vision Science

Rotation 4 (CA&I)

Clinical Assessment and Investigation

Duration: Each rotation should be of approximately 12 weeks duration. Order: It is expected that the first rotation completed will be Introduction to Audiology but the other modules can be completed in any order and may run in parallel in order to use the time and clinical contacts to best advantage, build confidence and enable learning from Clinical Assessment and Investigation to be applied in the other specialisms.

ELECTIVE COMPONENT The elective period can be taken any time during the specialist training. It may comprise a single 4- to 6-week elective or a series of shorter periods of elective training. SPECIALIST COMPONENT

Module 1 (A&VA-5) Adult Audiological and Vestibular Assessment

Module 2 (AA&R-6) Adult Audiology and Rehabilitation

Module 3 (PA&H-7) Paediatric Audiology and Habilitation

Module 4 (E&PH-8) Epidemiology and Public Health

Duration: The work based component of the four specialist modules should be completed during the specialist training period. The work based component of the modules can run in parallel in order to use the time and clinical contacts to best advantage. The following sections of the learning guide contain the learning frameworks for the rotational, elective, specialist and professional practice modules.

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STP WORK BASED TRAINING PROGRAMME IN

NEUROPHYSIOLOGY

The diagram below provides an overview of the programme each trainee in Neurophysiology will follow:





Page | 2 7



Trainees must then successfully complete the following rotations: Rotation 1 (N-2)


Rotation 2 (A-1)


Rotation 3 (O&V-3 ) Introduction to Ophthalmic and Vision Science

Rotation 4 (CA&I)


Duration: Each rotation should be of approximately 12 weeks duration. Order: The first rotation will usually be the Introduction to Neurophysiology with the other rotations being completed in any order. However, there is the flexibility for the host department to arrange the rotations in any order to best meet the needs of the trainee and local availability of training placements. Rotations may also run in parallel in order to use the time and clinical contacts to best advantage, build confidence and enable learning from Clinical Assessment and Investigation to be applied in the other specialisms.

ELECTIVE COMPONENT The elective period can be taken any time during the specialist training. It may comprise a single 4- to 6-week elective or a series of shorter periods of elective training. SPECIALIST COMPONENT Module 1 (E&NC&EP-5) Electromyography and Nerve Conduction Studies

and Evoked Potentials Module 2 (PEEG-6) Paediatric EEG

Module 3 (EEG on ICU-7) EEG in the Intensive Care Setting

Module 4 (S&LTM-8) Sleep and Long-term Monitoring

Duration: The work based component of the four specialist modules should be completed during the specialist training period. The work based component of the modules can run in parallel in order to use the time and clinical contacts to best advantage. The following sections of the learning guide contain the learning frameworks for the rotational, elective, specialist and professional practice modules.

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STP WORK BASED TRAINING PROGRAMME IN OPHTHALMIC AND VISION SCIENCE

The diagram below provides an overview of the programme each trainee in Ophthalmic and Vision will follow:





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Trainees must then successfully complete the following rotations: Rotation 1 (O&V-3 ) Introduction to Ophthalmic and Vision Science

Rotation 2 (N-2)


Rotation 3 (A-1)


Rotation 4 (CA&I)


Duration: Each rotation should be of approximately 12 weeks duration. Order: The first rotation will usually be the Introduction to Ophthalmic and Vision Science with the other rotations being completed in any order. However, there is the flexibility for the host department to arrange the rotations in any order to best meet the needs of the trainee and local availability of training placements. Rotations may also run in parallel in order to use the time and clinical contacts to best advantage, build confidence and enable learning from Clinical Assessment and Investigation to be applied in the other specialisms. ELECTIVE COMPONENT The elective period can be taken any time during the specialist training. It may comprise a single 4- to 6-week elective or a series of shorter periods of elective training. SPECIALIST COMPONENT Module 1 (PA-5) Patient Assessment

Module 2 (PAV-6) Psychophysical Assessment of Vision

Module 3 (OILL-7) Ophthalmic Imaging with Light and Lasers

Module 4 (UEO-8) Ultrasonography of Eye and Orbit

Module 5 (OMRB-9) Ocular Measurement, Refraction and Biometry

Module 6 (OMBF-10) Ocular Movement and Binocular Function

Module 7 (VE-11) Visual Electrophysiology

The following sections of the learning guide contain the learning frameworks for the rotational, elective, specialist and professional practice modules.

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Neurosensory Sciences

SECTION 3: ROTATIONAL LEARNING FRAMEWORKS

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STP Learning Framework

This section describes the Learning Framework for the Rotational Component of work based learning covering the Learning Outcomes, Clinical Experiential Learning, Competence and Applied Knowledge

and Understanding. Each trainee is also expected to build on and apply the knowledge, skills and experience gained from the MSc in Clinical Science.

Rotational Module

DIVISION Physiological Sciences

THEME Neurosensory Science

SPECIALISM Audiology

ROTATION Introduction to Audiology

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MODULE TITLE

Introduction to Audiology (A-1)

COMPONENT Rotation

AIM This module will provide the trainee with the knowledge, understanding and awareness of the diversity of patients attending audiology services. Trainees will undertake a range of investigations and assist with the assessment and management of a wide range of patients of all ages experiencing hearing, tinnitus or balance difficulties.

SCOPE On completion of this module, the trainee will understand the fundamental principles and range of services and investigations undertaken within an audiology department. They will be able to describe the range of patients and their special needs, together with the range of support services available. They will have gained experience of conducting or assisting with basic audiology investigations in a range of patients of all ages, including those with learning difficulties and with other impairments.

LEARNING OUTCOMES

On successful completion of this module the trainee will:

1. Perform the daily checks of equipment used in adult rehabilitation, e.g. audiometers, tympanometers, in a safe manner in accordance with standard procedures.

2. Obtain accurate and reproducible non-masked pure tone audiograms from adult patients. 3. Perform a subjective listening test and comment on the performance of a hearing aid. 4. Apply the fundamental principles of aural rehabilitation. 5. Assist in the assessment and management of routine audiological caseload, in particular adult rehabilitation.

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CLINICAL EXPERIENTIAL LEARNING The clinical experiential learning for this module is:

• Observe a range of routine investigations undertaken in an audiology department and describe the diversity of patients

attending audiology services and some of their special needs; this should include people with cognitive and sensory impairment, physical and learning disabilities, older people, paediatrics.

• Observe a range of routine investigations undertaken in an audiology department and identify a range of routine audiological equipment, and discuss their use in the assessment of a range of cases with your training officer.

• Observe history taking and clinical examinations in patients with signs and symptoms of audiological conditions and discuss with your training officer different clinical approaches and strategies using clinical reasoning, innovative approaches in complex situations and responding to differing priorities of a given situation.

• Attend outpatient departments where patients with audiological conditions are referred and summarise the investigation and likely management of routine audiological conditions.

• Observe the work of non-NHS or external statutory, voluntary charitable agencies or services, such as social care, that offer support to patients with hearing loss in the community and reflect on their role in the management of patients who experience loss of hearing.

All of these experiences should be recorded in your e-portfolio. The following section details the competence and knowledge and understanding each trainee must gain. Each competence is

linked to the relevant learning outcomes and trainees must demonstrate achievement of each competence for each linked learning

outcome.

PROFESSIONAL PRACTICE

Trainees should ensure they refer to the professional practice learning framework and continue to achieve the professional

practice competences alongside the competences defined in this module.

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KEY LEARNING

OUTCOMES

COMPETENCES KNOWLEDGE AND UNDERSTANDING

1 Undertake the stage A daily checks of equipment used in adult rehabilitation, including audiometers, tympanometers, etc.

• The range, purpose, basic principles and importance of equipment calibration.

• Health and safety requirements, including cross-infection techniques.

1,2,3,4,5 Control infection risks in accordance with departmental protocols.

• Protocols and requirements for hygiene and infection control related to the relevant range of investigations, including preparation, conduct and completion of investigation.

• Protocol for hand washing and how effective hand washing contributes to control of infection.

1,2,3,4,5 Minimise risks and hazards in compliance with health and safety policies.

• The relevant health and safety regulations specific to audiological and vestibular assessment.

• The potential hazards and risks and the actions to be taken to minimise these.

2,3,4 Obtain a basic history of hearing difficulties in a routine adult patient, their use of hearing aids where appropriate, using communication strategies appropriate to the patient and the situation. (NB patients seen in this section will often be new patients and are therefore unlikely to already have a hearing aid.)

• The range of communication strategies with people with a range of hearing and communication difficulties, including the use of verbal and non-verbal communication skills such as voice intonation, eye contact, use of gesture, questioning and listening skills.

• The importance of identifying the source of referral, including formal or opportunistic screening.

• The proportion of new to follow-up patients, and any differences in age range or in different diagnostic groups.

• The different referral routes and the range of diagnostic, assessment and management pathways.

• The range of diseases and conditions pertinent to history taking.

• Factors relevant to history, including communication need, social factors, if appropriate, speech and language.

• How to judge the reliability of information provided and the

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KEY LEARNING

OUTCOMES


importance of recording these judgements.

• The range of symptoms relevant to the clinical question.

• The importance of obtaining information at a sufficient level of detail and the implications of insufficient or inaccurate information for diagnosis and management.

• Identify the most common reason for attendance in at least one age range.

2,3,4,5 Perform the appropriate room set-up for different appointment sessions.

• The need for a conducive environment for a safe and efficient appointment.

• The combination of tests to be used and their efficacy.

• The type and range of measurements to be taken, their correct sequence and the importance of following relevant protocols.

• Protocols and procedures relevant to tests to be performed. 2,3,4,5 Explain the procedure to the patient,

address any questions they may have relating to the procedure, including the process after the procedure and how they will be informed of the results.

• The appropriate choice of investigation considering the findings from the history and clinical examination.

• Common questions and concerns of patients about procedures.

• Risks and benefits of undertaking the investigation.

• The information needs of patients following investigation.

• The authority level for provision of information to patients.

• Common causes of neurological disorders/referrals and the populations disproportionately affected (e.g. by age, ethnicity).

2 Identify normal landmarks of the external auditory meatus (EAM) and tympanic membrane (TM) via otoscopy.

• Normal and abnormal anatomy of the ear.

• Knowledge of basic abnormalities and pathologies.

• Safety requirements, including cross-infection techniques.

2 Gain informed consent for a pure tone audiogram (PTA).

• The importance of explaining the procedure for each investigation to the patient and gaining informed consent.

• The relevant procedures and requirements for patient conformance.

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KEY LEARNING

OUTCOMES


• Principles, guidance and law with respect to informed consent. 2 Following initial familiarisation, record

and accurately document with correct symbols, a non-masked PTA from a routine adult patient.

• BSA procedure for obtaining a non-masked pure tone audiogram.

• Principles of threshold measurements.

• Types of transducers that can be used for air-conduction audiometry.

• Differentiation between tests of middle ear and cochlear function.

• The information needs of individuals relating to assessment of hearing.

• The range of concerns that may be experienced by patients and carers.

• How to identify concerns that fall outside the scope of planned investigations

• Selection of tests in relation to patient condition, level of responsiveness, level of development, age-appropriateness and clinical question.

• Techniques to maximise patient responsiveness and reliability of testing procedures.

• How to check reproducibility and accuracy of results.

• Appropriate stimuli for the purpose of the investigation and adjusted to avoid unnecessary patient discomfort.

• Relevant recording methods and systems and their correct use.

• Relevant terminology and symbols. General testing

• The range of tests available, their application, limitations and possible effects on patients.

• The purpose and effectiveness of each assessment technique.

• Factors influencing the effectiveness of assessment methods and

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KEY LEARNING

OUTCOMES


how to manage these.

• Contraindications to tests and appropriate action if found.

• How to judge presence and categorise type and degree of abnormality or pathology.

3 Perform a subjective listening test and comment on the performance of a hearing aid, identify common errors or malfunctions and action as appropriate.

• Range of devices, to include hearing aids, assistive listening devices, implanted devices and white-noise generators.

• Relevant protocols and standard operating procedures (SOPs).

• The range of common hearing aid problems and how to troubleshoot and fix.

• Principles of digital and analogue signal processing.

• Prescription, compression and programming rationales.

• The use and relevance of Hearing Aid Test Box Measurements.

• Determine when additional tests (such as patient reassessment if no problem with the aid is found) may be required and action appropriately.

• Accurately complete relevant recording action taken to address the patient’s concerns

4,5 Summarise a patient’s history, suggest suitable aural rehabilitation strategies and recommend an initial management plan with a supervisor.

• The type of hearing disorders that can be assessed by interview and questionnaire, which may include associated but relevant symptoms of tinnitus and vertigo.

• How to modify and pace assessment to meet individual needs.

• The range of abnormalities and pathologies associated with auditory and vestibular investigations, their likely prognosis and the implications of these for future patient management of patients of all ages.

• How to interpret test results and present these in terminology that can be understood by patients and careers.

• Options and choices for the treatment and management of

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KEY LEARNING

OUTCOMES


conditions and their relevance to disorders, including likely outcomes, benefits and limitations.

• The importance of facilitating patient choice in management.

• How to confirm arrangements for referral to other specialists, agencies or support groups.

• The range of support groups available for patients and carers and how to access current information concerning these.

• Ethical issues surrounding the provision of care options, including consent issues.

• The psychosocial implications of hearing and/or balance impairments and related conditions.

• How to assess patients’ needs for advocacy or interpreting support. 4,5 Document findings and results from a

basic adult patient with hearing difficulties, using the relevant patient management system. Discuss and evaluate any changes to previous results.

• How to record information in a format that will enable further investigation.

• Importance of language used, dependent upon to whom the report is sent.

• How to collate and record results of assessments ready for the next action and treatment planning.

• The information needed prior to investigations.

• Next steps and possible treatment routes relating to hearing or balance disorders.

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Rotational Module


THEME Neurosensory Science

SPECIALISM Neurophysiology

ROTATION Introduction to Neurophysiology

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MODULE TITLE

Introduction to Neurophysiology (N-2) 3.6.1

COMPONENT Rotation

AIM This module will provide the trainee with the knowledge, understanding and awareness of the diversity of patients referred to a Neurophysiology Department. Trainees will undertake a range of investigations and assist with the assessment and management of a wide range of patients with conditions affecting the central or peripheral nervous system.

SCOPE On completion of this module the trainee will be able to describe the range and diversity of patients attending a general neurophysiology service for evoked potentials, their special needs including people with learning difficulties, cognitive and sensory impairment, physical disabilities, older people, paediatrics and intensive care.

LEARNING OUTCOMES


1. Measure visual, auditory or somatosensory evoked potentials in a normal subject. 2. Measure and label, using the correct nomenclature, the major components of a patient evoked potential (visual, auditory or

somatosensory).

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• Observe the calibration procedures undertaken on neurophysiological equipment and discuss with your training officer the effects of the recording characteristic of the equipment components.

• Observe the recording of electroencephalograms (EEGs) in a range of patients and reflect on the contribution this diagnostic test to the relevant patient pathway.

• Observe history taking and clinical examinations in patients with signs and symptoms of neurological conditions and discuss with your training officer how the history and clinical investigations inform the referral for neurophysiological investigation.

• Attend outpatient departments where patients with neurological conditions are referred and reflect on the multidisciplinary approach to the care and treatment of patients with neurological conditions.

• Attend a multidisciplinary team meeting and case presentation session and evaluate the methods of communication between team members and the patient and their family.

All of these experiences should be recorded in your e-portfolio. The following section details the competence and knowledge and understanding each trainee must gain. Each competence is linked to the relevant learning outcomes and trainees must demonstrate achievement of each competence for each linked learning outcome. PROFESSIONAL PRACTICE Trainees should ensure they refer to the professional practice learning framework and continue to achieve the professional practice competences alongside the competences defined in this module.

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KEY LEARNING

OUTCOMES


1 Control infection risks in accordance with departmental protocols.



1 Minimise risks and hazards in compliance with Health and Safety policies.

• The relevant health and safety regulations specific to neurophysiology investigations, the potential hazards and risks and the actions to be taken to minimise these.

1 Plan evoked potential recordings. • The range of conditions of patients referred for clinical neurophysiological testing.

• The referral system and the range of tests performed in a clinical neurophysiology department.

• The range and types of information required and its importance.

• How to check for validity of information.

• Appropriate action to be taken in the event of missing or invalid information.

• Types of investigation, their purpose and appropriateness for conditions presented.

• Criteria for determining whether investigations requested are appropriate to clinical question and the reason for referral.

• Potential special needs of patients and their carers, including communication, environmental and personal.

• Contra-indications to each investigation.

• Factors which may influence the duration and quality of investigations.

1 Prepare environment, equipment and subject for evoked potential recordings

• Safe and correct operation of the equipment to be used, including all peripheral devices.

• The importance of confirming the patient’s identity from the referral

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KEY LEARNING

OUTCOMES


document and correct entry on the recording system.

• How to establish and maintain effective communication with the patient, including explaining the test in a manner to ensure co-operation.

• Fault identification and appropriate action to rectify.

• The importance of checking that there is adequate storage volume for the investigation to be performed.

• The effects of sensitivity, time-base, filters, Common Mode Rejection Ratio (CMRR), signal to noise averaging.

1 Explain the procedure to the subject and address any questions they may have relating to the procedure, including the process after the procedure and how they will be informed of the results.






• Common causes of neurological disorders/referrals and the populations disproportionately affected (e.g. by age, ethnicity).

1 Gain informed consent for evoked potential recordings.

• The importance of explaining the procedure for each investigation to the patient/subject and gaining informed consent.


• Principles, guidance and law with respect to informed consent. 1 Obtain a full patient history from an

adult patient. • Factors and information of key importance to patient history.

• How to record information and check for validity.

• Typical medication used to treat patients. 1 Measure and apply the electrodes for

the recording of a visual evoked potential on a normal subject and assist in performing evoked potential recordings.

• Standard operating procedure for recording evoked potentials.

• The principles and importance of marking electrode sites, of placing electrodes and confirming the contact impedances are correct.

• The importance of ensuring that the patient is in a comfortable position and the effect on the quality of recording.

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KEY LEARNING

OUTCOMES


• Principles and importance of correct positioning of the stimulator.

• How to provide the necessary level of support and reassurance to the patient throughout the investigation.

• Requirements and principles of recording of evoked potentials, including monitoring the technical quality of raw data and identifying and eliminating artefacts (biological and non-biological).

• The importance of ensuring that sufficient samples are averaged to yield a waveform that is stable and contains minimal noise.

• How to check evoked potentials for reproducibility.

• Appropriate waveform marking. 2 Measure and document the latencies

and amplitude of the major components of the evoked potentials

• Normal range for latencies and amplitudes of the major components for each of the evoked potentials.

• Typical changes in latencies and amplitudes associated with common pathological conditions.

1, 2 Identify causes of error/artefacts encountered and the non-pathological effect in the recording of evoked potentials and their elimination.

• Common causes of error/artefacts encountered in the measurement of evoked potentials, including non-fixation, sub-maximal stimulation and muscle artefact.

• Non-pathological effects of error and artefacts in the recording of evoked potentials and their elimination.

1, 2 Complete and annotate evoked potential recordings.

• How to remove electrodes and clean electrode sites avoiding discomfort to the patient.

• Importance of continued information and reassurance for the patient.

• Importance, methods and techniques for cleaning equipment in line with infection control policy.

• Correct annotation of recordings and other patient documentation and the importance of accuracy, legibility and completeness.

• How to identify the degree of urgency with which the investigation needs reporting.

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KEY LEARNING

OUTCOMES


• Information needs of the patient following evoked potentials.

• The range of hospital and community-based services available to patients.

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This section describes the Learning Framework for the Rotational Component of work based learning covering the Learning Outcomes, Clinical Experiential Learning, Competence and Applied Knowledge and Understanding. Each trainee is also expected to build on and apply the knowledge, skills and experience

gained from the MSc in Clinical Science.

Rotational Module


THEME Neurosensory Sciences

SPECIALISM Ophthalmology and Vision Science

ROTATION Introduction to Ophthalmic and Vision Science

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MODULE TITLE

Introduction to Ophthalmic and Vision Science (O&V-3)

COMPONENT Rotation

AIM This module will provide the trainee with knowledge, understanding and awareness of the diversity of patients attending ophthalmic and vision science services. Trainees will observe a range of investigations and care pathways used in the management of a wide range of patients experiencing ophthalmic or vision difficulties.

SCOPE On completion of this module the trainee will be able to describe a range of methods and ophthalmic equipment used for the routine psychophysical assessment of patients’ vision and the principles and equipment used in a range of investigations that include imaging and measurement. They will have gained experience of conducting or assisting with basic ophthalmic investigations. They will have gained understanding of the special needs of a range of patients, including those with learning difficulties, cognitive and sensory impairments, physical disabilities, older people and children.

LEARNING OUTCOMES On successful completion of this module the trainee will: 1. Measure visual acuity using a LogMAR chart for adult subjects. 2. Perform an Ishihara colour vision assessment on an adult subject. 3. Perform an automated static perimetry or confrontation visual field on an adult subject. 4. Label the main peaks of a normal electroretinogram (ERG). 5. Identify the landmarks of the eye and fundus in different imaging modalities.

