Obstetrics and Gynaecology CESR Portfolio Guide

Facilitates discussion, Able to take history, Ability to facilitate women’s decision making, Provides treatment

• Uses empathy, respect and compassion when communicating with a patient to build trust and independence and establish patient-centred management plan
• Modifies their approach to the patient when cultural background or personal values may have an impact on engagement and care
• Recognises limitations and escalates care where appropriate
• Demonstrates ability to deal with complex situations including drug contra-indications and side effects
• Determines responsibility for follow up and can make referrals for complex cases
• Works effectively within a multi-professional team to meet the needs of the individual
• Creates the conditions for informed consent to be given, explaining the risks and benefits of, or the rationale for, a proposed procedure or treatment

Aware of healthcare systems and digital environment, Aware of and adheres to legal principles and professional requirements, Aware of ethical principles, Participates in clinical governance processes

• Follows GMC guidance on professionalism and confidentiality (Adheres to GMC Good Medical Practice)
• Understands the principles of data governance and the legislation around data protection and maintains an appropriate digital persona
• Understands the NHS constitution and the interactions with social care
• Demonstrates an awareness of budget and resource management
• Understands the human rights principles and legal issues surrounding informed consent and respectful care– including key legal rulings
• Understands ethical principles and how these underpin practice and acts professionally in difficult ethical situations
• Understands the principles of and participates in incident investigations and links recommendations to quality improvement.
• Discloses harmful patient safety incidents to patients and their families accurately and appropriately (exercises within the Duty of Candour)
• Demonstrates humanity and empathy for both first and second victims of adverse incidents
• Demonstrates awareness of areas of conscientious objection in themselves, their colleagues and their patients is able to respect diverse viewpoints while continuing their duty of care to the woman/patient.

Comfortable influencing and negotiating, Effective use of resources for time management and managed stress and fatigue, Demonstrates insight, Understand human behaviour when leading a team and manages conflict

• Evaluates own preferred negotiation style, handles a variety of negotiation challenges. Understands and is able to secure and consolidate agreements
• Understands the challenges and negative effects of conflict within teams and organisations and implements the methods and tools used to manage conflict and its resolution
• Understands the basic principles and importance of emotional intelligence
• Reflects on own leadership style and how this can impact on patient and colleague interactions. Continues to enhance leadership skills and demonstrates the ability to adapt leadership style to different situations
• Understands stress, its impact on personal and team wellbeing and its potential effect on delivering high quality patient care
• Develops personal strategies to maintain/improve mental strength and resilience
• Can prioritise effectively and can demonstrates effective time management in clinical settings
• Effectively delegates tasks to other members of the multiprofessional team

Understands quality improvement (quality is safety, experience and efficacy), Undertakes and evaluates impact of QI interventions

• Understands the difference between quality improvement and research.
• Understands QI methodology such as Plan, Do, Study, Act cycles (PDSA)
• Understands the concepts of big data and national clinical audit
• Appreciates the importance of stakeholders in QI work encouraging involvement with patient groups e.g. Maternity Voices Partnership
• Is actively involved in QI initiatives (examples include: clinical audit, guideline development, implementation of national guidance, service improvement)

Maintains situational awareness, Demonstrates insight and decision making, Ability to respond to human performance within adverse clinical events, Team-working, Understands systems and organisational factors

• Understands and applies the techniques as a team and an individual to maintain situation awareness in safety-critical environments
• Demonstrates insight into own decision-making process
• Can review and analyse the decisions of others
• Reflects on unconscious bias which may influence human interaction and behaviour
• Demonstrates knowledge and effects of various types of human error/violations on outcomes
• Understands team working in complex dynamic situations and ability to adapt to changing teams
• Demonstrates appropriate assertiveness and challenges constructively
• Reflects on breakdowns in team working and communication
• Recognises how equipment and environment contribute to outcomes and patient safety

Demonstrates a commitment to continued learning, Develops people and provides pastoral care, Promotes excellence and demonstrates performance management, Provides support to second victims

