Since many of the complex cases in uro-dynamics are neurological in origin, by the end of this module the Clinical Scientist in HSST must be able to critically analyse and synthesise their understanding, apply their knowledge in the clinical setting and demonstrate the initial clinical assessment of the patient presenting with symptoms and signs suggestive of neurological bladder dysfunction. They will also be able to recognise, deliver and report on the appropriate physiological test to address the findings from initial clinical assessment and apply a detailed knowledge of management options available to the supervising clinician based on the investigative findings, whilst critically evaluating their own response to both normal and complex situations using the professional attributes and insights required of a Consultant Clinical Scientist.
Knowledge and understanding
By the end of this module the Clinical Scientist in HSST will be able to analyse, synthesise and critically apply their expert knowledge with respect to neuro- urology including the:
- neuro-anatomy and neuro-physiology relevant to the lower urinary tract, including: how neuro-anatomy relates to normal and abnormal bladder, urethral and pelvic floor function. Both sensory and motor pathways are included here.
- urodynamic manifestations of common neurological diseases or injuries including:
- multiple sclerosis.
- spinal cord injury or compression.
- spina bifida.
- Parkinson’s disease.
- investigation and treatment of the complications of neurological bladder dysfunction, for example, recurrent urinary tract infections, bladder calculi and sexual dysfunction.
- physiological investigations appropriate for assessing the disorders above
- possible management options for common neuro-urological disorders including:
- intra-vesical botulinum toxin treatment.
- augmentation cystoplasty.
- sacral nerve stimulation.
- artificial urinary sphincter insertion.
- urinary diversion.
- urinary catheterisation including intermittent self-catheterisation.
Technical and clinical skills
By the end of this module the Clinical Scientist in HSST will be able to demonstrate a critical understanding of current research and its application to the performance and mastery of the following technical skills appropriate to delivery of the physiological investigations above including:
- calibration of equipment used for physiological measurements in neuro- urology
- aseptic technique.
- test preparation.
- performance of each investigation.
- cleaning, disinfection and sterilisation.
- quality control/quality assurance
By the end of this module the Clinical Scientist in HSST will be expected to critically reflect and apply in practice a range of clinical and communication skills to advise and communicate effectively with patients, relevant clinicians and other healthcare professionals and will:
- recognise the particular difficulties experienced by patients with concomitant neurological disease placing particular emphasis on the practical difficulties associated with carrying out invasive and undignified physiological measurements.
- take appropriate clinical history and critically assess the clinical question.
- make appropriate decisions about specialist investigations.
- explain and justify the rationale for the investigation, its risks and benefits to the patient or carer, using appropriate language or communication with respect to the cognitive abilities of the patient.
- obtain written informed consent or assent.
- interpret clinical data.
- produce diagnostic quality clinical reports.
- reflect on the challenges of applying research to practice in relation to these areas of practice and suggest improvements, building on a critique of available evidence.
Attitudes and behaviours
By the end of this module the Clinical Scientist in HSST will be expected to critically evaluate their own response to both normal and complex situations consistently demonstrating the professional attributes and insights required of a Consultant Clinical Scientist working within the limits of professional competence referring as appropriate to senior staff and will:
- maintain the highest standards of professional behaviour including a prioritisation of the patient’s dignity during intimate examinations.
- work within personal limitations and know when to ask for help, especially with regard to clinical issues.
- use effective judgement and decision-making skills.
- work effectively in a multi-disciplinary team and demonstrate leadership where appropriate.
- apply ethical principles, safety, confidentiality and consent.manage time and prioritise workload e.g. balance urgent and important demands.
- be committed to and support continuous improvement of urodynamic services, with particular reference to auditing practice, evidence based practice, innovation, new and improved technologies.