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• Observe the work of those offering support to patients with visual loss. This may be in the community, with non-NHS or external statutory, voluntary, charitable agencies, or in an NHS low visual aid and rehabilitation clinic, or with counsellor or liaison workers. The trainee will reflect on their role in the management of patients who experience visual impairment. Or, with permission, they will spend a day with a person with visual impairment to observe some methods for vision rehabilitation and discuss the advantages and disadvantages of optical and electronic aids, mobility training and daily living skills with them.

• Observe history taking and clinical examinations in patients with signs and symptoms of ophthalmic/vision disorders and diseases. Consider with your training officer the application of different clinical approaches and strategies that depend on clinical reasoning, innovative approaches to complex situations and the differing priorities of a given situation.

• Attend paediatric outpatient clinics and observe the processes of ophthalmic history taking in children and reflect on the differences in history taking between adults and children.

• Attend paediatric clinics and observe the assessment of visual acuity in preverbal and pre-literate children and the methods

used to assess disorders of binocular vision. Reflect on the experience and consider the differences between adults and

children.

• Observe a range of ocular imaging and measurement modalities used to assess ophthalmic diseases. These include retinal photography, optical coherence tomography (OCT) imaging and autofluorescence, biometry (low coherence interferometry), ultrasound, perimetry and visual electrophysiology, including electroretinography and visual evoked potentials. Critically evaluate how these investigations contribute to the diagnosis, management and care of patients. Reflect on how they are adapted to meet the needs of people with disabilities within a typical care pathway.

• Observe fundus fluorescein angiography (and indocyanin green angiography if available), and discuss with your training officer the indications, procedure, blood flow through the eye and how the procedure can aid the diagnosis of ocular disease.

All of these experiences should be recorded in your e-portfolio. The following section details the competence and knowledge and understanding each trainee must gain. Each competence is linked to the relevant learning outcomes and trainees must demonstrate achievement of each competence for each linked learning outcome.

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PROFESSIONAL PRACTICE Trainees should ensure they refer to the professional practice learning framework and continue to achieve the professional practice competences alongside the competences defined in this module.

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KEY LEARNING

OUTCOMES


1,2,3,4,5 Control infection risks in accordance with departmental protocols.



1,2,3,4,5 Minimise risks and hazards in compliance with health and safety policies.

• The relevant health and safety regulations specific to ophthalmic/vision disorders and disease and local policy to minimise the potential hazards and risks and the actions to be taken.

1,2,3,4,5 Plan investigations for various ophthalmic/vision referrals with supervisor.

• The range of conditions of patients referred for ophthalmology/vision testing.

• The referral system and the range of tests performed in ophthalmology/optometric/orthoptic and low vision aid clinics.

• The range and types of information required and its importance. • How to check for validity of information. • Appropriate action to be taken in the event of missing or invalid

information. • Types of investigation, their purpose and appropriateness for conditions

presented. • Assessment of the appropriateness of investigations requested with

reference to the clinical question and the reason for referral. • Potential special requirements of patients and their carers with respect to

the environment, communication and personal needs. • Contraindications to each investigation. • Factors that may influence the duration and quality of investigations. • How to choose appropriate test strategy according to patient’s age, co-

operation, ability and clinical condition. 1,2,3,4,5 Prepare the environment and lighting

level and select the equipment • Safe and correct operation of the equipment to be used, including all

peripheral devices.

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KEY LEARNING

OUTCOMES


needed for ophthalmic examination or measurement of:

• visual acuity

• Ishihara colour vision

• ocular or retinal imaging

• automated static perimetry or confrontational visual field.

• The importance of confirming the patient’s identity from the referral document and correct entry on the recording system.

• Steps and methods of routine clinical ophthalmic examination in adults, including: 1) clinical psychophysical tests and different ways of reaching a

threshold measure, e.g. visual acuity, colour vision, visual fields, tonometry

2) visualising ocular structures using fundoscopy, retinal imaging, slit lamp examination, corneal imaging, ocular ultra-sound,

3) objective assessment of vision function, e.g. visual electrophysiology (electroretinography, ERG and visual evoked potential, VEP), pupil assessment.

• Different methods and equipment used for these measurements. • Requirements and protocols for maintenance and calibration of

equipment. • Correct use of equipment. • Relevant international and national recommendations for performance of

investigation in addition to local protocols. • How to communicate effectively with patients, parents or carers, including

patients with a range of cultural and special needs. • Precautions and contraindications to procedure and the relevant

personnel to contact for further advice. 1,2 Obtain a full patient history from an

adult patient (under supervision). • Processes of ophthalmic history taking in adults, to include presenting

complaint, current and past ophthalmic history, current and past general medical history, and social and occupational history.

• The purpose and relevant protocols for obtaining and documenting patient history.

Communication • How to communicate effectively with patients, parents or carers, including

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KEY LEARNING

OUTCOMES


patients with a range of cultural and special needs. • The anxieties or concerns that patients, parents or carers may experience

and how to alleviate them. Symptoms and the relevance of patient history to ocular and systemic disease. • The symptoms of common diseases affecting the visual system, e.g.

glaucoma, cataract, diabetic retinopathy and age-related macular degeneration.

• The relationship between ocular/visual and non-ocular symptoms. • Ocular/visual manifestations of systemic disease. • The differences in presenting symptoms and signs between children with

developmental disorders and adults with acquired disorders, e.g. binocular vision, colour vision.

1,2,3 Explain to an volunteer adult subject the procedure for:

• visual acuity measurement

• Ishihara colour vision assessment

• automated static perimetry or confrontational visual field.






• Common causes of neurological disorders/referrals and the populations disproportionately affected e.g. by age, ethnicity.

1,2,3,4 Gain informed consent from a volunteer adult subject to:

• Perform LogMAR visual acuity

• Perform Ishihara colour vision assessment

• take and store an ocular image

• carry out an automated static



• Principles, guidance and law with respect to informed consent.

• Relevant protocols for procedure and their correct interpretation. Principles of visual acuity

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KEY LEARNING

OUTCOMES


visual field or a confrontational field.

• The principles of and relationship between visual acuity measurement and refractive error and how to estimate refractive error from unaided visual acuity.

• The range of tests for visual acuity, appropriate for age, ability, vision levels and occupation (e.g. driving standards), including distance and near LogMAR (e.g. EDTRS), Snellen, E-test, Sheridan-Gardiner, Cardiff Cards, preferential looking techniques, crowded and single letter presentations.

• How to measure visual acuity in patients with language or communication difficulties, illiteracy and patients with low vision. Different strategies and tests for measuring visual acuity in children of different ages, and the difficulties and limitations of these tests.

Principles of equivalent refractive for working distances of different tests

• When and how to use lenses to correct for the test distance of different tests, e.g. colour vision and visual fields, focusing retinal images in high myopia or hypermetropia.

• How to identify a spectacle optical prescription by inspection.

• Reasons for altering test distance.

• Background lighting needed to perform different tests.

• Importance of image focus and confounders.

• The principles and use of pinhole to correct reduced visual acuity due to uncorrected refractive error and its limitations.

• The non-refractive causes of reduced visual acuity and how they affect the measurement of visual acuity.

• Requirements for accurate and legible recording of information. 1,2,3,4,5 Perform on a volunteer adult subject: • Relevant protocols and standard operating procedures (SOPs) for the

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KEY LEARNING

OUTCOMES


• LogMAR visual acuity with and without spectacles

• Ishihara colour vision test

• an automated static visual field or a confrontational field.

Examine:

• normal ocular and retinal images

• normal ERG traces.

investigations to be performed.

• Anatomy and physiology of the eye, and visual pathways and pupillary pathways.

• Range of clinical conditions that may give rise to defects:

• in the red reflex ( e.g. cataract, retinal detachment)

• visual acuity (e.g. maculopathy, optic nerve dysfunction)

• colour vision (e.g. optic nerve dysfunction, congenital colour vision defects)

• visual field (e.g. chiasmal compression, hemisphere dysfunction) and the relevance of these tests to these conditions.

• How to instruct and reassure the patient to maximise effectiveness and compliance.

• Methods of judging reliability of patient response. 1 Write acuity measures using correct

notation. Compare with UK car driving standard.


• Importance, methods and techniques for cleaning equipment in line with infection control policy.


• How to identify the degree of urgency with which the investigation needs reporting.

• Information needs of the patient following investigation.

• The range of hospital and community-based services available to patients.

• Statutory provisions for patients with vision impairment.

• Basic methods for vision rehabilitation, including optical and electronic aids, mobility training and daily living skills.

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Rotational Module


THEME Cardiac, Vascular, Respiratory and Sleep Sciences,

Gastrointestinal Physiology and Urodynamic Science


SPECIALISM ALL

SHARED ROTATION Clinical Assessment and Investigation

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MODULE TITLE

Clinical Assessment and Investigation (CA&I)

COMPONENT Rotation

AIM This module draws on and integrates learning and clinical experience across the physiological sciences rotational modules. It will provide the trainee with the opportunity to apply their knowledge and skills of clinical assessment and investigation used in the diagnosis, care and treatment of patients in a range of clinical settings and care. Trainees will have the opportunity to gain a greater understanding of the role and integration of other related diagnostic modalities, including imaging and pathology, to provide holistic patient care.

SCOPE On completion of this rotation trainees will have had the opportunity to apply their knowledge and skills of clinical assessment and investigation used in the diagnosis, care and treatment of patients with conditions resulting in referral to physiological science services across a range of clinical settings. Examples include medical assessment and integrated care, critical care, outpatients, primary and community-based services. Fundamental to this rotation is that the trainee has an introductory knowledge and understanding of either cardiac, vascular, respiratory and sleep OR gastrointestinal and lower urinary tract disorders OR neurophysiological, auditory and vision (as relevant to their programme), and their signs and symptoms. This module provides an opportunity to gain a greater understanding of the role of other related diagnostic modalities, such as radiology and pathology, in the overall clinical assessment process. This module will give the trainee knowledge and understanding of the interpretation and clinical decision-making process associated with clinical assessment and investigations in the context of differential diagnosis, together with an overview of the principles of operation, data acquisition and quality assurance of a range of diagnostic service modalities.

LEARNING OUTCOMES

In this rotational module, learning outcomes are related to three key areas in Clinical Assessment and Investigation:

1. Working in partnership. 2. Related diagnostic services. 3. Patient pathways.

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Working in partnership

1. Record and integrate a patient history with the outcome of clinical examination and determine appropriate diagnostic investigations for patients commonly referred to cardiac, vascular, respiratory and sleep OR gastrointestinal, urodynamic science OR audiology, neurophysiology, or ophthalmic and vision science diagnostic services in conjunction with the wider clinical team.

2. Assist in performing a range of diagnostic and therapeutic procedures, recognising abnormal results/findings and appreciating the implication of results on patient treatment and care.

Related diagnostic services

3. Identify key anatomical landmarks on images obtained using ionising and non-ionising imaging media in the investigation of patients with cardiovascular, respiratory, sleep OR with gastrointestinal and lower urinary tract (LUT) disorders OR conditions resulting in referral to audiology, neurophysiology, or ophthalmic and vision science services, and describe the limitations and impact of results on patient diagnosis, treatment and care.

4. In a supportive role assist in performing pathology tests which patients with cardiovascular, respiratory, sleep OR with gastrointestinal and LUT disorders OR conditions resulting in referral to audiology, neurophysiology, or ophthalmic and vision science services will commonly undergo as part of an individual diagnostic plan.

5. In a supportive role assist in performing safety checks, calibration and quality assurance of imaging and pathology equipment using local, national or international standards.

Patient pathways

6. Devise a diagnostic plan for a patient based on the presenting symptoms and clinical information available, and indicate what the next steps might be (diagnostic or therapeutic), dependent on the outcome of the initial results from a mix of diagnostic modalities.

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CLINICAL EXPERIENTIAL LEARNING

The clinical experiential learning for this module should take place in a range of healthcare environments/services that contribute to the screening, primary prevention, diagnosis, treatment and rehabilitation of patients commonly referred to cardiac, vascular, respiratory and sleep OR gastrointestinal and urodynamic science OR audiology, neurophysiology and ophthalmic and vision science services. Trainees should also be encouraged by their trainer to gain wider experience that spans other local, novel procedures within their work place. Clinical experiential learning should span both primary and secondary care and should include at least three different experiences gained across a range of ages, selected from the list below: Secondary care • Medical assessment unit • Neonatal care unit • Intensive care unit or operating theatre • Endoscopy unit • Healthcare for older people service, which may include sensory, cognitive function and wellbeing Primary care • General practice • Community services • Walk-in/Drop-in centres • District nursing • Health visiting • Postnatal clinics • One-stop sexual health clinics Other healthcare providers • Independent sector, including hearing acuity, visual acuity, colour acuity • Social services • Other support services, e.g. drug and alcohol services

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Following each experience trainees should reflect on the experience and discuss with their supervisor: (a) the patient experience in the setting; (b) the potential for improvement in service delivery to enhance the patient experience and outcomes; and (c) implications for their own future professional practice. Trainees are also expected to:

• Assist experienced imaging staff in the safety checks, calibration and quality assurance of imaging equipment using local, national or international standards, and discuss the relevant health and safety policies for the imaging department with your trainer.

• Assist experienced pathology staff in routine maintenance, calibration and quality assurance checks on pathology test instrumentation using local, national or international standards, and gain experience of using a range of laboratory equipment, which could include pipettes, balances, centrifuges, refrigerators, water baths, incubators, pH meters, freezers, radioactive counters, sample preparation units and automated and semi-automated analysers.


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KEY LEARNING

OUTCOMES


Working in partnership

1 Assist with obtaining a clinical history using a logical sequence/framework, which might include: • brief biography • history of presenting complaint • past history • smoking/alcohol use • medication (prescribed and other) • allergies • family/social history • concerns and expectations • summary

• The importance of an accurate and complete patient history and the potential implications of missing or incorrect information.

• Factors relevant to the range of investigations to be undertaken.

• How to validate information provided.

• How to communicate with patients in ways that facilitate co-operation and an understanding of requirements, including patients with special needs.

2 Assist in a range of diagnostic and therapeutic procedures in a variety of clinical settings, recognising when results deviate from normal values/findings and appreciating the implication of results on patient treatment and care, for example: Cardiac, Vascular, Respiratory and Sleep Science • Medical assessment units – point of

care testing, e.g. blood and urine glucose tests.

• High dependency settings – blood gas analysis, preparation of monitoring and

• Relevant protocols and procedures for investigations.

• How to communicate with patients in a way that respects their dignity, rights, privacy and confidentiality.

• The importance of checking patient identity, fully explaining the procedure to the patient, including any potential contraindications, and obtaining informed consent prior to undertaking investigatory procedures.

• Requirements for the investigation environment to ensure privacy, dignity and comfort of the patient in order to facilitate the investigation procedure and optimise results.

• How to check, calibrate and prepare the appropriate equipment and devices.

• How to identify potential special needs of patients and the

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KEY LEARNING

OUTCOMES


ventilator system. • Community settings – spirometry, ankle

brachial pressure indices measurements (leg ulcer clinics).

Gastrointestinal Physiology and Urodynamic Science

• Endoscopy unit – assist with telemetric pH capsule placement; endoscopic placement of manometry catheter.

• Operating theatre – assist with 2D/3D ultrasound pre and post-op assessment, e.g. sphincterotomy, ’search and find‘ procedures.

• Diagnostic imaging – assist in the placement of small bowel manometry catheter.

• Ward – undertake hydrogen breath tests on non-ambulant patients, e.g. small bowel overgrowth.

• Assist with transrectal ultrasound (TRUS) clinic.

• Continence/flows clinic – fluid management advice, bladder training.

• Observe pressure/flow studies in patients with special needs, e.g.

relevant action required to address any issues.

• Infection control and decontamination procedures.

• Normal and abnormal ranges of relevant results and their implication for the treatment and care of the patient.

• Relevant patient pathways and referrals arising from these.

• The relationship between the results of a range of investigations across gastrointestinal and LUT disorders and their implication for holistic patient treatment and management.

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KEY LEARNING

OUTCOMES


stoma, mobility issues, neuropathic.

Neurosensory Sciences • Neurological signs. • Neurological monitoring and function. • Life sign measures. • Cognitive function and wellbeing. • Screening. See relevant rotational modules for integration of clinical experience, competence and knowledge requirements.

Imaging

3 View and identify key anatomical landmarks and abnormal pathology related to the relevant body systems on images obtained using ionising and/or non-ionising imaging media.

• Relevant health and safety policies for the imaging department for the safe use of ionising and non-ionising imaging equipment.

• Key anatomical landmarks appropriate to the investigation. • Normal and abnormal images. • How different imaging tests contribute to the holistic approach in

the diagnosis and management of relevant common conditions. • Choice of test equipment and the safety, calibration and quality

assurance checks required for diagnostic imaging equipment services.

• The selection of a particular imaging modality in preference to another.

• Key research and development areas that are likely to translate to improvements in imaging technique.

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KEY LEARNING

OUTCOMES


• The range of equipment within the scope of learning, its use, application and limitations.

• The strengths and weaknesses of each imaging modality within relevant care pathways.

3 Review and assist in making measurements on images on Picture Archiving Systems (PACS).

• PACS applications and measurement systems. • Confidentiality and information governance issues related to

PACS. • How imaging measurements are undertaken in a range of

imaging modalities and how these contribute to patient management.

Pathology

Assist in performing pathology tests with relevance to the routine investigation of relevant conditions, including the production of results, reference ranges and clinical interpretative reports, e.g.

• full blood count

• urea and electrolytes

• liver function test

• lipids

• cerebrospinal fluid monitoring

• sputum culture and sensitivity

• therapeutic drug monitoring, e.g. carbamazepine.

• Quality assurance and accreditation processes in pathology. • Relevant national, international and local standards. • Factors affecting health, safety and integrity in handling and

processing of specimens. • Generation of common pathology test results, comparison to

standard reference ranges and the possible abnormal results found in patients presenting to cardiac, vascular, respiratory and sleep or neurosensory science or gastrointestinal/urodynamic sciences services.

• Relevance and importance of specificity, sensitivity, accuracy, precision and linearity in the evaluation of analytical methods.

• Capabilities and limitations of methods, techniques and equipment.

• Safe laboratory practices, including principles of sterilisation and decontamination.

• Specimen preservation, distribution, separation, storage and disposal procedures.

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KEY LEARNING

OUTCOMES


• Methods and procedures to establish reference ranges and how to use reference ranges in interpreting results.

• Principles and applications of techniques using different instrumentation

• Use and application of reagents for analysis. • Significance of standard operating procedures (SOPs), internal

quality control and external quality assessment.

Imaging and Pathology

5 Critically evaluate the role of calibration and quality assurance in pathology and imaging departments in ensuring accuracy of test outcomes and identifying any potential errors or risks when applied in clinical practice.

• Methods of risk assessment relevant to work activity. • Hazards and risks associated with the working environment and

the procedures to be performed. • The implication of defective equipment and devices on patient

care.

Patient Pathways

6 Devise evidence-based diagnostic plans for presenting signs and symptoms and clinical information.

• The signs and symptoms of patients commonly presenting to cardiac, vascular, respiratory and sleep or neurosensory science or gastrointestinal/urodynamic sciences and their interaction and significance for differential diagnosis.

• The likely needs of people with disabilities within the relevant patient pathways.

• The requirements of a diagnostic plan and its presentation. 6 Assimilate reports from pathology and

imaging investigations from patients typically referred to cardiac, vascular, respiratory and sleep or neurosensory

• How these results are used in conjunction with physiological science investigation results in differential diagnosis or in response to treatment.

• The importance of ensuring that different assessments are

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KEY LEARNING

OUTCOMES


science or gastrointestinal/urodynamic sciences present the findings for review by the clinical team and propose a differential diagnosis.

combined appropriately in contributing to the differential diagnosis of disease or disability.

• The impact of the results of each different investigation on patient treatment, management and care.

6 Investigate the needs and options for patients referred to physiological services within neurosensory science or gastrointestinal/urodynamic sciences or cardiac, vascular, respiratory and sleep services as relevant.

• The patient demographic structure of neurosensory science or gastrointestinal/urodynamic sciences or cardiac, vascular, respiratory and sleep service, referral patterns and appropriate onward referrals pathways.

• The needs of people with disabilities in the relevant patient pathway.

6 Work within multidisciplinary teams to support the investigation, treatment and management of patients with relevant conditions to neurosensory science or gastrointestinal physiology and urodynamic sciences or cardiac, vascular, respiratory and sleep services as relevant.

• The role that different healthcare scientific services play in the care of patients with disorders presenting to cardiac, vascular, respiratory and sleep or neurosensory science or gastrointestinal/urodynamic sciences services in a range of healthcare settings for example: • integrated care • critical care • primary care • Independent sector.