• Implements SMART personal development plans to enhance and progress professional practice
• Acts as a supportive colleague and critical friend and encourages career development in others
• Understands concepts of formal mentoring and coaching
• Demonstrates an awareness of the characteristics of a colleague in difficulty, supporting and guiding them using the processes which exist within the NHS
• Sensitively debriefs after an adverse incident with an awareness that traumatic events may lead to psychological effects which may need professional intervention and support
• Understands the importance of signposting colleagues to psychological support services either through employer or doctors support service
• Understands the use of competency frameworks as a performance management and development tool

Demonstrates research skills, Demonstrates critical thinking, Innovates, Translates research into clinical practice

• Understands principles of healthcare research and different methodologies
• Understands and applies the principles of ethics and governance within research
• Performs literature searches, interrogates evidence and communicates this to colleagues and patients
• Critically evaluates arguments and evidence
• Can communicate and interpret research evidence in a meaningful, unbiased way to support informed decision making
• Understands the value of failure in innovation
• Engages with emerging diagnostic and treatment options.
• Is able to communicate to the patient the balance of risks and benefits of carrying out clinical treatment and uncertainty.
• Is able to appropriately interpret and communicate the results of, and understand the differences between, screening and diagnostic tests for an individual.
• Applies their knowledge of Mendelian inheritance, multifactorial inheritance, chromosomal abnormalities and genomic medicine to an individual and their healthcare options.

Delivers effective teaching, Embraces inter-professional learning, Supervises and appraises

• Plans and delivers effective learning strategies and activities
• Promotes a safe learning environment and ensures patient safety is maintained
• Understands techniques for giving feedback and can provide it in a timely and constructive manner
• Evaluates and reflects on the effectiveness of their educational activities
• Facilitates and participates in interprofessional learning
• Commits to learning from patients
• Contributes towards staff development and training, including supervision, appraisal and workplace assessment
• Demonstrates ability to act as a Clinical Supervisor
• Understands the appraisal and revalidation process

Manages acute pelvic pain and vaginal bleeding in the non-pregnant woman, Manages acute infections and acute complications of gynaecological treatment, Manages vaginal bleeding and pain in early pregnancy and other early pregnancy complications, Manages the acute gynaecological workload

• Performs a focused history, appropriate examination and orders appropriate investigations.
• Formulates a differential diagnosis.
• Discusses diagnosis in a sensitive manner.
• Formulates an appropriate individualised management plan taking into account a person’s preferences and the urgency required.
• Recognises limitations and escalates care to senior colleagues and other specialities when appropriate.
• Performs surgery where appropriate.
• Ensures continuity of care, effective handover and appropriate discharge plan.
• Ensures appropriate risk management procedures are undertaken
• Demonstrates understanding of the psychological impact of pregnancy loss. Is able to communicate bad news sensitively and effectively, and offer and initiate bereavement support.
• Is able to delegate appropriately to other members of the team.
• Is able to prioritise and escalate acute gynaecological workload according to clinical need
• Demonstrates prompt assessment of the acutely deteriorating patient.
• Is able to give a gynaecological opinion for another specialty.
• Makes safeguarding referrals where appropriate.

Manages pain and bleeding in the obstetric person, Manages suspected preterm labour/ruptured membranes, Manages labour, Manages emergency birth, Manages immediate postpartum problem, Manages concerns about fetal wellbeing prior to labour, Manages intrapartum fetal surveillance, Manages labour ward, Manages maternal collapse and people who are acutely unwell in pregnancy

