|Title||Developing independent professional practice|
By the end of the training period trainees will, in respect of achieving sufficient knowledge of professional practice to offer basic advice on the interpretation of results be able to:
- analyse, synthesise, evaluate and apply knowledge
- perform, adapt and master a range of technical and clinical skills and procedures.
- Demonstrate the attitudes and behaviours necessary for professional practice as a consultant clinical scientist dealing with the complexities, uncertainties and tensions of professional practice at this level.
Knowledge and understanding
By the end of the training period the trainee will be able to demonstrate the ability to analyse, evaluate and synthesise relevant knowledge and its application to their professional practice with respect to
- increasing familiarity with laboratory and clinical aspects of the subject area
- know what must be dealt with urgently and what may be dealt with less urgently.
- Recognition of the clinical utility and also limitations of results.
Technical and clinical skills
By the end of the training period the trainee will be able to demonstrate a critical understanding of current relevant research, theory and knowledge and its application to the performance, adaptation and mastery of the following technical procedures and laboratory skills:
- recognise and work within own limitations in knowledge
- liaise and communicate with a wide range of healthcare workers involved in in relevant patient care
- communicate effectively in person and by telephone
- refer to more experienced colleagues as appropriate
- provide continuity of care
- prioritise work according to urgency
- deal with difficult situations independently
- recognise and analyse the overall effects of competing pressures on healthcare resources, g. availability of laboratory tests, availability of beds
- collect, analyse and interpret information from a variety of sources
- make safe decisions when clinical, laboratory or epidemiological information is incomplete or evolving
- work with clinical and laboratory colleagues under pressure.
By the end of the training period the trainee will be able to apply knowledge of developing independent practice to perform, adapt and master the clinical skills necessary to:
- demonstrate increasing familiarity with laboratory and clinical aspects of the subject area
- demonstrate knowledge of what must be dealt with urgently and what may be dealt with less urgently.
- Begin to recognise the clinical utility and also limitations of analytical results.
Attitudes and behaviours
Throughout their training, trainees are given increasing responsibility and independence appropriate for their demonstrated level of competence and professional development, as judged by their clinical and educational supervisors. The purpose of this stage of training is to take such graded responsibility further, to enable the transition to the independent practice required of an FRCPath holder.
Demonstration of the skills required for independent practice is a requirement of the curriculum, and the relevant competencies must be assessed and achieved prior to completion of the training programme.
Currently, the most appropriate context in which to train for and achieve the competencies for independent practice is out-of-hours working, in an ‘on-call’ setting. However, there may be practical alternatives to this training context. If a training programme does not offer the opportunity to develop and demonstrate these skills through out-of-hours working, there must be alternative arrangements agreed by the relevant individual overseeing training.
Since the trainee will have reduced supervision during this form of training, to ensure patient safety and to optimise the benefits of this training, the following criteria must be met before it starts:
- the trainee must have been assessed by clinical and educational supervisors to be capable of safe practice with reduced supervision in relevant areas of the curriculum. They must therefore be in full compliance with the educational processes of the Annual Progression Review, i.e. ready to start more independent practice.
- before starting this training, the trainee must have a formal induction to ensure that they are familiar with the aspects of the work to be performed. This induction must be relevant to the time at which the work is to be performed, and for the organisations for which it is to be performed. It will include relevant local policies.
- the supervisor must ensure that the trainee understands the professional obligations of this form of practice, including availability and confidentiality
- the trainee must have demonstrated to clinical and educational supervisors through previous directly supervised practice, competence in managing common clinical and laboratory problems of the kind likely to be encountered in the clinical biochemistry service, relevant to the setting in which the trainee will undertake this form of practice.
- arrangements for ‘handover’ of clinical responsibility during this form of practice must be explicit.
Arrangements for cover by clinical supervisor
The ultimate responsibility for the quality of patient care and the quality of training lies with the clinical supervisor. However, the trainee will be expected to exercise professional judgement in recognising the limits of their capabilities and in involving senior colleagues in complex or challenging issues/decisions. The arrangements for obtaining such help and advice, at any time during this training period, must be formal and explicit. Although the purpose of this training is to enable independent working, the trainee must not be discouraged from asking for help from a clinical supervisor during this period at any time.
After a period of independent practice, the trainee must be debriefed by the clinical supervisor. The purpose of this debrief is to ensure that patients are being managed safely, and that prompt feedback is provided on the trainee’s performance against the relevance competencies for this form of training (see below) and other competencies in the curriculum. The debriefing session may take the form of ‘handover’ to colleagues.