Endocrinology and Diabetes Mellitus Sub-Speciality Training at ST3+

Endocrinology & Diabetes Mellitus

with General (Internal) Medicine

Programme Outline

Introduction

This document provides an overview of the Specialist Training Programme in Endocrinology and Diabetes Mellitus with General (Internal) Medicine in Leicestershire, Northamptonshire and Rutland Deanery - based around the University Hospitals of Leicester NHS Trust. It details the hospitals, trainers, proposed rotation of posts, arrangements for supervision and detailed job descriptions for each part of the programme.

Director of Training Programme

Dr M-F Kong Consultant Physician, Leicester General Hospital DM, FRCP

Marie-France.Kong@uhl-tr.nhs.uk +44 (0) 116 258 8304

Participating Hospitals and Trainers (in alphabetical order)

Special Interests:

Kettering General Hospital

Dr G N Clifford G(I)M Diabetes Mellitus Endocrinology

Dr B P O’Malley G(I)M Diabetes Mellitus Endocrinology

Dr K Rizvi G(I)M Diabetes Mellitus Endocrinology

Northampton General Hospital

Dr Charles Fox G(I)M Diabetes Mellitus Endocrinology

Dr Anne Kilvert G(I)M Diabetes Mellitus Endocrinology

Dr Jonathan Rippin G(I)M Diabetes Mellitus Endocrinology

University Hospitals of Leicester: Metabolic Medicine Service

Glenfield Hospital:

Dr R.F. Bing, FRCP*^ G(I)M Lipids & Metabolism Endocrinology

(Dr I.G.Lawrence) (Diabetic Clinic)

Leicester General Hospital

Dr R.Gregory, DM, FRCP*^ G(I)M Diabetes Mellitus Endocrinology

Dr S.N.Jackson, FRCP*^ G(I)M Diabetes Mellitus Endocrinology

Dr M-F. Kong, DM, FRCP^ G(I)M Diabetes Mellitus Endocrinology

Leicester Royal Infirmary

Dr M.J. Davies, MD, FRCP^ G(I)M Diabetes Mellitus Endocrinology

Dr T.A.Howlett, MD, FRCP^ G(I)M Endocrinology

Dr P.G. McNally, MD, FRCP*^ G(I)M Diabetes Mellitus Endocrinology

Dr I.G.Lawrence, FRCP*^ G(I)M Diabetes Mellitus Endocrinology

Dr M.J. Levy, MD, MRCP G(I)M Endocrinology

Dr A. Gallagher, MD, MRCP* G(I)M Diabetes Mellitus Endocrinology

* Also supervise community clinics in D&E

^ Also supervise specialist modules

Supervision of Training

· The Training Director will take overall responsibility for supervision of the content of training for all trainees participating in the training programme, in collaboration with all consultant colleagues in participating hospitals

· One consultant in each hospital will take responsibility as ‘Educational Supervisor’ of the trainee(s) currently in post in that hospital - and will provide written reports to the Training Director at the end of each training ‘slot’. As required by the SAC/STA (and by the national training log-book), this supervisor and trainee will meet formally to discuss training needs at monthly intervals throughout each slot, and the final report will consist primarily of an agreed statement (with optional separate confidential report by the trainer and/or trainee)

· Training director and trainee will meet together as required, and at least annually, to discuss the progress of training, complete the postgraduate dean’s assessments and plan the next steps in the training programme for that individual.

· Training director and supervisors will consult together at least annually to agree the practicalities of rotation of trainees through the various ‘slots’ of the programme, and to discuss any problems with individual trainees or with the overall training programme. All consultant trainers will be invited. In addition, the UHL Department has monthly consultant meetings.

Other Consultants & Specialities concerned in the training or service:-

Many other consultants will contribute to the training programme in sub-specialist areas:

Speciality	Name of Consultant		Hospitals	Joint Clinic ?
Endo/DM Speciality Clinics and Services:
Paediatric and Adolescent Diabetes & Endocrinology	Dr S. Shenoy Dr J. Greening		LRI Community	TAH & MJD
Combined Antenatal Diabetes/Endocrine Clinics	de Chazal / Howarth Scudamore / Hodgett		LRI LGH	Yes
Metabolic Medicine/Lipids	Dr J Iqbal Dr W. Madira		LRI/LGH GH	RB
Endocrine Surgery	Prof. P Bell Prof N. London Prof M L Nicholson		LRI LRI LGH	TAH TAH
Thyroid Ophthalmopathy	Mr Sampath		LRI
Retinopathy	Mr Richardson		LRI
Neurosurgery Services (incl. Transsphenoidal surgery)	Mr I Robertson		LRI QMC Nottingham	TAH
Assisted Conception Unit	Mr R. Neuberg Mr A Davidson		LRI
Bone Metabolism / Osteoporosis	Dr P. Sheldon Dr J. Iqbal Mr F. Al-Azzawi		LRI LRI/LGH LRI
Molecular Genetics	Prof R Trembath		LRI
Other Medical Services: (Endo/DM and G(I)M)
Cardiovascular Medicine (including hypertension, vascular risk assessment and management)	Profs B Williams/ H Thurston	LRI
Nephrology	Profs/Drs. Feehally/ Harris/ Warwick/ Carr / Brunskill	LGH		SJ
Cardiology Services	NHS Head of Service: Dr D Skeehan University: Prof N. Samani	GH
Related Surgical Specialities:
Andrology	Mr Sandhu/Osborn/Terry		LGH	RG/MFK
Vascular Surgery	Prof Bell/London/Naylor Mr Sayers/Dennis/McCarthy		LRI	PGM/MJD
Transplantation, (including pancreatic islets)	Prof Nicholson		LGH

The Diabetes Nurse Specialists, Endocrinology Nurse Practitioners, Dieticians, Chiropodists and other allied professions at all the participating hospitals will also contribute to the training as appropriate.

Clinical Posts of the Programme and Rotation

The aim of the programme is for trainees to obtain a CCT in both general internal medicine (acute) and diabetes & endocrinology.

The scheme will rotate trainees between either of 2 District General Hospitals (Kettering, or Northampton) and the 3 Leicester Teaching Hospitals (Leicester General, Leicester Royal Infirmary and Glenfield hospital).

