The Foundation Programme at a Glance

The Foundation Programme at a Glance
Contents
List of contributors
Preface
Acknowledgements
List of abbreviations
How to use your textbook
1 Shadowing and induction
Shadowing and induction
Clinical placements
Student assistantships
Learning how to do your first F1 job
Shadowing
Induction
What you need to know
Who else should you meet?
2 The e-portfolio – how to plan, manage and evidence your learning
What is the e-portfolio for?
Who has access to my e-portfolio?
What do I put in it?
Planning and recording your learning
Recording your meetings with your clinical and educational supervisors
Supervised learning events and assessments
Reflection
Additional evidence
Sign-off at the end of F1 and F2
3 Supervised learning events and assessments
Supervised learning events (SLEs)
What are SLEs?
When and how do you record a SLE?
What is DOPS?
What is mini-CEX?
What is CBD?
What is developing the clinical teacher?
Assessments
How will you be assessed?
What is TAB?
How are core procedural skills assessed?
What are the supervisor’s reports?
How to use feedback
4 Reflective learning
What is reflection?
Why is it important?
Using the e-portfolio to help your reflective practice
A model for reflection
What examples can you use in your reflective log
5 Managing your medical career
What should I aim for in my medical career?
Career discussions and where to find career support
Exploring options in the foundation programme
Other career issues and changes to plan
6 Applying to specialty training
Exploration of the options
Career structure of your chosen specialties
Application process timelines
Interview/selection process
Applicant etiquette
Less than full time (LTFT) training
Myths about speciality training applications
7 Quality improvement and clinical leadership
What is quality improvement?
Improving healthcare for the benefit of patients
Leading and implementing changes
8 Quality improvement projects
Plan, do, study, act (PDSA)
Plan
Do
Study
Act
Audit
Stage 1 – what problemwould you like to fix?
Stage 2 – what are you seeking to achieve?
Stage 3 – how are you going to gather and analyze the data?
Stage 4 – what changes or improvements need to be made?
Stage 5 – how will you demonstrate that you have made a difference?
9 Breaking bad news and handling complaints
Breaking bad news
Handling complaints
10 Assessing capacity and informed consent
What is mental capacity?
Principles
Supporting patients to make decisions
Two-stage test of mental capacity
Stage 1 – diagnostic test
Stage 2 – functional test
Acting in the patient’s best interests
11 Handover and communicating with colleagues
Effective communication with colleagues
Safe handover
Leadership and communication
Dealing with poor performance in others
Dealing with your own difficulties
12 Communication between primary and secondary care
Written communication
Discharge letters
Referral letters and internal referrals
Clinic letters
13 Introduction to evidence-based medicine
What is evidence-based medicine?
Why is it important?
How to practice EBM – the five steps
Step 1 – how to ask structured clinical question
Step 2 – how to access (search for) the best available evidence
Step 3 – how to critically appraise the evidence
Step 4 – how to apply the evidence in practice
Step 5 – how to assess your performance
14 Critical appraisal of randomized controlled trials
What is critical appraisal?
Is the RCT applicable and valid?
Are the results important?
Is it a poor quality study or a poorly reported study?
15 Critical appraisal of systematic reviews and meta-analyses
Question – does it ask a clearly focused question?
Find – did it find all the best evidence?
Appraise – were the studies critically appraised?
Synthesis – were the results appropriately combined?
What could you tell your patient?
16 Making the most of guidelines and protocols
What is the difference between a guideline and protocol?
How to find guidelines and protocols
How to critically appraise a guideline or protocol
How to use guidelines and protocols
17 Running a teaching session and presentation skills
Maximising learning
Choosing the right media
PowerPoint
Printed material
Audio
Videotape
Practical/simulation
Length
Emphasize key messages
18 Assessment and feedback
Assessment methodology
Assessment tools
Miller’s pyramid of clinical competence (Fig. 18.1)
Assessment demonstrating cause for concern
Feedback
Principles of feedback
Giving feedback
19 Assessing and managing the acutely ill patient
Identifying the unwell patient
Approaching the acutely ill patient
Initial assessment
Airway
Breathing
Circulation
Disability
When should I call for help?
20 Rational prescribing
First steps
Prescribing
Treatment
Compliance
External effects on prescribing
Drug reactions
What to report
21 Medical record keeping
Why keep medical records?
What is included in medical records?
Who contributes to medical records?
What information should be recorded?
What should not be recorded in the notes?
