GMC Domains

• THE DOCTOR AS A SCHOLAR
  • TD 8: APPLICATION OF BIOMEDICAL SCIENTIFIC PRINCIPLES, METHOD AND KNOWLEDGE
    • Medical knowledge: ANATOMY (TD 8.1)
    • Medical knowledge: PHYSIOLOGY (TD 8.2)
    • Medical knowledge: BIOCHEMISTRY (inc. Metabolism) (TD 8.3)
    • Medical knowledge: CELL BIOLOGY (TD 8.4)
    • Medical knowledge: MOLECULAR BIOLOGY and GENETICS (TD 8.5, 8.6)
    • Medical knowledge: PATHOLOGY (TD 8.7)
    • Medical knowledge: CANCER
    • Medical knowledge: IMMUNOLOGY and INFLAMMATION (TD 8.8)
    • Medical knowledge: MICROBIOLOGY and INFECTION (TD 8.9)
    • Medical knowledge: PHARMACOLOGY (TD 8.10)
    • Medical knowledge: NUTRITION (TD 8.11)
    • Medical knowledge: CLINICAL FEATURES of DISEASE (TD 8 b)
  • TD 9: APPLICATION OF PSYCHOLOGICAL PRINCIPLES, METHOD AND KNOWLEDGE
    • Medical knowledge: PSYCHOLOGY (TD 9 a-g)
  • TD 10: APPLICATION OF SOCIAL SCIENCE PRINCIPLES, METHOD AND KNOWLEDGE
    • Medical knowledge: SOCIOLOGY (TD 10 a-e)
  • TD 11. PRINCIPLES, METHODS AND KNOWLEDGE OF POPULATION HEALTH
    • Medical knowledge: PUBLIC HEALTH and GLOBAL HEALTH (TD 11 a-j)
  • TD 12; APPLICATION OF SCIENTIFIC METHOD AND APPROACHES TO MEDICAL RESEARCH
    • Medical knowledge: EPIDEMIOLOGY
    • Medical Knowledge: SCIENTIFIC METHOD & RESEARCH
• THE DOCTOR AS A PRACTITIONER
  • TD 13: CARRY OUT A CONSULTATION WITH A PATIENT
    • Clinical skills: HISTORY (TD 13 a-b)
    • Clinical skills: PHYSICAL EXAMINATION (TD 13 c)
    • Clinical skills: MENTAL STATE EXAMINATION (TD 13 d)
  • TD 14: DIAGNOSE AND MANAGE CLINICAL PRESENTATIONS
    • Clinical skills: INTERPRETING FINDINGS AND INITIAL ASSESSMENT (TD 14 a-b)
    • Clinical skills: PLANNING AND INTERPRETING INVESTIGATIONS (TD 14 c-d)
    • Clinical skills: MAKING A DIAGNOSIS and CLINICAL JUDGEMENT (TD 14 e-f)
    • Clinical skills: FORMULATING A TREATMENT PLAN (TD 14 g)
    • Clinical skills: SURGERY and ANAESTHETICS (TD 14 g)
    • Clinical skills: SUPPORTING PATIENTS and IDENTIFYING ABUSE and NEGLECT (TD 14 h-i)
    • Clinical Skills: CARE OF PATIENTS AND RELATIVES AT END OF LIFE (TD 14 j)
  • TD 15: COMMUNICATE EFFECTIVELY WITH PATIENTS AND COLLEAGUES
    • Clinical skills: INTERACTION WITH PATIENTS (TD 15 a-b)
    • Clinical skills: MANAGING INFORMATION (TD 15 c)
  • TD 16: PROVIDE IMMEDIATE CARE IN MEDICAL EMERGENCIES
    • Emergency Management of Patients (TD 16 b-e)
  • TD 17: PRESCRIBE DRUGS SAFELY, EFFECTIVELY AND ECONOMICALLY
