BASHH

STIFIntermediateCompetency for non-GUM staff

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 & place of work):

• management of male urethral discharge (if working in a Level 2 or 3 service with on-site microscopy)
• bimanual pelvic examination
• management of genital herpes infection

It is anticipated that doctors will aim to achieve all the competencies listed above 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 course. Other theory based STI courses may be considered by the individual clinical trainer for suitable equivalence to the STIF courses 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 sessions 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?

The DH has defined 18 clinical competencies for "more specialised sexually transmitted infection services within primary care". The DH has also 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 is the latest addition to 'The STI Foundation' education portfolio. It has been adapted from the DH toolkit to provide training and assessment within a realistic timeframe of the competencies (including the nine essential) considered to be most practical for non-specialist doctors and nurses providing STI services in a community setting. To achieve training and assessment in all 18 competencies would require a longer clinical attachment within GUM and is aimed at health care professionals running a Level 2 service (see STIFLevel2Competency).

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. Depending on the trainees prior experience in sexual health it will require an average of 10 clinical sessions (40 hours) but less for those with considerable experience and up to 15 clinical sessions (60 hours) for those with little previous experience. It is not 'sitting in with a trainer' or 'doing clinics unsupervised' (ie the trainee should not be doing any unsupervised 'service' work during the sessions.)

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

If the trainee has previously worked in GUM it may be possible to proceed straight to the assessment stage and complete the package in fewer sessions.

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

• A closer link with local GUM Specialists

• Accreditation with BASHH through 'The STI Foundation' and receipt of a Certificate of 'competence'

How much will it cost?

Funding for the training needs to be identified in advance of training arrangements being made. Training will usually be commissioned by the Primary Care Trust (PCT) but may also be paid for by an individual Practice or privately funded. The trainer will need to be supernumerary whilst training and assessing. The pilot established that, on average, only 3-4 patients were seen per clinical session which has significant cost implications. Precise costs of clinical training will need to be negotiated locally, either in terms of income lost or cost of locum cover. GUM services will have different constraints with respect to staffing, time and clinical space so it is not possible to recommend one set cost but loss of income by Payment by Results (PBR) can be most universally applied.

Costs

• The 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).
• The local course fee reflects the intensive nature of the training and assessment package. Below is a crude guide to facilitate the calculation of local training costs;

Income lost

• In a standard four-hour clinic, 7-8 patients are seen.
• In a training session only 3-4 patients will be seen. This equates to a loss of income equivalent to 4 patients (2 new; 2 follow-up) which, using the 2009-10 PBR Tariff, is £450 (excluding Market Forces Factor {MFF}) lost income per training clinic. This is £4500 for the complete program, for a trainee taking 10 sessions.
• A proportion of PBR has to be attributed to direct patient costs (eg tests/treatment/supplies) therefore to calculate costs of training in terms of income lost for staff time, administration and overheads would equate to approximately 50% of PBR tariff (new and follow up).
• An estimated cost of training for 10 sessions would be £2250 (excluding MFF)

Costs	£
Central Registration Fee to BASHH	175 / 125* (& VAT)
Local Course Fee (for 10** sessions)	2250 (excluding MFF)
Total cost of training (for 10** sessions)	2425 /2375* (excluding MFF & VAT on BASHH fee)

*If trainee is BASHH member

**As this is competency based training the number of sessions required may be different for each trainee (10 is average)

Charge for backfill

This is the cost of locum cover used, which may include the following:

• eg Specialty Doctor/Locum Consultant x 10 sessions plus extra for advertising etc.
• Additional administrative time (sorting out honorary contracts, CRB checks, arranging sessions)
• Trainer preparation time
• Overheads (15-20%)

What to do next?

It may be helpful to look at the Flow Chart now.

i: Trainees

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 local GUM clinic to arrange training and identify a clinical trainer. An up-to-date list of registered trainers is available from the STIFIntermediateCompetency section of the BASHH website. If no one from your local GUM clinic appears on the list of registered trainers you may contact them directly to see if they are prepared to register and provide training. You will also need to identify funding for your training either privately or from your PCT or place of practice.

NB: Nurses who wish to register can be supervised by either a medical or a nurse consultant. If there are no nurse consultants in your local GUM unit, 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 with BASHH using the form below. Alternatively, your training can be supervised by a medical consultant alone.

You should agree a potential start date with your trainer (suggest leaving at least 6 weeks to allow for making practical arrangements). As soon as you have found a clinical trainer and secured appropriate funding, 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.

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 (please look in the Trainee section):

• Flow chart of STIFIntermediateCompetency process for non-GUM trainees
• Learning Needs Assessment Questionnaire
• User Guide to STIFIntermediateCompetency training: Notes for non-GUM Trainees
• 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 with the consultant. Alternatively 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 the above 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 non-GUM trainees
• User Guide to STIFIntermediateCompetency training: Notes for Clinical Trainers whose trainees work in non-GUM settings
• 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 a GP, community nurse, Reproductive & Sexual Health doctor or nurse, who has done a STIF theoretical course, and wishes you to provide clinical competency training & act as their Named Clinical Trainer, you should:

• check that they fulfil the knowledge & skills required (see table above)
• ensure that funding has been identified prior to making any arrangements
• ensure they register with BASHH STIF administration & agree a potential start date with them (suggest leaving at least 6 weeks to make practical arrangements)

If you wish to provide STIFIntermediateCompetency training for nurses working within your own GUM Department, please click here

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).