Advanced Training Skills Module
LABOUR WARD LEAD
The labour ward is an area of enormous complexity within any hospital. At any time there may be women experiencing normal childbirth, as well as
others, fortunately fewer in number, who may be suffering complications of pregnancy. It is also an area where successful multidisciplinary working
is vital for patient safety.
A key recommendation of the Safer Childbirth Report from the RCOG is the designation of a lead obstetrician, a consultant midwife and a clinical
manager for the labour ward in each hospital. These people will have overall responsibility for the organisation, standard setting and audit on the
labour ward, and for training and support of staff – medical, midwifery and ancillary.
This ATSM has been designed to prepare individuals towards becoming lead obstetricians. Specifically, once trained, individuals should:
•
Understand staffing structures and needs across the whole of the labour ward
•
Understand the physiology of normal labour and delivery, how to actively support it and how to avoid negative influences
•
Work well as part of a multidisciplinary team, including service users
•
Be clinically competent and confident in the management of high dependency care on the labour ward
•
Be clinically competent in the transfer of women to and from HDU/ITU
•
Have a thorough understanding of neonatal resuscitation, intensive care and outcomes
•
Be able to supervise, teach, appraise and assess junior medical and midwifery staff on the labour ward
•
Have a thorough understanding of clinical governance, including the process of risk management, clinical incident reporting and
investigation, and of the litigation process
•
Be able to undertake and use audit
•
Be able to write evidence based guidelines
•
Be able to risk assess their unit against a National Enquiry or Report
It is expected that trainees will have successfully completed an obstetric emergency training course (eg ALSO, MOET, MOSES or equivalent) prior
to embarking on the ATSM. Attendance at the theoretical course ‘Preparation for Obstetric Leadership on the Labour Ward’ run by the RCOG is
compulsory. The course must be attended before completion of the ATSM, and not more than 3 years before commencing the ATSM. Completion of
the Advanced Labour Ward Skills ATSM is also compulsory, and this can be done concurrently.
09/02/2007
Advanced Training Skills Module
The ATSM must be undertaken under the supervision of an identified supervisor, who must be in a position to directly supervise and assess
competence. In order to ensure exposure to the required case mix the Unit must be of a sufficient size to ensure completion of the training, and
must have achieved CNST Level I, or equivalent and have a level 2 neonatal unit on site.
A minimum of two sessions per week should be dedicated to this ATSM, and during the course of the ATSM the trainee must attend HDU / ITU
sessions, neonatal sessions, develop or update a labour ward guideline, conduct or supervise a relevant audit, attend the labour ward forum and risk
management meetings, and set up and run skills and drills training, scenario-based training and fire drills.
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Advanced Training Skills Module
Organisation / Management of the Labour Ward
Learning Outcomes :
To
To
To
To
understand the organization / staffing structure / equipment needs of the Labour Ward
be expert in triaging clinical cases and allocating staff appropriately
be proficient in writing evidence-based guidelines and performing audit relevant to the Labour Ward
be able to analyse and understand Labour Ward workload and statistics
To be able to implement and manage change effectively
Knowledge criteria
Clinical competency
Professional skills and
Attitudes
Training support
Evidence/
Assessment
Organisation
staffing structures
equipment needs
relationship with
neonatologists
relationship with anaesthetists
relationship with users
Co-ordinate the clinical running of the LW
at a daily level including;
•
staff allocation
•
appropriate triaging of clinical cases
Ability to
•
co-ordinate the LW
appropriately and communicate
effectively all plans and
decisions to team members
•
write evidence-based
guidelines (relevant to LW)
•
perform audit (relevant to LW)
•
review LW workload and
statistics
•
implement change
Observation of and
discussion with senior
medical / midwifery staff
Log of experience
and competence
Understand
how to triage clinical cases
how to allocate staff
the role of LW Forum
the role of guidelines
- audit (incl. collection / analysis
of LW workload) and how this
influences practice
Perform clinical audit relevant to Labour
Ward
•
define standard based on evidence
•
prepare project & collate data
•
re-audit and close audit loop
•
formulate policy
•
implement change based on audit
results
Develop and implement a clinical guideline
relevant to Labour Ward
•
purpose and scope
•
identify and classify evidence
•
formulate recommendations
•
identify auditable standards
•
introduce into practice
Interpret LW workload / statistics
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Appropriate postgraduate
courses e.g.