Confidentiality
Who can view medical records?
22 Time management
How can I maximize my time?
Ward rounds
Preoperative assessments
Ward work
On call
Protected time
Reference
23 Fluid management
Normal body fluids
Abnormalities of fluid balance
Assessment of the volume state
Management of abnormalities of fluid balance
Administration and monitoring of fluid replacement
Volume overload
Maintenance fluids’
24 Blood transfusion
Blood transfusion
Risks of transfusion
Managing transfusion reactions
Prescribing blood products
Avoiding transfusion errors
Sampling
Setting up a transfusion
Reference
25 Discharge planning
Why is discharge planning important?
What is discharge planning?
What is the foundation doctor’s role in discharge planning?
How is a discharge planned?
Early supported-discharge teams
Who can discharge a patient?
26 Nutrition
Specific malnutrition (vitamin and mineral deficiencies)
Nutritional support
Indications
Therapeutic diets
27 Health promotion and public health
Alcohol
Smoking
Drugs
Diet and nutrition
Wider public health issues
28 Do not attempt CPR decisions
Ethical and legal considerations
When to consider making a DNACPR decision
Discussions about CPR
What if a person lacks capacity?
What if there is a disagreement?
Practical Issues
29 Palliative care
Pain
Assessment
Treatment (Fig. 29.1c)
Terminal phase of illness
30 Certifying death
How to complete a MCCD
When to inform the coroner or procurator fiscal
What does the coroner or procurator fiscal need to know?
What happens next?
31 The unconscious patient
History
Examination
Airway
Breathing
Circulation
Disability
Examination/Everything Else
Investigations
Management
32 Stridor
What is stridor?
What you see
History
Management
What to do while waiting for help to arrive
Ongoing management
33 Anaphylaxis
Mechanism
Triggers
Presentation/range of symptoms
What questions to ask the patient?
Examination/anything else to look for?
Practical management
Investigations
34 Asthma
Definition
Epidemiology
Aetiology
Pathology
Assessment
Severe uncontrolled asthma
Prognosis
35 Pneumothorax and pulmonary embolism
Pneumothorax
Definition
Classification
Assessment
Management
Pulmonary embolism
Definition
Risk factors
Pneumothorax and pulmonary embolism (continued)
Clinical features
Investigations
Treatment (Fig. 35.2)
36 Chronic obstructive pulmonary disease
Definition
Aetiology
Pathology
Clinical features
Investigations
Management
37 Community-acquired pneumonia
Classification
Epidemiology
Risk factors
Clinical features
Investigations
Severity assessment
Management
38 Acute chest pain
Key points
Differential diagnosis
Heart and aorta
Lung
Oesophagus, stomach and abdominal disease
Chest wall
Important diagnostic features
Ischaemic chest pain
Pulmonary embolism
Pleuritic pain
Aortic dissection
Pericarditis
Oesophageal pain
Musculoskeletal pain
The acute coronary syndromes
Key investigations
ECG
Cardiac troponin
Other blood tests
Chest X-ray
CT scanning
Echocardiography
39 Palpitations
Key points
Differential diagnosis: what is the patient describing?
Irregular heart beat
Paroxysmal tachycardia (Fig 39.1)
Abnormal or increased awareness of the normal heartbeat
Important diagnostic features
Supraventricular tachycardias
Ventricular tachycardia
Paroxysmal atrial fibrillation
Key investigations
ECG
Holter (ambulatory) ECG recorders
Invasive electrophysiology study
40 Hypotension
Definitions
Blood pressure
Hypotension
Symptoms and signs
Causes
Acute hypotension
Chronic hypotension
Management
Evaluate
Acute hypotension
Chronic hypotension
41 Severe sepsis
Definitions
Systemic inflammatory response syndrome (SIRS)
Sepsis
Severe sepsis
Incidence and risk factors
Management
Early management (1st hour)
Monitoring and reassessment (1–4 hours)
Advanced management (1–6 hours)
42 Oliguria – including acute kidney injury
Presentation
Prevention
History
Examination
Investigations
Management
Immediate management for all patients
If you suspect hypovolaemia . . .
If the patient has urinary obstruction . . .