• Performs focused history, appropriate examination and orders appropriate investigations
• Establishes maternal and fetal wellbeing
• Formulates a differential diagnosis
• Discusses diagnosis in a sensitive manner
• Formulates an appropriate and individualised management plan taking into account patient preferences and the urgency required
• Demonstrates awareness of the risk factors for the morbidly adherent placenta.
• Understands the referral pathways when a morbidly adherent placenta is suspected.
• Aware of additional issues at extremes of viability including ethical concerns and additional therapies which may be of benefit
• Shows awareness of how to manage preterm labour when a cervical suture is present.
• Appropriately assesses concerns regarding fetal movements
• Demonstrates the skills to use ultrasound to locate the fetal heartbeat.
• Demonstrates the skills to use ultrasound to confirm the loss or death of a baby.
• Discusses the diagnosis in a sensitive manner and recognises in cases where a baby has died the psychological impact on an individual and their family including offering post mortem examination and taking informed consent.
• Is able to sensitively discuss management options where the death of a baby has occurred
• Can provide a supportive environment and signpost to relevant support services for an individual and her partner who have suffered the loss of a baby
• Demonstrates understanding of the physiology of labour
• Is aware of situations where labour may be more complex such as multiple pregnancy
• Uses history and clinical signs to anticipate possible problems
• Can formulate safe management plans taking into account the woman’s preferences
• Can succinctly explain management plans to women and birthing partners
• Discusses options for pain relief in labour
• Can use intrapartum fetal surveillance strategies to help assess risk
• Can recognise abnormal fetal heart rate patterns, perform and interpret related tests
• Communicates concerns effectively and sensitively with colleagues, women and birthing partners
• Can formulate safe management plans for induction and augmentation taking into account the woman’s preferences
• Can recognise when birth may need to be expedited
• Communicates concerns and recommendations effectively and sensitively with colleagues, women and birthing partners
• Formulates an appropriate and individualised management plan taking into account patient preferences and the urgency required
• Demonstrates the skills needed to facilitate safe operative birth
• Plans for birth with non-cephalic presentation, including breech.
• Plans for birth with variations in fetal position, including occiptio posterior (OP).
• Demonstrates the skills needed to use ultrasound to confirm fetal presentation and lie.
• Demonstrates the skills needed to use ultrasound to confirm fetal position, including OP.
• Demonstrates skills in managing problems arising immediately postpartum
• Demonstrates the skills needed to manage problems in the immediate postpartum period, including physical and mental health.
• Can demonstrate knowledge of what constitute signs of life.
• Demonstrates the skills needed to use ultrasound to assess the postpartum uterus.
• Demonstrates the skills needed to assess, classify and manage birth and pregnancy-related pelvic floor dysfunction and perineal trauma, including obstetric anal sphincter injuries (OASI).
• Demonstrates the ability to debrief women and their families in the postnatal period.
• Discusses and prescribes appropriate pain relief.
• Demonstrates prompt assessment of acutely deteriorating patient
• Performs procedures necessary in emergency situations
• Escalates to senior colleagues and other specialities
• Recognises and manages sepsis in pregnancy.
• Escalates to senior colleagues and demonstrates the skills needed to collaborate with other specialities.
• Demonstrates leadership skills within the multidisciplinary team, anticipating problems, prioritising and managing obstetric care
• Recognises limitations and escalates care to senior colleagues and other specialities when appropriate
• Ensures continuity of care, effective handover and appropriate discharge plan
• Manages complex problems, including liaison with, and referral to, other specialties where appropriate
• Demonstrates the skills to sensitively explain unexpected events of labour and birth and anticipates where later debrief may be necessary

Manages abnormal bleeding, Manages pelvic and vulval pain and pelvic masses, Manages pain in the postoperative patient, Manages the abnormal cervical smear, Manages suspected gynaecological cancer symptoms, Manages urogynaecological symptoms, Manages menopause and postmenopausal care, Manages subfertility, Manages sexual wellbeing