•
Management of the
Labour Ward
•
Management course
Attendance at:
•
LW Forum
•
Guidelines group
•
Audit meeting
•
Perinatal mortality
meetings
National enquiries /
reports
LW Management
Assessment Tool
Team observations
Advanced Training Skills Module
Normality
Learning Outcomes :
To understand the physiology and mechanisms of normal labour and delivery
To understand, support and respect the role of the midwife as an expert in normality
To be able to actively promote the ethos of normality
To recognise and avoid negative influences, and avoid unnecessary interventions
Knowledge criteria
Clinical competency
Professional Skills and
Attitudes
Training support
Evidence/
Assessment
Understand
the role of the midwife as an
expert in normality
the physiology and mechanisms
of normal labour and delivery
intermittent auscultation
how to actively promote the
ethos of normality
negative influences on the
process of normality and how
to avoid them
how to avoid unnecessary
interventions
the impact of the birth
environment
Be able to manage a normal labour and
delivery
Ability to
•
understand and actively
promote normality
•
avoid negative influences
•
avoid unnecessary
interventions
•
recognise the midwife as an
expert in normality
•
respect and support midwifery
staff
Observation of and
discussion with senior
medical / midwifery staff
Log of experience
and competence
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Be able to perform intermittent
auscultation
Appropriate postgraduate
courses e.g.
•
Management of the
Labour Ward
LW Management
Assessment Tool
Team observations
Advanced Training Skills Module
Intensive Care
Learning Outcomes :
To understand the organization and role of high dependency and intensive care
To understand the indications for and methods of invasive monitoring
To understand the management of organ failure
Knowledge criteria
Clinical competency
Professional skills and
attitudes
Training support
Evidence /
Assessment
Organisation
structure and organization of
•
high dependency care
•
intensive care
role of outreach teams
indications for high dependency and
intensive care in obstetrics
Take and appropriate history and
perform an examination to assess
critically ill woman
Ability to;
•
formulate, implement and where
appropriate modify a management
plan including transfer to HDU/ITU
•
liaise with intensivists, physicians,
anaesthetists, neonatologists
•
counsel women and their partners
accordingly
management options, including
therapeutic interventions
maternal and fetal risks
debrief family and staff
Observation of and
discussion with senior
medical staff
Log of
experience &
competence
Appropriate
postgraduate courses
e.g.
•
Management of the
Labour Ward
•
ALSO / MOET or
equivalent
Case based
discussions
Management
methods of invasive monitoring
•
oxygenation / acid base
•
arterial pressure
•
cardiac output, preload and
contractility
organ failure (incl.
principles/techniques of supportive
therapy)
•
respiratory failure
•
cardiac failure
•
renal failure
•
hepatic failure
•
coagulation failure
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Manage a woman with organ failure;
•
undertake resuscitation
•
arrange and interpret
appropriate investigations to
confirm diagnosis / cause and
monitor organ function
•
arrange transfer to HDU / ITU
where appropriate arrange
appropriate investigations
Perform (under supervision) or refer,
where appropriate, for same
•
insertion of CVP line
•
endotracheal intubation
•
insertion arterial line / PA
catheter (optional)
Attendance at sessions
in
•
Anaesthesia
•
Intensive Care
Attendance at;
•
Medical clinics
Team
Observations
Advanced Training Skills Module
Neonatology
Learning Outcomes:
To be proficient at neonatal resuscitation and assess acid-base balance
To understand and be able to counsel about gestation related outcomes
To understand the intrapartum factors that influence neonatal outcome
To understand the short and longterm consequences of HIE
Knowledge Criteria
Clinical Competency
Understand
•
the principles of basic and advanced
neonatal resuscitation
•
conditions requiring admission to
NICU
•
the implications of prematurity
•
intrapartum factors that influence
neonatal outcome
•
acid-base balance
Ability to:
•
assess a neonate at
birth
•
perform basic
neonatal life support
•
assist in advanced
neonatal life support
•
interpret cord gases
and assess acid-base
balance
Outcome
•
neonatal complications of HIE (incl.
seizures, abnormal neurological function,
organ failure)
•
gestation related outcomes
•
long term health implications of HIE (incl.
