The Diploma of the Faculty of Sexual & Reproductive Healthcare: An innovative training programme

1. The Diploma of the Faculty of Sexual & Reproductive Healthcare:An innovative training programme

2. DFSRH – why change? National drive to increase access to LARC and ↓ unplanned pregnancy rates (inc. teenage pregnancy) Demand for sexual health training outstrips supply, leading to delays in training Trainees arrive at clinics under prepared Theory, practical training and assessments often not linked Tension: service v training for trainees and for course organisers, and 3-4 day courses are expensive to run Major investment in e-learning by Department of Health

4. http://www.e-lfh.org.uk/e-srh

5. E learning Component if not Doing Diploma • Visit: www.e-lfh.org.uk/e-srh • Select the ‘sign up for access’ button on the left • Complete the registration form and click ‘ submit’ • For support email support@e-lfh.org.uk

6. Diploma – Registration To register for the Diploma: • Go to FSRH website - www.fsrh.org • Click training, choose new DFSRH Stage 2 • Download and complete Trainees Registration Form • Post form to FSRH and pay £50

7. Trainee Pathway

8. Preparation of trainees for clinical experience Entry requirements will ensure that trainees access DFSRH training at an appropriate stage in their training Knowledge/theory component all on e-SRH, and can be refreshed if there is a delay in starting clinical training 9 assessments will have been completed in Course of 5 • This will include topics such as sterilisation counselling and diaphragms that were sometimes difficult to provide in clinics • All trainees will have done model arm training for subdermal implants

9. Plan for changeover • Continue current practical training with log book for those who attend theory courses up to December 2009. (3 years to complete from date of theory course.) • All trainees who take the e-learning route to follow the new blended learning package with an e-portfolio. The components of the two training programmes are not interchangeable.

10. The Diploma of the Faculty of Sexual & Reproductive Healthcare:Entry requirements

11. 1. Consultation skills To be signed by educational supervisor, (self certified if GP or consultant). Before going on Course of 5, trainee must be able to • Adapt consultation style to suit the patient • Address patients’ ideas, concerns and expectations and answer their questions • Assess whether a patient is competent to consent to treatment and ensure consent is well-informed • Protect confidentiality • Make an appropriate offer of a chaperone • Demonstrate clear record-keeping • Use time effectively in consultations

12. Is able to give an intramuscular injection

13. 3. Basic gynaecological examination Trainee 1. Must be able to perform a basic gynaecological examination including: • Digital vaginal examination • Speculum examination 2. Has been observed taking a cervical cytology sample and understands the need for audit of cytology results to confirm competence Or Has achieved locally agreed competence to participate in cervical cytology screening programme.

14. Trainee Pathway

15. The Diploma of the Faculty of Sexual & Reproductive Healthcare: The Course of Five

16. Course of 5: Purpose • To demonstrate that delegates have a good knowledge of the theory– to empower and prepare them for clinical experience • Ask questions from theory course content • To consolidate theory course eg handle barriers, pill packs etc • To practice sexual history taking – using the right vocabulary • Explore personal issues – prejudices, emotional, religious eg termination, young people • Assessment of knowledge application rather than knowledge itself, (which is assessed in e-learning)

17. Course of 5: Delivery • 5 one hour sessions • Delivered in small groups (4 or less) • Standardised format: course material includes lesson plans, teaching notes, cases, lists of equipment needed etc • Facilitators not lecturers to deliver sessions • Candidates are advised to prepare for the sessions • Assessments for each session

18. Advantages of Small Groups1. Delivery Maximum 4 trainees to each facilitator • Opportunity to ask questions from e-learning • Gain ‘hands on’ practical experience eg swab taking • Deal with issues not easily encountered in practical session eg diaphragms • Explore difficult consultations and skills required in ‘safe’ environment rather than a busy clinic • Opportunity for significant number of assessments removing the burden from practical sessions