• Performs focused history, appropriate examination and orders appropriate investigations.
• Formulates a differential diagnosis.
• Discusses diagnosis in a sensitive manner and recognise the psychological impact of condition
• Formulates an appropriate and individualised management plan taking into account patient preferences and the urgency required.
• Recognises limitations and escalates care to senior colleagues and other specialities when appropriate.
• Performs surgery where appropriate.
• Ensures appropriate follow up.
• Demonstrates awareness of the quality of patient experience.
• Demonstrates the ability to assess the postoperative patient and makes sure they have adequate/optimum analgesia.
• Recognises non-gynaecological causes of pain.
• Demonstrates the ability to manage pain due to common gastrointestinal and urological conditions and to counsel a patient appropriately.
• Recognises when the patient with postoperative pain requires referral to other specialties.
• Demonstrates ability to counsel about cytology reports and HPV testing.
• Refers to colposcopy services in accordance with national guidelines.
• Demonstrates knowledge of when referral to a tertiary gynaecological oncology centre will be required.
• Can counsel about surgical and non-surgical treatment options, taking into account the individual woman’s background health and preferences.
• Ensures appropriate follow up in line with national guidance.
• Can counsel about surgical and non-surgical treatment options, taking into account the individual woman’s background health and preferences.
• Ensures appropriate follow up.
• Demonstrates awareness of the quality of patient experience.
• Recognise common vulval disorders
• Recognise when to refer to allied specialties and the importance of the multidisciplinary team
• Formulates an appropriate and individualised management plan taking into account patient preferences including complimentary therapies and lifestyle modifications.
• Appreciates the impact that the menopause may have on other aspects of wellbeing.
• Is able to interpret results in order to plan effective care and counsel about management options, including local referral pathways and alternatives for conceiving.
• Understands the ethical issues surrounding IVF treatment.
• Offers advice regarding all contraceptive methods and understands the factors affecting choice of contraception, including comorbidities, patient preference, failure rates, etc.
• Demonstrates ability to administer/fit different contraceptive methods
• Demonstrates the ability to manage unplanned pregnancies (including medical and surgical abortion)
• Is aware of alternative sources of support and follow-up for patients, particularly in cases of unplanned pregnancy and termination of pregnancy.
• Offers sexual health screening advice and provides appropriate referral to genitourinary medicine (GUM) services for management of sexually transmitted infections.
• Identifies psychosexual problems, explores and can initiate referral to specialist services where available.
• Recognises the interactions between gynaecological problems and psychosexual problems.

Manages medical conditions including pre-existing conditions in pregnant women, Manages fetal concerns, Supports antenatal decision making, Manages the postnatal period, Manages mental health conditions in pregnancy and the postnatal period, Manages complications in pregnancy affected by lifestyle

• Demonstrates ability to discuss concerns and clinical uncertainties in a sensitive manner.
• Demonstrates knowledge and ability to work within local clinically managed networks.
• Effectively estimates risks to advise and inform decision making for individuals and their families.
• Identifies risk factors relating to previous pregnancy outcomes and advises women on best current practice to mitigate risk.
• Can advise pregnant people on the potential impact of the mode of birth and intrapartum interventions on general and pelvic floor health.
• Supports decision making for the pregnant person and their family when a fetal anomaly is identified.
• Demonstrates the ability to provide preconception advice to women and sensitively discuss risks during pregnancy to create tailored management plans with liaison with other specialties where appropriate.
• Identifies, assesses and manages pre-existing physical and mental health conditions in a pregnant or postnatal woman.
• Demonstrates the ability to recognise when conditions related, and unrelated, to pregnancy develop.
• Offers screening for, and treatment of, maternal infections that can affect fetal wellbeing and development.
• Identifies, assesses and manages both pregnancy-specific and non-specific conditions, and considers the impact on both maternal and fetal health.
• Prepares and plans the different options for the birth of a baby in the breech presentation, including using External Cephalic Version (ECV).
• Facilitates timely and appropriate investigation, management and referral to tertiary centres if required
• Demonstrates an ability to obtain a focused history, undertake an appropriate examination and order a clinically indicated investigation.
• Demonstrates ability to effectively and sensitively screen for mental health concerns arising in pregnant people.
• Demonstrates ability to formulate the initial diagnosis and management of mental health conditions with appropriate liaison and involvement of mental health services.
• Manages perinatal mental health emergencies in the antenatal and postnatal period effectively.
• Understands the impact that birth, birth trauma and adverse outcomes may have on future mental health and is able to signpost women and their families to support services
• Understands the significant impact that lifestyle factors may have on maternal and fetal health.
• Sensitively enquires about lifestyle factors to facilitate disclosure.
• Understands and demonstrates ability to manage pregnancies where lifestyle factors cause complications.
• Uses support services appropriately according to local provision and taking into account the wishes of the woman and the needs of the fetus/neonate.
• Demonstrates ability to sensitively debrief women and their families after an unexpected birth experience or when a baby is admitted to the neonatal unit.
• Advises on the impact of events in this pregnancy on future health and pregnancies.
• Demonstrates ability to discuss and advise on postnatal contraception and administer/fit different contraceptive methods
• Uses support services appropriately according to local provision, taking into account the wishes of the woman and her family.
• Ensures effective handover and discharge to primary care
• Demonstrates the ability to obtain a focused history, undertake an appropriate physical examination for women who have sustained an OASI and either manage, or refer on to specialist services, for further investigations, management and advice on future mode of birth