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SECTION 4: PROFESSIONAL PRACTICE LEARNING FRAMEWORK

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This section describes the Learning Framework for the Professional Practice Component of work based learning covering the Learning Outcomes, Clinical Experiential Learning, Competence, and Applied Knowledge and Understanding. This module spans the Rotational and Specialist period of

training. Each trainee is also expected to build on and apply the knowledge, skills and experience gained from the MSc in Clinical Science


DIVISION Life Sciences, Physiological Sciences, Physical Sciences

and Biomedical Engineering

THEME ALL

SPECIALISM ALL

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Introduction

Good Scientific Practice (GSP) sets out the principles and values on which good practice undertaken by the Healthcare Science workforce is founded. GSP sets out for the profession and the public the standards of behaviour and practice that must be achieved and maintained in the delivery of work activities and the provision of care. GSP uses as a benchmark the Health Professions Council (HPC) Standards of Proficiency and Standards of Conduct, Performance and Ethics, but expresses these in the context of the modalities within Healthcare Science. Good Scientific Practice represents standards and values that apply throughout an individual’s career in Healthcare Science at any level of practice. Therefore the standards have been contextualised for the role of healthcare scientist. There will, however, always be a requirement for an individual to work within the limits of their scope of practice and competence. Professional Practice in the STP Training Programme This generic professional practice module, which all STP trainees have to complete, defines the knowledge, skills and experience that each trainee is expected to gain and apply during the STP programme and develop in subsequent employment. The degree to which each specialism applies the knowledge, skills and experience will vary, but this module sets the baseline for all trainees. Each rotational and specialist learning framework then develops areas as appropriate, for example clinical history taking in patient-facing specialisms. While it is expected that trainees will be able to achieve the majority of the learning outcomes and competences within their specialism, some specialisms may have to make special arrangements to ensure all trainees achieve the learning outcomes and competences defined in this learning framework. For example, to work with a local clinical skills laboratory to help trainees develop basic skills in history taking. The Learning Framework that defines the learning outcomes, clinical experiential learning, competences, and knowledge and understanding are contained on the following pages.

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MODULE TITLE

Professional Practice (PP1) COMPONENT GENERIC

AIM Professional Practice is part of the generic curriculum (applicable to all trainees) on the Scientist Training Programme. The overall aim of the module is to ensure that each trainee has the underpinning knowledge and applies this and the accompanying skills and attitudes to work as a healthcare scientist in accordance with Good Scientific Practice (GSP).

SCOPE GSP sets out the principles and values on which the practice of Healthcare Science is undertaken. It sets out for the profession and the public the standards of behaviour and practice that must be achieved and maintained in the delivery of work activities and the provision of care. This module encompasses the knowledge, skills, experience and attitudes across four of the five domains of Good Scientific Practice, namely Professional Practice, Scientific Practice, Clinical Practice, Research and Development, and Clinical Leadership, but all other modules within this programme will contribute to embedding professional practice at the centre of the work of each trainee.

LEARNING OUTCOMES


Professional Practice

1. Place the patient at the centre of care in daily practice, ensuring the needs of patients are respected. 2. Communicate with patients, relatives, service users, other healthcare professionals, colleagues and the public with respect,

empathy and sensitivity, including listening, speaking, giving and receiving information, giving and receiving feedback. 3. Respond to the ethical and legal issues and challenges arising from the practice of Healthcare Science. 4. Demonstrate a commitment to the continuing professional development of themselves and others, and attend professional

meetings.

Clinical Practice

5. Make appropriate and effective use of information and communication technology. 6. Under supervision, obtain a patient history from a normal volunteer or typical patient referred to your service and present the

findings to a colleague or peer in order to understand the clinical decision-making process in clinical practice.

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7. Promote the importance of patient safety and general health, safety and security in the workplace, including infection control and information governance.

Research, Development and Innovation

8. Apply knowledge, skills and experience of research, development and innovation appropriate to the role in order to identify effectively actions that will improve service provision.

9. Engage in evidence-based practice, participate in audit procedures and critically search for, appraise and identify innovative approaches to practice and delivery.

Clinical Leadership

10. Demonstrate a range of leaderships skills required of an emerging leader within Healthcare Science.


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The clinical experiential learning for this module is:

• Attend clinics, ward rounds, treatment and/or rehabilitation sessions, etc., in primary or secondary care, or in the charity or voluntary sector where patients attend, and observe how patient–professional relationships are developed and maintained, and reflect on how the following impact on the patient–professional relationship: • response to illness • patient and carer perspective • health belief models • diversity of the patient experience • disability, including learning disabilities • potential health inequalities • self-care • impact of life-threatening and critical conditions • patient involvement in decisions regarding their healthcare.

• Observe a current screening programme in the workplace and discuss the principles and practice of screening programmes in healthcare as a means of reducing disease burden with your training officer.

• Observe and participate in internally and externally accredited quality management systems and critically appraise both in your area of practice.

All of these experiences should be recorded in your e-portfolio. The following section details the competence and knowledge and understanding each trainee must gain. Each competence is linked to the relevant learning outcomes and trainees must demonstrate achievement of each competence for each linked learning outcome.

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KEY LEARNING

OUTCOMES


Professional Practice 1 Treat each patient as an

individual, respecting their dignity and confidentiality and upholding the rights, values and autonomy of every service user.

• NHS Constitution. • Patient-centred care and the patient carer perspective with respect to:

• response to illness • patient and carer perspective • health belief models • diversity of the patient experience • disability, including learning disabilities • potential health inequalities • self-care • impact of life-threatening and critical conditions • patient involvement in decisions regarding their healthcare.

• Local guidelines for responding to unacceptable behaviour by patients, carers, relatives, peers and colleagues, including harassment, bullying and violent behaviour.

1 Discuss personal values, principles and assumptions, emotions and prejudices, and how these may influence personal judgement and behaviour, and identify how you will practise in accordance with Good Scientific Practice.

• Good Scientific Practice. • The importance of maintaining own health.

2 Communicate effectively with the public, services users and other healthcare

• The principles of effective communication including: • written and electronic, verbal and non-verbal and feedback • the way effective communication can assist in identifying problems accurately,

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KEY LEARNING

OUTCOMES


professionals, adapting communication style and language to meet the needs of listeners.

increase patient satisfaction, enhance treatment adherence, and reduce patient distress and anxiety

• the importance of some key ideas, for example signposting, listening, language, non-verbal behaviour, ideas, beliefs, concerns, expectations and summarising in communication

• the range of question types that can be used in a communication. 2 Give and receive feedback

sensitively to or from a peer or colleague.

• The range of feedback models for giving and receiving feedback. • The evidence base underpinning the importance of effective feedback/feedback

models.

2 Obtain, analyse and act on feedback from a variety of sources and use it to consider personal impact and change behaviour.

• How to analyse feedback and frameworks for action planning. • Behavioural change models.

2 Present complex ideas in understandable terms in both oral and written formats.

• The importance of public engagement in science and its role in health and society.

• The factors that enable scientists to communicate to specialist and non-specialist audiences.

• Barriers to effective communication. 2 Use effective negotiation

skills, including influencing colleagues.

• Communication channels with/in your host department; patients and the public; your employing institution; your profession and professional body; the wider Healthcare Science community.

2 Work constructively and effectively as a member of a multidisciplinary team.

• The underpinning principles of effective teamwork and working within and across professional boundaries.

3 Comply with relevant

guidance and laws, to include those relating to:

• Principles, guidance and law with respect to: • medical ethics • confidentiality

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KEY LEARNING

OUTCOMES


• your scope of practice

• research ethics and governance

• patient confidentiality

• data protection

• equality and diversity

• use of chaperones

• informed consent.

• information governance • informed consent • equality and diversity • child protection • elder abuse • use of chaperones • probity • fitness to practise. • The importance of maintaining your own health.

4 Contribute to the education and training of colleagues.

• The key principles and evidence base underpinning clinical education, encompassing curriculum design, planning, delivery and assessment.

4 Take responsibility for your learning and demonstrate a commitment to continuing professional development.

• How continuous personal development can improve personal performance.

4 Meet commitments and goals in your professional practice, using a range of organisational and planning tools.

• Different methods of planning, prioritising and organising, and how they can enhance personal effectiveness.

4 Reflect on your practice and generate a reflective diary that demonstrates how you utilise the skills required of an independent learner and your commitment to your continuing professional development.

• Core theories of learning, particularly adult learning and reflective practice, and demonstrate how these are relevant to your practice as a healthcare scientist.

• Personal values, principles and assumptions, emotions and prejudices, understanding how these may influence personal judgement and behaviour.

• The role of critical reflection and reflective practice and the methods of reflection that can be used to maintain or improve knowledge, skills and attitudes.

4 Take responsibility for • How to horizon scan, identify and evaluate the potential role for new and

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KEY LEARNING

OUTCOMES


keeping your professional and scientific knowledge and skills up to date.

innovative technologies and scientific advances.

4 Develop an action plan based on your experiential learning and reflection on completion of the Scientist Training Programme.

• Action planning. • Models and frameworks for critical reflection.

Clinical Practice 5 Use a range of information

and communication technologies within the workplace for service delivery, research, audit and innovation, including data filing and archiving:

• word processing

• databases

• statistics packages

• PowerPoint

• internet • email.

• The range and application of clinical information systems used in the work base. • The systems in use in the work base to file and archive information and the

processes for retrieval. • The principles underpinning identification, storage and retrieval of scientific

literature for example end note/end note web. • The purpose of a range of NHS information systems, including the regulations in

place to ensure data security and confidentiality. This may include hospital information system, linked information systems (e.g. laboratory information management system) and middleware linking equipment to information systems.

6 Under supervision, demonstrate that you can obtain and present a patient history from a normal volunteer or

• The importance of patient-centred care and how it ensures that the wishes, beliefs, concerns, expectations and needs of patients are respected.

• Patient and carer perspective with respect to illness, disability, health inequalities and diversity of the patient experience.

• Structured models for presenting a patient history.

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KEY LEARNING

OUTCOMES


consenting patient in order to better understand the clinical decision-making process in your clinical practice.

• Process of patient-centred interviewing and the features of a good consultation, including Initiating the session, gathering information, building the relationship, explaining and planning, and closing the session.

• Link between the patient history and examination and development of clinical investigation and management plans.

7 Apply current regulations with respect to patient safety and safe systems within the workplace. To include, as appropriate to scope of practice:

• risk management

• biological specimen handling

• COSHH

• RIDDOR

• radioactivity

• fire safety

• electrical safety

• moving and handling

• display screen equipment

• incident reporting

• infection control.

• The importance of health and safety within the workplace, wider healthcare environment and NHS.

• Principles, process and governance of risk management. • Factors influencing health, safety and security. • Current legislation, codes of practice, guidance notes and related documents. • Principles and practice of health and safety in the workplace. • The requirements of relevant local health and safety guidelines, manuals and

other documents, including the underpinning legislation. • The cause of errors related to patient safety, including patient and/or sample

identification.

7 Use clinical coding and medical terminology in accordance with stated guidance, as appropriate to

• The importance of the correct use of clinical coding and medical terminology in contributing to good healthcare science practice.

• Information governance principles and process.

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KEY LEARNING

OUTCOMES


scope of practice. 7 Keep accurate records in

accordance with current guidelines and the legal framework for data security.

• Best practice recommendations for record keeping and data security. • The Data Protection Act and current key guidelines, and the legal framework for

data security.

7 Use, in your practice:

• standard operating procedures

• protocols

• clinical guidelines.

• Standard operating procedure, protocol and guideline, and understand the purpose of and difference between each document.

• Evidence base that underpins the use of procedures employed by the service.

7 Continuously improve your practice through good practice in:

• identifying common sources of error

• identification of risk

• reporting critical incidents.

• The desirability of monitoring performance, internal and external quality control, learning from mistakes and adopting a no-blame culture in order to ensure high standards of care and optimise patient safety.

• The importance of honesty and effective apology in responding to errors of practice.

• The principles and practice of risk management and the effective investigation of incidents, resulting in the identification of root causes.

Research and Innovation 8,9 Participate in innovation,

research, service development and audit activities complying with compliance with guidance and laws relating to research ethics.

• The importance of innovation across healthcare science. • The role of innovation in improving quality and patient care. • Processes to disseminate innovation, research and audit findings. • The role of the healthcare scientist and the potential impact of scientific research

in your area of practice. • The role of the healthcare scientist in service developments in your area of

practice. • Current and developing clinical practice. • The effectiveness of investigations, therapies, interventions and treatments and

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KEY LEARNING

OUTCOMES


the mechanisms by which they contribute to patient care. • How to horizon scan, identify and evaluate the potential role for new and

innovative technologies and scientific advances. • The role of the healthcare scientist and the potential impact of scientific

developments, for example health prevention, genomic medicine, diagnostics and rehabilitation.

• The importance of public engagement in science and its role in health and society.

• The legal framework relevant to informed consent and the application to clinical care, research, audit and teaching.

8,9 Contribute to service and quality improvement and productivity in the work base and embed evidence-based developments within routine practice.

• How planning can actively contribute to the achievement of service goals. • How to measure and monitor performance against agreed targets. • The current structure, management, legal framework and quality improvement

structures and processes within the NHS. • The current quality improvement structures and processes within the NHS and

give examples of the implications for Healthcare Science. • Importance of self-care and shared care as part of NHS function and the impact

of life-threatening and critical conditions. • Principles and application of evidence-based practice.

8,9 Undertake a literature review and prepare and present to peers a critical analysis of a publication from the scientific literature.

• How to critically analyse scientific literature. • How to structure and present a critical analysis. • Systems of referencing. • Reference manager software.

8,9 Prepare and deliver an oral scientific communication to peers at a local, national or

• How to prepare an oral scientific communication. • How to give an effective and timely oral presentation. • How to respond to questioning.

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KEY LEARNING

OUTCOMES


international meeting.

Clinical Leadership 10 Lead in your clinical role

through appropriate application of;

• self-management

• self-development

• integrity

• self-direction

• problem solving

• dealing with complex issues

• making sound judgements in the absence of complete data.

• How self-awareness, self-management and self-development and acting with integrity at all times contribute to leadership.

• The use of evidence, both positive and negative to identify options in addressing challenges.

• Methods of prioritising and organising academic and work based tasks to optimise own performance.

10 Identify potential areas for change and accept change identified by others, working across different provider landscapes as required.

• Structure of the NHS. • The need for change, working across different provider landscapes as required. • Change management methodologies.

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SECTION 5: ELECTIVE LEARNING FRAMEWORK

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This section describes the Learning Framework for the Elective component of Specialist work based learning, covering the Learning Outcomes, Clinical Experiential Learning, Competence, and Applied

Knowledge and Understanding. This module spans the Rotational and Specialist period of training. Each trainee is also expected to build on and apply the knowledge, skills and experience gained from the MSc

in Clinical Science

ELECTIVE

DIVISION Life Sciences, Physiological Sciences, Physical Sciences and

Biomedical Engineering

THEME ALL

SPECIALISM ALL

The elective period can be taken any time during the specialist training. It may comprise a single 4- to 6-week elective or a series of shorter periods of elective training.

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MODULE TITLE

Elective (EL) COMPONENT Specialist

AIM The aim of the elective period is to facilitate wider experience of healthcare and/or the practice of Healthcare Science in a cultural and/or clinical setting that is different from the usual training environment. This may involve healthcare or Healthcare Science in a different area of the health service, or in pursuit of a particular clinical or research interest.

SCOPE The elective provides opportunities for you to: • explore in depth areas of particular interest beyond the scope of the scientist training programme • increase awareness of important health issues and develop an understanding of the effect of disease on

communities and individuals in different cultural contexts • explore unfamiliar scientific, social, economic or cultural areas • become more proficient at communication with individuals from different social, cultural and ethnic

backgrounds • gain hands-on experience that might not otherwise be possible in a scientist training programme • design and undertake a significant assignment with appropriate guidance and supervision, thereby

developing personal and organisational skills • undertake a small audit or research project in a different clinical setting • relate your experiences to your own area of practice.

LEARNING OUTCOMES

Learning outcomes are specific to each student: with guidance, you are expected to identify your own educational objectives and organise an elective to achieve them.

1. Agree, organise and complete a period of education and training that provides a wider experience of healthcare and/or the practice of healthcare science, and aligns with Good Scientific Practice.

2. Critically reflect on your experience in your elective and develop an action plan as part of your continuing personal and professional development.

3. Prepare a presentation and present your elective experiences to colleagues, including trainee healthcare scientists.

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KEY LEARNING

OUTCOMES


1 Produce learning outcomes for the elective training period and link these to Good Scientific Practice.

• Good Scientific Practice.

2 Write a report of your elective training that includes your learning outcomes (mapped to Good Scientific Practice), a critical reflection on your experience and an action plan.

• Report writing.

• Critical reflection.

• Action planning.

3 Plan, prepare and deliver an oral presentation that describes and reflects on the learning from your elective and shows how your experience will shape your future practice.

• How to prepare an oral communication.

• How to give an effective and timely oral presentation.

• Use of visual aids.

• How to respond to questioning.

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SECTION 6: AUDIOLOGY SPECIALIST LEARNING FRAMEWORK

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This section describes the Learning Framework for the Specialist Component of work based learning covering the Learning Outcomes, Clinical Experiential Learning, Competence and Applied Knowledge


Specialist Modules



SPECIALISM Audiology

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AUDIOLOGY – SPECIALIST MODULES

Module 1 (A&VA-5) Adult Audiological and Vestibular Assessment

Module 2 (AA&R-6) Adult Audiology and Rehabilitation

Module 3 (PA&H-7) Paediatric Audiology and Habilitation

Module 4 (E&PH-8) Epidemiology and Public Health

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MODULE 1 Adult Audiological and Vestibular Assessment (A&VA-5)

COMPONENT Specialist

AIM To be able to safely and efficiently maximise the information gained from the assessment consultation and develop an effective treatment plan.

SCOPE To work within a supervised environment in adult audiology vestibular assessment clinics, including interviews with patients, and performance of subjective and objective hearing tests. The trainee will be able to interpret test results and present information with relevant advice.

LEARNING OUTCOMES


1. Perform daily calibration and checks of the equipment and environment following local procedures, to ensure patient safety and quality of facilities.

2. Formulate, prior to patient contact, a consultation plan and plan appropriate clinical testing, utilising the relevant information available.

3. Interview a variety of different patients, overcoming any communication barriers. 4. Perform subjective and objective hearing and balance tests in a safe and effective manner, adapting as required to ensure

information is efficiently gained within the time available. 5. Interpret test results and consolidate these in relation to all other relevant information obtained and make informed decisions

concerning the diagnosis and management options. 6. Present information regarding results, advice and recommendation for follow-up actions/interventions to patients and carers,

using appropriate language and communication strategies, and formulate individual management plan. 7. Write reports/letters regarding test results and management, including appropriate onward referrals.

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• Observe and participate with direct supervision in audiological support for ear, nose and throat (ENT) or audiovestibular medicine (AVM) outpatient clinics to understand and observe the patient pathway, including medical, nursing and other professional consultations.

• Observe and participate with direct supervision in routine adult direct access clinics, including onward referrals to multiprofessionals, e.g. social services, ENT/AVM and radiology.

• Observe and participate, with direct supervision, in diagnostic audio vestibular clinics, including onward referrals to multiprofessionals, e.g. ENT/AVM and radiology.



outcome.


Trainees should ensure they refer to the professional practice learning framework and continue to achieve the professional practice competences alongside the competences defined in this module.

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KEY LEARNING

OUTCOMES


2 Formulate a consultation plan relevant to audiological and vestibular assessment.

• Information sources relevant to planning consultation.

• Significance of information to clinical investigation, use of testing equipment, range of tests and potential diagnosis.

1,2 Control infection risks in accordance with departmental protocols.



1,2 Minimise risks and hazards in compliance with health and safety policies.

• The relevant health and safety regulations specific to audiological and vestibular assessment.


1 Undertake and document Stage A and Stage B calibration checks of all necessary audiovestibular equipment and preparation of facilities for the consultation.

• Range of equipment used, correct use, limitations and principles of measurement.

• Recognition of the errors or potential risks of using defective equipment in clinical practice and the implications of use.

• Identification of common faults and remedial action.

• Importance of documentation of calibration

• Ensure all equipment conforms to departmental and/or trust health and safety policies.

• Principles and standards of calibration of all audiovestibular equipment.

1,2 Prepare the clinic environment for audiological and vestibular investigation.

• Ensure resources required are available within the room prior to consultation.

1,2 Obtain a suitably completed referral form/letter, greet and introduce

• The requirements for correct completion of request forms and how to validate the request.

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KEY LEARNING

OUTCOMES


yourself to patient, and check patient details.

• The importance of checking and confirming the patient identity and the implications of not doing so.

3 Explain the full procedure to the patient and address any questions they may have relating to the procedure.


• Requirements for patient compliance with investigations, including pre-test instructions.


• The information needs of patients before, during and after investigation.

• The authority level for provision of information to patients. 3,4 Document all aspects of patient

contact in accordance with record keeping procedures for your training department.

• Medicolegal requirements of health documentation.

• Procedures of record keeping (legislative and local).

• Patient confidentiality, data protection, freedom of information.

• Clinical audit procedures.

• Individual clinical responsibility and accountability. 3 Obtain a clinical history as

appropriate for each investigation. • Framework for clinical history taking.

• Possible sources of clinical history information. 4 Perform test that may include as

standard investigations:

• otoscopy

• bedside testing

• pure tone audiometry

• videonystagmography (VNG) or electronystagmography (ENG).