Entry to the scheme will be at ST3. The total duration of the scheme is 5 years (following on from core medical training [CMT] and assuming entry at ST3).

The programme will consist of 10 clinical ‘slots’ between which trainees will rotate during the 5 year training programme required to achieve CCST in Endocrinology and Diabetes Mellitus and General (Internal) Medicine.

The ten clinical slots are as follows:

· Glenfield Hospital 1 post

· Kettering General Hospital 1 post

· Leicester General Hospital 3 posts

· Leicester Royal Infirmary 3 posts

· Northampton General Hospital 1 post

· UHL Sub-Speciality/Special Interest 1 post

In addition, trainees will be encouraged to spend up to one year in a research ‘slot’ (to be funded by a variety of research funds) as an integral part of their training programme, as agreed in the STA Curriculum and by the European Board of Endocrinology. Appropriate individuals may wish to undertake more prolonged periods of research (while the ‘training clock stops’) and will be encouraged to do so. The availability of a dedicated research ‘slot’ for any trainee will always be subject to the attainment of appropriate research funding for a specific project and trainees are encouraged to discuss their research ambitions at the earliest possible stage with their supervisor, the training director or any consultant trainer.

All clinical posts forming this training programme, have been approved by the JCHMT for higher specialist training in Diabetes & Endocrinology and General (Internal) Medicine, and the programme is approved as a Training Centre by the European Board of Endocrinology.

Rotation Between Clinical Posts of the Training Programme

The progression between clinical and research posts of the training programme will be directed primarily by the training needs of the individual. Nevertheless, it is clear that the practicalities of administration of the programme will require co-ordination of moves between posts and a ‘default’ plan for rotation. We have also found over the years that it is impossible to stick to fixed rotations in a small programme such as this where trainees arrive with different lengths of prior training and take variable lengths of time in research.

It is envisaged that trainees will normally obtain experience in General (Internal) Medicine, Diabetes and Endocrinology in each of the clinical slots throughout the training programme. The precise proportion of G(I)M will vary from post to post and with the training needs of the individual.

In principle, the 10 clinical slots of the programme are regarded as a single rotating pool, through which trainees rotate for the time required to achieve CCST. Practical considerations mean that ..

· Entry and exit points to the training programme will obviously depend on the ‘slot’ from which an individual is appointed to a consultant post, or leaves the rotation for some other reason, and will therefore inevitably occur at all points in the rotation over time. However, wherever practical we aim for the rotation to commence with DGH experience at Kettering General Hospital or Northampton General Hospital.

· Thereafter, trainees will return to a DGH post later in the programme on 1 or 2 occasions

· The timetables at Leicester General Hospital and Leicester Royal Infirmary reflect working patterns when more senior and more junior trainees occupy the 3/4 posts at each site. The actual distribution of duties of the individuals and the content of the training in the posts at these hospitals will depend on an individual assessment of the clinical skills and training needs of the individuals in post at any one time.

· Slots may occur in any order (subject to mutual agreement between all trainees and trainers)

· ‘Research slot’ may be taken at any appropriate stage of the programme

Following the expansion of the programme to 10 training posts, trainees will progress between ‘slots’ in an agreed sequence at 12 monthly intervals as indicated by the following diagram - but precise timings and sequence of posts will depend on an individual assessment of training needs and research aspirations.

Since trainees will inevitably enter and leave the clinical training programme at different times and places and for different durations, it is impossible to predict a fixed pattern of post rotation. In addition, individual trainees will require different lengths of time in clinical training because of different length of prior training (e.g as LAT or FTTA) and recognition of time in research before or during the programme.

Appointment to Consultant Post

Entry from SHO Grade or CMT

Leicester General Hospital (B)

UHL Sub-Speciality / Special Interest Module

More ‘Senior’ Posts

in Rotation

More ‘Junior’ Posts

in Rotation

Northampton General Hospital

Leicester Royal Infirmary (A)

Kettering General Hospital

Leicester Royal Infirmary (B)

Glenfield Hospital

Exits and entries may occur at any point

Leicester General Hospital (A)

Research Slot(s) in Training Programme

(Optional but encouraged) (Funded by Research Grants)

Usually 12-24 months

Descriptions of Individual Hospitals and Clinical Training Slots

KETTERING GENERAL HOSPITAL

Kettering general hospital is a modern district general hospital with 588 beds and serving a population of 320,000. There is advanced investigative facilities including and MRI on site.

The endocrine department staff is as follows:

Dr K Rizvi – consultant physician & endocrinologist (Lead)

Dr BP O’ Malley - consultant physician & endocrinologist (medical director)

Dr G Clifford – consultant physician acute medicine & Diabetes / endocrinology (royal college tutor)

The training will be supervised by Dr Rizvi and Dr O’ Malley (out – patients)

Duties of the Post:

Inpatient and Outpatient Services Commitment

Clinical:

Timetable of Activity

	Monday	Tuesday	Wednesday	Thursday	Friday
A.M.	Ward Round (Dr Rizvi) Joint endocrine / biochemistry meeting	SPR ward round	Diabetic clinic (Dr Rizvi & Dr O’Malley) X-ray Meeting	Endocrine clinic (Dr Rizvi & Dr O’Malley)	Ward Round (Dr Rizvi)
P.M.	Admin	Peripheral Clinic (Rushden / Willingboro’) (Dr Rizvi)	Monthly Education Session Or Research / Admin	General & endocrine clinic (Corby) Or young persons diabetic clinic Once a month (Dr Rizvi)	Academic Half Day

During the post there will be ample opportunity for involvement in the in-patient and outpatient general medical, endocrine and diabetic management, there is an active endocrine day case unit and the SPR is expected to take the lead in day to day running of it.

There are regular, weekly joint meetings with the biochemistry and radiology colleagues as well as within the multidisciplinary diabetes team.

