|
Acute Medicine Sub-Speciality Training at ST3+ |
|
SpR and ST3+ training within the specialty of Acute Medicine (Acute Medicine Level 3 in 2007 curriculum) have been established at all 3 main NHS Trusts within East Midlands South.
These posts were initially appointed to individual Trusts, but the programme is now under the overall supervision of the School’s Acute Medicine Committee and the Training Programme Director in Acute Medicine and in future all posts will form part of a single programme in Acute Medicine. Trainees will be expected to rotate between the 3 Trusts to achieve a balanced training in the specialty, although probably attached primarily to one site for a majority of their training.
Trainees will be working towards a CCT in Acute Medicine and are expected to become future lead clinicians for Acute Medical Units.
All components of the programme are approved by JRCPTB/PMETB for training in the specialty of Acute Medicine (General Internal Medicine with Acute Medicine Subspecialty Training prior to 2007)
The training is supervised by the Acute Medicine Leads on each site (who are typically based on the Trusts Acute Medicine Units) but trainees rotate through a modular programme providing a balance between ward-based, acute work and the care of the critically ill patient.
Details of the programme currently vary slightly from site to site, but broadly contain the following components:
Ward-based SpR with
responsibility for continuing care of patients.
Also participating
in acute on-call rota and post take ward rounds.
Clinic work in GIM,
with the option of clinic experience in specialties.
This will include
clinical experience of “care of the elderly” as part of the formal ward-based
SpR duties.
This 12 month
period typically be split between two different ward locations (6 months each)
to broaden and enhance the clinical experience in GIM.
Coronary Care: 6 months – regular morning ward round, review and
triage of acute cardiac admissions, training in acute procedures.
Intensive Care / HDU: 6 months, divided between general ITU/HDU and more
specialised Cardiothoracic and/or Respiratory ITU.
On-Call GIM
continues during these attachments
Acute Medical Admissions Unit (AMU) SpR – 6
months: Dedicated time
on AMU with an opportunity to develop skills in managing the Unit and
developing its activities, audit etc. – This is in addition to AMU-based
work when on call
A & E Medical SpR – 6 months; This
posting would provide experience in acute medical triage and resuscitation in
A&E and the interface with AMUs.
The above components can potentially be
undertaken in any order related to individual training needs and the
practicalities of rotation within the programme.
The final year will
provide additional experience and training in this discipline with the
opportunity to broaden experience, develop sub-specialist skill according to
individual specialist interests and develop of management skills in the
AMU. Ideally in the final 6 months the
trainee will undertake a more senior/responsible capacity, i.e as an acting
consultant on the rota, under supervision.
All components of
the programme can be undertaken on any site within the School.
The programme will
be flexible but the time spent in various blocks is an important guide to
ensure comprehensive training and compliance with JRCPTB/PMETB requirements.
CONTRACTED HOURS
The contracted hours are as follows:-
Standard Hours: 40
Plus Pay Banding as appropriate
The contracted hours are subject to change dependent upon the stage of the training programme and individual local hospitals circumstances and service needs
There are currently 9 training
posts in Acute Medicine within University Hospitals of
Training in acute care will be provided in Acute Medical Units, Coronary Care units, Intensive Care and Higher Dependency Units and the Emergency department. Training in continuing care will be provided via specialist medical wards and outpatient clinics.
Posts may potentially rotate
among the three Hospitals of the
The delivery of acute medical care
is increasingly focussed on specialist Acute Medical Units. Leicester has the
first Academically-led Acute Medical Unit in the
UNIVERSITY HOSPITALS OF
University Hospitals of Leicester NHS Trust (UHL) is one of
the largest and busiest teaching Trusts in
The Trust was formed on 1 April 2000, following the merger
of
Acute
Medicine in
The Leicester Royal Infirmary has the only Emergency Medicine Department (A&E) in the District. Acute admissions also occur via GP referral to a centralised bed bureaux. Acute medical admissions can be directed to each of the three teaching hospitals that comprise the University Hospitals of Leicester NHS Trust.