Optional investigations

• Speech testing

• Otoacoustic emissions (OAE) and tympanometry

• Identification of accurate results and need for verification and replication (throughout the training period all the tests should be completed successfully on at least three occasions at an above average standard).

• Requirements for safe and timely performance of testing.

• When to to seek supervisory guidance where required.

• Individual limitations of patient as well as individual personal professional abilities.

• How to adapt tests as required, ensuring information gained is maximised within the time available.

• Use of questionnaires, as appropriate, to assess such aspects as activity limitation, participation and motivation, and psychosocial

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• Auditory evoked potentials (AEP)

• Vestibular evoked myogenic potentials (VEMP)

• Dix Hallpike

• Body and neck positional testing

• Caloric testing.

impact of tinnitus.

5 Interpret individual test results, taking into account accuracy, patient’s response/co-operation.

• Patient’s cognitive and physical ability to perform test and its potential impact on the reliability of test results.

5 Use available information to formulate an initial diagnosis unless results support an inconclusive outcome.

• The use of consolidated information from all tests and non-test processes and its significance for formulation of initial diagnosis.

3,6 Debrief patient/carer regarding the assessment outcome and management options available.

• How to provide relevant verbal and written information to support the patient and significant other.

• The information needs of patients and carers following investigation/assessment.

• How to explain complex or technical terms in user-friendly terms and confirm understanding.

6,7 Agree and document individual management plan.

• Requirements for documentation of management plans.

7 Write a report of results to all appropriate professionals.

• Requirements for reporting and the needs of other professionals for relevant information.

• The significance of information for the future management of patients.

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MODULE 2 Adult Audiology and Rehabilitation (AA&R-6)


AIM To be able to safely and efficiently maximise the information gained from the assessment consultation to be able to effectively develop a treatment plan.

SCOPE To work within a supervised environment in adult audiology and hearing aid assessment clinics. This will include selection and fitting of appropriate aids or other equipment under supervision.

LEARNING OUTCOMES


1. Perform daily calibration and checks of the equipment and environment following local procedures, to ensure patient safety and quality of facilities.

2. Formulate, prior to patient contact, a consultation plan and plan appropriate clinical testing, utilising the relevant information available.

3. Interview a variety of different patients, overcoming any communication barriers. 4. Iinterpret test results and consolidate these in relation to all other relevant information obtained, and make informed decisions

concerning the diagnosis and management options. 5. Under the supervision of a senior adult audiologist select and fit appropriate hearing aid(s) or other equipment as appropriate. 6. Advise patient and their carers on wider support and equipment available, e.g. social services. 7. Write reports/letters regarding the outcome of the consultation and provide patients/carers with an agreed individual

management plan (IMP).

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• Observe and participate, with direct supervision, in audiological support for ENT or AVM outpatient clinics to understand and observe the patient pathway, including medical, nursing and other professional consultations.

• Observe and participate, with direct supervision, in routine direct access clinics, including onward referrals to multiprofessionals, e.g. ENT/AVM, radiology, elderly medicine, social services.

• Observe and participate, with direct supervision, in diagnostic adult hearing and hearing aid assessment clinics, including onward referrals to multiprofessionals, e.g. ENT/AVM and radiology, etc.

• Observe and participate, with direct supervision, in adult vestibular rehabilitation and tinnitus therapy clinics, including onward referrals to multiprofessionals, e.g. ENT/AVM, falls clinics, psychology etc.



outcome.



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KEY

LEARNING OUTCOMES


1 Undertake and document calibration checks of all necessary audiovestibular equipment and preparation of facilities for the consultation.

• Range of equipment used, correct use, limitations and principles of measurement.



• Importance of documentation of calibration.

• Ensure all equipment conforms to departmental and/or trust health and safety policies.

• Principles and standards of calibration of all audiovestibular equipment.

2 Formulate a consultation plan for adult audiology and rehabilitation.

• Information sources relevant to planning consultation.

• Significance of information to clinical investigation, use of testing equipment, range of tests and potential diagnosis.

• Clinical reasoning strategies, with reference to identified purpose of assessment and information needs of others.





• The relevant health and safety regulations specific to Adult Audiology and Rehabilitation.


1,2 Prepare the environment for relevant assessments/investigations.

• Resources required are available within the room prior to consultation.

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KEY LEARNING

OUTCOMES


2,3 Obtain a suitably completed referral form/letter, greet patient, and check patient details.



3 Explain the full procedure to the patient and address any questions they may have relating to the procedure.


• Requirements for patient compliance with investigations, including pre-test instructions.


• The information needs of patients pre, during and post investigation.

• The authority level for provision of information to patients. 3,4,7 Document all aspects of patient

contact in accordance with record keeping procedures.

• Medicolegal requirements of health documentation.


• Patient confidentiality, data protection, freedom of information.


• Individual clinical responsibility and accountability. 3 Obtain a clinical history as

appropriate for each investigation. • Framework for clinical history taking.

• Possible sources of clinical history information.

• Identification of possible aetiological or contributing factors.

• How to spontaneously probe for more relevant information,

• Factors that may influence the need for more specialist assessment and management, e.g. tinnitus, vestibular or related medical concerns.

• Protocols for management of vulnerable adults. 3,4 Evaluate the patient’s progress

against agreed goals. • Identification of potential changes needed to the patient’s hearing

aids or individual management plan.

• Use of self-reporting outcome measures as appropriate.

• Factors influencing the need for change to the patient’s hearing aids or individual management plan.

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KEY LEARNING

OUTCOMES


• Use of questionnaires, as appropriate, to assess such aspects as activity limitation, participation and motivation, and psychosocial impact of tinnitus.

4 Interpret relevant information and make an informed decision concerning any change in the diagnosis, the needs and individual management plan.

• Appropriate outcome measures for each intervention.

• Purpose of outcome measures linking their use to the evidence base.

• Need for and initiation of other treatments or onward referral, as necessary.

• Appropriate resources for the patient and significant other referral processes for other professionals and agencies to the patient and their significant other.

5 Deliver interventions that may include recommendations for hearing aid fitting or other assistive devices, such as:

• tinnitus maskers

• telephone or TV equipment tailored to meet the needs of the individual patient.

• Tailoring of interventions to meet the needs of the individual patient.

• The need for clear instructions on hearing aid handling and maintenance, involving significant others as appropriate.

• Accepted guidance of use of hearing aids in tinnitus management.

• Use of questionnaires, as appropriate, to assess such aspects as activity limitation, participation and motivation.

• How to elect and program the hearing aid system to a prescribed amplification rational in accordance with current published recommended procedures.

• The functions and controls of the device. Ensure the patient can manipulate and use the device.

• Acclimatisation techniques and expectations of the new amplified acoustical environment the patient can expect, in particular focusing on sounds that potentially may be unexpected or sudden.

5 Take an impression of the ear and select ear mould type in accordance with current published

• British Society of Audiology (BSA) protocols for the taking of ear mould impressions.

• Acoustic considerations for ear mould type and modifications

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KEY LEARNING

OUTCOMES


recommended procedures. • Contraindications of ear mould type and modifications 5 Carry out fitting of an appropriate

hearing aid, under supervision as appropriate, in a safe and effective manner.

• Protocols and requirements for safe and effective fitting of an appropriate hearing aid.

• Methods and processes for objective verification e.g. REM.

• Contraindications to objective verification.

• Use of appropriate test set-up and hearing aid signal processing settings.

5 Verify the performance of the hearing aid in accordance with current published recommended procedures.

• How to perform hearing aid measurements using a test box in accordance with appropriate ISO standards.

• Hearing aid listening checks to identify faults

• How to make appropriate modifications to facilitate comfort and use.

• Use of a range of outcomes measures to evaluate intervention and benefit.

6 Provide the patient and significant other clear information on the agreed outcomes.

• Factors influencing choice of individual management plan to patients.

• The importance of agreement of goals.

• The range of written information on tinnitus and management options.

• Common questions from patients and significant others. 7 Write reports on outcomes and

recommendations, suitable for the intended audience, to include a range of appropriate professionals. Save and document results with the department’s patient management system.

• The range of documentation associated with reports on outcomes and recommendations, including referral documentation.

• Correct and full completion of relevant documentation and implications of missing, incorrect or inappropriate information.

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MODULE 3 Paediatric Audiology and Habilitation (PA&H-7)


AIM To be able to safely and efficiently maximise the information gained from the assessment consultation to be able to effectively develop a treatment and rehabilitation plan.

SCOPE Training to be carried out in a department accredited for paediatric and paediatric rehabilitation training. The trainee will work within a supervised environment in paediatric audiology diagnostic and rehabilitation clinics. On completion of this module the trainee will be able to perform any subjective and objective development and age-appropriate hearing tests in a safe and effective manner, adapting as required to ensure information is gained efficiently within the time available. They will be able to interpret test results and consolidate these in relation to all other relevant information obtained, and make informed decisions concerning the diagnosis and management options and plan future rehabilitative care, linking all different professionals and agencies who work with hearing impaired children and their families, to include the provision of necessary equipment and liaison with all relevant external agencies and professionals as part of achieving a ’family-friendly‘ service.

LEARNING OUTCOMES


1. Perform any subjective and objective development and age-appropriate hearing tests within the field of paediatric audiology and rehabilitation.

2. Interpret test results and consolidate these in relation to all other relevant information obtained. 3. Make informed decisions concerning the diagnosis and management options. 4. Plan future rehabilitative care for hearing impaired children and their families.

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The clinical experiential learning for this module is: • Observe and participate with direct supervision in audiological support for ENT or AVM outpatient clinics to understand and

observe the patient pathway, including medical, nursing and other professional consultations. • Observe paediatric, specialist speech and language, and teacher advisory service to understand the patient pathway, including

medical, language and education provision for a child with hearing loss. • Observe and participate, with direct supervision from a paediatric audiologist, in paediatric assessment clinics, including

onward referrals to multiprofessionals, e.g. ENT/AVM, paediatrics, education services. • Observe and participate, with direct supervision from a paediatric audiologist with experience in paediatric rehabilitation, in the

management of a child with hearing loss, including the prescription and fitting of hearing aids and liaison with all relevant external agencies.

• Observe and participate, with direct supervision from a paediatric audiologist, in audiology screening programmes to include the Newborn Hearing Screening Service, which may involve either hospital or community-based screening programmes, diagnostic auditory brainstem response (ABR) clinics, liaising with midwives, paediatric and health visiting staff, role and responsibilities of the school nurses in hearing screening.



outcome.



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KEY LEARNING

OUTCOMES


1,3,4 Document all aspects of patient contact in accordance with record keeping procedures.

• Medicolegal requirements of health documentation, local and national child protection procedures.


• Patient confidentiality, data protection, freedom of information


• Individual clinical responsibility and accountability. 1 Undertake and document calibration

checks of all necessary equipment used in paediatric assessment, including:

• audiometer (AC and BC; headphones and insert earphones), tympanometers

• sound field VRA system,

• ABR and OAE equipment, which may be performed by external agencies.

• Requirements for equipment conformance to departmental and/or trust health and safety policies.

• Principles and standards of calibration of all paediatric equipment, e.g. traceability of Stage, A, B and C processes.

• Importance of documentation of calibration.

• The principles of different calibration scales used in paediatric audiology, e.g. dB A, dB, eHL, dB nHL.

1,2 Prepare the room and equipment set-up in order to meet the needs of the consultation.

• The importance of hygiene, infection control, health and safety.

• The recommended use of disposable items, e.g. ear tips, electrodes, etc.

• The resources required are available within the room prior to consultation.

1,2 Formulate a consultation plan utilising the relevant information available.

• How and where to access all patient information (including referral) relevant to the consultation e.g. from medical notes, audiology database.

• Understanding of the limitations of the available information.

• How to introduce the parent/carer/child as appropriate to the

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KEY LEARNING

OUTCOMES


consultation process. 2 Interview a variety of parents, carers

and children, if appropriate, with different communication needs and levels of understanding to gain relevant clinical and social information. .

• Interview strategies and mechanisms of gaining maximum historical and psychosocial information.

• Equality and diversity awareness.

• Different communication strategies, including the use of interpreters, spoken or manual.

• Deaf awareness.

• Awareness of non-verbal language.

• Process of mental capacity assessment.

• Use of a variety of interview techniques to ascertain the relevant clinical and psychosocial information.

• Clinical pathology signs and profiles.

• Use of suitable and relevant questionnaires.

• The identification of possible aetiological or contributing factors as they arise and how to spontaneously probe for more relevant information.

• Expectations of patients from the consultation. 1,2 Formulate a plan identifying the

relevant tests to be performed to aid diagnosis.

• Tools, resources and tests available.

• The relevance and clinical significance of each test.

• Local and national protocols and procedures, including contraindications of individual tests.

• Evidence-based practice, including sensitivity and specificity of individual tests.

• The importance of gaining patient consent and local procedures for this.

• Limitations of individual tests.

• Physiological site of testing.

• Appropriateness of order of testing.

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KEY LEARNING

OUTCOMES


2 Perform with a senior paediatric audiologist tests that are age and development appropriate for a child aged 6–24 months, which may include: sound field/insert phone/BC visual reinforcement audiometry (VRA),distraction testing.

• Recommended procedures for VRA.

• Recommended procedure for distraction testing.

• Identification of accurate results and the need for verification and replication.

• Individual limitations of an individual child as well as individual personal professional abilities.

• Benefits and limitations of sound field testing.

• National recommended procedures for diagnostic testing.

• Test protocols and parameters for AC, BC.

• Test contraindications.

• NHSP guide lines on early audiological assessment. 1 Perform, under supervision with a

paediatric audiologist, appropriate tests for a child with a development age of 24–40 months, which may include VRA, as above, speech discrimination tests, performance sound field, headphone, BC audiometry.

• The range of relevant tests and their application.

• The range and use of speech discrimination tests.



• Test contraindications.

• NHSP guidelines on early audiological assessment.

1 Perform appropriate tests for a child with a development age of 5 years, which may include VRA, toy discrimination tests and pure tone audiometry (AC and BC).

• BSA protocols for pure tone audiometry.

• The presentation of patients with a functional hearing loss.



• Test contraindications. 1 Perform otoscopy and tests to

assess middle ear function in all age groups as listed above.

• BSA protocols for tympanometry, including the specificity and use of different probe tone frequencies.

• NHSP requirements for the assessment of middle ear function in the newborn population.

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KEY LEARNING

OUTCOMES


2,3 Interpret individual test results.

• Patient’s cognitive and physical ability to perform test and its potential impact on the reliability of test results.

• The significance of taking into account accuracy and the patient’s response/co-operation.

• Normal paediatric developmental milestones. 2.3 Under the guidance and supervision

of a senior paediatric audiologist formulate an initial diagnosis.

• How to consolidate information gathered from all test and non-test processes.

• How to recognise results that support an inconclusive outcome and action to be taken.

2,3,4 Under supervision, debrief the parent/carer on the assessment outcome and the management options available.

• Local and national referral pathways and protocols.

• The medical management of hearing loss.

• Management of all relevant clinical outcomes, e.g. glue ear, sensorineural hearing loss.

• Language development in the paediatric population. 4 Under supervision, agree and

document individual management plan.

• Format of individual management plans.

2,3,4 Produce a report on investigations suitable for all relevant professionals and the family.

• Report writing and written communication with patients and the public.

1

In cases of hearing aid fitting over 5 years of age, under supervision of a senior paediatric scientist, instruct and take an ear mould impression.

• BSA protocols for Impression taking ear mould types and materials and modifications.

• Modern Children’s Hearing Aid Services (MCHAS) guidelines.

1 Perform objective electroacoustic tests.

• Different prescription formulae used in the paediatric service.

• Verification methods in paediatric habilitation, e.g. real-ear to coupler difference (RECD), real-ear measurement (REM).

• MCHAS guidelines (or equivalent).

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KEY LEARNING

OUTCOMES


• Correct recording and interpreting of test box measures.

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MODULE 4 Epidemiology and Public Health (E&PH-8)


AIM This module provides the trainee with experience of the epidemiology of disorders of hearing, tinnitus and balance. They will also explore the role of screening and the impact of disorders of hearing, tinnitus and balance on public health and the impact of acquired hearing impairment on everyday life.

SCOPE On completion of this module the trainee will perform a range of methodologies used in epidemiology, design a screening protocol and explore the role of health education, primary and secondary prevention in disorders of hearing, tinnitus and balance.

LEARNING OUTCOMES


1. Perform the range of methodologies, including statistical analysis, used in epidemiology to identify the prevalence and incidence of hearing, tinnitus and balance disorders and their relationship to relation to demographic characteristics.

2. Design a screening protocol that could be used in a community setting such as a GP practice, write a proposal that includes the implementation, evaluation and cost benefit of the programme and the potential patient benefit from the programme.

3. Undertake a rehabilitation session, under supervision, for example with a hearing therapist, to support patients through the behavioural change process and provide evidence-based advice.

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• Identify a patient with hearing, tinnitus or balance disorders and, with permission, observe and reflect on the psychosocial and communication implications of an acquired hearing impairment on the individual’s everyday life. (This is possible particularly patients with hearing loss – younger working people with hearing loss may be appropriate here.)

• Mimic the effect of hearing impairment by the use of appropriate ear plugs to directly observe the practical impact of hearing loss.

• Take part in a multidisciplinary meeting and reflect on the way the multidisciplinary team contributes to the rehabilitation of patients with hearing, tinnitus or balance disorders, for example paediatric audiology, newborn screening.

• Link with other screening services within the community or acute setting to understand alternative methodologies in screening across a number of disciplines and to reflect on good practice within routine health screening services.



outcome.



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KEY

LEARNING OUTCOMES


1 Review the evidence base and use your findings to identify the proportion of the UK population who experience hearing, tinnitus or balance disorders by age, gender and other sociodemographic measures and predict how this is likely to change over the next 20 years.

• Functional impact of acquired hearing loss on communication.

• Impact of hearing loss on mental and physical health.

• Impact of disability on opportunities for employment.

• Disability Discrimination Act.

• Epidemiological studies.

• Public health publications.

• Local demographic data.

• Relevant national stat and voluntary publications.

• Public health publications.

• Local demographic data.

• National census.

• Rate at which hearing, tinnitus or balance disorders occur in the UK population by age, gender and other sociodemographic measures.

1 Use a range of IT systems to undertake a literature review, data storage, statistical analysis, referencing and report writing.

• Evidence-based practice.

• Electronic literature review systems.

• Reference management systems.

• Statistical techniques. 2 Undertake a literature review and

design a screening programme to improve public health related to hearing/balance/tinnitus.

• Which populations might benefit from health screening.

• Risks and benefits of health screening, including financial implications.

• Screening processes and interventions that could be offered based on screen findings.

• Prevention of disorders of hearing, tinnitus and balance.

• Screening test sensitivity and specificity. 2 Undertake an audit of a relevant

screening programme, write a report and make recommendations for the

• Audit cycle.

• Evidence base underpinning the screening programme.

• Report writing.

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KEY LEARNING

OUTCOMES


implementation and evaluation of the programme.

3 Assist at a specialised rehabilitation clinic/session that supports patients with tinnitus or balance disorders to change their lifestyle as part of a management strategy.

• Principles of health education to improve public health related to hearing/balance/tinnitus.

• Information resources to enable patients to develop an awareness of the impact of lifestyle choices on hearing, tinnitus and balance.

• Behavioural change models.

• Health technology assessments.

• International and national recommendations/practice. 3 Observe a number of acute or

community-based screening programmes across a number of different specialties.

• Principles and methodology of different screening programmes.

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SECTION 7: NEUROPHYSIOLOGY SPECIALIST LEARNING

FRAMEWORK

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This section describes the Learning Framework for the Specialist Component of work based learning covering the Learning Outcomes, Clinical Experiential Learning, Competence and Applied Knowledge


Specialist Modules



SPECIALISM Neurophysiology

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NEUROPHYSIOLOGY – SPECIALIST MODULES

Module 1 (E&NC&EP-5) Electromyography and Nerve Conduction Studies and Evoked Potentials

Module 2 (PEEG-6) Paediatric EEG

Module 3 (EEG on ICU-7) EEG in the Intensive Care Setting

Module 4 (S&LTM-8) Sleep and Long-term Monitoring

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MODULE 1 Electromyography and Nerve Conduction Studies and Evoked Potentials (E&NC&EP-5)


AIM This module will provide the trainee with detailed knowledge and understanding of electromyography, peripheral nerve conduction studies and evoked potentials, and their use in clinical assessment, diagnosis and management in various disease processes. They will have the ability to plan, prepare, perform and interpret peripheral nerve conduction studies and evoked potentials.

SCOPE On completion of this module the trainee will be able to describe the range and diversity of patients attending a general neurophysiology service for electromyography, peripheral nerve conduction studies and evoked potentials, and their special needs, including people with learning difficulties, cognitive and sensory impairment, physical disabilities, older people, paediatrics and those in the intensive care setting.

LEARNING OUTCOMES


1. Plan, prepare and perform nerve conduction studies obtaining recordings from the upper and lower limbs in adult and/or paediatric patients referred for investigation of disorders of the peripheral nervous system, e.g. carpal tunnel syndrome, peripheral neuropathy, etc.