NORTHAMPTON GENERAL HOSPITAL

Northampton General Hospital is an acute District General Hospital with 800 beds, 217 of which are acute Medical beds. The Medical Unit handles all acute Medical admissions in the surrounding area

This post will specialist registrar to one of the Medical Firms working for:

Dr Charles Fox - Specialist interest in Diabetes & Endocrinology

Dr Anne Kilvert - Specialist interest in Diabetes & Endocrinology

Dr Jonathan Rippin - Specialist interest in Diabetes & Endocrinology

Additional training and supervision will be provided by:

Dr John O’Donnell - Clinical Biochemistry – including Lipids

Duties of the Post:

Inpatient and Outpatient Services Commitment

Clinical:

Timetable of Activity

	Monday	Tuesday	Wednesday	Thursday	Friday
A.M.	Diabetes Annual Review Clinic	+Consultant Ward Round	Diabetic Foot Clinic (alternate weeks)	Endocrine and GIM clinic (1^st & 3^rd weeks) (Specialist Endocrine Clinic monthly – BPOM)	Flexible: Admin, Audit, Research
P.M.	+ SpR-led Ward Round	Diabetes New Patient Clinic	Academic Afternoon and Diabetes Clinical Team Meeting	Pregnancy Clinic (alternate weeks) Young Adult Diabetic Clinic	Flexible: Admin, Audit, Research

* The trainee will normally be expected to undertake the Diabetes New Patient and Annual Review Clinics and Endocrine/GIM clinic on 1^st and 3^rd weeks of month, together with one other clinic chosen (from those marked with an asterisk) in collaboration with the educational supervisor to reflect experience and training needs

+ The trainee will normally be expected to attend 1 consultant ward round per week, and to perform a trainee-led ward round – and times chosen to co-ordinate with the chosen outpatient training experience

UNIVERSITY HOSPITALS OF LEICESTER NHS TRUST

The remaining training slots are within the Metabolic Medicine Service of University Hospitals of Leicester NHS Trust (UHL), which is run as a single service, with departments on the 3 constituent hospital sites (which were previously separate NHS Trusts). Current Head of Service is Dr Robert Gregory.

UHL is currently undertaking a major reconfiguration project (styled "Pathway"), lasting the rest of this decade, which will ultimately result in acute medical care on 2 sites (LRI and GH) with the LGH site becoming a centre for planned care, and the site of most outpatient and day case services. This development is the subject of a large PFI project, and interim reconfiguration and relocations are likely to affect the site and pattern of service work during the training of all trainees appointed in the next few years.

In particular, the Diabetes, Endocrinology and Lipid Services are increasingly viewed as a single entity across the 3 sites, and the working pattern of specialist clinics may change with time to reflect this. It is also a priority for the Trust to move to emergency medicine on 2 rather than 3 sites to ease compliance with working time regulations.

Leicester Royal Infirmary (3 training posts)

The Leicester Royal Infirmary is the largest of these 3 acute hospitals which comprise the University Hospitals of Leicester NHS Trust, with 1070 beds, 315 in the medical directorate. 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.

Integrated Medicine Teams at the Leicester Royal Infirmary

Since the opening of the Windsor Building in 1992 inpatient general medicine services at the Leicester Royal Infirmary have provided integrated acute medical care to patients of all ages. These posts will form a part of the Integrated medicine team working for:

Dr M.J.Davies, MD FRCP (Diabetes & Endocrinology)

Dr T.A.Howlett, MD FRCP (Endocrinology)

Dr I.G.Lawrence, MRCP (Diabetes&Endocrinology,

Educational Supervisor)

Dr P.G.McNally, MD FRCP (Diabetes & Endocrinology)

Dr M.J.Levy, MD, MRCP (Endocrinology)

Dr A Gallagher, MD, MRCP (Diabetes & Endocrinology)

Bed Allocation

The Department of Diabetes and Endocrinology has responsibility for 24 beds on Ward 38 and 30 beds on Ward 8. The routine duties of these posts are all related to these two wards, and only exceptionally (due emergency responsibilities, sickness and unavoidable overlapping leave) will the trainees have any duties on the other Ward. Beds are shared between the consultant members of the integrated team by mutual agreement, and dependent on the acute work-load, and Diabetes and Endocrinology patients who require admission are also accommodated here. Currently, a single consultant takes responsibility for all the patients on each of the 2 wards for 6 weeks blocks in rotation.

Junior Staff

The Diabetes and Endocrinology Team currently consist of the following junior medical staff to assist with its inpatient and outpatient activities:

1 House Officer

2 Senior House Officers

3 SpR Trainees

Diabetes and Endocrinology

The LRI is the site of the busiest Diabetes and Endocrinology outpatient service in Leicestershire - and has recently relocated to excellent refurbished clinic and office accommodation in the 1771 Building (Victoria Block). In addition to the 4 general diabetes and 2 general endocrinology clinics per week there are regular subspecialist clinics in gynaecological endocrinology, surgical endocrinology, pituitary surgery, paediatric diabetes and endocrinology, adolescent diabetes, antenatal clinic, diabetic foot clinic and erectile dysfunction clinic. Trainees will be able to obtain experience in all of these clinics as appropriate. There are also regular specialist training, audit, case review, radiology, postgraduate training and research meetings.

The Department has an active research programme, with established links to the Academic Departments of Medicine and Clinical Genetics. Trainees will be encouraged to participate in this research programme. Current research interests include: Population screening and prevention for Type 2 Diabetes; Clinical Trials of novel insulins and oral agents; Cardiovascular and renal complications of diabetes & hypertension; long-term follow-up of diabetes diagnosed in childhood; aetiology and incidence of Type 2 Diabetes; insulin resistance in diabetes and polycystic ovary syndrome; molecular genetics of lipodystrophy and other inherited endocrine syndromes; clinical management of pituitary disease; optimal healthcare delivery in diabetes & endocrinology; medical informatics.

Arrangements for acute medical take:

Acute admissions to the Medical Unit usually take place via the Acute Medical Unit (AMU – based on 2 30-bed wards) or via CCU. AMU is where patients are initially assessed and managed. After assessment by the Consultant on-call, patients may be discharged, transferred to the care of an appropriate general medical ward or specialist team or remain within the AMU wards if only short admission for stabilisation or results of tests is required. In times of bed shortage, patients may also be transferred or discharged from AMU between 5pm and 8am after review by the SpR on call.

Consultants are responsible for all Admissions on AMU15 and AMU16 in rotation – during which they are based on AMU throughout the working day and on-call from home at night.

