Clinics

 

STIFFIntermedcomp2

STIFIntermediateCompetency for clinical staff working in a Level 3 GUM service

Which competencies will be assessed?

Core competencies:

  • taking a sexual history
  • offering screening for STIs including Chlamydia
  • male & female examination
  • diagnostic testing & interpretation
  • management of female genital discharge
  • management of genital warts
  • offering advice on safer sex
  • effective partner notification
  • HIV testing

Additional optional competencies (assessment dependent on trainee skill & experience):

  • management of male urethral discharge (compulsory if there is on-site microscopy at a trainee's workplace)
  • bimanual pelvic examination
  • management of genital herpes infection

It is anticipated that doctors will aim to achieve all competencies but nurses may not achieve the additional competencies unless they have significant clinical and sexual health experience.

Knowledge & skills required for STIFIntermediateCompetency training

Knowledge/skill

Doctors

Nurses

STIF Core theory course or equivalent*

essential

essential

e-Learning for Healthcare (eLfH) sessions in the Sexual Health & HIV (eHIV-STI) project or equivalent**

essential

essential

STIF Plus theory course*

desirable

desirable

Vaginal speculum examination experience

essential

essential

Bimanual pelvic examination experience

essential

Nurses will not be routinely trained and assessed in this unless they regularly perform it in current practice

* Must have completed STIF theory course in last 3 years (either the 2 day course running between 2002 & 2010 or the newer 1 day STIF Core course with e-learning, running from 2010 onwards). The STIF Plus course forms the optional second day of the new format STIF courses.

An alternative to attending a STIF course is regular attendance at GUM departmental CPD sessions as long as all the areas included in a STIF course are covered. Other theory-based STI courses may be considered by the individual clinical trainer for suitable equivalence to the STIF course eg. University based courses. Advice and clarification for trainers can be sought from the BASHH STIFCompetency group via the BASHH secretariat (bashh@rsm.ac.uk).

**The eLfH sessions recommended for completion for the new format STIF theory course (CLICK HERE to see list of session and how to register for eLfH). It is recommended that these are completed before starting the training and it is required that they are all completed before you can be signed off as competent.

What is the NHS context?

STIFIntermediateCompetency was initially developed for training non-specialist clinical staff based on the 18 clinical competencies defined by the DH for the provision of "more specialised sexually transmitted infection services within primary care". The DH set out the knowledge, skills and attitudes that are required for each competency, and how they should be assessed, in a toolkit which can be found at http://www.dh.gov.uk/ (Gateway reference - 7088) or go directly to http://tinyurl.com/26c7k31. Nine of the 18 competencies are defined as 'essential'.

STIFIntermediateCompetency has now been adapted so that it can be used by nurses and junior doctors working in a Level 3 GUM service. It may be used both as a training and assessment tool or purely as an assessment tool for those that have already completed their departmental induction, have sufficient experience and are working independently in a way commensurate with their role.

What does STIFIntermediateCompetency training involve?

STIFIntermediateCompetency involves intensive and tailored one-to-one clinical training and assessment by GUM specialists within a GUM clinic setting.

Essentially each clinical encounter during the designated clinical sessions is used for either

  • training - in the early stages a trainee may observe the clinical trainer carrying out a consultation or is closely supervised carrying out a consultation or
  • assessment - the trainee carries out a consultation while being assessed by the clinical trainer using mini-Clinical Examination Exercise [mini-CEX] forms

Nurses:

It will be up to individual units to determine precisely how the training is organised. This may also vary depending on the grade and experience of the nurse trainee. For example, if the nurse is already experienced in GUM it may be possible to proceed straight to the assessment stage and complete this fairly quickly (4-5 clinical sessions). For nurses who are new to GUM, STIFIntermediateCompetency can be used to both train and assess them, although we suggest that they should have been in post for a minimum of 3 months before commencing.

Possible models for using the package include carrying out all the assessments in one block (eg one week) or using specifically allocated clinical sessions each week. If the second model is chosen it is advisable to arrange these in advance and there should be an upper limit of 9-12 months from starting the package to finishing it. If it is predicted that the time needed to complete the training and assessment is likely to be longer than this then it is probably too early for the nurse to commence this module.

Junior doctors:

Specific times should be arranged between the trainee and the Named Clinical Trainer when she or he can assess competence in the tasks which need to be completed, using the mini-CEX forms. These can be added onto sessions when the junior doctor is already being assessed for the core curriculum.

What else will STIFIntermediateCompetency training give the trainee?

  • Comprehensive course materials available to download including
    • Learning Needs Assessment Questionnaire
    • A comprehensive assessment pack
  • An understanding of issues specific to
    • men who have sex with men (MSM)
    • young people, including how to assess Fraser competence
  • Knowledge and experience on the following as they relate to sexual health:
    • Legislation, regulations & guidelines
    • Infection control, screening programmes & databases
    • Referral pathways
  • Accreditation with BASHH through 'The STI Foundation' and receipt of a certificate of 'competence'

How much will it cost?

There is a central registration fee of £175 (& VAT) per trainee to BASHH to cover all course materials and administration - this has to be paid up front through the on-line registration process. If you are a BASHH member the cost is reduced to £125 (& VAT). If your assessment is being undertaken in your place of work there should not be additional charges for the training.

What to do next?