    • Clinical skills: PRESCRIBING DRUGS SAFELY AND EFFECTIVELY (TD 17 a-h)
  • TD 18: CARRY OUT PRACTICAL PROCEDURES SAFELY AND EFFECTIVELY
    • Clinical skills: DIAGNOSTIC PROCEDURES (TD 18 a)
    • Clinical skills: THERAPEUTIC PROCEDURES (TD 18 b)
  • TD 19: USE INFORMATION EFFECTIVELY IN A MEDICAL CONTEXT
    • Clinical skills: EVIDENCE BASED MEDICINE
• THE DOCTOR AS A PROFESSIONAL
  • TD 20: BEHAVE ACCORDING TO ETHICAL AND LEGAL PRINCIPLES
    • Professional issues: ETHICS and LAW (TD 20 a-g)
  • TD 21: REFLECT, LEARN AND TEACH OTHERS
    • Professional Issues: PERSONAL LIMITS OF CARE (TD 21e)
    • Professional issues: LEARNING (TD 21 a-d)
    • Professional issues: TEACHING AND MENTORING (TD 21 f)
  • TD 22: LEARN AND WORK EFFECTIVELY WITHIN A MULT-PROFESSIONAL TEAM
    • Professional issues: WORKING IN TEAMS (TD 22 a-c)
  • TD 23: PROTECT PATIENTS AND IMPROVE CARE
    • Professional issues: DUTIES OF A DOCTOR (TD 23 a-b)
    • Professional issues: MEDICAL FRAMEWORK IN THE UK (TD 23 c)
    • Professional issues: RISK MANAGEMENT and PATIENT SAFETY (TD 23 d)
    • Professional issues: GOVERNANCE, QUALITY MATTERS and AUDIT (TD 23 e)
    • Professional issues: PERSONAL ATTITUDES and SELF CARE (TD 23 f-j)

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TD 14: DIAGNOSE AND MANAGE CLINICAL PRESENTATIONS: Clinical skills: SURGERY and ANAESTHETICS (TD 14 g)

Index

• General Outcomes for Anaesthesia
• General Outcomes for Surgery
• Cardiovascular and Respiratory Surgery
• GI Surgery
• Renal and Urological Surgery
• Breast and Endocrine Surgery (inc. Breast Cancer)
• Neurosurgery
• Orthopaedic Surgery

• General Outcomes for Anaesthesia
  • General Anaesthestic Outcomes
  • Anaesthesia: The Role of the Anaesthetist
    1. Develop a general understanding of the role of the anaesthetist and the multiple roles they perform (MET3A)
    2. Know the role of the anaesthetist includes: pre-operative assessment of patient (MET3A)
    3. Know the role of the anaesthetist includes: peri-operative management of patients (MET3A)
    4. Know the role of the anaesthetist includes: all aspects of post-operative care; intensive therapy care; pain management (acute & chronic); obstetric anaesthesia and analgesia (MET3A)
  • Anaesthesia: Types of Anaesthesia
    1. Have a basic understanding of the different types of anaesthesia: General, Regional and Local including major nerve blocks and the difference between spinal and epidural anaesthetic.