Organisation of Workload

The precise distribution of duties will be determined individually for each pair of trainees - bearing in mind their relative experience, training needs and other commitments.

In general, the more ‘Junior’ SpR will require general training in the speciality and significant ongoing experience in acute general medicine, whereas the ‘Senior’ SpR trainee’s educational needs will be to maximise their experience of the speciality and its subspecialities. Therefore, by default, the more junior SpR will fulfil the ‘Ward’ SpR role.

Both SpR’s will have equal responsibility for the ‘on-take’ general medicine commitments of the firm (MAU, CCU and hospital referrals) as detailed below

Commitment to individual ‘routine’ specialist clinics will continue throughout the 6 month attachment - to increase continuity of patient experience

Throughout the 12 months a more ‘senior’ SpR will often be able to give appropriate advice and supervision to a more ‘junior’ SpR - and will perform a ‘problem solving’ ward round on Friday afternoons.

LRI Timetable 1

	Monday	Tuesday	Wednesday	Thursday	Friday
Morning	9am Ward 38 Problems (New Admissions and Potential Discharges)	9am Ward 38 Problems / Administration	9am SpR Ward Round Ward 38	9am Consultant Ward Round Ward 38	8.45am PGM / TAH Diabetes & Endocrine Clinics
Lunchtime			1pm Endocrine Journal Club	12.30pm Lunch and Diabetes Seminar / Clinical Governance Meeting	12.30pm Lunch and Medical Directorate Meeting (Postgrad Centre)
Afternoon	2pm Consultant Ward Round Ward 38	1.15pm AG Diabetes & Endocrine Clinic General Medicine Training Programme (Alternate Months)	2pm Research And Audit (Weeks 1, 3, 4 and 5) 2pm Mid Trent and South Trent Training Programme (Week 2)	2pm Administration / Ward 38 Problems General Medicine Training Programme (Alternate Months)	2pm Research And Audit

Summary of duties:

Supervision of the care of general medicine patients under all 4 consultants on Ward 38, directing 2 SHOs and 1 house physician

Attendance at consultant ward rounds on Monday as listed

Full SpR Business round on Wednesday

Contribution to problems review on Friday afternoon when required

Advice to SHO & HP at other times

· New transfers from MAU 33 and CCU should be reviewed daily with SHO/HP

Supervision of the management of inpatient specialist cases undergoing intensive investigation or therapy

Post-operative pituitary reassessment

Petrosal catheterisation

Cushing’s and other inpatient investigations

· Including responsibility for collating results and discharge summary

Outpatient clinics as listed in the timetable

· Research, Teaching and Administration

· SpR may adjust their timetable flexibly outside their fixed commitments to cover these activities.

· In particular, all day Thursday could be available for research on alternate weeks

LRI Timetable 2

	Monday	Tuesday	Wednesday	Thursday	Friday
Morning	9am Ward 8 Problems (New Admissions and Potential Discharges)	8.45am TAH/MFK/ML Endocrine Clinic	8.30am PGM Diabetes Clinic	8.45am Diabetic Foot Ulcer / Gynae Endocrine Clinics*	9am SpR Ward Round Ward 8 Medical Student Teaching
Lunchtime		1pm Endocrine Clinic Meeting	1pm Endocrine Journal Club	12.30pm Lunch and Diabetes Seminar / Clinical Governance Meeting	12.30pm Lunch and Medical Directorate Meeting (Postgraduate Centre)
Afternoon	2pm Consultant Ward Round Ward 8	2pm Administration / Ward 8 Problems General Medicine Training Programme (Alternate Months)	2pm Research And Audit (Weeks 1, 3, 4 and 5) 2pm Mid Trent and South Trent Training Programme (Week 2)	2pm Research and Audit 3pm Young Adult Diabetes Clinic (Week 3) General Medicine Training Programme (Alternate Months)	2pm Administration 2pm Medical Andrology Clinic (Week 2)

*Alternate weeks

Summary of duties:

· ‘Trouble shooting’ responsibility for Ward 32 General Medicine (need not attend consultant ward rounds, except when 'Ward SpR' is absent)

Outpatient clinics as listed in the timetable

Very Urgent New Outpatient Cases may be seen from time to time in the department outside clinic sessions and will be the responsibility of this SpR

· Optional clinics for specialist experience (to meet needs of the individual trainee): Paediatric Endocrine Clinic, Thyroid Ophthalmopathy Clinic, Joint Surgical Endocrine, Joint Pituitary Clinic, Impotence/Andrology Clinic

Specialist Supervision / Provision of initial opinion - on specialist cases referred as inpatients from elsewhere in the hospital:

Diabetics undergoing surgery or on non-medical wards for other reasons

Patients undergoing surgery for endocrine conditions - thyroidectomy, parathyroidectomy, adrenalectomy etc

New inpatient referrals for Diabetes and Endocrinology problems

Supervision of non-clinic management of diabetes and endocrinology patients

*Supervision of dynamic endocrine testing - including reports to GP and patient

*Supervision of programmed sequential investigation of outpatients

*Some responsibility for thyrotoxicosis shared-care (e.g. when TAH on leave)

* In collaboration with nurse practitioner and jointly with TAH

Review of long-term outcome of management of diabetes and endocrine disorders (for discussion at review and audit meetings)

· Research, Teaching and Administration

· SpR may adjust their timetable flexibly outside their fixed commitments to cover these activities.