2. Assist in electromyography (EMG) studies and identify the electropotentials associated with electromyography. 3. Plan, prepare and perform evoked potential studies (visual, auditory and somatosensory) and measure visual acuity and

hearing and sensory threshold. 4. Interpret the data and produce high-quality reports with respect to nerve conduction studies and evoked potentials, and

differentiate between artefact and physiological occurrences.

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• Identify a patient with a peripheral nerve or muscular problem requiring EMG and/or nerve conduction investigations and, with permission, follow the progress of the patient from the initial consultation, through investigations and follow-up appointment, and reflect on your learning from this process.

• Identify five patients with different peripheral nerve or muscular conditions (e.g. motor neuron disease, myasthenia gravis, etc.), write a case study on each patient and critically reflect on the role of EMG and nerve conduction studies in such conditions.

• Observe the application of evoked potentials in the surgical setting and describe, compare and contrast the different techniques used and the evidence base underpinning their use.

• Identify a patient with multiple sclerosis and, with permission, follow the progress of the patient from initial consultation, through investigations, including evoked potentials, and follow-up appointment, and reflect on your learning from this process.

• Attend a neurology, neurosurgery, neuromuscular or neurorehabilitation clinic and critically appraise the process of referral, diagnosis and treatment, including the range of healthcare professionals that contribute to the care of each patient and how the interprofessional team work together.

• Use your clinical experience to critically evaluate the use of evoked potentials and nerve conduction studies. It is also recommended that trainees undertake the following clinical experiential learning:

• Observe the surgical treatment of patients with a peripheral nerve entrapment, such as carpal tunnel syndrome, and discuss the evidence base underpinning the surgical and non-surgical management of peripheral nerve entrapment.

• Attend an outpatient clinic and observe the work of the therapists in the treatment and management of peripheral nerve entrapment conditions.

• Observe paediatric EMG and reflect of the differences between assessing children and adults. • Participate and contribute to multidisciplinary team meetings (MDTs) and case presentation sessions and discuss the role of

MDTs in the diagnosis and management of patients. All of these experiences should be recorded in your e-portfolio. The following section details the competence and knowledge and understanding each trainee must gain. Each competence is


outcome.

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KEY LEARNING

OUTCOMES


1,2,3 Control infection risks in accordance with departmental protocols.



1,2,3 Minimise risks and hazards in compliance with health and safety policies.

• The relevant health and safety regulations specific to neurophysiology investigations, the potential hazards and risks, and the actions to be taken to minimise these.

1,2 Prepare for nerve conduction studies including the environment, equipment and patient.

• Local standard operating procedure (SOP) for peripheral nerve conduction studies.

• Clinical indications and contraindications for nerve conduction studies in the range of conditions of patients referred for nerve conduction studies.

• The referral system for EMG and nerve conduction studies.


• How to check for validity of information.


• Types of nerve conduction study, their purpose and the appropriateness for conditions presented.

• How to assess whether investigations requested are appropriate to clinical question and the reason for referral.

• Potential special needs of the patients.

• Possible patient needs and environmental needs.

• Factors that may influence the duration and quality of investigations.


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KEY LEARNING

OUTCOMES



• How to establish and maintain effective communication with the patient, including explaining the test in a manner that will ensure cooperation.

• The importance of checking there is adequate storage volume for the investigation to be performed.

• The effects of sensitivity, time base, filters, signal to noise (S:N) ratio.

• The range of electrodes and stimulators used in nerve conduction recordings.

• Factors of key importance to patient history.

• How to record information and check for validity. 1,2,3 Explain the procedure for each type

of investigation to the patient and address any questions they may have relating to the procedure, including the process after the procedure and how the patient will be informed of the results.




• The information needs of patients following the investigation.


1,3 Gain informed consent for each investigation.



• Principles, guidance and law with respect to informed consent. 1 Identify and place recording and

stimulating electrodes at the correct sites of the major peripheral nerves and obtain recordings of nerve

• The importance of ensuring the patient is in a comfortable position and the effect on the quality of the recording.

• Importance of limb temperature maintenance.

• The recording and stimulus parameters for motor and sensory

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KEY LEARNING

OUTCOMES


conduction studies (upper and lower limbs).

recording.

• The principles and importance of correct electrode placement for motor, sensory and F wave studies.

• Principles and importance of correct positioning of the stimulator.

• The use of supra-maximal stimulus.

• Measurement of sensory and motor latencies and amplitudes.

• The importance of correct measurement and documentation of distances between recording and stimulating electrodes.

• Conduction velocity calculation.

• Protocols and requirements for hygiene and infection control related to the relevant range of investigations.

2 Observe/assist in EMG recording. • Clinical rationale for undertaking EMG.

• Indications/contraindications for EMG.

• Electropotentials associated with electromyography. 1,2,3 Identify the cause(s) of errors and

recognise the non-pathological effects on the recording on nerve conduction studies and evoked potentials and their elimination.

• Identification, elimination and minimisation of physiological and non-physiological artefacts.

1 Interpret the results and formulate accurate reports for peripheral nerve conduction studies, recognising the pathophysiological changes.


• Correct annotation and documentation of results.

• The importance of evaluation and reviewing the findings.

• Identification of the need for further investigations.

• When to seek assistance and advice beyond the level of expertise.

• Interpretation of the results in the clinical context. Hospital and community-based services for patients.

3 Plan and prepare for evoked potentials (visual, auditory and

• The range of conditions of patients referred for clinical neurophysiology testing.

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KEY LEARNING

OUTCOMES


somatosensory).

• The referral system for multimodality evoked potentials.


• Checking for validity of information.


• Types of evoked potentials, their purpose and the appropriateness for conditions presented.

• Assessment of appropriateness of investigation requested with respect to the clinical question and referral.

• Potential special needs of the patients.



• Contraindications to investigations.



• Establish and maintain effective communication with the patient, including explaining the test in a manner that will ensure co-operation.


• The effects of sensitivity, timebase, filters, Common Mode Rejection Ratio, S:N averaging.

• The range of electrodes and stimulators used in evoked potential recordings.


• Recording information and checking for validity.

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• Visual acuity, auditory and somatosensory thresholds. 3 Perform evoked potentials (visual,

auditory and somatosensory) using a range of stimulators.

• Local SOP for evoked potential investigations.

• Principles of derivation and electrode placement used for evoked potentials (visual, auditory and somatosensory).

• The importance of electrode impedance and its effects.

• Correct machine, recording and stimulus parameters.

• The importance of patient positioning and compliance.

• The principle and effects of limb temperature.

• Positioning and use of correct stimulators (visual, auditory and somatosensory).

• Requirements and principles of recording and monitoring evoked potentials, including the monitoring of technical quality of raw data and identifying and eliminating biological and non-biological artefacts.

• The importance of the independent testing of right and left (eye, ear and limb).

• The importance of acquiring sufficient samples and checking for reproducibility.

• Appropriate waveform marking to published nomenclature.

• Importance of continued information and reassurance for the patient. 4 Interpret the results and formulate

accurate factual reports for peripheral nerve conduction studies.

• Correct annotation and documentation of results.




• Interpretation of the results in the clinical context.

• Hospital and community-based services for patients. 4 Interpret the results and formulate

accurate factual reports for evoked • Correct annotation and documentation of results.


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potentials (visual, auditory and somatosensory), recognise, label and critically evaluate the major components of all modalities of evoked potentials.



• Interpretation of the results in the clinical context.

• Hospital and community-based services for patients.

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MODULE 2 Paediatric EEG (PEEG-6)


AIM This module will provide the trainee with detailed knowledge, understanding and the ability to perform resting and sleeping electroencephalograms (EEGs) and its use in the clinical assessment, diagnosis and management of children with neurological conditions. They will understand the pathophysiology, clinical presentation and electrocephalographic findings in paediatric epileptic syndromes and other clinical conditions.

SCOPE On completion of this module the trainee will recognise normal variants in the resting and sleeping EEG in paediatric patients and the pathophysiology, clinical presentation and electrocephalographic findings in paediatric epileptic syndromes and other clinical conditions. They will be able to describe the range and diversity of paediatric patients attending for an EEG, and recognise their special needs, including learning difficulties, physical disabilities and the needs of their carers. They will be able to use of EEG machine and transducers.

LEARNING OUTCOMES


1. Plan, prepare and perform EEG recordings, accurately measuring electrode sites, site electrodes using recommended placement system, and differentiate between artefact and physiological occurrence in paediatric patients.

2. Interpret the data and produce high-quality reports with respect to paediatric EEG.

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• Identify a paediatric patient with an epilepsy syndrome requiring EEG and, with permission, follow the progress of the patient from the initial consultation, through investigations and follow-up appointment and reflect on your learning from this process.

• Identify five patients with different epilepsies or neurological conditions (e.g. childhood absence epilepsy, West syndrome), write a case study on each patient, critically reflect on the role of EEG in paediatric conditions and evaluate the use of EEG in childhood.

• Observe the application of EEG in the non-dedicated environment and describe the different techniques used.

• Observe a paediatric epilepsy clinic and critically appraise the process of referral, diagnosis and treatment, including the range of healthcare professionals that contribute to the care of each patient and how the interprofessional team work together.

• Use your clinical experience to critically evaluate the range of montage derivations and recording parameters used in paediatric EEG.

It is also recommended that trainees undertake the following clinical experiential learning:

• Observe the surgical treatment of patients with intractable epilepsy, evaluate the evidence base underpinning the surgical and medical management of intractable epilepsy, and present your findings to colleagues.

• Observe neonatal EEG and reflect of the maturation of the EEG.

• Participate and contribute to multidisciplinary team meetings (MDTs) and case presentation sessions and discuss the role of MDTs in the diagnosis and management of patients.

All of these experiences should be recorded in your e-portfolio.

The following section details the competence and knowledge and understanding each trainee must gain. Each competence is linked to the relevant learning outcomes and trainees must demonstrate achievement of each competence for each linked learning outcome.



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1 Minimise risks and hazards in compliance with health and safety policies.


1 Gain informed consent for each type

of investigation. • The importance of explaining the procedure for each investigation to

the patient/parents/guardian and gaining informed consent.

• Principles, guidance and law with respect to informed consent. 1 Plan and prepare for the recording

of a paediatric EEG. • Local Standard Operating Procedure for paediatric EEG.

• The range of paediatric conditions requiring an EEG investigation.

• Special needs of paediatric patients.

• The referral system for paediatric EEG.




• The purpose of paediatric EEG and its appropriateness for the conditions presented.

• Assessment of appropriateness of the investigation requested with respect to the clinical question and referral.



• The different activation procedures used in paediatric EEG, their indications, contraindications, risks and benefits.

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• The physiology of hyperventilation.

• Grades of photoparoxysmal response.



• The importance of establishing and maintaining effective communication with the patient, including explaining the test in a manner that will ensure cooperation


• The effects of sensitivity, display speed, filters, CMRR and sampling rate.

• The range of electrodes and transducers used in paediatric EEG recordings.


• Information that should be recorded and the checks for validity.

• Effects of medication on the paediatric EEG, including that which may be administered for or during the EEG.

• Electrode placement systems used in paediatric EEG.

• Potential requirement for modification of the plan. 1 Record a paediatric EEG, to include

activation procedures identifying and rectifying the non-pathological features of paediatric EEG recordings.

• Local Standard Operating Procedure for paediatric EEG.

• The importance of a range of control settings and the importance of reviewing throughout the recording.

• The principle and importance of marking electrode sites of placing electrodes and confirming the contact impedances are appropriate to the paediatric patient in clinical context.

• Principles of derivation of montages (referential and bipolar) and

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electrode placement used for paediatric EEG.


• Correct recording parameters.

• The importance of patient positioning and compliance.

• Requirements and principles of recording paediatric EEG, including identifying and eliminating biological and non-biological artefacts.

• The importance of continued information and reassurance for the patient.

• The protocol for hyperventilation and its effects on the paediatric EEG, normal and abnormal, and when the procedure should be discontinued.

• Intermittent photic stimulation and its effect on the paediatric EEG, normal and abnormal, and when the procedure should be discontinued.

• Sleep activation and its importance in the clinical context of the referral question.

• Annotation of ongoing recording.

• Recognition of and correct response to clinical events. 2 Annotate and interpret a paediatric

EEG recording, recognising the normal features (wake and sleep) and abnormalities in paediatric epileptic syndromes and other conditions requiring EEG.


• Normal and abnormal features in EEG, awake and asleep.

• Maturation of EEG.

• Manipulation of data.

• Anticonvulsant therapy used in paediatrics.

• Identification of the degree of urgency of clinical report.

• Hospital and community-based services for patients.

• Abnormalities associated with paediatric epileptic syndromes and other conditions requiring EEG, e.g. anoxic/hypoxic episodes.

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MODULE 3 EEG in the Intensive Care Setting (EEG on ICU-7)


AIM This module will provide the trainee with the knowledge, understanding and practical skills to record an electroencephalogram (EEG) in the intensive care setting. The trainee will appreciate the clinical use of the EEG and how it is used in patient management. The trainee will understand sources of errors, effects of sedation and non-pathological effects during EEG monitoring.

SCOPE On completion of this module the trainee will be able to describe the range and diversity of patients requiring EEG monitoring in the intensive care setting.

LEARNING OUTCOMES


1. Plan, prepare and perform EEG recordings in an intensive care setting, siting electrodes using recommended placement system, including any modifications due to the nature of the patient.

2. Report on a range of EEGs recorded from patients in ICU, for example status epilepticus, anoxic/hypoxic brain injury.

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The clinical experiential learning for this module is: • Identify a patient in the intensive care setting requiring EEG and, with permission, follow the progress of the patient from the

initial admission, through investigations and outcome. Reflect on your learning from this process. • Identify three intensive care patients referred for EEG for different reasons (e.g. status epilepticus, head injury, etc.), write a

case study on each patient and critically reflect on the role of EEG in such conditions. • Observe the application of cerebral function monitoring in the intensive care setting and describe the different techniques used. • Attend an intensive care unit ward round and critically appraise the process of admission, diagnosis and treatment, including

the range of healthcare professionals that contribute to the care of each patient and how the interprofessional team work together.


• Observe the neurosurgical treatment of intensive care patients and discuss how this experience will shape your professional practice.

• Observe neonatal intensive care cerebral function monitoring. • Participate and contribute to multidisciplinary team meetings (MDTs) and case presentation sessions and discuss the role of

MDTs in the diagnosis and management of patients.


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1 Control infection risks in accordance with departmental and intensive care protocols.

• Protocols and requirements for hygiene and infection control related to the relevant range of investigations, including preparation, conduct and completion of investigation, and special precautions in the intensive care setting.




1 Plan and prepare for EEG

recordings in the intensive care setting.

• Local Standard Operating Procedure for EEG recordings in ICU.

• The range of conditions of patients referred for EEG monitoring in the intensive care setting.

• Special needs of intensive care patients.

• The referral system and the justification for EEG monitoring in the intensive care setting.




• The purpose of EEG in the intensive care and its appropriateness for the conditions presented.

• Assessment of the appropriateness of the investigation requested with respect to the clinical question and the reason for referral.



• The specific environmental hazards and precautions required in the intensive care setting.

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• The effect of medication (sedation) on the EEG.



• The importance of establishing and maintaining effective communication persons associated with the patient (e.g. nursing staff, relatives, etc.).



• The range of electrodes and transducers used in intensive care recordings.



• Appropriate electrode and transducer selection.

• The necessary quantity and type of consumables required.

• Confirmation of the patient’s identity.

• Correct entry/identification on the recording system.

• Recognised measuring systems and how they may need to be adapted in the intensive care setting.

• Contact impedances are confirmed as appropriate to the electrode type and to the patient.

1 Explain the procedure for the investigation as appropriate to the intensive care setting.

• The appropriate choice of investigation, considering the findings from the history and clinical examination.

• Common questions and concerns of patients relatives/carers about procedures.

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• The information needs of patients relatives/carers following investigation.

• The authority level for provision of information regarding results of investigation.

Gain consent for each type of investigation.

• Local consent procedures when the patient is unconscious.

• Principles, guidance and law with respect to informed consent. 1 Record an EEG on the unconscious

patient in the intensive care setting, identifying and rectifying the non-pathological features and recognising the common EEG features observed in intensive care recordings (e.g. burst suppression).

• The importance of a range of control settings and of reviewing throughout the recording.

• The principle and importance of placing electrodes and confirming the contact impedances are appropriate to the patient in the clinical context of the intensive care setting.

• Principles of derivation of montages (referential and bipolar) and electrode placement used for EEG in the intensive care setting.



• Requirements and principles of recording the EEG in the intensive care setting, including identifying and eliminating biological and non-biological artefacts, in particular the environmental challenges.

• The use and effects of painful, auditory and tactile stimulation.

• The need to modify or extend the current investigation.

• Annotation of ongoing recording.

• Recognition of and correct response to clinical events.

• The effects of sedation on the EEG. 2 Factually report the recorded EEG,

recognising the effects of sedation, and evaluate the findings in the clinical context of the intensive care




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patient. • Drug therapy used in the intensive care patient.


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MODULE 4 Sleep and Long-term Monitoring

(S&LTM-8)


AIM This module will provide the trainee with the detailed knowledge and understanding of the physiology of sleep and the practical skills required to record sleep parameters during polysomnography and multiple sleep latency recordings, as well as the clinical uses and management. It will also provide detailed understanding of the uses of long-term monitoring techniques, clinical uses and management in epileptic syndromes and sleep disorders.

SCOPE On completion of this module the trainee will be able to describe the range and diversity of patients requiring sleep studies and long-term monitoring. They will be able to recognise normal and abnormal sleep patterns and put them in the clinical context with the pathophysiology and clinical presentation of the patient. They will be able to recognise the pathophysiology, clinical presentation and electroencephalographic findings in patients undergoing long-term monitoring.

LEARNING OUTCOMES


1. Prepare, plan and perform multiple sleep latency tests (MSLT) and/or polysomnography (PSG). 2. Prepare, plan and perform videotelemetry and/or ambulatory EEG recordings. 3. Factually report on the results from MSLT and/or PSG. 4. Factually report on the results from video telemetry and/or ambulatory EEG recordings.

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The recommended examples of clinical experiential learning for this module are:

• Identify a patient undergoing a sleep study and, with permission, follow the progress of the patient from the initial consultation, through investigations and follow-up appointment, and reflect on your learning from this process.

• Identify a patient undergoing long-term monitoring and, with permission, follow the progress of the patient from the initial consultation, through investigations and follow-up appointment, and reflect on your learning from this process.

• Identify a patient referred for a multiple sleep latency test or polysomnography, write a case study on the patient and critically reflect on the role of the multiple sleep latency test in the diagnosis of narcolepsy or excessive daytime somnolence.

• Identify two patients referred for long-term monitoring for different conditions (e.g. intractable epilepsy, non-epileptic attacks), write a case study on each patient and critically reflect on the evidence base underpinning the role of long-term monitoring in the management of each condition.

• Attend a sleep disorders or specialist epilepsy clinic and critically appraise the process of admission, diagnosis and treatment, the contribution of each member of the healthcare team contributing to the care pathway and the factors that promote effective interprofessional working.

• Using your clinical experience gained in this module critically evaluate, including the underpinning evidence base, the application of videotelemetry and ambulatory recording in the diagnosis of epileptic and non-epileptic attacks and adults and children.


• Observe the neurosurgical treatment of patients with intractable epilepsy and discuss the advantages and disadvantages and evidence base for each treatment modality and present your findings at a departmental meeting.

• Observe a range of sleep studies undertaken within respiratory and sleep science and discuss the similarities and differences between the service provided by a neurophysiology and respiratory and sleep service.

• Participate and contribute to multidisciplinary team meetings (MDTs) and case presentation sessions and discuss the role of MDTs in the diagnosis and management of patients.


The following section details the competence and knowledge and understanding each trainee must gain. Each competence is linked to the relevant learning outcomes and trainees must demonstrate achievement of each competence for each linked learning outcome.

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PROFESSIONAL PRACTICE Trainees should ensure they refer to the professional practice learning framework and continue to achieve the professional practice competences alongside the competences defined in this module.

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KEY

LEARNING OUTCOMES







1 Plan and prepare for the sleep investigation (multiple sleep latency test (MSLT) and/or polysomnography (PSG).

• The physiology of sleep and normal and abnormal sleep patterns in EEG.

• The range of conditions of patients referred for sleep studies.

• The pathophysiology of sleep disorders.

• Special needs of patients undergoing sleep studies.

• The referral system and the justification for sleep studies.




• The purpose of sleep studies and their appropriateness for the conditions presented.




• The specific environmental hazards.

• The effect of medication on the EEG.

• Safe and correct operation of the equipment to be used, including all

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peripheral devices.


• The importance of establishing and maintaining effective communication with the patient.



• The range of electrodes and transducers used in sleep studies.



• Selection of appropriate electrodes and transducers.

• Quantity and type of consumables required for the investigation.

• Confirmation of the patient’s identity and match to the referral documents.

• Correct entry/identification of patient details on the recording system.