The Leicester Royal Infirmary has a large Acute Medical Unit (AMU) (54 beds) for the delivery of acute medical care. The AMU incorporates a higher dependency area. The AMU delivers a consultant-led service under the leadership of the Academic Medical Unit with one Consultant/(Hon) Senior Lecturer in Acute Medicine with a specific responsibility for developing and co-ordinating undergraduate education and post-graduate clinical training within the AMU. A third adjacent ward comprises the Short Stay Unit. The AMU receives the majority of its admissions via an unselected intake from the Emergency Department and the AMU staff work closely with the staff of the Emergency Department. The Trust will soon appoint a new
The
The
The Leicester Royal Infirmary is the largest of these 3 acute hospitals
which comprise the University Hospitals of Leicester NHS Trust, with 1070 beds.
All 3 acute hospitals currently admit acute medical emergencies, but the LRI is
the site of the only Accident and Emergency Department in Leicestershire, and
is therefore responsible for a very busy acute medical commitment.
This is the second largest acute hospital
with approximately 700 beds. Its
specialities include Renal & Urology with satellite sites in
Maintaining Medical
Excellence
The Trust is committed to providing safe and effective care for patients. To ensure this, there is an agreed procedure for medical staff that enables them to report quickly and confidentially, concerns about the conduct, performance or health of medical colleagues (Chief Medical Officer, December 1996). All medical staff, practising in the Trust, should ensure that they are familiar with the procedure.
MEDICAL STAFFING
Academic Medical Unit Core Team:
Professor B. Williams
Dr. M. Ardron
Dr S. Conroy - Senior Lecturer / Lead for
Medical Education & Training (AMU)
Dr. J. Francis
Dr A. Gallagher
Dr. M. Levy
Dr S. Shah
Dr K Higgins (Short Stay Unit Consultant)
Consultant Physicians in Integrated Medicine and Medicine for the Elderly
Dr M Ardron
Dr D. Lakhani
Dr J Reid
Consultant Physicians with speciality interests
Dr B Rathbone, Prof J Jankowski, Dr P. Wurm, Dr A Grant, Dr T. Delahooke, Dr J. Stewart (Gastroenterology)
Dr P McNally, Dr M Davies, Dr I Lawrence, Dr A Gallagher, Dr T Howlett, Dr M Levy (Diabetes / Endocrinology)
Dr I Squire, Prof Barnett, Dr L Ng, Dr J E Davies, (Clinical Pharmacology & Therapeutics)
Prof. B. Williams (Professorial Medical Unit)
Dr M Wiselka, Prof K Nicholson, Dr I Stephenson (Infectious diseases)
Consultant Physicians in Integrated Medicine and Medicine for the Elderly
Dr N Lo
Prof T Robinson (Professor of Stroke Medicine)
Dr M Fotherby (Senior Lecturer)
Dr S Dawson (Stroke Medicine)
Dr D. Eveson
Dr N Vijakumar
Consultant Physicians with speciality interests
Dr R Robinson, Dr J S deCaestecker, Dr J Mayberry (Gastroenterology)
Dr S Jackson, Dr R Gregory, Dr M-F Kong (Diabetes)
The
Consultant Physicians in Integrated Medicine and Medicine for the Elderly
Dr G Fancourt
Cardiorespiratory Directorate
Cardiologists and Respiratory Consultants form part of the Cardiorespiratory Directorate
RESEARCH
Ample time is given for research and for those wishing to pursue an Clinical Academic Career, the Academic Medical Unit will provide a very supportive environment. . There are many opportunities for Clinical and/or Basic Laboratory Research within the University Academic Departments.
TEACHING
The post holder will be expected to teach medical students. This will involve the clinical teaching of students on the Acute Medical Unit, on medical wards and in tutorials. A comprehensive teaching programme is being developed for Acute Medicine for medical students and all grades of clinical and nursing staff. There will also be opportunities for Post-Graduate clinical teaching.
ADMINISTRATION
Involvement with the arrangement of rotas, clinical meetings, outpatient letters, discharge summaries, and clinical audit will be expected.