· In particular, all day Friday could be available for research (except for week 2 options)

LRI Timetable 3

	Monday	Tuesday	Wednesday	Thursday	Friday
Morning	9am Administration Specialty Clinic Options (Bone Clinic and MJL Endocrine Clinic)	8.45am TAH/MFK/ML Endocrine Clinic	9am Paediatric Endocrine Clinic Surgical Endocrine Clinic (Week 2)	8.45am Diabetic Foot Ulcer / Gynae Endocrine Clinics*	9am SpR Ward Round Ward 38 Pituitary Endocrine Clinic (Week 2)
Lunchtime		1pm Endocrine Clinic Meeting	1pm Endocrine Journal Club	12.30pm Lunch and Diabetes Seminar / Clinical Governance Meeting	12.30pm Lunch and Medical Directorate Meeting (Postgrad Centre)
Afternoon	1.15pm MJD Diabetes Clinic	2.00pm Research And Audit General Medicine Training Programme (Alternate Months)	1.30pm Diabetes Pregnancy Clinic (Weeks 1, 3, 4 and 5) 2pm Mid Trent and South Trent Training Programme (Week 2)	2.00pm Research And Audit General Medicine Training Programme (Alternate Months)	2.00pm Administration

*Alternate weeks

LRI Timetable 4

	Monday	Tuesday	Wednesday	Thursday	Friday
Morning	8.30am IGL Diabetes Clinic	9am Ward 8 Problems / Administration	9am SpR Ward Round Ward 8	9am Consultant Ward Round Ward 8	9am Research and Audit Pituitary Endocrine Clinic (Week 2)
Lunchtime			1pm Endocrine Journal Club	12.30pm Lunch and Diabetes Seminar / Clinical Governance Meeting	12.30pm Lunch and Medical Directorate Meeting (Postgrad Centre)
Afternoon	2.00pm Research and Audit	1.15pm IGL Diabetes & Endocrine Clinic General Medicine Training Programme (Alternate Months)	1.30pm Diabetes Pregnancy Clinic (Weeks 1, 3, 4 and 5) 2pm Mid Trent and South Trent Training Programme (Week 2)	2pm Admin / Ward 8 Problems General Medicine Training Programme (Alternate Months)	2pm Ward 8 SpR Troubleshooting Ward Round 2pm Medical Andrology Clinic (Week 2)

Organisation of Outpatient Lists:

· Individual trainees will have their own identified list in the Endocrine and Gynae Endocrine clinics throughout their attachment in order to maximise patient continuity

· Lists in diabetic clinics and medical clinic will be attached to the 2 posts as listed above, in order to avoid timetable clashes.

· Attendance / lists in the various optional clinics will be established for a specific individual for an identified timescale

· All cancellations for leave or on-call should be made at least 6 weeks and ideally 8 weeks in advance

Organisation of Ward 38 Inpatient Activity

(Ward SpR responsible for supervision/compliance)

· SHOs and HP will divide the workload on Ward 38 equitably

· Every transfer to Ward 38 from MAU, CCU or elsewhere must be fully reviewed by either SHO or HP on the day of arrival (or morning after arrival if transferred overnight or over weekends). This includes direct confirmation of the history with the patient (including a check on drug history), re-examination of all relevant systems, documentation of all results obtained to date and construction of a provisional management plan. These data and the management plan must then be reviewed by the Ward SpR within 24h.

· All discharge letters can be printed from the Clinical Information System

· Discharge summaries to be dictated by SpR or SHO within 24h of discharge (and preferably before the patient leaves hospital)

Glenfield Hospital

Glenfield Hospital is the newest of the 3 acute teaching hospitals in Leicester, opening in 1985. There are 570 beds covering Thoracic Medicine & Surgery, Breast Surgery, Orthopaedics and Cardiology including CCU and Cardiothoracic Surgery. There is an ITU and Radiology and other support services on site. The University Departments of Cardiology, Respiratory Medicine and Orthopaedics are based at Glenfield, along with representatives of other University Departments.

The post provides experience in Cardiology and Respiratory Medicine at Glenfield, and ongoing experience in endocrinology and metabolism in Dr Bing’s General Clinics and in the Lipid Clinic. In addition, the post will attend the diabetic clinic and will co-ordinate the management of other aspects of the care of patients with diabetes in Glenfield (under the guidance of Dr Ian Lawrence and in collaboration with the diabetes nurse specialist)

Throughout this year, the individual will be expected to gain experience in Community Diabetes and Endocrinology clinics, and in a variety of Sub-Specialist Modules, under the supervision of a variety of D&E specialists in Leicestershire.

Medical Staffing:

Medical Staff Ward 20

Consultants: Dr R F Bing, Hon Senior Lecturer Cardiovascular Medicine

                         Dr GF Fancourt Medicine for the Elderly

 SpR: 2

SHO 1

FY2 2

FY1 1      

Duties of the Post:

The appointee will work mainly with Dr RF Bing at Glenfield. The SpR will be based on ward 20. Responsibilities will include supervision of inpatients, both emergency and elective admissions, and outpatient clinics. It will also be expected that the appointee will contribute to undergraduate and postgraduate teaching.

Clinical Timetable:

	Monday	Tuesday	Wednesday	Thursday	Friday
A.M.	Community GIM/Diabetes/ Endocrine Hinckley Clinic or Ward Problems Administration	Endocrinology LRI or Hypertension Clinic GGH	Diabetes Clinic or SpR Ward Round	Module* Attachment/ Research	Lipid Clinic (RFB)  or Diabetes Clinic (IGL) (alt. weeks)
					Weekly clinical meeting
P.M.	SpR Ward Round	Consultant Ward Round	Monthly Education Session Or Teaching / WR	Ward work	Consultant Ward Round

* Various modules available in Leicestershire to complement training. The precise choice of modules will depend on the training needs of the individual:

· Paediatric & Adolescent Diabetes and Endocrinology

· Antenatal Diabetes & Endocrine Clinic

· Diabetic Nephropathy Clinic

· Diabetic Retinopathy Clinic

· Diabetic Foot Clinics

· Gynae/Endocrinology Clinic

· Thyroid Ophthalmopathy Clinic

· Surgical Endocrine Clinic

· Assisted Conception Unit

· Lipid Clinic

· Vascular Clinics

· Impotence Clinic

· General Practitioner run mini-clinics, (attend larger practice clinics)

· Domicillary visits (paediatric and adult for initiation of insulin)

· Education Sessions for teaching patients about diabetes

· Research, Teaching and Administration

· SpR may adjust their timetable flexibly outside their fixed commitments to cover these activities.

· In particular, all day Tuesday or Wednesday could be available for research, depending on the week of the month and the other options chosen.

Leicester General Hospital (3 training posts)

The three trainees at Leicester General Hospital will work under the supervision of:

Dr R. Gregory, DM, FRCP Consultant Physician, Educational Supervisor

Dr S.N. Jackson, FRCP Consultant Physician

Dr M-F Kong DM, FRCP Consultant Physician

Other Staff:

2 SHOs (GP Registrar) and 2 House Physician

Dr N. Vaghela, Dr P. Ghatora Hospital Practitioners

The firm has 34 acute medical beds on ward 3.