• Recognised measuring systems and how they may need to be adapted for sleep studies.

• Correct use, placement and parameters of additional transducers.

• Appropriate contact impedances.

• The needs of the patient and the recording environment for the required investigation.

• Recording parameters and protocols for the planned investigation.

• The requirement for ongoing communication with medical, nursing staff and/or patient as appropriate.

2 Plan and prepare for long-term monitoring and/or ambulatory EEG

• Normal and abnormal EEG features of wake and sleep.

• The range of conditions of patients referred for long-term monitoring.

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recording. • Epilepsy and other seizure disorders.

• Special needs of patients undergoing long-term monitoring.

• The referral system and the justification for long-term monitoring.




• The purpose of long-term monitoring and its appropriateness for the conditions presented.




• The specific environmental hazards.

• The effect of medication on the EEG.



• The importance of establishing and maintaining effective communication with the patient.



• The range of electrodes and transducers used in long-term monitoring.

• Factors of key importance to the patient history.

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• Selection of appropriate electrodes and transducers.

• Quantity and type of consumables required for the investigation.

• Confirmation of the patient’s identity and match to the referral documents.

• Correct entry/identification of patient details on the recording system.

• Recognised measuring systems and how they may need to be adapted for long-term monitoring.

• Correct use, placement and parameters of additional transducers.

• Appropriate contact impedances.

• The needs of the patient and the recording environment for the required investigation.

• Recording parameters and protocols for the planned investigation.

• The requirement for ongoing communication with medical, nursing staff and/or patient as appropriate.

1,2 Explain the procedures for investigations to the patient and address any questions they may have relating to the procedure, including the process after the procedure and how the patient will be informed of the results.






1,2 Gain informed consent for each type of investigation.



• Principles, guidance and law with respect to informed consent. 1,2 Accurately measure electrode sites

and site electrodes using • Principles of derivation of montages (referential and bipolar) and

electrode placement used for sleep studies and long-term

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recommended placement system for EEG, electro-oculography (EOG) and sub-mental muscle, electrocardiogram (ECG) and respiratory etc. as required.

monitoring.


1,2 Perform the investigation (MSLT and/or PSG, ambulatory EEG and/or videotelemetry).

• The importance of a range of control settings and of reviewing throughout the recording.


• The use of activation or provocation procedures.

• The need to modify or extend the current investigation.

• Annotation of ongoing recording, including by external parties.

• Recognition of and the correct response to clinical events.

• Recognised sleepiness scales.

• Protocols and requirements for hygiene and infection control related to the relevant range of investigations.

3,4 Recognise normal EEG features (wake and sleep) and abnormal EEG features observed in epileptic syndromes and sleep disorders.

• Normal wake and asleep EEG features.

• Abnormal EEG features observed in epileptic syndromes and sleep disorders.

3,4 Produce a factual report from the investigations performed (MSLT and/or PSG, video telemetry and/or ambulatory EEG recording) pertinent to the investigation required.




• Drug therapies commonly seen in patients with sleep disorders or conditions requiring long-term monitoring.

• Sleep scoring and staging methodologies used for MSLT and PSG, e.g. Rechtschaffen and Kales.


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SECTION 8: OPHTHALMIC AND VISION SCIENCE

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This section describes the Learning Framework for the Specialist Component of work based learning covering the Learning Outcomes, Clinical Experiential Learning, Competence and Applied

Knowledge and Understanding. Each trainee is also expected to build on and apply the knowledge, skills and experience gained from the MSc in Clinical Science.

Specialist Modules



SPECIALISM Ophthalmic and Vision Science

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OPHTHALMIC AND VISION SCIENCE – SPECIALIST MODULES

Module 1 (PA-5) Patient Assessment

Module 2 (PAV-6) Psychophysical Assessment of Vision

Module 3 (OILL-7) Ophthalmic Imaging with Light and Lasers

Module 4 (UEO-8) Ultrasonography of Eye and Orbit

Module 5 (OMRB-9) Ocular Measurement, Refraction and Biometry

Module 6 (OMBF-10) Ocular Movement and Binocular Function

Module 7 (VE-11) Visual Electrophysiology

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MODULE 1 Patient Assessment (PA-5)


AIM This module will provide the trainee with detailed knowledge and understanding of the impact of visual impairment and its clinical assessment, diagnosis and management. They will understand the aetiology and progression of a range of visual disorders AND gain experience of assisting in investigations and the interpretation of patient results.

SCOPE This module provides comprehensive training in patient assessment, through interpreting referral letters, patient history and examination, understanding and dealing appropriately with patients of varying ages with vision impairment, and ensuring a safe clinical environment. The trainee will gain insight into the aetiology, progression and management of a range of ophthalmic disorders, and will learn how to interpret and analyse clinical findings and understand how they contribute to the development of a differential diagnosis and the preparation of a diagnostic report.

LEARNING OUTCOMES On successful completion of this module the trainee will: 1. Interpret referral letters in conjunction with medical and ophthalmic history, together with any pre-existing optometric, imaging or

electrophysiological findings, where available, to formulate the appropriate testing strategy. 2. Care for visually impaired individuals and their families appropriately, with due consideration of the impact of their visual

impairment. 3. Undertake a comprehensive ophthalmic examination safely and effectively, including external examination of ocular adnexae,

assessment of pupil size and reactions, examination of anterior segment with a slit lamp or direct ophthalmoscope and fundus examination, and understand of the principles of tonometry.

4. Derive a differential diagnosis and identify further investigations that will facilitate reaching a diagnostic conclusion. 5. Maintain an ongoing accurate, relevant and legible recording of information in the patient record. 6. Administer appropriate and approved eye drops where required, according to applicable protocols.

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• Identify a patient referred for investigations of vision impairment and, with permission, follow the progress of the patient from the initial consultation through investigations, follow-up appointment and/or surgery, and reflect on your learning from this process.

• Observe history taking, with permission, with at least two patients, to include a new referral and a follow-up appointment. Develop and practise the skill of history taking and present your history findings for a range of patients, and suggest appropriate investigations based on this information.

• Support the management of the patient appointment system from initial appointment through follow-up and discharge processes to understand the patient pathway and the significance of the appointment system. Discuss the options for patient pathways and support with your supervisor, including patient treatment for at least two types of vision impairment and to include two patients of different age ranges.

• Attend and support at ophthalmic/vision clinics. To include observation and support for triage, eye casualty, medical imaging, routine consultant-based clinic, orthoptics, low vision clinic, surgery (theatre or day case) and, for example, refractive surgery such as LASIK. Relate clinic experience to individual patient pathways and treatment plans, and further follow-up activities and intervention options.

• Under supervision, maintain electronic patient records. Discuss the importance of these records and the associated statutory and patient rights associated with patient data. Evaluate the effectiveness of electronic data systems and their use within the ophthalmic and vision patient services.

• Eye-drop administration training and certification to local protocol. Under supervision, observe and assist with administration of eye drops for at least two patients, to include patients of different age range and vision impairment. Discuss the risks, benefits and requirements for prescription/administration.

• Observe the role of social work, including child/vulnerable adult protection policy, in relation to vision impairment. Report on the potential range of services and support available and how this interacts with services provided in the ophthalmic/vision primary and secondary care services.

• Take part in a multidisciplinary team meeting and reflect on the way the multidisciplinary team contributes to the care of patients with vision impairment.

• Attend a range of outpatient clinics for patients with vision impairment and discuss the role of the multiprofessional team in patient care. This may include community units, medical outpatients, primary and secondary care contexts, and specialist units.


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The following section details the competence and knowledge and understanding each trainee must gain. Each competence is


outcome.


Trainees should ensure they refer to the professional practice learning framework and continue to achieve the professional practice

competences alongside the competences defined in this module.

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KEY LEARNING

OUTCOMES






• The relevant health and safety regulations specific to vision science investigations, the potential hazards and risks, and the actions to be taken to minimise these.

2 Interpret referral letters in conjunction with medical and ophthalmic history, together with any pre-existing optometric, imaging or electrophysiological findings where available, to formulate the appropriate testing strategy.

• Information required for review in referral letters in conjunction with medical, optometric, ophthalmic and imaging findings, where available, and their importance in formulation of the appropriate examination and testing strategy.

• Sources of referral and sufficient, accurate and appropriate information for provision to the referral source following completion of investigations.

• The purposes and procedures of screening programmes for ocular disease, and note if a referral is a result of formal or opportunistic screening.

2 Explain the procedure for assessment to the patient and address any questions they may have relating to the procedure, including the process after the procedure and how the patient will be informed of the results.

• Common questions and concerns of patients about assessment.

• The information needs of patients before, during and following assessment.


• The process of notifying patients of the results.

2 Gain informed consent for each investigation.



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• Principles, guidance and law with respect to informed consent. 2 Obtain a comprehensive ophthalmic

history from the patient. To include:

• a patient presenting with ocular and/or visual symptoms and no previous history of vision disorder

• a patient with recurring symptoms.

• The importance of introducing yourself and your colleagues and explaining to the patient their own role and responsibility in taking patient history.

• The importance of accurately recording all information gathered, including relevant dates and the implications of missing, incorrect or invalid information.

• The importance and relevance of information, including history of patient past ocular diseases, conditions and surgery to the eye or ocular adnexae; family history of diseases, in particular those affecting the eye or vision; any current and past problems relating to general health, including any surgical procedures.

• Other important information and its relevance, including: • occupation of patient • relevant details of patient’s social circumstances and special

needs • birth history where appropriate • any known allergies or other adverse reactions • current medications (prescribed and self-purchased) for any

ocular and other medical conditions.

• How to verify all information obtained and the importance of name, signature, date and time on the entry.

• Requirements for security and confidentiality of patient information, including verbal, written, electronic and imaging data.

3 Assess the requirements of visually impaired patients and their carers and ensure that the clinical environment is suitable for patients with vision impairment.

• Common presenting conditions and pathological processes underlying the presentation of patients referred for ophthalmic investigations.

• The impact of visual impairment and its clinical assessment,

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KEY LEARNING

OUTCOMES


diagnosis and management.

• How to ensure that the clinical environment is appropriate for patients with special needs, e.g. sensory impairment, physical disability, learning disability, cognitive dysfunction, paediatric patients.

• The impact of visual loss on a patient, and, as needed, refer the patient for advice, support, rehabilitation and certification of vision impairment.

2,3 Prepare and position the patient

appropriately for a comprehensive ophthalmic examination.

• Standard operating procedures (SOPs) for the investigation.

• Optimisation of test results through correct use of equipment and positioning of the patient.

2,6 Perform a comprehensive ophthalmic examination safely and effectively, to include: • external examination of ocular

adnexae

• assessment of pupil size and reactions

• examination of anterior segment with a slit lamp or direct ophthalmoscope

• fundus examination.

• The component parts of the slit lamp and perform slit lamp examination techniques.

• The use of a slit lamp or direct ophthalmoscope to examine ocular adnexae and the anterior segment of the eye to confirm normal appearance or show evidence of disease or disorder.

• How to determine full range of ocular movement and note any abnormalities of eye movement.

• Correct examination of pupil responses and the recognition of abnormal responses, including afferent pupil defect.

• Tear production and patency of the naso-lacrimal passage.

• The identification of components of the Goldman tonometer and the principles of tonometry for accurate measurement of intraocular pressure.

• Sources of error when performing tonometry, and how to minimise them.

• Precautions and contraindications to the procedure and the relevant

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personnel to contact for further advice.

• Recognition of the significance of abnormal findings and measurements and the appropriate action needed.

2,6 Observe and note any abnormalities of head posture or facial appearance.

• The relevance and importance of abnormalities to the investigation/test being performed.

• The aetiology, progression and management of a range of ophthalmic disorders.

4 Derive a differential diagnosis and identify further investigations that will facilitate reaching a diagnostic conclusion.

• The appropriate member of the multidisciplinary team to be notified in all instances of unexpected or clinically significant information.

• Further actions to be taken as a consequence of the information in the notes, stating the date and the time.

• Recognition of when additional tests or expertise from other clinical staff may be needed and the appropriate action.

• Further investigations that may contribute to understanding of the pathology and facilitate reaching a diagnostic conclusion.

5 Maintain an ongoing, accurate, relevant and legible record of information in the patient record.

• Requirements for documenting all assessment findings legibly, accurately and appropriately in the patient record, with date and signature.

• Requirements for data in a suitable form for clinical reporting and provision of factual assessment of results.

6 Administer appropriate and approved eye drops where required, according to applicable protocols.

• The importance of confirming the prescription for the substance to be instilled, including strength, timing and frequency, and the implications of not doing so.

• Correct positioning of the patient for administration of eye drops.

• The importance of confirming that medication to be instilled has not exceeded its expiry date and the implications of failure to do so.

• Possible precautions that need to be taken or contraindications to instillation of medication.

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• Action to be taken where precautions or contradictions have been identified.

• The purpose, effects and duration of the medication.

• Correct and safe method for instillation of the correct medication in the correct strength and at the prescribed frequency to the correct eye.

• Recording requirements for instillation in accordance with relevant protocol or procedure, including signature, time and date of administration.

• The range of drugs used in ophthalmic practice, their indication and mode of action, adverse effects and contraindications to their use.

• Ocular adverse effects of drugs used to treat non-ophthalmic disease.

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MODULE 2 Psychophysical Assessment of Vision (PAV-6)


AIM This module will provide the trainee with detailed knowledge and understanding of the measurement of visual performance. They will gain experience of assisting in performing and interpreting patient results using a range of ophthalmic equipment to assess, for example, visual acuity, colour vision and contrast sensitivity.

SCOPE During this module the trainee will gain practical experience in the performance of a range of psychophysical tests in adults and children, including visual acuity, contrast sensitivity, visual field assessment, colour vision assessment and, where available, dark adaptometry.

LEARNING OUTCOMES


1. Prepare patients and the clinical environment for psychophysical assessment of vision. 2. Perform assessment of visual acuity in children and adults, including adults who are illiterate, have learning difficulties, or who

are non-English speaking, with Snellen/logMAR and contrast sensitivity. 3. Assess colour vision with Ishihara charts and at least one other form of colour vision assessment, e.g. D15, City Plates. 4. Assess the visual field with standard automated perimetry and other methods, which may include kinetic perimetry,

microperimetry, automated Amsler grid testing and frequency doubling perimetry. 5. Interpret and report results in the correct clinical context.

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• Attend and, where possible, participate in screening programmes for glaucoma and/or diabetes, and evaluate and discuss the role of screening programmes and their contribution to patient care.

• Identify at least one patient attending for subjective tests and, with permission, follow the progress of the patient from the initial consultation, through investigations, follow-up appointment and/or surgery and discharge, and reflect on your learning from this process.

• Attend a range of outpatient clinics for assessment of visual acuity in children and adults, including adults who are illiterate, have learning difficulties, or who are non-English speaking, with Snellen/logMAR and contrast sensitivity and discuss the role of the multiprofessional team in the care of patients.

• Assess the visual field with standard automated perimetry (or equivalent where not possible) and observe other methods that may include kinetic perimetry, microperimetry, automated Amsler grid testing and frequency doubling perimetry. Reflect on the selection and use of each type of equipment in relation to patient referral and needs.

• Observe dark adaptometry being performed on a patient/volunteer and experience the test being performed on oneself. (Not all vision centres have such equipment.)




outcome.




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• The relevant health and safety regulations specific to ophthalmology, the potential hazards and risks, and the actions to be taken to minimise these.

1 Select suitable technology for each type of investigation, choosing and adapting the appropriate diagnostic technique, patient position and equipment settings for each patient.

• Factors influencing the choice of technology for investigating vision and ophthalmic disorders/disease.

• Clinical indications for, contraindications to and patient benefit from investigations.

• Medication used to treat ophthalmic symptoms and conditions. 1 Set up equipment ready for use for

each type of investigation.

• Range of equipment used, relative merits and the principles of measurement, including: • recognition of the errors or potential risks of using defective

equipment in clinical practice and the implications of use • identification of common faults and remedial action • current safety standards, including safety testing and routine

maintenance. 1 Select appropriate colour vision test.

• Factors affecting selection, including any instruction in the patient’s

notes, patient’s age, co-operation, ability and any special needs. 1 Explain the procedure for each type

of investigation to the patient and address any questions they may have relating to the procedure, including the process after the procedure and how the patient will

• The relevant pathophysiology and the appropriate choice of investigation considering the findings from the history and clinical examination.


• The impact of visual impairment and its clinical assessment,

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be informed of the results. diagnosis and management.


• The information needs of patients before, during and following investigation.


• The process of notifying patients of the results. 1 Gain informed consent for each

investigation in the most appropriate form, e.g. verbal, written.



• Clinical indications for and contraindications to testing

• Principles, guidance and law with respect to informed consent. 1 Prepare and position the patient

appropriately. • SOPs for the investigation.

• Optimisation of test results through correct use of equipment and positioning of patient.

2 Perform assessment of visual acuity in children and adults, including:

• adults who are illiterate

• adults who have learning difficulties

• adults who are non-English speaking

using the following equipment/techniques:

• Snellen

• logMAR

• contrast sensitivity.

• The role of subjective testing in the visual sciences and how this differs from objective testing.

• The principles of vision processing in the higher cortical visual areas.

• Appropriate visual acuity test according to any instruction in the patient’s notes, patient’s age, co-operation, ability and any special needs.

• The importance of correct positioning of the occluder over the non-tested eye and the position of monitoring throughout the test.

• The appropriate form of notation for recording visual acuity.

• How to adjust testing strategies during the test according to patient co-operation and reliability indices.

• How to select the correct series of tests.

• The importance of completion of the required series of tests.

• Requirements for accurate recording of results and any patient

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responses or difficulties at a place appropriate for the test. 3 Assess colour vision with Ishihara

charts and at least one other form of colour vision assessment.

• The correct and appropriate use of Ishihara charts for a range of patient needs.

• Normal and accepted variances in colour vision and the range of abnormalities.

• The recognition and significance of abnormal results.

• The range of abnormalities and differential diagnoses. 4 Assess visual field with standard

automated perimetry and other methods that may include:

• kinetic perimetry

• microperimetry

• automated Amsler grid testing

• frequency doubling perimetry.

• The application, limitations and purpose of the stated range of methods.

• Normal and accepted variances in visual field.

• The recognition and significance of abnormal results.

• The range of abnormalities and differential diagnoses.

5 Interpret and report on investigations.

• Requirements and accepted format for recording assessment of: • visual acuity • colour vision • visual field.

• The importance of identifying and reporting abnormal results.

• Options and responsibilities for follow-up, treatment and potential interventions for patient care.

• How to interpret and analyse clinical findings and understand how they contribute to the development of a differential diagnosis and the preparation of a diagnostic report.

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MODULE 3 Ophthalmic Imaging with Light and Lasers (OILL-7)


AIM This module will provide the trainee with detailed knowledge and understanding of ophthalmic imaging techniques that utilise light and lasers, their clinical use and how they help in ophthalmic assessment, diagnosis and management. They will understand the aetiology, progression and management of ocular disorders using imaging techniques. They will gain experience in Ophthalmic Imaging by assisting in performing imaging studies and interpreting patient results in a range of ocular disorders.

SCOPE The trainee’s understanding will extend to appreciation of the differences in procedures and techniques for retinal disease imaging and screening for retinal disease, understanding the principles of contact lens imaging of the eye, including gonioscopy, and understanding the technique and indications for recording autofluorescence.

LEARNING OUTCOMES


1. Prepare patients and the clinical environment for investigations using ophthalmic imaging with light and lasers. 2. Perform colour photography and optical coherence tomography (OCT) (or other scanning laser modality) of the fundus and

anterior segment of the eye. 3. Observe ocular angiography, and if appropriate, take late-phase (non-time-critical) images under supervision. 4. Assess image quality and identify artefacts. 5. Interpret findings of investigations in the correct clinical context.

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• Observe a range of investigations by specialists to include photography/angiography/OCT and, if possible, gonioscopy sessions, and discuss the indications for and contraindications to each investigation with your training supervisor.

• Identify a patient referred for ophthalmic imaging and, with permission, follow the progress of the patient from the initial consultation, through investigations, follow-up appointment and/or surgery and discharge, and reflect on your learning from this process.

• Under supervision, perform a range of investigations using photography and OCT, leading eventually to hands-on experience of angiography, not necessarily including critical-phase images. Reflect on and discuss your experiences in terms of the appropriateness of method, effectiveness and patient experience.

• Observe and participate in post-acquisition image assessment and possible image processing, and discuss results in terms of differential diagnosis and treatment plans for patients with a range of vision disorders/disease.

• Attend reporting sessions and discuss a series of reports and the impact on clinical care with your training officer.




outcome.




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1,2,3 Control infection risks in accordance with departmental protocols.



1,2,3 Minimise risks and hazards in compliance with health and safety policies.

• The relevant health and safety regulations specific to ophthalmic investigations, the potential hazards and risks, and the actions to be taken to minimise these.

1,2,3 Select a suitable technology for each type of investigation, choosing and adapting the appropriate diagnostic technique, patient position and equipment settings for each patient.

• Factors influencing the choice of technology for investigating vision and ophthalmic disorders/disease.