It may be helpful to look at the Flow Chart now

i: Trainees

Doctors: If you fulfil the knowledge and skills required to register for STIFIntermediateCompetency training (see table above) you should discuss registering with your educational supervisor and identify a GUM consultant who can be your Named Clinical Trainer (this may be the same person as your educational supervisor). They will need to register to be a trainer with BASHH using trainer registration form below. You should then complete a 'Registration for Clinical Competency Training form ' on the website.

Nurses: If you fulfil the knowledge and skills required to register for STIFIntermediateCompetency training (see table above) and wish to do so, you should approach your manager to discuss this. As this is something you will be doing in work time it is vital that you have their explicit support. You will also need to identify someone to be your Named Clinical Trainer. This person needs to be a medical or nurse consultant in GUM. If there are no nurse consultants in your unit, you should discuss this with your manager and one of the medical consultants in your unit. Your training can be supervised either by a medical consultant alone or the responsibility for training can rest jointly with a medical consultant and a senior GUM nurse nominated by that consultant, with ultimate responsibility lying with the medical consultant. In these circumstances, the medical consultant will be your Named Clinical Trainer and needs to register to be a trainer using the trainer registration form.

You should agree a potential start date with your trainer and then complete a 'Registration for Clinical Competency Training form ' on the website.

NB: When you register you will be asked for payment by credit or debit card. Once you have paid, an automatic email will be generated confirming your transaction is completed. If this does not arrive in a timely manner please check it has not gone into your Spam or Junk mail box. To avoid this please consider adding bashh@rsm.ac.uk to your address book.

Once registered your details will be logged on the STIFIntermediateCompetency database and the BASHH STIF administrator will email you an introductory letter with your username & password. Using these you can access the following training documents on the STIFIntermediateCompetency section of the BASHH website (http://www.bashh.org/stif_ic - please look in the Trainee section):

  • Flow chart of STIFIntermediateCompetency process for GUM trainees
  • Learning Needs Assessment Questionnaire
  • User Guide to STIFIntermediateCompetency training: Notes for Trainees working in Level 3 GUM services
  • Mini CEX forms and sign-off forms for each of the Tasks to be assessed
  • Confirmation of Competence Proforma
  • Department of Health Assessment Toolkit: Competencies for providing more specialised sexually transmitted infection services within primary care. (http://www.dh.gov.uk/ - Gateway ref: 7088 or http://tinyurl.com/26c7k3)
  • Trainee evaluation questionnaire

ii: Named Clinical Trainers

To register as a Named Clinical Trainer, you need

  • to be a member of BASHH
  • to be a medical or nurse Consultant in GUM/Sexual Health & HIV
  • to have had training in the correct use of the assessment tools (i.e. mini-CEX forms and Case-based Discussion). This training is available for doctors in all deaneries and many trusts.

Named Clinical Trainers, who are medical consultants, must have completed this training and are responsible for ensuring that other trainers in their centres are competent to use the assessment tools.

Nurse consultants must have completed an NMC approved Mentorship course and be able to show evidence of recent updates and should be shown the correct use of the assessment tools by medical consultant colleagues.

If you are a medical consultant and a nurse approaches you to be their Named Clinical Trainer (because there is no nurse consultant in your unit), the responsibility for training can rest jointly with you and an appropriately senior GUM nurse in your unit. Alternatively, you alone can supervise the trainee. If you share the training with a senior nurse, they can be responsible for most of the day-to-day work of organising and carrying out the training & assessment of the trainee. The ultimate responsibility however, for signing the trainee off as competent will rest with you. The senior nurse who you nominate must be competent in all the areas covered by the STIFIntermediateCompetency training & assessment package with the possible exception of pelvic bimanual examination. To ensure competence, the senior nurse may want to go through the training & assessment package themselves or they should be working independently in your unit and be able to carry out competently all the tasks assessed in the training package.

If you fulfil these requirements, you can register as a Named Clinical Trainer now by completing this Trainer Registration form. Your name will then appear on a list which will be available in the STIFIntermediateCompetency section of the BASHH website. In addition, you will be sent a user name & password. Using these you can access the following training documents on the STIFIntermediateCompetency pages of the BASHH website (www.bashh.org/stif_ic) in the Clinical Trainers section:

  • Flow chart of STIFIntermediateCompetency process for GUM trainees
  • User Guide to STIFIntermediateCompetency training:
    • Either 'Notes for Clinical Trainers whose trainees are Level 3 GUM nurses' or
    • Or 'Notes for Clinical Trainers whose trainees are Level 3 GUM junior doctors'
  • Mini CEX forms & sign-off sheets for each of the Tasks to be assessed
  • Confirmation of Clinical Competence Proforma
  • Department of Health Assessment Toolkit: Competencies for providing more specialised sexually transmitted infection services within primary care. (http://www.dh.gov.uk/ - Gateway ref: 7088 or go directly to http://tinyurl.com/26c7k3)
  • Clinical Trainer Evaluation Questionnaire

Alternatively you can register when someone approaches you to be their Named Clinical Trainer.

If you are approached by one of your own staff (nurse or junior doctor) who wishes you to provide clinical competency training & assessment and to act as their Named Clinical Trainer, you should:

  • check that they fulfil the knowledge & skills required (see above)
  • ensure they register with BASHH STIF administration & agree a potential start date with them

Contact us

If you have any further queries or comments, please send an e-mail to the STIFCompetency working group via the BASHH secretariat at bashh@rsm.ac.uk.

Reference

  1. Competencies for providing more specialised sexually transmitted infection services within primary care. Assessment toolkit. 2006, Department of Health (http://www.dh.gov.uk/; Gateway reference - 7088).