Promotes non-discriminatory practice, Aware of broader social and cultural determinants of health, Aware of individual’s social wellbeing, Aware of the interaction between mental health and physical health

• Possesses knowledge of ethical and legal issues and an awareness of the situations where discrimination might occur.
• Recognises how health systems can discriminate against patients with protected characteristics and works to minimise this discrimination and must not allow their personal beliefs to lead to discrimination.
• Adopts patient-centred assessments and interventions that are inclusive and respectful of diversity.
• Is able to perform consultations addressing the specific needs of a disabled person and being mindful that not all disabilities are visible.
• Understands the specific needs of transgender and non-binary individuals and is able to perform consultations and refer appropriately to specialist services.
• Understands the impact of a patient’s social, economic and environmental context on their health.
• Interacts with appropriate patient representatives and engages with colleagues from different professional and personal backgrounds when working in multidisciplinary teams to promote the health of patients and the public.
• Must be aware of and adhere to the legislation regarding certain cultural practices (e.g. FGM, modern slavery) within the UK.
• Takes an appropriate social history to identify any pertinent social issues and can signpost patients to appropriate services.
• Considers the interaction between medical conditions, care and a woman’s broader work and family life.
• Understands that people who care for dependents may face barriers in engaging with healthcare services or as a result have delayed engagement with healthcare providers which could impact on their health
• Understands the principles of safeguarding and their responsibility in protecting people's health, wellbeing and human rights, and enabling them to live free from harm, abuse and neglect.
• Understands how mental health issues can affect a woman’s reproductive health.
• Knows how reproductive health issues can significantly impact on the mental health of a woman and her partner
• Enquires about safety of a woman and her children and is able to act if they have a history of domestic abuse.

Promotes a healthy lifestyle, Promotes illness prevention, Aware of the national and international policies and politics which impact on women’s healthcare, Aware of globalisation of healthcare

• Understands lifestyle factors which impact on short- and long-term health
• Contributes to developments or education in health promotion.
• Understands the concept of screening and has an awareness of and promotes the current national screening programmes in women’s health.
• Knows about the current recommended vaccinations available to protect women and their unborn children.
• Is able to provide balanced counselling regarding illness prevention strategies.
• Is able to challenge and advocate to ensure local service provision equates with national standards
• Is aware of the interaction between the NHS and international healthcare bodies (e.g. the WHO).
• Understands how the increasing movement of people and health migration impacts on health services.
• Is aware of the basic principles of global health
• Provides appropriate lifestyle advice to women in a sensitive manner and facilitates access to useful support or services, e.g. smoking cessation, weight management, pelvic floor health and sexual health
• Is able to inform a patient about the impact of pregnancy and childbirth on their general, sexual and pelvic health and advise on mitigating strategies

Currency Window

Competent summative OSATS should be submitted from the last three years of practise (with the exception of insertion of IUS or IUCD and/or endometrial biopsy and ultrasound which can be from the last five years).

Evidence Volume

usually no more than 1000 pages of evidence