STUDY AND TRAINING
East Midlands Deanery is committed to developing postgraduate training programmes for both general and higher professional training as laid down by Colleges and Faculties, and by the Postgraduate Deans' network. The Academic Medical Unit has appointed a Consultant Physician/(Hon) Senior Lecturer with a major commitment to medical education and training within the AMU to ensure that the many teaching and training opportunities provided in the busy environment are fully utilised. At local level, college/specialty tutors work with unit postgraduate clinical tutors in supervising these programmes. Trainees will be expected to take part in these programmes, including audit, and to attend appraisal, feedback and counselling sessions/professional review. Study leave will form part of these educational programmes and will be arranged in conjunction with the appropriate tutor.
There is a
postgraduate medical centre and library at each of the three
The Academic Medical Unit SpR Training
Rotation in GIM/Acute Medicine:
The posts are an
integral part of the development of an Acute Medical Unit led by the Academic
Medical Unit. The core training programme incorporates the mandatory
requirements for GIM training;
-
An
average of 1 day per week on call for acute receiving with a consultant-led
post-take ward round
-
A
weekly GIM clinic commitment
-
Continuing
care of GIM patients with attendance at 1 consultant-led ward round per week and
1 personal (SpR) led ward round per week.
There would also be
mandatory training in:
-
Management
skills (course based)
-
Clinical
Audit (in-house)
-
Advanced
Life Support (course based)
-
Teaching
Skills (course based)
-
Clinical
Ethics & Research method (in-house)
-
CME
(monthly RCP-organised)
There are currently 3 training
posts in Acute Medicine in
The following clinical
attachments are available in
Dedicated time on AMU with an opportunity to develop skills in managing the Unit and developing its activities, audit etc. – This is in addition to AMU-based work when on call
Regular morning ward round, review and triage of acute cardiac admissions, training in acute procedures. On-Call GIM continues during these attachments
Divided between general ITU/HDU and more specialised Cardiothoracic and/or Respiratory ITU. On-Call GIM continues during these attachments
This posting would provide experience in acute medical triage and resuscitation in A&E and the interface with AMUs.
in relevant specialties depending on the interests of the trainee
The final 3 months of training would be ward-based and would require the SpR to join the consultant on-call rota and to lead ward-based “consultant ward rounds” under supervision to gain experience for the transition to consultant status in Acute GIM.
Kettering General Hospital NHS Trust is a 590 bedded
associate teaching hospital serving the north end of the
Accommodation is generally available on site and there is an active Doctors Mess and social club within the hospital.
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.
The firms at present are as follows
Cardiology : 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
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:
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 K. Patel, Dr BP O’Malley
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
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.
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.
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.
There are currently 2 training
posts in Acute Medicine in
The
The county is part of a designated growth area, which will see significant development and consequent population growth over the next 25 years. The population of the town is predicted to increase by more than 50,000 people by 2021. Whilst there is a relatively young population, which includes people from many different ethnic backgrounds and cultural beliefs, there is also a rapidly rising number of people in the over 75 age group.
The town provides easy access to
Northampton General Hospital NHS Trust is a large (700 beds) district hospital providing a full range of acute services from a site located close to the centre of the town.
Our vision is to become a ‘DGH Plus’, providing all the secondary care services normally found in a district general hospital, including emergency care, planned care, maternity care, diagnostic and therapy services. In addition we will also provide specialised services for a wider population including designated cancer centre services, interventional cardiology, renal medicine, plastic surgery and level three neonatal care.
NGH aims to be the hospital of choice for patients and staff, and has developed its corporate objectives around five key principles:
The Directorate of Medicine is one of eight clinical directorates within the Trust, with the Clinical Director being a member of the Hospital Management Board. The Directorate provides the acute medicine service, with a common admission pathway for adult patients irrespective of age. Around 10,000 patients are admitted per year through a purpose-built 26 bedded Emergency Assessment Unit (EAU. The EAU links into a short stay ward where patients will remain under the care of the admitting team until discharge. Patients who have specialty needs such as cardiology, respiratory and stroke are admitted to the appropriate wards.