• Principles of contact lens imaging of the eye, including gonioscopy.

1 Set up equipment ready for use for each type of investigation.

• Range of equipment used, and the relative merits and principles of measurement, including: • recognition of the errors or potential risks of using defective


maintenance.

1,2,3 Obtain a suitably completed request form, greet the patient, check patient ID and ensure that the patient’s identity is confirmed as correct and fully identified on each type of recording system.



1,2,3 Explain the procedure for each type • The differences in procedures and techniques for retinal disease

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imaging and screening for retinal disease.

• Technique and indications for recording autofluorescence.

• The pathophysiology of the vision system and the appropriate choice of investigation considering the findings from the history and clinical examination.

• The impact of visual impairment and its clinical assessment, diagnosis and management.




• The authority level for the provision of information to patients.


investigation. • The importance of explaining the procedure for each investigation to

the patient and gaining informed consent in the appropriate format, e.g. written, verbal.


• Clinical indications for and contraindications to challenge testing.

• Principles, guidance and law with respect to informed consent. 1,2,3 Prepare and position the patient

appropriately. • SOP for the investigation.

• Optimisation of test results through correct use of equipment and positioning of patient.

2 Perform colour photography and OCT (or other scanning laser modality) of the fundus and anterior segment of the eye.

• Detailed knowledge of various imaging modalities used to investigate, diagnose and monitor ophthalmic diseases, their capabilities, limitations and clinical indications.

• How to determine the patient’s refractive error with autorefraction, keratometry and focimetry as required.

• Appropriate adjustments to the equipment required to accommodate the patient’s refractive error.

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• The importance of reviewing and changing image modality as necessary throughout the procedure.

• How to ensure consistent and reproducible image measurements are obtained.

3 Observe ocular angiography, taking late-phase (non-time-critical) images under supervision as appropriate.

• The range of contraindications to performance of ocular angiography.

• The appropriate imaging technique and clinical significance of time interval in the imaging sequence and interpretation in the clinical context.

• The appropriateness of the procedure for investigating the ocular condition.

• Risk factors and side effects associated with angiography.

• Procedures for administration of fluorescein and indocyanine green dyes.

• The purpose and safe use/administration of dyes in the investigation of ophthalmic disorders and disease.

• Risks, benefits and contraindications to administration.

• Procedures and protocols for administration, including level of authority.

4 Assess image quality. • The identification of normal and abnormal results in imaging of the fundus and anterior segment of the eye.

• Artefacts that may affect image quality.

• Other factors affecting the quality of imaging. 5 Interpret the findings of

investigations in the correct clinical context.


• Requirements and accepted format for recording investigations using:

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• photography • scanning lasers • angiography.

• The importance of identifying and reporting abnormal results.

• Options and responsibilities for follow-up, treatment and potential interventions for patient care.

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MODULE 4 Ultrasonography of Eye and Orbit (UEO-8)


AIM This module will provide the trainee with detailed knowledge and understanding of ultrasonography of the eye and orbit, and its clinical applications in ophthalmic assessment, diagnosis and management. The trainee will understand the aetiology, progression and management, gaining experience of assisting in performing and interpreting patient results using a range of ultrasound equipment.

SCOPE During this module the trainee will learn the clinical applications and techniques of ultrasonography of the eye and orbit, including topographic examination of the globe and kinetic echography. The trainee will also gain knowledge and understanding of methods of quantitative echography and ultrasound biomicroscopy. This will be based on the understanding of the application of ‘special examination techniques’ that include topographic, kinetic and quantitative echography, and understanding of the principles of high-frequency ultrasound and its application in ophthalmic diagnosis. The trainee will also be familiar with the principle of ophthalmic ‘standardised echography’, including the unique features of standardised A-scan, and the principle of ‘echographic tissue diagnoses.

LEARNING OUTCOMES


1. Prepare the patient and the clinical environment for ultrasonography investigations. 2. Screen the globe with A- and B-scan, understanding normal features and artefacts, and distinguishing features of dense

cataract, vitreous haemorrhage, retinal detachment and ocular tumours. 3. Measure the dimensions of ocular masses and other lesions in the eye and orbit using ultrasound imaging. 4. Screen the orbits and image and measure the optic nerve and extraocular muscles. 5. Assess image quality. 6. Annotate, interpret and report results of ultrasonography investigations.

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• Identify two patients with disorders of vision requiring ultrasonography and critically reflect on the effect on the lifestyle of the patient and the role of the healthcare scientist in the diagnosis and treatment of the patients.

• Observe a series of patients reviewed as new and follow-up patients in an outpatient clinic and critically appraise the process of referral, diagnosis and treatment, including the range of healthcare professionals who contribute to the care of each patient and how the inter-professional team work together.

• Observe, with permission, patient investigations at clinics that use ultrasonography extensively, e.g. adnexal clinic, oncology clinic, vitreo-retinal clinic. Reflect on and discuss the patient experience.

• Observe other structural ionising and non-ionising imaging departments, e.g. computed tomography (CT) imaging, magnetic resonance imaging (MRI) and X-ray, and evaluate/discuss how other imaging modalities complement one another.

It is also recommended that trainees get the opportunity to:

• Perform A- and B-scan ocular ultrasound imaging on healthy and abnormal eyes.




outcome.




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• Appropriate imaging modality with clinical/systemic status, age, ability and co-operation.

• Methods of quantitative echography and ultrasound biomicroscopy.

• Applications and techniques of ultrasonography of the eye and orbit, including topographic examination of the globe and kinetic echograph.

• The application of ‘special examination techniques’ that include topographic, kinetic and quantitative echography.

• The principles of high-frequency ultrasound and its application in ophthalmic diagnosis.

• The principle of ophthalmic ‘standardised echography’, including the unique features of standardised A-scan, and the principle of ‘echographic tissue diagnoses.



each type of investigation, including resuscitation equipment.

• The range of equipment used, relative merits and principles of measurement, including: • recognition of the errors or potential risks of using defective

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maintenance. 1 Obtain a suitably completed request

form, greet the patient, check patient ID and ensure that the patient’s identity is confirmed as correct and fully identified on each type of recording system.



1 Explain the procedure for each type of investigation to the patient and address any questions they may have relating to the procedure, including the process after the procedure and how the patient will be informed of the results.




• The risks and benefits of undertaking the investigation.





the patient and gaining informed consent.


• Clinical indications for and contraindications to challenge testing.

• Principles, guidance and law with respect to informed consent. 1 Position and align the patient

correctly for the investigation, avoiding patient discomfort.

• SOPs for the investigation.


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2 Screen the globe with A- and B-scan, understanding normal features and artefacts, and distinguishing features of dense cataract, vitreous haemorrhage, retinal detachment and ocular tumours.

• Understand the personal role, responsibilities and level of competence for performing ultrasound investigation of the eye and orbit.

• Understand the requirements and protocols for maintenance and calibration of equipment.

• Precautions that need to be taken or contraindications to planned procedures and the importance of referring to relevant history from the patient and the patient’s records.

• Factors that require action advice and relevant personnel to contact.

• Possible side effects and consequences of procedure.

• Correct dosage, strength and frequency of use and relevant protocol for topical medications instilled.

2,5 Obtain images of suitable clarity and in sufficient quantity to answer the clinical question.

• A and B ultrasound, instrumentation and probe orientation.

• Assessment of images in terms of clarity and suitability for processing.

• The quantity of images required to address clinical questions. 3,5 Measure with ultrasound the

dimensions of ocular masses and other lesions in the eye and orbit.

• Clear knowledge of the clinical-pathological correlation of the ultrasound A- and B-scan image and its significance in diagnosis.

4,5 Screen the orbits and image and measure the optic nerve and extraocular muscles.

• A and B ultrasound, instrumentation and probe orientation.

• Clear knowledge of the clinical-pathological correlation of the ultrasound A- and B-scan image and its significance in diagnosis.

6 Evaluate, interpret and annotate images as required to obtain the appropriate result.

• Correct annotation of images.

• The clinical-pathological correlation of the ultrasound A- and B-scan image and its significance in diagnosis.

6 Record and store images in accordance with the relevant protocols and procedures.

• Relevant protocols and procedures for recording and storing ultrasonography images and their application.

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6 Record and report on results of the investigations in the correct clinical context.


• Requirements for reporting the results of ultrasonography investigations.

• Factors affecting the urgency of treatment or interventional response and the appropriate action to be taken.

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MODULE 5 Ocular Measurement, Refraction and Biometry (OMRB-9)


AIM This module will provide the trainee with detailed knowledge and understanding of a range of methods for measuring ocular structures, and experience of performing, interpreting and applying results for a range of ocular disorders, including cataract, glaucoma and corneal pathologies. The trainee will also learn how to measure refractive error and optical aids.

SCOPE During this module the trainee will learn how to measure refraction and the optical prescription in glasses and contact lenses, and the dimensions of the eye with low-coherence interferometry, ultrasound and at least one method of corneal topography. The trainee will learn how to use these measurements to determine intraocular lens power, including for patients who have had corneal refractive surgery, and to assist with the diagnosis of different forms of corneal pathology and glaucoma.

LEARNING OUTCOMES


1. Prepare patients and the clinical environment for investigations of ocular measurement, refraction and biometry. 2. Measure the axial length of the eye with low coherence interferometry A- and B-scan modalities, including in patients with

significant ocular pathology or previous corneal refractive surgery, and make appropriate calculations of intraocular lens power. 3. Perform corneal pachymetry with ultrasound and at least one other imaging modality. 4. Perform corneal topography, distinguishing abnormal results. 5. Perform focimetry and autorefraction and interpret results in the context of the patient’s current optical prescription and ocular

disease or condition. 6. Interpret and report on results of investigations.

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CLINICAL EXPERIENTIAL LEARNING The clinical experiential learning for this module is: • Attend low visual aid clinic, orthoptics clinic, adnexal clinic and contact lens clinic to observe the assessment of refraction in

patients of different ages with a range of visual disorders of varying severity. Reflect on and discuss your experiences and the effect/benefits for patient care and pathways.

• Hands-on experience of performing refraction measurements on colleagues/volunteers and appropriate patients. Reflect and discuss the experiences from your own/volunteers’ perspectives in relation to the patient needs. Consider the application of these investigations for a range of patients with differing needs, including a range of visual impairments, language, speech or physical disability.

• Observe how the full range of equipment is calibrated to ensure correct, repeatable and reliable measurement, and to better understand the techniques underlying ocular measurement, refraction and biometry. Discuss the implications of incorrect calibration for patient investigation and care.

It is also recommended that the trainee: • Under supervision, perform/check calibration of a limited range of equipment.


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• The range of methods for measuring ocular structures.



each type of investigation. • Range of equipment used, relative merits and principles of

measurement, including: • recognition of the errors or potential risks of using defective






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the patient and gaining informed consent.


• Clinical indications for and contraindications to testing

• Principles, guidance and law with respect to informed consent. 1 Position and align the patient

correctly for investigation, avoiding patient discomfort.

• SOP for the investigation.


2 Measure the axial length of the eye with low-coherence interferometry A- and B-scan modalities, to include:

• patients with significant ocular pathology

• previous corneal refractive surgery.

• Technique of A- and B-scan biometry and low-coherence interferometry.

• How to differentiate which test modality should be used to produce an accurate measurement for a particular type of pathology.

• The range of measurements and sequencing.

• How to measure refraction and the optical prescription in glasses and contact lenses.

• How to measure the dimensions of the eye with low-coherence interferometry.

2 Make appropriate calculations of • The range of calculations to be applied.

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intraocular lens power to include, patients who have had corneal refractive surgery.

• Normal and abnormal ranges.

• How to measure refractive error and optical aids.

3 Perform corneal pachymetry with ultrasound and at least one other imaging modality, and interpret and utilise results in the clinical context.

• Ultrasound modalities, including pachymetry, A-scan biometry and low-coherence interferometry.

• How to differentiate which test modality should be used to produce an accurate measurement.

4 Perform corneal topography, distinguishing abnormal results and interpreting these in the clinical context.

• Techniques to perform corneal topography.

• Application of results to the diagnosis and management of varying corneal pathologies.

5 Perform focimetry and autorefraction, and interpret results in the context of the patient’s current optical prescription and ocular disease or condition.

• Different methods for correcting refractive error.

• The importance of correct calibration of the focimeter and its adjustment.

• Types of refractive error, any correlations with ocular anatomy and measurements, and methods for determining refractive error.

5 Instil mydriatic, cycloplegic and/or topical anaesthetic drops as indicated.

• Relevant protocol and procedures.

• Indications for use of mydriatic, cylcoplegic and topical anaesthetic drops.

• Level of responsibility for instillation of topical medications.

• Purpose and correct use of mydriatic, cylcoplegic and topical anaesthetic drops.

• Contraindications to use. 6 Interpret and report on results of

investigations in the correct clinical context.

• Interpretation and application of results for a range of ocular disorders, including cataract, glaucoma and corneal pathologies.


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• The diagnosis of different forms of corneal pathology and glaucoma.

• Requirements for reporting the results of investigations.

• Factors affecting the urgency of treatment or interventional response and the appropriate action to be taken.

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MODULE 6 Ocular Movement and Binocular Function (OMBF-10)


AIM This module will provide the trainee with knowledge and understanding of ocular movement and binocular vision, methods of assessment and their clinical applications in ophthalmic assessment, diagnosis and management.

SCOPE During this module the trainee will gain understanding of the clinical presentations of disorders of eye movement and binocular function and how they can be assessed and documented. The trainee will also gain familiarity with methods of assessment of binocular vision and stereopsis, and demonstrate ability to perform at least one method of assessment of stereopsis.

LEARNING OUTCOMES


1. Prepare the patient and clinical environment for assessment of stereopsis. 2. Distinguish and assess different forms of ocular movement (saccades, smooth pursuit, optokinetic nystagmus [OKN], etc.) and

demonstrate familiarity with recording methods, including video-oculography and electro-oculography. 3. Perform at least one method of assessment of stereopsis. 4. Interpret and report on results of assessment of stereopsis.

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CLINICAL EXPERIENTIAL LEARNING The clinical experiential learning for this module is: • Identify at least two patients of varying ages and varying degrees of severity who require orthoptic assessments and, with

permission, follow the progress of the patient from the initial consultation, through investigations, follow-up appointment and/or surgery, and reflect on your learning from this process.

• Assess a patient with suspected stereopsis with one commonly used method and explain the underlying principles of the method used.

• Observe strabismus surgery of both adults and children and discuss the impact of this treatment on patient recovery and vision improvement.

• Attend strabismus clinics and reflect on the way the multidisciplinary team contributes to the care of patients. • Attend a range of outpatient clinics that patients with orthoptic disorders may attend, and discuss the role of the multiprofessional

team in the care of patients. • Attend a meeting at which the outcome of a clinical audit, research, innovation or service development is presented and discuss

with your training supervisor how evidence-based practice is implemented with respect to strabismus investigation.


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1 Select suitable technology for assessment of stereopsis, choosing and adapting the appropriate diagnostic technique, patient position and equipment settings for each patient.


• Clinical indications for methods and techniques.

• Contraindications to and patient benefit from investigations.

• Medication used to treat ophthalmic symptoms and conditions.

1 Set up equipment ready for use for assessment of stereopsis.

• Range of equipment used, relative merits and principles of measurement, including: • recognition of the errors or potential risks of using defective






1 Explain the procedure for each type • The pathophysiology of the vision system and the appropriate choice

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of investigation, considering the findings from the history and clinical examination.






• The process of notifying patients of the results. 2 Distinguish and assess different

forms of ocular movement (saccades, smooth pursuit, OKN, etc.)

• The basis for binocular vision and ocular movement, including anatomical and functional concepts.

• Familiarity with recording methods, including video-oculography and electro-oculography.

• Normal and abnormal visual development and the differences between developmental and acquired disorders of binocular vision.

• Methods of assessment of binocular vision and stereopsis.

• Reflex systems that control ocular movement and the clinical manifestation of disorders of these reflex systems.

2 Justify the clinical evaluation of ocular movement, including saccades, smooth pursuit and OKN, and methods used to record ocular movement, including video-oculography and electro-oculography.

• Ocular movement and binocular vision, methods of assessment and their clinical applications in ophthalmic assessment, diagnosis and management.

3 Assess at least two patients with suspected stereopsis using at least one commonly used method.

• Methods and techniques for assessment of stereopsis.

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4 Interpret and report results of assessment of stereopsis.


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MODULE 7 Visual Electrophysiology (VE-11)


AIM This module will provide the trainee with detailed knowledge and understanding of electrophysiological testing of the eye and its clinical use in ophthalmic assessment, diagnosis and management. They will understand aetiology, progression and management, gaining experience of assisting in performing and interpreting patient visual electrophysiological recordings.

SCOPE During this module the trainee will gain experience of clinical indications for, methods and techniques, and interpretation of results of investigations of the electrophysiology of the visual system. The trainee will become familiar with the international standard tests and their relevant clinical applications, understanding specific modifications or adaptations required for recording in neonates and paediatrics, and the challenges and restrictions associated with recording in environments such as theatre or the intensive care unit. They will know the normal waveforms and understand the effect of patient age, sex and race, and the nature and limitation of normative data.

LEARNING OUTCOMES


1. Prepare patients and the clinical environment for visual electrophysiology investigations. 2. Record all visual electrophysiology tests (electroretinograms [ERGs], electro-oculography [EOG], visual evoked potentials

[VEPs]) using the correct procedures. 3. Critically evaluate the effects and merits of altering the recording conditions, electrode types and positions, acquisition

parameters and stimulation parameters. 4. Recognise, identify and remove sources of artefact. 5. Analyse recordings correctly, with appropriate use of a wide range of analysis techniques. 6. Interpret and report findings of visual electrophysiology investigations.

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CLINICAL EXPERIENTIAL LEARNING The clinical experiential learning for this module is: • Observe adult and paediatric electrophysiology clinics and discuss the indications, contraindications and adaptations that need

to be made. Reflect on how this will inform your future practice. • Observing tests being performed in theatre and/or the intensive care unit (ICU) and discuss the impact of this treatment on

patient prognosis and future care. • Experience of the tests being performed on oneself (not necessarily with pupillary dilation and topical anaesthesia) and reflect

on the experience in terms of the patient needs for support, information and care. • Experience of using the equipment to perform standard tests and analyse results. Reflect and discuss the use, benefits,

differentiation and application of different equipment and range of tests. Discuss and agree the analysis of results to inform your future practice.

• Experience of experimentation on colleagues/volunteers to observe the effects of varying stimulus and recording parameters. Discuss and review with colleagues/volunteers to reflect on the patient needs for support and information, including patients with varying levels of visual disability/disorder, language/speech difficulties and patients of different age ranges.

• Attendance at reporting sessions. Discuss with your training supervisor how evidence-based practice is implemented with respect to patients receiving ophthalmic/vision care and treatment.

• Perform routine calibration of stimulator and recording equipment and discuss the implications of incorrect calibration for patient care and investigation results.

It is also recommended that the trainee: • Experiences extended test protocols that go beyond International Society for Clinical Electrophysiology of Vision (ISCEV)

standards and discussion of their application, use and impact on patient care, experience and investigations. • Observes normal data collection to contrast with patient data collection. Consider the differentiation between the two and the

implications for evidence-based practice, patient care, patient engagement and patient treatment. All of these experiences should be recorded in your e-portfolio.

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The following section details the competence and knowledge and understanding each trainee must gain. Each competence is linked to the relevant learning outcomes and trainees must demonstrate achievement of each competence for each linked learning outcome. PROFESSIONAL PRACTICE Trainees should ensure they refer to the professional practice learning framework and continue to achieve the professional practice competences alongside the competences defined in this module.

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• The relevant health and safety regulations specific to ophthalmic investigations, the potential hazards and risks and the actions to be taken to minimise these.

1 Select suitable technology for assessment of stereopsis, choosing and adapting the appropriate diagnostic technique, patient position and equipment settings for each patient.


• International standard tests and their relevant clinical applications.

• The challenges and restrictions associated with recording in environments such as theatre or ICU.



electrophysiological assessment. • Range of equipment used, relative merits and principles of

measurement.

• Specific modifications or adaptations required for recording in neonates and paediatrics.



• Current safety standards, including safety testing and routine maintenance.

1 Obtain a suitably completed request form, greet the patient, check


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patient ID and ensure that the patient’s identity is confirmed as correct and fully identified on each type of recording system.



• Electrophysiological testing of the eye and its clinical use in the ophthalmic assessment, diagnosis and management.

• The pathophysiology of the vision system and the appropriate choice of investigation, considering the findings from the history and clinical examination.






• The process of notifying patients of the results. 2 Perform and record all visual

electrophysiology tests, to include:

• ERGs

• EOG

• VEPs.

• Personal role, responsibilities and level of competence for performing investigations.

• Aetiology, progression and management.

• Relevant protocols and procedures and their application.

• Normal waveforms.

• The effect of patient age, sex and race,

• The nature and limitation of normative data.

• Relevant international and national recommendations for performance of electrophysiological investigations in addition to local protocols.

• The likely electrophysiological consequences of the clinical condition being investigated.

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• How to review and change the plan of investigation as necessary during the course of the procedures, and the importance of doing so.