Diabetes Care Staff:

· There are 5.5 whole time Diabetes Specialist Nurses who cover all over Leicestershire including the Community Diabetes Clinics at Loughborough, Coalville and Melton Mowbray. They are supported by a secretary.

· Two Senior Specialist Diabetes Dietician

· Three Diabetes Research Nurses with responsibility for the research projects within the department. The research is supported by a research co-ordinator

The Diabetes firm functions as an acute general medicine firm admitting unselected adult medical emergencies. In addition, it admits diabetic emergencies at any time on request from referring clinicians and accepts diabetic and endocrine referrals from other firms within the hospital.

It provides a comprehensive adult diabetes service servicing approximately half the population of Leicestershire. There are 3 general diabetic clinics per week with approximately 900 new and 1100 follow-up consultations. The consultants are responsible for Community Diabetic Clinics in Loughborough (SJ) and Coalville and Melton Mowbray (RG). In addition, there are the following specialist clinics:

· Combined antenatal clinic (weekly) for the management of medically-complicated pregnancies jointly with Mr Ian Scudamore & Dr Sheena Hodgett (Consultants, Obstetrics & Gynaecology)

· Foot clinic (weekly) for the management of diabetic foot ulceration (multidisciplinary team comprising plaster nurses, orthotist and podiatrist with vascular surgical and orthopaedic expertise available on demand).

· Education clinic (monthly): group education for patients with newly-diagnosed diabetes and their relatives. Separate sessions for insulin-treated and others

· Combined diabetic nephropathy clinics - Consultant Nephrologists and Dr Gregory (Tuesday PM) and Dr Kong (Friday AM)

· Andrology clinic (weekly) for the diagnosis and management of impotence run by Mr D.Sandhu & Mr T.Terry (Consultant Urologists). There is a parallel medical impotence clinic for diabetic patients once a month (RG).

Opportunities for experience in Endocrinology include Dr Gregory’s Endocrine Clinic (alternate weeks), Obesity Clinic (alternate weeks) and a Surgical Thyroidology clinic run by Prof M. Nicholson (Consultant Surgeon). Training in fine needle aspiration of thyroid nodules (FNA) is available. There is also an islet cell auto transplantation programme for patients undergoing pancreatectomy.

Duties of the Post:

Clinical Timetable:

It is envisaged that there should be some flexibility regarding the menu of options available, according to the precise training requirements of the individual in post and service requirements, for e.g. provide cover for gaps which may occur due to on-call commitments and leave of the other SpRs The general organisation of the job plan for the trainees will be as follows:

Trainee 1

	Monday	Tuesday	Wednesday	Thursday	Friday
A.M.	Research	SpR Ward Round	Diabetes Clinic (SJ) or Administration (Discharge summaries/ Clinic results)	X-ray Meeting Consultant Ward Round	Community Clinic (Melton or Loughborough)
	X-ray Meeting	Journal Club / Beta-Cell Club		Medical Staff Round	Joint lunchtime meeting with HCE
P.M.	Research	Nephropathy Clinic or Ward work	Diabetes Team Meeting	Diabetes Foot Clinic Or Diabetes Clinic (RG)	Trouble-shooting Ward Round

Trainee 2

	Monday	Tuesday	Wednesday	Thursday	Friday
A.M.	Consultant Ward Round	General Medical / Endocrine / Obesity Clinics	SpR Ward Round	X-ray Meeting Consultant Ward Round	Nephropathy Clinic or Research
	X-ray Meeting	Journal Club / Beta-Cell Club		Medical Staff Round	Joint lunchtime meeting with HCE
P.M,	Diabetes Clinic (MFK)	Combined Antenatal/ Diabetes/ Endocrine Clinic or Nephropathy Clinic	Diabetes Team Meeting	Diabetes Clinic (RG)	Research

Trainee 3

	Monday	Tuesday	Wednesday	Thursday	Friday
A.M.	Consultant Ward Round	Research clinic	Speciality Clinic	X-ray Meeting Research	Administration - Discharge summaries/clinic results
	X-ray Meeting	Journal Club / Beta-Cell Club		Medical Staff Round	Joint lunchtime meeting with HCE
P.M,	Diabetes Clinic (MFK) Or Audit	Ward work	Diabetes Team Meeting	Diabetes Foot Clinic/Research	Trouble-shooting ward round

Education Meetings:

· Diabetes Multidisciplinary Team Meeting - Weekly (Attendance is Mandatory): Beside discussion of current clinical problems, a rolling programme of topics are discussed on a regular basis - foot problems, psychological aspects, pregnancy, audit and research in progress.

· X-ray Meetings - one per week for the firm.

· ‘Beta-Cell Club’: a monthly multidisciplinary Diabetes Interest Group. Trainees are expected to be regular presenters.

· Audit: There is an active programme of clinical audit for diabetes care. Trainees are expected to participate actively in this programme. In addition, there are monthly Medical Directorate Audit meetings.

· Medical Staff Round: Weekly during term time - a wide range of topics are presented

· There is an SpR training programme jointly with Nottingham (usually the 1^st Wednesday afternoon of the month).

Research Opportunities:

There is an active programme of research in diabetes at the Leicester General Hospital. The main interests are in delivery of care, ethnic aspects of disease, screening for and prevention of Type 2 Diabetes, and diabetic pregnancy.

Trainees will be encouraged to take part in research as part of their attachment. By having a whole day for research if required it should also be possible for trainees who have started a project at another hospital in the Leicestershire rotation to complete it.

UHL Sub-Speciality / Special Interest Module (1 Training Post)

This new SpR attachment has been designed to take advantage of the extensive sup-specialist experience throughout UHL and to relieve the pressure of clinical workload on the other 5 SpR’s working in UHL to allow optimal opportunities for training for all SpR’s. At the time of writing manpower approval is still awaited

This post will be physically based at the Leicester Royal Infirmary, which is the site of the largest outpatient service and busiest acute medical take in UHL, but will have the opportunity to obtain clinical experience and training on any site within UHL, or in Community hospitals and primary care, or even outside Leicestershire if the special interests of the individual SpR dictate (e.g. a trainee interested in greater experience of specialist reproductive endocrinology, bone disease or endocrine oncology).