19. Advantages of Small Groups2. Administrative • Flexible delivery, directed by local needs • to a small group or one-to-one as stand alone sessions or full day • To a large number of groups with rotating stations • Administration reduced – forms standardised • More options for venues • Course can be run more frequently as less time out of clinical work for facilitators • Course of Five can generate local income to replace that of DFSRH theory course

20. Overview of Course of 5 sessions and assessments

21. Course of 5 sessions • Session 1: Taking a sexual history and HIV pre test discussion and testing • Session 2: STI screening and testing and teaching the use of condoms • Session 3:Practical aspects of contraception • Session 4:Young people • Session 5:Managing sensitive scenarios

22. Assessments • Focuses learning • Consolidates knowledge from e-SRH • Preparation recommended before attending • Scenarios that are not always encountered in clinic • eg sterilisation, requests for diaphragm • Group discussion and views of others often valuable • Makes effective and efficient use of practical sessions • Trainees better prepared when they arrive in clinic • Less competencies to be assessed in clinic • Fewer sessions likely to be required

23. Assessments • Recorded in e-portfolio by course convenor (directly, or via a ticket request from trainee) • At least 7 of the 9 must be assessed as satisfactory to move on to practical sessions. • Maximum of 2 assessments can be repeated during clinical experience by agreement with the primary trainer • Less than 7 passed – repeat whole Course of 5

24. Assessments Trainees are expected to demonstrate an appropriate professional, non judgemental attitude. This is an explicit component of the Course of 5 assessments. Further guidance from the General Medical Council publication ‘Good Medical Practice’ (www.gmc-uk.org)

25. Trainee Pathway

26. The Diploma of the Faculty of Sexual & Reproductive Healthcare:Clinical experience and assessments

27. Clinical experience and assessments Trainee-led, more emphasis on experience and assessment, less on teaching basics Theoretical knowledge has already been assessed in e-learning Trainees at an appropriate stage in their postgraduate medical training

28. 7 core topic areas • Effective contraception choices consultation • Consultation for a woman wishing to use an oral or injectable contraceptive, patch or vaginal ring • Assess and advise a woman wishing to use an intrauterine method or subdermal implant, prior to insertion • Managing a request for emergency contraception • Taking an appropriate history and assessment of a woman with bleeding problems whilst using hormonal methods • Take an appropriate sexual history and risk assessment for STI and pregnancy, and perform the appropriate tests for an asymptomatic woman or man requesting sexual health screening • Taking an appropriate history and assessment of a woman with vaginal discharge or pelvic pain

29. Assessment tools • ACP (Assessment of Clinical Practice) structured assessment of a directly observed consultation • RDCP (Reflection and Discussion of Clinical Practice) structured assessment based on a consultation which has not been directly observed • Consultation feedback

30. At least one assessment for each core topic 1. Contraception choices 2. Hormonal contraception3. Intra uterine/ subdermal methods 4. Emergency contraception5. Bleeding problems with hormonal methods6. STI risk assessment and screening7. Vaginal discharge and pelvic pain • At least 4 ACP’s (observed consultations) One ACP in topic 1 One ACP for topic 3 One ACP for topic 6 or 7 One ACP in one of the other topic areas The remaining assessments may be ACP or RDCP

31. Summary of progress chart

32. Check list for topic 1

33. An acceptable assessment is one where the trainee is assessed as competent at the level of independent practice in each section (with the exception of those marked * if not relevant).

34. Letters of Competence(LoC SDI and LoC IUT) • May be run in tandem with DFSRH • Can apply for LoC at same time as Diploma (but not before) • LoCs have additional e-SRH modules which will cover the theory component for all those taking the LoC SDI or IUT • SDI model arm training is part of the Course of 5; trainees who have taken the old diploma course will still need model arm training for LoC SDI, but can use e-SRH for the theory

35. Local Courses • New Croft Centre 2012 February 14, April 17 and October 16 Contact Joanne Borthwick 0191 229 2871 • Practical training throughout North East and Cumbria