This trainee started the Advanced labour ward practice ATSM at the end of August 2019. They also started the Fetal medicine ATSM in October 2019 and is a full-time trainee.
After discussion with their ES they decided to move to the new core curriculum. All the documentation and evidence for their ATSMs is contained on the new ePortfolio aside from a small number of WBA which they undertook in August and September 2019. These can be linked to via the pdf download from the old ePortfolio.
The trainee and ES are meeting to review progress in advance of the September 2020 ARCP.
Evidence provided to the ARCP panel
The trainee has judged themselves to be at level 3 competency for CiPs 1, 2 and 3. This is the progress expected by the curriculum guide. They opted not to undertake CiP 4 (amniocentesis), as they have been scanning for over a year before undertaking the ATSM and have well developed scanning skills. The trainee has collected a large number of OSATs attesting to their skills and confidence with normal fetal anatomy, biometry and Doppler assessment. Indeed, they have performed an audit against fetal anomaly screening programme (FASP) standards for routine anomaly scanning and also updated a guideline on the management of pregnancies complicated by maternal red cell antibodies. The evidence from the audit and development of a guideline also informed much of the evidence needed for the CiPs.
They attend the fetal medicine and paediatric multidisciplinary meetings on a regular basis, and their multi-source feedback suggests good communication skills and empathy. The ES actually feels that CiP 1 should be signed off at level 4 and explains why. The ES agrees that CiP 2 is at level 3.
The trainee has seen a number of cases of most of the key conditions screened for at 20 weeks and has appropriate knowledge with regards to their prognosis and management, as evidenced by various CBDs, and a couple of teaching sessions covering these anomalies. They have completed eLearning accessed through the FASP website, and have spent time with the screening midwife in the department and the laboratory staff. They have also given a teaching session to the medical students on the principles of screening tests and programmes. With another 6 months, the ES feels it is very likely that the trainee will be assessed as independently competent for the requirements set out in this CiP.
However, there is more concern with CiP 3. The trainee appears to do very little reading around the wider subject of fetal medicine, and the ES has been surprised by how superficial their knowledge is outside of the most common abnormalities. The trainee has seen none of the more advanced fetal medicine procedures and has very little knowledge of genetics and molecular techniques now used to investigate fetal anomalies. No evidence is presented to convince the ES that level 3 competency has been reached with this CiP, and they judge that only level 2 has been reached for this CiP and its headline statement.
The ES reassures the trainee that they are making overall adequate progress with the ATSM. They are ahead of expected progress in one CiP, and a little behind in another. They use this discussion to plan the next six months of training.
Because the trainee has very good scanning skills, it is suggested that they spend more time with the complex cases with rare anomalies. Plans are made for the trainee to attend a series of clinical genetics clinics and for them to present a more unusual case at each MDT. The ES provides the trainee with a number of reviews, online resources and textbook chapters to take away and read, and asks for help with the writing of an article covering the management of pregnancies complicated by fetal cardiac anomalies.
The trainee has also made good progress with the Advanced labour ward practice ATSM. Because of their rapidly improving ultrasound skills they have evidence to support all the procedures in CiP 10 at level 4 with evidence of OSATs, CbDs and evidence of achievement of all the key skills supported by NOTSS, their log of cases and reflective practice involving their management of an antenatal stillbirth. After discussion the ES signs off CiP 10 as achieved at level 5.
For CiP 7 and 9 the trainee has also accumulated good evidence of their progress with some key skills achieved to level 4 and others varying between 2, 3 and 4. In particular they need to have more experience in the assessment and management of the critically ill woman and their management in HDU/ITU. They discuss how this might be achieved in the next few months so that the trainee can increase their confidence in this area before the CCT.
The ES then discusses the non-clinical generic competencies and sign off. The trainee has assessed themselves for all the generic CiPs as meeting expectations for the year of training. The ES agrees with this and signs off all the generic CiPs as meeting expectations. They feel that the progress in both ATSMs demonstrates that the trainee is meeting expectations as they provide evidence for many of the key skills across the core curriculum.
Overall the ES assesses that the trainee has made good progress in ST6 and should progress to ST7. This is documented on the educational supervisors report.