Acute general medical experience during this attachment will be obtained in the first instance at the Leicester Royal Infirmary, the site of Leicestershire’s A&E department, but these details will be influenced by the review of provision of services for acute medicine in UHL being undertaken during 2003. To optimise the specialist training opportunities, this trainee will normally be a relatively senior member of the training programme and will not be scheduled for routine post-acute inpatient duties in General Medicine (although they will be expected to act as part of the Department’s general medicine team, supervise more junior trainees and provide cover for gaps which may occur due to on-call commitments and leave of other junior staff members)

The weekly timetable will be flexible and tailored to the needs of the individual trainee – who would normally be in the latter part of the training program and need to fill in ‘gaps’ and develop subspecialist interests.

A typical programme might be..

	Monday	Tuesday	Wednesday	Thursday	Friday
A.M.	Diabetes Clinic (DAFNE)	Research, Education or Special Interest	Paediatric Endocrine / Surgical Endocrine / Dynamic Tests	Options: Gynae-Endocrine Foot Clinic Paediatric Diabetes	Pituitary Clinic (2^nd Week) Or Complex cases Endocrine New Patient Clinic
		Endocrine Clinic Case Discussion / Training	1pm X-Ray Meeting	1pm D&E Postgraduate Meeting	1pm LRI Physicians’ Meeting / Audit
P.M.	Inpatient Referrals, Adminstration & Teaching	Research, Education or Special Interest Young Adult Diabetic Clinic (Monthly)	Monthly Education Session Or Antenatal/ D&E Clinic	Inpatient Referrals & Administration	Ward ‘Trouble-Shooting’ Round Erectile Dysfunction Clinic (2^nd Week)

… however the trainee’s programme would be individually agreed to meet their educational needs and might include:

· Antenatal Diabetes & Endocrine Clinic

· Assisted Conception Unit

· Diabetic Foot Clinics

· Diabetic Nephropathy Clinic

· Diabetic Retinopathy Clinic

· Domicillary visits (paediatric and adult for initiation of insulin)

· Education Sessions for teaching patients about diabetes – including DAFNE sessions

· Erectile Dysfunction Clinic

· General Practitioner run mini-clinics (attend larger practice clinics)

· Gynae/Endocrinology Clinic

· Paediatric & Adolescent Diabetes and Endocrinology

· Pituitary Surgery Joint Clinic

· Surgical Endocrine Clinic

· Thyroid Ophthalmopathy Clinic

· Vascular Clinics

Education and Training

The Leicestershire SpR Training Programme provides opportunities for training and education on a variety of levels. Trainees will be encouraged to available themselves of those opportunities which are most appropriate for their current experience

Hospital Based:

· There are regular postgraduate speciality meetings at both Leicester Royal Infirmary and Leicester General Hospital. Trainees will be expected to attend these meetings when they are in these posts (and to organise and present some of the sessions). Trainees in other hospitals on the programme will be sent the programmes and will be welcome to attend as appropriate. General Medicine Postgraduate Meetings are held weekly on all sites.

Local:

· There is a monthly, half-day (Wednesday afternoon) speciality postgraduate education meeting for all trainers and trainees associated with the programme. Typically, this will consist of a presentation/review of one topic of interest by a consultant trainer, and another (possibly related) topic by one of the trainees. A short presentation of interesting cases may be included for light relief. We aim to allow some discussion of all major areas of clinical practice during a 5-year programme. This programme is now integrated with the Mid-Trent programme to allow a greater critical mass of trainees.

· A South Trent training programme in General Medicine began in 2003 and all trainees are expected to attend.

Regional:

· East Midlands Endocrine Society: meets annually. Trainees should aim to attend whenever possible, and should present cases at this meeting on a regular basis

· Royal College of Physicians Regional CME Courses: Trainees should ensure that they are on the mailing list and aim to attend whenever possible.

National:

· RCP/Society for Endocrinology/DUK - 2 day training programmes occur 1-2 times per year and are a very valuable source of structured endocrine training.

· Scientific Meetings: British Endocrine Societies in Spring, Diabetes UK in Spring, Society for Endocrinology in November, Full and Half-day Clinical meetings of Society for Endocrinology

International:

· Anglo-Danish-Dutch Diabetes Meeting

· EASD, EFES Meetings and Training Courses, American Endocrine Society and American Diabetes Association

· Consultant trainers will support attendance at an appropriate selection of these local and national meetings up to the statutory study leave allowance. Attendance at international meetings will be encouraged when trainees have data to present, but will always be subject obtaining appropriate financial support.

· In general, trainees in the early years of the programme will be advised to concentrate on the more structured training courses listed above, while trainees nearing the end of the programme are likely to derive greater benefit from the national scientific meetings (at which we would expect them to be able to make regular presentations)

University of Leicester, School of Medicine

Dean: Professor Ian Lauder, MB BS, FRCPath, FMedSci

As part of the School of Medicine’s commitment to the maintaining and improving on its existing high standards of research and teaching, it carried out an extensive restructuring process in 2003. There are five substantial academic departments, defined primarily by their research interests and spanning the traditional clinical subject areas. These are Cancer Studies and Molecular Medicine (Head: Professor W P Steward); Cardiovascular Sciences (Head: Professor N J Samani); Health Sciences (Head: Professor R H Baker); Infection, Immunity and Inflammation (Head: Professor P W Andrew); and Medical and Social Care Education (Head: Professor S Petersen).

These Departments are able to bring considerable intellectual resources to bear on a range of vital medical challenges and reflect the priorities of the National Health Service. They provide a stimulating environment for research and for study at all levels, and offer a wide range of opportunities for professional training and development.

In addition to the departments there are clinical divisions, which bring together clinical academics from cognate specialties, and whose role is to co-ordinate links with NHS colleagues, the Royal Colleges and postgraduate medical education. There are clinical divisions for Anaesthesia, Critical Care and Pain Management; Child Health; Epidemiology and Public Health; General Practice and Primary Health Care; Medical Physics and Radiology; Medicine; Obstetrics and Gynaecology; Oncology; Pathology; Psychiatry; and Surgery, Orthopaedic Surgery and Ophthalmology.