cerebral palsy)
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Be able to follow the
admission process of a
neonate to NICU
Professional skills and
attitudes
•
•
counsel parents about
the outcomes of
prematurity
counsel parents about
the outcomes of HIE
Training support
Evidence /
Assessment
Attendance at:
•
resuscitations
•
NICU ward
rounds
•
neonatal
follow-up
clinics
Log of experience
and competence
ALSO course or
equivalent
Team
observations
Advanced Training Skills Module
Communication, team working and leadership skills
Learning Outcomes :
Demonstrate effective communication with colleagues
Demonstrate good working relationships with colleagues
Demonstrate the ability to work in clinical teams and have the necessary leadership skills
Knowledge Criteria
Clinical Competency
Professional skills and
attitudes
Training
support
Evidence /
Assessment
Communication
how to structure a staff interview to
identify:
ƒ
concerns & priorities
ƒ
expectations
ƒ
understanding & acceptance
breaking bad news
joint decision making
Be able to communicate both verbally
and in writing with colleagues
Ability to communicate
effectively with colleagues
Observation of
and discussion
with senior
medical /
midwifery staff
Log of experience
and competence
Team working
roles and responsibilities of team
members
factors that influence & inhibit team
development
ways of improving team working incl.
•
objective setting & planning
•
motivation and demotivation
•
organization
•
respect
contribution of mentoring and
supervision
Leadership
qualities and behaviours
styles
implementing change / change
management
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Ability to communicate effectively
with:
•
junior medical staff
•
senior medical staff
•
midwifery staff
•
patients & relatives
•
obstetric anaesthetists
•
neonatologists
Ability to break bad news
appropriately and support
distress
Ability to:
• work effectively within a
multidisciplinary team
• lead a clinical team
• respect other’s opinions
• deal with difficult
colleagues
Be able to recognise and
positively influence a
dysfunctional team
Communications
skills course
Leadership course
Team
observations
LW Management
Assessment Tool
Advanced Training Skills Module
Training / Assessment / Skills & Drills
Learning Outcomes :
To understand different methods of training and learning
Demonstrate the ability to assess competencies / set objectives / deal with difficult learners
To understand and use different methods of assessment, and feed back effectively
To utilise and deliver skills training, scenario training and fire drills appropriately
Knowledge Criteria
Clinical Competency
Professional skills and
attitudes
Training
support
Evidence /
Assessment
Training
how to assess basic competencies
ƒ
deficiencies
ƒ
strengths
ƒ
understanding of level of skills
how to set objectives
how to support and facilitate training
understand different methods of
adult learning
how to deal with difficult learners
Be able to assess basic competencies
of different members of staff
Ability to:
use different assessment
tools
feed back effectively
Observation of
and discussion
with senior
medical /
midwifery staff
Log of experience
and competence
Ability to:
understand different
methods of training
understand different
methods of learning
set up and run skills
training, scenario training
and fire drills
know which method to use
depending on training
session objective
Management of
the Labour Ward
course
Assessment
formal assessment of individuals using
different assessment tools
•
OSATS
•
DOPS
•
Mini-CEX
•
Case based discussions
•
Labour ward assessment tool
assessment of team performance
feedback techniques eg Pendleton’s
rules
Skills & Drills
understand the differences between
skills training, scenario training and
firedrills, and when to use them
how to set up, deliver and assess each
of the above
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Be able to set objectives and assess
against these objectives
Be able to deal with difficult learners
Be proficient in the use of the
various assessment tools
•
OSATS
•
DOPS
•
Mini-CEX
•
Case based discussions
•
Labour ward assessment tool
•
Lead training sessions /
emergency drills on LW
•
set up & running of skills
training
•
set up & running of
scenario training
•
set up & running of fire
drills
Training the
Trainers course
Instructor
training courses
(eg ALSO / MOET
instructor courses
or equivalent)
Team
observations
Advanced Training Skills Module
Clinical governance and risk management
Learning Outcomes:
Understand and demonstrate appropriate knowledge and skills in relation to CG and risk management
Knowledge Criteria
Clinical Competency
Professional skills
and attitudes
Training support
Evidence /
Assessment
Clinical Governance
organizational framework at local,
SHA and national levels
standards e.g. NSF, NICE, RCOG
guidelines
clinical effectiveness
principles of evidence based practice
grades of recommendation
guidelines and integrated care
pathways
•
formulation
•
advantages and disadvantages
clinical audit
patient / user involvement
types of clinical trial/evidence
classification
Participate in risk management
•
investigate a critical incident
by reviewing the case and
taking appropriate statements
•
write a time line
•
perform a root cause analysis
•
assess risk
•
formulate recommendations
•
write a response/report
•
feed back to staff & families
Ability to practice
evidence based medicine
Log of experience
and competence
Ability to report and
investigate a critical
incident
Observation of and
discussion with
senior medical /
midwifery staff and
clinical governance
team.
