Training in General Medicine at Kettering General Hospital

Kettering General Hospital

Kettering General Hospital NHS Trust is a 590 bedded associate teaching hospital serving the north end of the county of Northamptonshire. It has a very wide catchment area encompassing a population of 330,000 and offers services in all of the acute medical specialties. The patient demographics comprise an interesting mixture of town and countryside in addition to its London commuters and consequently there are a wide and diverse range of clinical cases that present to the Hospital.

As part of the Leicestershire, Northamptonshire and Rutland Strategic Health Authority, Kettering has well-developed links with Leicester Medical School, receiving medical students, pre-registration house officers and rotational SpRs from both South Trent and Oxford.

Accommodation is generally available on site and there is an active Doctors Mess and social club within the hospital.

Kettering has very strong road and rail links in addition to its excellent leisure facilities which makes it a popular place to live and work. London is only 60 minutes away by train and there are three international airports within an hours drive.

Core Medical Training at Kettering General Hospital

Kettering has been a popular choice for medical trainees for many years due to its friendly atmosphere and good track record with the MRCP exam, many former trainees returning to the Trust subsequently as senior trainees or Consultants.

We have used the introduction of MMC to design a Core Medical Training program that will provide trainees with a broad range of skills and experience to enable them to confidently progress to higher specialist training. The rotations thus contain a good mixture of the essential medical specialties with two of the rotations offering the further possibility of gaining valuable experience of Emergency medicine. These posts would be especially suited to trainees wanting to enter acute medicine which ties in well with the new Kettering training scheme in acute medicine starting in 2007.

Medical Trainees at Kettering operate within a ‘firm’ based structure which is exclusively ward based, each ward accepting its own specialty based patients and also general medical patients. Each firm has a full complement of senior and junior trainees according to the number of beds covered. Firms are only responsible for patients on their own wards with the exception of patients transferred to ITU.

For all firms, normal daily work will include attendance at Consultant ward rounds which occur on a daily basis on all wards and continuing care of all inpatients under the care of the firm. Additionally, trainees are encouraged to attend the outpatient department whenever possible. All firms participate in the on call rota.

The firms at present are as follows

Consultants : Dr N Shaukat, Dr J Cullen, Dr K Hogrefe, Dr S Nishtar (Associate Specialist)

There are currently 13 juniors on this firm including 2 FY1 trainees.

Duties include the day-to-day care of inpatients on the cardiology ward and coronary care unit and attending the cardiology outpatient clinic. There is a ‘consultant of the week’ system in place with regard to the Coronary Care unit and referrals and there is a daily coronary care ward round with ample opportunity for teaching. There is a busy permanent pacing programme with over 200 device implants per year, on up to 3 lists per week and a very active Cardiac Investigation department, including echocardiography, 24 ambulatory monitoring stress testing. Dr's Cullen, Shaukat and Hogrefe are all fully trained Interventionists and percutaneous coronary intervention and angiography will be performed on site at Kettering from 2007.

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Chest Medicine: Dr S F Hussain, Dr A Sattar, Dr A Al-Aidi

There are currently 11 trainees supporting this firm including 2 higher specialist trainees, 2 FY1 and 1 FY2 trainees

Based on the respiratory unit this firm offers a wide exposure to respiratory medicine with excellent teaching opportunities. The unit is fully supported by respiratory technicians and specialist nurses. There is extensive use of community outreach teams to enable rapid but safe discharge of patients. The recently opened NIV beds offer a useful opportunity to gain experience in non-invasive ventilation.

There is a close liaison with the community TB team and weekly multidisciplinary lung cancer meetings

Gastroenterology Firm: Dr A P Chilton, Dr A Hussain, Dr A Steel

Currently supported by 12 junior staff including 3 Higher Trainees, 2 FY1 and 1 FY2 trainees, this 44-bedded unit covers all aspects of gastroenterology and hepatology and includes GI bleed beds.

There is an excellent opportunity to gain hands on experience in the management of acute GI and hepatological emergencies as well as the ample exposure to ambulatory GI services. The aim of the unit is to provide a balance between service and professional development with the aim of grounding trainees in the delivery of evidence-based care. Core objectives will be set against which the trainee development will be measured. The trainee will provide care for patients in a multidisciplinary environment in which teamwork is essential. We aim to provide the tools for growth in the deliver of modern health care.

There is a very busy endoscopy unit providing a range of therapeutic and diagnostic work. There are weekly multidisciplinary meetings and GI clinical meetings.

Care of the Elderly / Stroke Unit : Dr I M Hubbard, Dr K Ayes, Dr Das

This firm is supported by 11 trainees including trainees in Renal Medicine and rheumatology. The Care of the Elderly and Stroke wards were newly opened in 2006 and offer different specialised areas of training, mainly in general medicine, geriatrics, movement disorders and stroke medicine. The placement offers additional opportunity to gain valuable experience in the rapid access neurovascular clinics, the rapid response stroke service and further training opportunities in the Parkinson’s clinics and falls.