The Faculty of Medicine and Biological Sciences

Dean: Professor W J Brammar, BSc, PhD, FRSA

The annual undergraduate intake target to the Faculty comprises 175 to the MB ChB degrees, 21 to the BSc (Hons) degree in Medical Biochemistry, 100 to the BSc (Hons) degree in Biological Sciences, 55 to the BSc (Hons) degree in Psychology, 15 to the BSc (Hons) degree in Medical Genetics and 13 to the BSc (Hons) degree in Psychology with Neurosciences. In addition, courses shared with other Faculties comprise the BSc in Combined Science, the BA in Combined Arts, the BSc in Psychology with Sociology, the BSc in Biological Chemistry and the BSc in Physics with Medical Physics. Medical undergraduates may undertake an intercalated BSc (Hons) by research. There are taught Masters courses for the degree of MSc in Forensic Psychology, Forensic and Legal Psychology (by distance learning), Medical Statistics, Molecular Genetics, Molecular Pathology and Toxicology, Natural Resource Management, Pain Management and a Doctorate in Clinical Psychology. There is a part-time Master of Clinical Science. The Faculty admits postgraduates to study for the degrees by research of MD, PhD and MPhil.

The Faculty comprises three Schools: Medicine, Biological Sciences and Psychology. The School of Psychology consists of a single Department of Psychology, plus the Centre for Applied Psychology. The School of Medicine includes the Cardiovascular Research Institute, the Institute for Lung Health, the Division of Medical Education (including the Centre for Studies in Community Health Care), the Division of Medical Physics and the Centre for Postgraduate Medical Education. There are twenty departments in the Schools of Medicine and Biological Sciences: Anaesthesia & Pain Management, Biochemistry, Biology, Cell Physiology and Pharmacology, Child Health, Epidemiology and Public Health (including the Nuffield Community Care Studies Unit), General Practice and Primary Health Care (including the Clinical Governance Research & Development Unit), Genetics, Medicine (including the Divisions of Cardiology, Dermatology, Gastroenterology, Medical Genetics, Medicine & Therapeutics, Medicine for the Elderly, Renal Medicine, Respiratory Medicine), Microbiology & Immunology (including the Division of Immunology), Obstetrics & Gynaecology, Oncology, Ophthalmology, Orthopaedic Surgery, Pathology (including the Divisions of Chemical Pathology, Histopathology and Haematology), Pre-Clinical Sciences, Psychiatry (including the Divisions of Child and Adolescent Psychiatry, Forensic Mental Health & Psychiatry for the Elderly), Radiology, Surgery (including the Divisions of Cardiac Surgery and Transplant Surgery) and the Centre for Mechanisms of Human Toxicity (CMHT) including the MRC Toxicology Unit. An Institute of Environment and Health has been developed alongside the MRC Toxicology Unit.

The main accommodation for the Faculty of Medicine and Biological Sciences comprises the Maurice Shock Medical Sciences Building, the Adrian Building, the Hodgkin Building and the Astley Clarke Building (Psychology) on the University campus; and the Robert Kilpatrick Clinical Sciences Building at the Leicester Royal Infirmary, half a mile from the campus.

There is also University accommodation at the Leicester General Hospital and a Clinical Sciences wing at Glenfield Hospital. The Maurice Shock Building is linked by footbridges to the Adrian Building, which houses the Departments of Biochemistry, Biology and Genetics, and to the Hodgkin Building which houses the CMHT and the MRC Toxicology Unit. The University Library has a good medical collection. There is a separate Clinical Sciences Library in the Robert Kilpatrick Building, whilst the NHS Libraries at the Leicester General Hospital Trust and Glenfield Hospital Trust have rapid access to the University Library facilities.

There are a number of Faculty Boards and Committees on which members of the Faculty, whether full-time or part-time lecturers, may serve e.g. the Board of the Faculty of Medicine and Biological Science, undergraduate and postgraduate Boards of Studies, the Research Committee, the Learning and Teaching Committee, the Graduate Studies Committee, the Safety and Security Committee and Staff-Student Committees.

THE CITY OF LEICESTER

Leicester is a thriving city in the centre of England. It offers all the attractions of a busy urban setting with rolling countryside within easy reach. The city has a rich history going back to Roman times and now has prosperous industries based upon hosiery, light engineering, printing and a range of service activities.

The Leicester market is one of the largest in Europe and has occupied its present site, in the centre of the city, for over 700 years. The surrounding shops are set in an attractive pedestrianised area; there are two enclosed shopping centres and squares, lanes and arcades with smaller shops and cafes. The city has some fine parks including Castle Gardens and Abbey Park, both alongside the River Soar, and Victoria Park, which is adjacent to the University.

The Haymarket is one of the country’s leading theatres and has a large auditorium as well as a small studio. The Phoenix Arts Centre particularly attracts young people with a varied programme of film, drama, dance and music. The De Montfort Hall, adjacent to the University, is one of the finest concert venues outside London and the city has a fine collection of museums. The city centre is linked to the Museum and Art Gallery and to the De Montfort Hall by New Walk, an elegant pedestrian thoroughfare laid out in 1785.

LEICESTERSHIRE AND RUTLAND

Leicestershire is a county of surprising beauty and style. Its rural landscape and picturesque villages are within easy reach of the city. Bradgate Park, 800 acres of magnificent deer park, and the ancient rocks and hills of the Charnwood Forest, lie to the north-west of the city. To the east is the County of Rutland with delightful countryside and villages.

The county offers a wide variety of sporting facilities. The Grace Road ground houses the County Cricket Club, while the renowned Leicester Tigers Football Club is a five minute walk

from the University. For soccer enthusiasts, the Leicester City Stadium is similarly close at hand. Castle Donington and Mallory Park motor racing circuits are easily reached and facilities for basketball, ten-pin bowling, roller skating and swimming are to be found in the City. The county is well known for its horse-riding, rambling and cycling, and Rutland Water provides excellent facilities for fishing, sailing and watersports.

The county is well placed at the centre of England with good road and motorway links. It is also well served by two international airports - East Midlands and Birmingham. Midland Mainline operate a regular service to London, approximately half hourly.

Dr Marie-France Kong

Training Programme Director January 2007