    2. Attain a basic understanding of the different types of anaesthesia: general; regional; local (MET3A)
  • Anaesthesia: Pre-operative Assessment
    1. Have an understanding of patient physiology and pathology relevant to the peri-operative period with special emphasis on cardiac and respiratory assessment and disease (MET3A)
    2. Have an understanding of patient physiology and pathology relevant to the peri-operative period with special emphasis on the diabetic patient (MET3A)
    3. Have an understanding of patient physiology and pathology relevant to the peri-operative period with special emphasis on the obese patient (MET3A)
    4. Have an understanding of patient physiology and pathology relevant to the peri-operative period with special emphasis on investigations relevant to anaesthesia and surgery (MET3A)
  • Anaesthesia: Patient Monitoring
    1. Be able to use and know the limitations of pulse oximetry and blood pressure management (automated and invasive methods) (MET3A)
    2. Understand oxygen therapy
    3. Be able to use and understand the limitations of monitoring
    4. Be able to use and know the limitations of ECG (continuous monitoring) (MET3A)
    5. Be able to use and know the limitations of the use of CO2 monitoring (capnography) to confirm correct placement of endotracheal tubes (MET3A)
  • Anaesthesia: Prescribing (General)
    1. Have a general understanding of safe prescribing practice
    2. Have a general understanding of safe prescribing practice (MET3A)
    3. Understand simple post-operative prescribing (analgesia, anti-emetics, fluids); and how to complete such prescriptions on mock charts (MET3A)
    4. Know how to reduce the risk of medication error (MET3A)
    5. Understand the importance of allergy checks and documentation (MET3A)
  • Anaesthesia: Post-operative Pain
    1. Have an understanding of analgesia including post-operative pain; NSAIDs and opioids; the WHO pain ladder (MET3A)
    2. Have an understanding of analgesia including post-operative pain
    3. Have a general understanding of safe prescribing practice
    4. Have a basic understanding of the use of patient controlled analgesia (PCA) and epidurals for post-operative pain (MET3A)
    5. Understand the role of the acute pain team. (MET3A)
  • Anaesthesia: Anti-emetics
    1. Know the anti-emetic drugs commonly used (MET3A)
    2. Have a general understanding of safe prescribing practice
    3. Know the indications for use of anti-emetics (MET3A)
  • Anaesthesia: Oxygen Therapy
    1. Know when to give oxygen and which delivery system to use (MET3A)
    2. Understand oxygen therapy
    3. Know the methods of delivering oxygen (fixed vs. variable delivery systems) (MET3A)
    4. Know how to monitor patients receiving oxygen (MET3A)
  • Anaesthesia: Fluid Therapy
    1. Understand fluid therapy
    2. Have a general understanding of safe prescribing practice
    3. Know the types of IV fluid and their uses peri-operatively; how to write a simple post-operative fluid regimen and perform a simple assessment of a patient's fluid status (MET3A)
    4. Know the procedure for the safe prescription and delivery of blood (MET3A)
  • Anaesthesia: Local Anaesthetics
    1. Understand the use of Local Anaesthetics
    2. Know the long and short acting and methods of administration of local anaesthetics (MET3A)
    3. Regarding local anaesthetics, know the maximum safe dosages and have an understanding of how the % concentration relates to mg/ml when calculating doses (MET3A)
    4. Regarding local anaesthetics, know the toxicity symptoms signs and treatment (MET3A)
    5. Relate the nerve supply of the female pelvis and perineum to methods of anaesthesia. (GEP/HD, HD2)
  • Anaesthesia: Care of the Unconscious Patient
    1. With regard to Intensive Care
    2. Know the care of the unconscious patient
    3. Know the assessment and management of the airway and prevention of aspiration (MET3A)
    4. Know the assessment of the Glasgow Coma Scale (GCS); attention to pressure points and maintenance of temperature (MET3A)
  • Anaesthesia: Interpretation of Arterial Blood Gases (ABG's)
    1. Have a basic understanding to allow the interpretation of patient oxygenation with respect to the inspired oxygen concentration
    2. Have an understanding of Type I and II respiratory failure; and the causes and consequences of hyper and hypocapnia
    3. Have a basic understanding of acid-base balance and the causes of acidosis
  • Anaesthesia: Shock
    1. Know the different types of shock
    2. Know the basic approach to the treatment of shock
  • Anaesthesia: The Sick Patient
    1. Be able to recognise the sick patient and know the early warning scores e.g. patient at risk scores; know and understand the ABCDE approach to any acutely ill patient