Endocrinology and Diabetes: Dr G N Clifford, Dr K Rizvi

This firm contains 7 trainees including 1 higher specialist trainee, 1 FY1 and 1 FY2.

The unit offers specialist care to patients with predominantly diabetic or endocrine problems and also admits day-case patients for dynamic endocrine testing. Attendance at outpatients is encouraged and there are regular radiology and pathology meetings where interesting cases can be discussed.

Emergency Medicine: Dr S McMorran, Dr A Dancocks, Dr R Thamizhavell

The medical staffing comprises three Consultants, 1 Associate Specialist, 8 Middle Grade doctors, and 11 SHOs including 2 FY2 posts.

Based in close proximity to the Medical Assessment Unit, the A&E department offers excellent training in Emergency Care with a fully staffed and supported unit. The department has a five-bedded Resuscitation room, a separate Trauma room and its own Observation Unit. There is an established ENP service which assists in the assessment and management of patients presenting with minor injuries. The department is committed to teaching and offers a weekly protected teaching programme. Support for CT scanning is provided on a 24-hour basis by a supportive radiology department.

There are good links with other departments and an integrated medicine/A&E quarterly teaching programme.

On Call Medicine

The medical take at Kettering General Hospital is unselected and Consultant led with a very high turnover. Typically about 40% of patients referred to the medical take are assessed, investigated, treated and discharged within the confines of our Medical Assessment Unit without ever having to be admitted to an acute medical ward.

This efficiency has been developed through close liaison with the pathology and radiology departments who prioritise work from the Medical Assessment area.

GP admissions are admitted directly to our newly built clinical decisions unit where the on-call medical team is supported by our extremely competent and highly skilled nurse practitioners. Senior help is available from the Consultant of the day and this results in a very high discharge rate. There is a very close liaison between medicine and A&E and with the use of combined documentation the junior medical staff are able to avoid duplication of paperwork enabling them to devote more time to the educational side of the job.

A Key feature of the on call team is that each tier of on call juniors has its own backup with the result help is always available and the rota is compliant with respect to breaks / rest periods.

The On Call Team consists of

Consultant (all normal commitments cancelled, based on MAU)

Middle grade cover ST3+

Clinical Fellow or ST2 (depending on experience)

Junior cover ST1 or ST2

FY2

FY1

A full shift system is in place with change over at the following times

DAY SHIFT NIGHT SHIFT

ST3+ 09:00 to 21:30 21:00 to 09:30

Clinical Fellow / ST2 09:00 to 21:30 21:00 to 09:30

ST1 09:00 to 21:00 20:30 to 09:30

FY2 10:00 to 21:00 20:30 to 09:30

FY1 08:00 to 20:30 17:00 to 22:00

The shift system allows for proper handovers and is fully compliant with EWTD.

The normal duties of Core Medical Trainees when on call will be to attend consultant ward rounds, facilitate management of patients already admitted to the unit and assess patients referred to the medical take. On call trainees will also be a part of the cardiac arrest team.

Several consultant ward rounds are carried out on the assessment unit each day, the first major ward round starting at 8.00am with three further mini-rounds later in the afternoon at 12pm, 3pm and 5pm to see any further admissions and review selected patients. In between these times consultants are expected to be available to junior staff and GP’s for advice and to review any new admissions from time to time through the day. The on-call consultant is responsible for all the patients admitted on the medical assessment unit until they are transferred to another ward when they will then become the responsibility of the consultant covering that general medical ward. There is an average of about 35 medical admissions per day. This number may vary from between about 20 patients and as many as 60 admissions daily.

Similar ward rounds are carried out by the consultant on-call at weekends. During evenings and the rest of the weekends the consultant is on-call from home.

Education and Audit

Teaching

In house teaching is delivered by the Medical Academic Half Day which takes place on a Friday afternoon and is bleep free protected learning time. Attendance is obligatory for all Consultants and junior staff excepting those who are on call. This teaching session is consultant led and provides an excellent forum for firms to present unusual cases as well as concentrating on key areas of the trainee curriculum.

Additionally, there are a variety of meetings amongst the medical teams that are open to all trainees e.g, the weekly cardiology meeting, radiology meetings etc.

Audit

All trainees are expected to take part in regular audits and we have a rolling program of audit in place. This enables trainees to take on a ‘ready made’ audit and thus close the audit loop. Original ideas for audit will always be considered however and supported where appropriate.

Study Leave

The Trust fully supports study leave as approved by the postgraduate dean.

The Prince William Education Centre

The Education Centre was opened in 1976 and recently enlarged at a cost of £3.4million. This excellent facility now provides a further 3 seminar rooms and has a medical skills room and 2 IT suites. There is a large lecture theatre, a range of smaller seminar/tutorial rooms and an extensive Post Graduate Library.

Last updated: 22 January 2007