3 Critically evaluate the effects and merits of altering the recording conditions, electrode types and positions, acquisition parameters, and stimulation parameters.

• The effect of type of electrodes (actives, references and ‘ground’); absolute and relative impedances; polarisation/bias; amplification; bandpass; sampling rate; time period; artefact rejection; signal processing.

• The effect of stimulus type; pattern; presentation mode; adaptation state.

• How to adjust stimulus and acquisition parameters according to the test being performed.

• Stimulus modalities and characteristics appropriate to the purpose of the investigation and adjusted to avoid unnecessary patient discomfort or harm.

4 Recognise, identify and remove sources of artefact.

• Evaluation of presence of noise or artefact in signal, and determination of the cause.

• Relevant corrective action and annotation. 5 Analyse recordings correctly with

appropriate use of a wide range of analysis techniques.

• Normal waveforms, and effect of age (neonates to geriatrics), gender and race on the normal waveform.

6 Interpret and report results of electrophysiological investigations.


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SECTION 9: CONTRIBUTORS

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Contributor List

Members of the STP Work Based Learning Guide Development Group for Neurosensory Sciences Production of the STP Work Based Learning Guides for Neurosensory Sciences has been coordinated by the Modernising Scientific Careers team and the National School of Healthcare Science working with NHS colleagues. The professionals who have contributed to the development of this Learning Guides include: Kelly Bill Worcestershire Acute Hospitals Lawrence Brown Sheffield Teaching Hospitals NHS Foundation Trust Laura Booth Royal Berkshire Hospital Graham Brickley Royal Hampshire County Hospital, Winchester Debbie Cane Royal Berkshire Hospital Leah Cooper Norfolk and Norwich University Hospital Amanda Davis Queen Elizabeth Hospital Birmingham Sarah Fancy Royal Berkshire Hospital Alison Farrow Grampian University Hospitals Trust Robert Gardner Bradford Royal Infirmary Joanne Horrocks York Teaching Hospitals NHS Foundation Trust Rachel Hutchings Queens Medical Centre, Nottingham Victoria Keighley Queen Elizabeth Hospital Birmingham Magella Neveu Moorfields Eye Hospital, London Richard Pottinger Barts and The London Huw Thomas Queen Alexandra Hospital, Portsmouth Matthew Thomas Bristol Eye Hospital Dorothy Thompson Great Ormond Street Hospital for Children, London Jagjit Sethi King Edward VII Hospital, Berkshire Simon Veal Portsmouth Hospitals NHS Trust Professional bodies and societies were invited to review the Learning Guides for Neurosensory Sciences and their feedback has shaped the final publication: ANS Association of Neurophysiological Scientists BAA British Academy of Audiology BSA British Society of Audiology BriSCEV British Chapter of International Society of the Electrophysiology of Vision OIA Ophthalmic Imaging Association Modernising Scientific Careers Professional Advisor: Professor Gerald Armstrong-Bednall

National School of Healthcare Science Professional Lead: Mrs Theresa Fail and Dr Jagjit Sethi September 2012

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SECTION 10: APPENDICES

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APPENDIX 1: GLOSSARY Term Definition

Clinical Experiential Learning

The cyclical process linking concrete experience with abstract conceptualisation through reflection and planning.

Clinical Experiential Learning Outcomes

The activities that the trainee will undertake to enable and facilitate their learning in the workplace.

Competence The ability of an individual to perform a role consistently to required standards combining knowledge, understanding, skills and behaviour.

Competence statements

Active and outcome-based statements that provide a further breakdown of the Learning Outcomes –reflecting what the trainee will be able to do in the workplace at the end of the programme. Each competence should linked back to the numbered Learning Outcomes.

Component An indication of the type of module within a learning guide ie; rotational, specialist or elective

Curricula An outline of the expected educational outcomes across a subject area The learning that is expected to take place during the Scientist Training Programme described in terms of knowledge, skills and attitudes,

Division A high level description of an area of practice within healthcare science. There are three divisions: Life Sciences, Physical Sciences and Biomedical Engineering and Physiological Sciences.

Domains of Learning Cognitive (knowledge and intellectual skills), affective (feelings and attitudes), interpersonal (behaviour and relationships with others) and psychomotor (physical skills)

Feedback Specific information about the comparison between a trainee’s observed performance and a standard, given with the intent to improve the trainee’s performance (van de Ridder JMM, Stokking KM, McGaghie WCand ten Cate OT. What is feedback in clinical education? Medical Education 2008: 42: 189–19)7

Good Scientific Practice

Non-statutory guidance on the minimum requirements for good practice for the healthcare science workforce.

Host Department The department which is responsible for the 3-year training programme and which the training officer is based.

Job A specific definition of the work activities, requirements, skills required to undertake work activities within a local context. This differs from a role – see below.

Key Learning Outcome

A defined learning outcome linked to relevant competence(s) within the workplace Learning Guide

Knowledge and Understanding

The knowledge and understanding that must be applied in the work place to achieve the stated competence.

Learning Framework The specification for work based learning contained within the Learning Guide

Learning Module A distinct set of learning outcomes and competences that form part of a programme. Modules may be rotational, specialist,

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elective or professional practice and can be combined to meet the needs of specific programmes

Learning Outcome A high level, outcome based statement that describes what a trainee will be able to do at the end of the module

Mentoring Mentoring is a process in which a trainer (mentor) is responsible for overseeing the career and development of the trainee. The emphasis is therefore on the relationship (rather than the activity).

Module Aim

The overall objective of a work based learning module – defining the intended learning achievements of the trainee. The Aim works together with the ‘Scope’ statement to define the overall objectives and scope of the module

Module Scope A statement within work based learning modules that defines the range/limits/ of the learning undertaken by the trainee in a module – patients/investigations/equipment/modalities etc)

National Occupational Standards

Nationally recognised standards of expected workplace performance and level of competence for a role. The standards are outcome-based, defining what the role holder should to be able to do, as well as what they must know and understand to demonstrate competent work performance. National Occupational Standards are supported by nationally agreed frameworks of expected attitudes, behaviour and skills.

Practical Skill A cognitive, psychomotor, physical or communicative ability that supports performance of required role.

Programme The package of learning, teaching assessment and quality assurance leading to an award.

Provider An organisation that delivers required training and learning activities, to specified quality assurance requirements

Role A collection of functions undertaken in the workplace that represent the main broad areas of work for all similar workers at national level. A role differs from a job, the latter being defined specifically for a local context.

Specialism A focused area of practice within a theme of healthcare science.

Trainer A qualified individual who provides learning and development support for trainees

Theme A cluster of related specialisms within a division of healthcare science.

Work based learning Learning that takes place in a real work setting and involves the application of academic learning to real work activities

Work Performance The requirements of satisfactory and consistent demonstration of competence in specified functions for a work role.

Work place A real work setting in which the trainee can apply learning.

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APPENDIX 2: GOOD SCIENTIFIC PRACTICE

Good Scientific Practice

Section 1: The purpose of this document

There are three key components to the Healthcare Science workforce in the UK:

1. Healthcare Science Associates and Assistants who perform a diverse range of task based roles with appropriate levels of supervision.

2. Healthcare Science Practitioners have a defined role in delivering and reporting quality assured investigations and interventions for patients, on samples or on equipment in a healthcare science specialty, for example Cardiac Physiology, Blood Sciences or Nuclear Medicine. They also provide direct patient care and more senior Healthcare Science Practitioners develop roles in specialist practice and management.

3. Healthcare Scientists are staff that have clinical and specialist expertise in a specific clinical discipline, underpinned by broader knowledge and experience within a healthcare science theme. Healthcare scientists undertake complex scientific and clinical roles, defining and choosing investigative and clinical options, and making key judgements about complex facts and clinical situations. Many work directly with patients. They are involved, often in lead roles, in innovation and improvement, research and development and education and training. Some pursue explicit joint academic career pathways, which combined clinical practice and academic activity in research, innovation and education.

This document sets out the principles and values on which good practice undertaken by the Healthcare Science workforce is founded. Good Scientific Practice sets out for the profession and the public the standards of behaviour and practice that must be achieved and maintained in the delivery of work activities, the provision of care and personal conduct. Good Scientific Practice uses as a benchmark the Health Professions Council (HPC) Standards of Proficiency and Standards of Conduct, Performance and Ethics, but expresses these within the context of the specialities within Healthcare Science, recognising that three groups of the workforce, Biomedical Scientists, Clinical Scientists and Hearing Aid Dispensers are regulated by the HPC. The aim is that the standards are accessible to the profession and understandable by the public.

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Good Scientific Practice represents standards and values that apply throughout an individual’s career in healthcare science at any level of practice. The standards will be contextualised by the role within Healthcare Science that an individual undertakes. This means that the standards must be interpreted based on the role that an individual performs. For example, in supervised roles where individuals work within defined procedures, rather than autonomously, some standards will need to be interpreted appropriately for the context of the specific role. There will, however, always be a requirement for an individual to work within the limits of their scope of practice and competence. Students and trainees will be expected to be working towards meeting the expectations set out in this document. However, if an individual is undertaking further training and development following qualification from a professional training programme, he or she will be expected to be able to meet the standards in this document within their scope of practice. The standards have been used to support curriculum development and will be used to underpin the process of judging individual equivalence, particularly for emerging specialisms. The standards have been divided into five domains. The domains of Good Scientific Practice detailed in section 2 are:

1. Professional Practice 2. Scientific Practice 3. Clinical Practice 4. Research and development 5. Clinical Leadership

Section 2: The domains of Good Scientific Practice Domain 1: Professional Practice All patients and service users are entitled to good standards of professional practice and probity from the Healthcare Science workforce including the observance of professional codes of conduct and ethics. In maintaining your fitness to practice as a part of the Healthcare Science workforce, you must: 1.1 Professional Practice 1.1.1 Make the patient your first concern 1.1.2 Exercise your professional duty of care 1.1.3 Work within the agreed scope of practice for lawful, safe and effective

healthcare science 1.1.4 Keep your professional, scientific, technical knowledge and skills up to date 1.1.5 Engage fully in evidence based practice 1.1.6 Draw on appropriate skills and knowledge in order to make professional

judgements 1.1.7 Work within the limits of your personal competence

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1.1.8 Act without delay on concerns raised by patients or carers or if you have good reason to believe that you or a colleague may be putting people at risk

1.1.9 Never discriminate unfairly against patients, carers or colleagues 1.1.10 Treat each patient as an individual, respect their dignity and confidentiality

and uphold the rights, values and autonomy of every service user, including their role in the diagnostic and therapeutic process and in maintaining health and well-being.

1.1.11 Respond constructively to the outcome of audit, appraisals and performance reviews, undertaking further training where necessary

1.2 Probity 1.2.1 Make sure that your conduct at all times justifies the trust of patients, carers

and colleagues and maintains the public’s trust in the scientific profession 1.2.2 Inform the appropriate regulatory body without delay if, at any time, you

have accepted a caution, been charged with or found guilty of a criminal offence, or if any finding has been made against you as a result of fitness to practice procedures, or if you are suspended from a scientific post, or if you have any restrictions placed on your scientific, clinical or technical practice

1.2.3 Be open, honest and act with integrity at all times, including but not limited to: writing reports, signing documents, providing information about your qualifications, experience, and position in the scientific community, and providing written and verbal information to any formal enquiry or litigation, including that relating to the limits of your scientific knowledge and experience

1.2.4 Take all reasonable steps to verify information in reports and documents, including research

1.2.5 Work within the Standards of Conduct, Performance and Ethics set by your profession

1.3 Working with colleagues

1.3.1 Work with other professionals, support staff, service users, carers and relatives in the ways that best serve patients’ interests

1.3.2 Work effectively as a member of a multi-disciplinary team 1.3.3 Consult and take advice from colleagues where appropriate 1.3.4 Be readily accessible when you are on duty 1.3.5 Respect the skills and contributions of your colleagues 1.3.6 Participate in regular reviews of team performance.

1.4 Training and developing others

1.4.1 Contribute to the education and training of colleagues 1.4.2 If you have responsibilities for teaching, develop the skills, attitudes and

practices of a competent teacher 1.4.3 Ensure that junior colleagues and students are properly supervised 1.4.4 Support colleagues who have difficulties with performance, conduct or

health

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1.4.5 Share information with colleagues to protect patient safety 1.4.6 Provide work-based development for colleagues to enhance/improve skills

and knowledge

Domain 2: Scientific Practice As a part of the Healthcare Science workforce, you will keep your scientific and technical knowledge and skills up to date to effectively: 2.1 Scientific Practice

2.1.1 Develop investigative strategies/procedures/processes that take account of

relevant clinical and other sources of information 2.1.2 Provide scientific advice to ensure the safe and effective delivery of

services 2.1.3 Undertake scientific investigations using qualitative and quantitative

methods to aid the screening, diagnosis, prognosis, monitoring and/or treatment of health and disorders appropriate to the discipline

2.1.4 Investigate and monitor disease processes and normal states 2.1.5 Provide clear reports using appropriate methods of analysing, summarising

and displaying information 2.1.6 Critically evaluate data, draw conclusions from it , formulate actions and

recommend further investigations where appropriate 2.2 Technical Practice

2.2.1 Provide technical advice to ensure the safe and effective delivery of

services 2.2.2 Plan, take part in and act on the outcome of regular and systematic audit 2.2.3 Work within the principles and practice of instruments, equipment and

methodology used in the relevant scope of practice 2.2.4 Demonstrate practical skills in the essentials of measurement, data

generation and analysis 2.2.5 Assess and evaluate new technologies prior to their routine use 2.2.6 Identify and manage sources of risk in the workplace, including specimens,

raw materials, clinical and special waste, equipment, radiation and electricity.

2.2.7 Apply principles of good practice in health and safety to all aspects of the workplace

2.2.8 Apply correct methods of disinfection, sterilisation and decontamination and deal with waste and spillages correctly.

2.2.9 Demonstrate appropriate level of skill in the use of information and communications technology

2.3 Quality 2.3.1 Set, maintain and apply quality standards, control and assurance

techniques for interventions across all clinical, scientific and technological activities

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2.3.2 Make judgements on the effectiveness of processes and procedures 2.3.3 Participate in quality assurance programmes 2.3.4 Maintain an effective audit trail and work towards continuous improvement

Domain 3: Clinical Practice As a part of the Healthcare Science workforce, you will keep your clinical skills up to date and undertake the clinical duties appropriate to your role in order to effectively: 3.1 Clinical Practice

3.1.1 Ensure that you and the staff you supervise understand the need for and

obtain relevant consent before undertaking any investigation, examination, provision of treatment, or involvement of patients and carers in teaching or research

3.1.2 Ensure that you and the staff you supervise maintain confidentiality of patient information and records in line with published guidance

3.1.3 Ensure that you and your staff understand the wider clinical consequences of decisions made on your actions or advice

3.1.4 Demonstrate expertise in the wider clinical situation that applies to patients who present in your discipline

3.1.5 Maintain up to date knowledge of the clinical evidence base that underpins the services that you provide and/or supervise and ensure that these services are in line with the best clinical evidence

3.1.6 Plan and determine the range of clinical/scientific investigations or products required to meet diagnostic, therapeutic, rehabilitative or treatment needs of patients, taking account of the complete clinical picture

3.1.7 Plan and agree investigative strategies and clinical protocols for the optimal diagnosis, monitoring and therapy of patients with a range of disorders

3.1.8 Ensure that detailed clinical assessments are undertaken and recorded using appropriate techniques and equipment and that the outcomes of these investigations are reviewed regularly with users of the service

3.1.9 Ensure the provision of expert interpretation of complex and or specialist data across your discipline in the context of clinical questions posed

3.1.10 Undertake and record a detailed clinical assessment using appropriate techniques and equipment

3.1.11 Provide specialised clinical investigation and/or analysis appropriate to your discipline

3.1.12 Provide interpretation of complex and/or specialist data in the context of the clinical question posed

3.1.13 Provide clinical advice based on results obtained, including a diagnostic or therapeutic opinion for further action to be taken by the individual directly responsible for the care of the patient

3.1.14 Provide expert clinical advice to stakeholders in order to optimise the efficiency and effectiveness of clinical investigation of individuals and groups of patients

3.1.15 Prioritise the delivery of investigations, services or treatment based on clinical need of patients

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3.1.16 Represent your discipline in multidisciplinary clinical meetings to discuss patient outcomes and the appropriateness of services provided

3.1.17 Ensure that regular and systematic clinical audit is undertaken and be responsible for modifying services based on audit findings.

3.2 Investigation and reporting 3.2.1 Plan and conduct scientific, technical, diagnostic, monitoring, treatment and

therapeutic procedures with professional skill and ensuring the safety of patients, the public and staff

3.2.2 Perform investigations and procedures/design products to assist with the management, diagnosis, treatment, rehabilitation or planning in relation to the range of patient conditions/equipment within a specialist scope of practice

3.2.3 Monitor and report on progress of patient conditions/use of technology and the need for further interventions.

3.2.4 Interpret and report on a range of investigations or procedures associated with the management of patient conditions/equipment

Domain 4: Research, Development and Innovation As part of the Healthcare Science workforce, research, development and innovation are key to your role. It is essential in helping the NHS address the challenges of the ageing population, chronic disease, health inequalities and rising public expectations of the NHS. In your role, you will undertake the research, development and innovation appropriate to your role in order to effectively: 4.1 Research, Development and Innovation

4.1.1 Search and critically appraise scientific literature and other sources of

information 4.1.2 Engage in evidence-based practice, participate in audit procedures and

critically search for, appraise and identify innovative approaches to practice and delivery of healthcare

4.1.3 Apply a range of research methodologies and initiate and participate in collaborative research

4.1.4 Manage research and development within a governance framework 4.1.5 Develop, evaluate, validate and verify new scientific, technical, diagnostic,

monitoring, treatment and therapeutic procedures and, where indicated by the evidence, adapt and embed them in routine practice

4.1.6 Evaluate research and other available evidence to inform own practice in order to ensure that it remains at the leading edge of innovation.

4.1.7 Interpret data in the prevailing clinical context 4.1.8 Perform experimental work, produce and present results 4.1.9 Present data, research findings and innovative approaches to practice to

peers in appropriate forms 4.1.10 Support the wider healthcare team in the spread and adoption of innovative

technologies and practice

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Domain 5: Clinical Leadership All patients and service users have a right to expect that Healthcare Science services efficiently and effectively managed to meet service needs. As a leader in Healthcare Science, you will seek to effectively: 5.1 Leadership

5.1.1 Maintain responsibility when delegating healthcare activities and provide

support as needed 5.1.2 Respect the skills and contributions of your colleagues 5.1.3 Protect patients from risk or harm presented by another person’s conduct,

performance or health 5.1.4 Treat your colleagues fairly and with respect 5.1.5 Make suitable arrangements to ensure that roles and responsibilities are

covered when you are absent, including handover at sufficient level of detail to competent colleagues

5.1.6 Ensure that patients, carers and colleagues understand the role and responsibilities of each member of the team

5.1.7 Ensure that systems are in place through which colleagues can raise concerns and take steps to act on those concerns if justified

5.1.8 Ensure regular reviews of team performance and take steps to develop and strengthen the team

5.1.9 Take steps to remedy any deficiencies in team performance 5.1.10 Refer patients to appropriate health professionals 5.1.11 Identify and take appropriate action to meet the development needs of

those for whom you have management, supervision or training responsibilities

5.1.12 Act as an ambassador for the Healthcare Science community

Good Scientific Practice AHCS V.2 Final

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APPENDIX 3: FURTHER INFORMATION NHS Networks An open network to share curricula produced for the Modernising Scientific Careers programme. Join this network to get updates whenever there is new content. http://www.networks.nhs.uk/nhs-networks/msc-framework-curricula/ Details of the Scientist Training Programme including MSc Clinical Science Curricula, Work Based Learning Guides. http://www.networks.nhs.uk/nhs-networks/msc-framework-curricula/stp

Chief Scientific Officer (CSO), Department of Health Source of information and news including the CSO Bulletin, latest press releases, publications and consultations. http://www.dh.gov.uk/health/category/chief-scientific-officer/

National School of Healthcare Science (NSHCS) The National School of Healthcare Science is an important part of the new system for healthcare science training established through Modernising Scientific Careers. This new system was set up to ensure that patients benefit from the scientific and technical advances by ensuring that healthcare science staff have the knowledge and skills to put these advances into practice. www.nshcs.org.uk

Academy for Healthcare Science (AHCS) The Academy for Healthcare Science (AHCS) is a UK wide organisation bringing together a diverse and specialised scientific community working within the National Health Service (NHS) and other associated organisations (e.g. the Health Protection Agency, NHS Blood and Transplant), Health and Social Care Northern Ireland (HSCNI) and the academic and independent healthcare sector. http://www.academyforhealthcarescience.co.uk/

Health and Care Professions Council (HCPC) The HPC are a regulator set up to protect the public. They keep a register of health professionals who meet the HPC standards for their training, professional skills, behaviour and health. http://www.hpc-uk.org/ Last Accessed 29th September 2012

neurosensory sciences 2012/13 - nhs networks · msc in clinical science can be found in the student...

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