    2. Be able to recognise the sick patient (MET3A)
    3. Know the early warning scores eg, patient at risk scores (MET3A)
    4. Understand a simple ABCDE approach to any acutely ill patient (MET3A)
  • Anaesthesia: Communication Skills
    1. Consent - the discussion of risk with patients. This is best accomplished by student observation of the anaesthetic pre-assessment (MET3A)
    2. Effective communication between professionals; how to refer a patient and ask for advice or help from another professional (MET3A)
    3. Effective telephone communication (MET3A)
    4. Communication within a team during an emergency (MET3A)
  • Anaesthesia: Patient Safety
    1. Have a general understanding of safe prescribing practice
    2. Know the importance of safe team working
    3. Understand issues of risk management and patient safety
    4. Know the importance of safety checking procedures such as anaesthetic checks; patient checks pre-theatre; in-theatre checks (Time Out, WHO Safer Surgery Initiative); blood transfusion checks
    5. Know the importance of infection control within theatre; handwashing; sterile and clean techniques
    6. Effective handover (MET3A)
• General Outcomes for Surgery
  • General Surgical Outcomes
    1. Perform correct procedures for scrubbing up, gowning and gloving (MET3A)
    2. Is familiar with, and able to describe 14 common surgical procedures (click here for list)
    3. Describe the anatomy of the pelvic floor. (GEP/HD, HD2)
    4. know basic theatre principles (MET3A)
    5. List the different types of tissue grafts and identify their advantages and disadvantages. (LOC2)
• Cardiovascular and Respiratory Surgery
  • General Outcomes for Cardiovascular Surgery
  • Amputation
    1. List the indications for amputation and its complications
    2. Explain the process of rehabilitation of the amputee
  • Aortic Aneurysm
    1. Know the indications for surgical intervention in aortic aneurysm disease (CR3)
    2. Explain the difference between an open and endovascular repair (CR3)
    3. Describe the potential complications of aortic aneurysm surgery including mortality figures for elective and emergency aneurysm surgery (CR3)
    4. Describe complications of arterial surgery and explain how these should be managed (CR3)
  • Coronary Bypass
    1. Discuss indications for coronary artery bypass surgery (CR3)
    2. Describe some details about the process of putting a patient onto cardiopulmonary bypass (CR3)
    3. Learn the common complications of cardiopulmonary bypass and explain why these occur (CR3)
  • Endocarditis
    1. Give indications for the surgical treatment of infective endocarditis and discuss the timing of surgery in patients with this condtion (CR3)
  • Replacement Heart Valves
    1. Describe different types of prosthetic heart valve that may be used to replace defective valves and discuss the advantages and disadvantages of each (CR3)
  • Pericardial Disease
    1. Outline the use of pericardiocentesis and surgery in the diagnosis and treatment of patients with pericardial effusion or constriction (CR3)
  • Congenital Cardiac Disease
    1. Discuss the role and timing of surgery in the management of congenital cardiac disease (CR3)
  • Varicose Veins
    1. Outline the management options for a patient with varicose veins including indications for surgery (CR3)
    2. Describe the surgical options for treatment of varicose veins to a patient (CR3)
• GI Surgery
  • Surgery: Gastrointestinal Surgery (General)
    1. Be able to describe the complications from major abdominal surgery (MET3A)
    2. Describe the surgical anatomy of appendicectomy (MET3A)
    3. Be able to describe the indications, operations and complications associated with splenectomy (MET3A)
    4. Know the possible post-operative complications of surgical treatment (MET3A)
    5. Know the different surgical approaches to appendicectomy (MET3A)
    6. Know the complications of appendicectomy (MET3A)
    7. Be aware of the role of surgery in the management of acute pancreatitis
    8. Be able to recognise when surgical referral is appropriate (MET3A)
  • Surgery: Upper GI Surgery
    1. Be able to describe the indications, operations and complications associated with oesophagectomy and gastrectomy (MET3A)
    2. Be aware of the role of surgery in the management of acute pancreatitis (MET3A)
  • Surgery: Lower GI Surgery
    1. Know the indications, operations and complications associated with right hemicolectomy, anterior resection and the formation of stoma (MET3A)
    2. Know the indications for surgical intervention and the consequences of resection of the large bowel (MET3A)