Ongoing management
43 Electrolyte derangement–hyperkalaemia
Hyperkalaemia
Presentation
History
Examination
Investigations
Management
44 Electrolyte derangement – hyponatraemia
Hyponatraemia
Presentation
History
Examination
Investigations
Management
45 Diabetic ketoacidosis
Recognition and management of DKA
Pathophysiology
Aetiology
Mortality and morbidity
Treatment
Rationale for best practice
Patient care
Resolution phase
46 Hypoglycaemia
Recognition of hypoglycaemia
Spontaneous hypoglycaemia
Causes of hypoglycaemia in diabetes
Risk factors for hypoglycaemia in diabetes
Treatment
Follow on care
47 Abdominal pain
History
Examination
Investigations
Red flag conditions
Ruptured abdominal aortic aneurysm
Ectopic pregnancy
Perforated viscus
Appendicitis
48 Gastrointestinal bleeds
Causes
History
Initial assessment and management: the ABC approach
49 Back pain and large joint pain
Back pain
Differential diagnosis
Investigations
Treatment
Large joint pain
Polyarthritis
Monoarthritis
Investigations
Treatment
References
50 Fractures and dislocations
Causes
Shape and direction of injury
History
Examination
Investigation
Classification of fractures
Growth plate fractures in children
Management
Complications
Osteotomies
51 Coma
Causes
Assessment of the level of consciousness
Priorities
History
Examination
Urgent investigation of the unconscious patient
Further management
52 Seizures
Stop the seizure
First line: benzodiazepines
Second line: benzodiazepines
Third line: anticonvulsants
Fourth line: sedation and intubation
After the seizure: the post-ictal period
Search for a cause
Was it a seizure?
Seizure vs pseudoseizure
Causes, triggers and auras
Examination
Investigations
Who can go home?
53 Meningitis and encephalitis
Meningitis
Bacterial meningitis
Viral meningitis
Other causes of meningitis
Encephalitis
Cerebral abscess
54 Stroke/acute onset of focal neurological signs
Clinical assessment
Investigations
Stroke
Stroke subtypes: clinical syndromes
Stroke mimics
Treatment
Transient ischaemic attack
55 Acute visual impairment
Vascular occlusion
Retinal vein occlusion
Retinal artery occlusion
Non-arteritic anterior or posterior ischaemic optic neuropathy
Cerebrovascular accident
Acephalgic migraine
Vitreous haemorrhage
Management
Retinal detachment
Management
56 Depression
How to diagnose a major depressive episode
What are the risk factors for depression?
What are the risks associated with depression?
What else could it be?
How to manage patients with a depressive episode
What is the prognosis?
57 Psychosis
What is psychosis?
Schizophrenia
How to assess for psychosis
Differential diagnosis for schizophrenia
How to manage a patient with schizophrenia
Prognosis and risk
Assessing and managing aggressive patients
Recognizing aggression
History from others
Assessment of the patient
Management
Follow-up
58 Anxiety disorders
Anxiety disorders
Epidemiology
Aetiology (Fig. 58.1)
Panic disorder
Generalized anxiety disorder (GAD)
59 Harmful drinking and alcohol dependence
Screening for harmful use/alcohol dependence
Detailed assessment
Management of assisted alcohol withdrawal
Alcohol withdrawal in hospital
60 Child abuse and protection
Cause for concern – the child’s injury
Parental responsibility
History
Examination
Distinguishing accidental from non-accidental injuries
Action
Referral to social services
In an emergency
Pitfalls in diagnosis
Reference
61 The febrile child, and recognizing the seriously ill child (including UTI and meningitis)
Detection of fever
Assessment
Remote assessment, e.g. telephone
Assessment by the non-paediatric practitioner, e.g. GP
Assessment by the paediatric specialist service
Further clinical assessment of the child with fever
Symptoms and signs of specific illnesses
62 Cough and wheeze
Is it asthma?
Initial assessment
For a child with a high probability of asthma
For a child with a low probability of asthma
For a child with an intermediate probability of asthma
Managing acute asthma in children
Children under 2 years
Children over 2 years
Long-term management of stable asthma
Reference
63 Diarrhoea, vomiting and constipation in young children
Diarrhoea and vomiting (D&V)
Diagnosis
Children at greater risk of dehydration or recurrence
Fluid management
Antibiotic therapy in gastroenteritis
Constipation
Assessment and diagnosis
Management of idiopathic constipation
References
64 Confusion, dementia and delirium
Delirium
Dementia
Risk factors
Diagnosis
Treatment
65 Fits, faints and falls
Check
History
Treatment in fits and faints
Implications of a diagnosis of epilepsy
Prevention of falls
Next steps
Index