Ability to respond to a
complaint in a focused and
constructive manner.
Attendance at risk
management
meetings
Investigate and respond to a
complaint
Ability to perform
appraisal
DH, RCOG and Trust
publications
Risk management
incidents/near miss reporting
methods of analysing incidents
including root cause analysis
complaints management
litigation and claims management
Appraisal and revalidation
principles
process
Risk management on LW
- principles of risk management
critical incident reporting
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Perform appraisal
An Organisation with
a Memory (DoH
2000)
NPSA Website
(www.npsa.nhs.uk)
Human Error: models
and management.
Reason, BMJ 2000;
320, 768-770
CbD
Advanced Training Skills Module
MODULE
Leadership on the Labour Ward
Competence Level
Skill
Observation
Date
Labour Ward Management
Co-ordinate daily running of the LW
Staff allocation
Appropriate triaging of clinical cases
Normality
Participate in a midwife led labour and
delivery
Perform intermittent auscultation
appropriately
HDU/ITU
Assessement/counselling high risk case
Assessment of the ‘sick’ patient
Assessment of respiratory function
Interpretation of arterial gases
Assessment of renal function
Management of fluid balance
Assessment of maternal cardiac function
Assessment of haemodynamic status
Management of transfer to/from HDU/ITU
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Signature
Direct Supervision
Date
Signature
Independent Practice
Date
Signature
Advanced Training Skills Module
Neonatology
Basic neonatal resuscitation
Advanced neonatal resuscitation
Admission of a baby to neonatal unit
Assess acid-base balance
Counsel parents about the outcomes of
prematuirty
Counsel parents about the outcomes of HIE
Communication, team-working and
leadership skills
Communicate effectively with colleagues
Work well within a multidisciplinary team
Lead a multidisciplinary team
Recognise and positively influence a
dysfunctional team
Training, assessment, skills and
drills
Assess basic competencies
Set objectives
Assess against objectives
Deal with difficult learners
Use OSATs effectively
Use DOPs effectively
Use Mini-CEX effectively
Perform case-based discussions
Use the Labour Ward Assessment Tool
effectively
Give feedback appropriately
Set up and run skills training
Set up and run scenario training base
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Advanced Training Skills Module
training
Eclampsia drill
Obstetric collapse drill including CPR
Shoulder dystocia
Massive haemorrhage drill
Crash section drill
Neonatal resuscitation drill
Clinical Governance / Risk
Management
Investigate complaint / conflict re
intrapartum care
Collate information in response to complaint
Draft response letter to complaint
Be involved in a multidisciplinary serious
adverse event investigation (maternal)
Be involved in a multidisciplinary serious
adverse event investigation (neonatal)
Develop a time line
Participate in root cause analysis
Formulate recommendations
Feed back to staff / family
Perform appraisals
Sessions Attended
ITU/HDU
ITU/HDU
ITU/HDU
ITU/HDU
ITU/HDU
ITU/HDU
09/02/2007
Date
Supervisors Signature
Advanced Training Skills Module
NICU/resuscitations
NICU/resuscitations
NICU/resuscitations
NICU/resuscitations
NICU/resuscitations
NICU/resuscitations
Neonatal follow-up clinic
Neonatal follow-up clinic
Neonatal follow-up clinic
Neonatal follow-up clinic
Labour Ward Forum
Labour Ward Forum
Labour Ward Forum
Labour Ward Forum
Risk Management Meeting
Risk Management Meeting
Risk Management Meeting
Risk Management Meeting
Root cause analysis completed
Audit completed
Guideline completed
Response to National Enquiry / Report
Completed
Training course or session
Title
09/02/2007
Signature of educational supervisor
Date
Advanced Training Skills Module
Authorisation of Signatures – please print your name and sign below
Name (please print)
Signature
Completion of Module
I confirm that all components of the module have been successfully completed
Date
Name of Educational Superviser
Signature of Educational Superviser
09/02/2007