    3. Understand the operative procedures available for large bowel obstruction (MET3A)
    4. Know the indications for surgical intervention and the consequences of resection of small bowel (MET3A)
    5. Know the operative procedures available for small bowel obstruction (MET3A)
    6. Know the possible post-op complications of surgical treatment for small bowel obstruction (MET3A)
  • Surgery: Colorectal Surgery
    1. Understand the role of surgery in the management of a patient with acute diverticulitis (MET3A)
    2. Be able to describe the indications, operations and complications associated with Hartman's Operation and abdominoperineal excision of the rectum (MET3A)
    3. Be able to describe the indications, operations and complications associated with treatment for haemorrhoids, fissures and fistula (MET3A)
    4. Know the surgical treatment of colorectal cancer (MET3A)
  • Surgery: Gastrointestinal Bleeding
    1. Know the endoscopic management of bleeding from the gastrointestinal tract (MET3A)
    2. Know the role and indication of surgery in the management of gastrointestinal bleeding (MET3A)
    3. Understand the role of oesophago-gastro-duodenoscopy (OGD) and colonoscopy in the management of gastrointestinal bleeding (MET3A)
    4. Know the surgical management of a perforated peptic ulcer (MET3A)
  • Surgery: Gall Bladder / Gall Stones
    1. Know the indications, operations and complications associated with laparoscopic cholecystecomy (MET3A)
    2. Know the surgical options for the treatment of gallstones (MET3A)
    3. Understand the role of Surgery in a patient with obstructive jaundice (MET3A)
  • Surgery: Herniae
    1. Discuss the formation of inguinal hernias, the relevant anatomy and the possible surgical interventions (GEP/HD, HD2)
    2. Know and be able to describe the principles and indications of the various surgical options for the repair of the following hernias: inguinal; femoral; strangulated
    3. Know which hernias should be repaired surgically
    4. Know that a strangulated hernia is a surgical emergency
  • Surgery: Abdominal Trauma
    1. Be able to describe the principles of surgical treatment to the multi-injured patient
    2. Know the indications for operative and non-operative management of a patient with abdominal trauma
    3. Understand the role of damage control surgery and its indications
• Renal and Urological Surgery
  • Renal Transplant
    1. Understand that transplantation can be a very effective treatment for organ failure
    2. Describe the complications associated with antirejection therapy
    3. Be aware of the prognosis, advantages and disadvantages of transplantation
    4. Describe the basic principles of tissue typing and lymphocytotoxic cross matching
    5. Understand why kidney transplantation is better than dialysis.
    6. Know that there is a shortage of donated organs
    7. Be aware of the prognosis, advantages and disadvantages of renal transplantation
    8. Know that that deceased may come from people whose death has been defined by brain stem or circulatory death.
    9. Understand that there is a high refusal rate regarding potential donors and the possible reasons why.
    10. Describe strategies for increasing the availability of organs
  • Renal and Urological Malignancies
    1. Describe the pathology, clinical features, investigation and management of renal cell cancer.
    2. Describe the pathology, clinical features, investigation and management of bladder cancer.
    3. Describe the pathology, clinical features, investigation and management of prostate cancer.
    4. Describe the pathology, clinical features, investigation and management of testicular cancer.
• Breast and Endocrine Surgery (inc. Breast Cancer)
  • Breast Surgery (inc. Breast Cancer)
    1. Recognise and justify the differing methods of surgical treatment of breast cancer
    2. Recognise the role of breast reconstruction after mastectomy
• Neurosurgery
  • Deep Brain Stimulation
    1. Understand the principles underlying deep brain stimulation and appreciate the impact of this technique in neurology.
• Orthopaedic Surgery
  • General Outcomes for Orthopaedic Surgery
    1. Common orthopaedic procedures and treatment options (LOC2)
    2. To understand the different types of joint replacement available and the advantages and disadvantages of each
    3. To describe the main treatment options for dealing with bone fractures (GEP/M&P)
    4. To describe the main treatment options for dealing with bone fractures (LOC2)
    5. To understand surgical options for OA (GEP/M&P)
    6. To understand surgical options for OA (LOC2)
    7. List local and general complications post orthopaedic surgery (MusSkel4)

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