There is a well-established night team comprising a medical SpR, a medical and surgical SHO,
and an F1 doctor, with support from a night nurse practitioner. The night team is responsible for all medical admissions and for problems with in-patients. The team works blocks of 3 or 4 nights at a time.
There are nineteen physicians who support the acute general medical take. From April 2008, they will be grouped in five firms: cardiology and respiratory medicine firms, and three firms of mixed specialties. The specialties of consultant physicians with responsibility for acute general medicine are as follows:
|
Dr Lyndsey Brawn |
Stroke Medicine / Medicine of the Elderly (Clinical Director) |
|
Dr Helen Binns |
Cardiology |
|
Dr Melanie Blake |
Stroke Medicine / Medicine of the Elderly |
|
Dr Dominic Cox |
Cardiology |
|
Dr Patrick Davey |
Cardiology |
|
Dr Andrew Jeffrey |
Respiratory Medicine / Intensive Care (Director of Education) |
|
Dr Angela Kannan |
Stroke Medicine / Medicine of the Elderly |
|
Dr Iqbal Khan |
Gastroenterology (Director of Medical Studies) |
|
Dr Anne Kilvert |
Diabetes / Endocrinology |
|
Dr Balakrishna Manivannan |
Medicine of the Elderly |
|
Dr Roger Morgan |
Medicine of the Elderly |
|
Dr Alan Ogilvie |
Gastroenterology |
|
Dr Josephine Ojoo |
Respiratory Medicine |
|
Dr Brian Richardson |
Respiratory Medicine (Foundation Programme Director) |
|
Dr Jonathan Rippin |
Diabetes / Endocrinology |
|
Dr Parul Shah |
Medicine of the Elderly |
|
Dr Paul Sherwood |
Gastroenterology |
|
Dr David Sprigings |
Cardiology |
|
Dr Udi Shmueli |
Gastroenterology |
|
Dr John Timperley |
Cardiology |
Other consultants who are part of the Directorate of Medicine and may share junior medical staff but who do not participate in the acute medical take are:
|
Dr Charles Fox |
Diabetes / Endocrinology |
|
Dr Paul Davies |
Neurology |
|
Dr Kannan Nith |
Neurology / Neurophysiology |
|
Dr Somsuntram Thiyagaraja |
Neurology / Rehabilitation |
|
Dr Ann Bissessar |
Neurophysiology |
|
Dr Rachel Jeffery |
Rheumatology |
|
Dr James Taylor |
Rheumatology |
|
Dr Pick Woo |
Dermatology |
|
Dr John Mahood |
Dermatology |
|
Dr Warren Pickering |
Nephrology |
|
Dr Eddie Tan |
Nephrology |
|
Dr Fiona Poyner |
Accident and Emergency Medicine |
|
Dr Victoria Holloway |
Accident and Emergency Medicine |
|
Dr John Sutherland |
Accident and Emergency Medicine |
|
Dr John Trenfield |
Accident and Emergency Medicine |
The Directorate currently has 11 Foundation year 1 house officers, 19 senior house officers and 9 specialist registrars. From August 2008, there will be 5 additional SpRs in medicine.
Title:
Prime responsibilities:
Accountable to:
Educational supervisor and programme director:
Key tasks:
Monday: AM Specialty ward round
PM Specialty clinic
Tuesday: AM Education / training / teaching
Meeting with educational supervisor
PM Echocardiography clinic
Clinical audit and research
Wednesday: AM Specialty clinic
PM Lunchtime specialty meeting
Dept of Medicine academic meeting
Thursday: On-take (Emergency Assessment Unit)
Friday: AM Post-take ward round
PM Specialty ward round
Candidates are invited to visit the hospitals concerned by making arrangements with:-
Professor
B Williams
Academic Medical Unit
Infirmary Square
LE1 5WW
Tel: 0116 252 3182
Dr
Anwar Hussain
Anwar.Hussain@kgh.nhs.uk
Dr David Sprigings
01604 545901
david.sprigings@ngh.nhs.uk.
Updated:
April 2009