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Gastroenterology Sub-Speciality Training at ST3+ |
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TRAINING SCHEME FOR
SPECIALIST TRAINEES
The Digestive Diseases Centre
CONTENTS:
1. General Description of the
Scheme
2. General Medicine
3. Gastroenterology:
"core" experience and skills; special options
4. Research
5. Formal Training Schedule
6. Appraisal
7. Individual Units and
Trainers
8. Further Details
1. GENERAL DESCRIPTION OF THE SCHEME
The aim of the scheme is for trainees to obtain a CCT in both general
internal medicine (acute) and gastroenterology.
The scheme will rotate trainees between either of 3 District General
Hospitals (
Entry to the scheme will be at ST3 (except during MMC transition when it
may be at a higher level). The total duration of the scheme is 5 years
(following on from core medical training [CMT] and assuming entry at ST3).
For trainees recruited to ST3 of the scheme, training will usually
commence at either
The trainer (or educational supervisor) for each post on the scheme will
be one of the consultant gastroenterologists with whom the trainee will agree a
weekly program to include the training features set out in section 7 of this
document. Each post will include a half day a week for education/research and
protected time for the monthly training half days.
Rotation date will be 1st October each year. Each trainee's needs and
preferences will be considered in deciding which post he/she will rotate to for
the year. Normally, if a trainee takes a year out for research (strongly encouraged), the
consultant/trainer to whom he/she is responsible will need to find a locum for
the clinical post for the year (normally a "LAT" - locum appointment
for training).
SUMMARY OF TRAINING SCHEME
YEAR 1 YEARS
2 – 4 YEAR
5
2. GENERAL MEDICAL
TRAINING
Each post provides experience of unselected acute general medical
admissions and care of both general medical inpatients and outpatients. The
proportion of time spent on GIM differs between the training units, with in
general more time being required in the
3. GASTROENTEROLOGY
All areas of diagnosis and management of gastroenterological and
hepatological conditions will be covered in accordance with the National
Curriculum. Training will be provided in basic diagnostic and advanced
therapeutic Endoscopy; with the opportunity to learn ultrasound, ERCP or
oesophageal manometry/pH studies should the trainee have a desire to do so.
Each trainee will be exposed to a minimum of 6 months Hepatology with the
possibility of further exposure. There is also the opportunity to be exposed to
specialised nutrition training.
4. RESEARCH
The Diegestive Disease Centre encompasses all the relevant sites in the
training programme (see www.digestivediseases.org)
All trainees are strongly encouraged to take one or two years
(the latter if a higher degree such as MD is desired) during the scheme for
full-time clinical or laboratory research. Those interested may have areas they
wish to research or may develop interests during the scheme. The special and
research interests of trainers are indicated below, and any will be pleased to
discuss further any proposals and opportunities.
Professor Janusz Jankowski has a Visiting Professorship at
The Unit has published in prestigious journals including
Lancet, Gastroenterology, Cancer Research and The Journal of the National
Cancer Institute. In addition we are well funded with over 2 million pounds in
in funding from Cancer Research
Trainees
will be given opportunities to work locally in Leicester on clinical research
or depending on the individual’s track record translational and basic science
opportunities at his laboratories at the
The
University is committed to producing research and teaching of the highest
quality, to promoting undergraduate and postgraduate studies through campus
based and distance-learning programmes and to developing close collaboration
with the local and regional community. Links also exist between the South Trent
scheme and
Dr John de Caestecker has clinical and research interests in upper GI
motility disorders, gastro-oesophageal reflux and Barrett’s oesophagus. He is
responsible for the GI function laboratory and would be keen to
encourage/support any interested trainees in project development related to any
of the above topics.
5. FORMAL TEACHING
SCHEDULE
There is a regional training day rotating between Leicester, Nottingham
or
There is a separate GIM teaching program organised by the Director of
Training in GIM whilst trainees are in
6. APPRAISAL
A logbook will be made available to each trainee in which conditions
experienced and techniques/practical procedures carried out will be recorded.
This is a logbook provided by the JCHMT and will normally form the basis for
reviewing experience attained and further training needs. Trainees will also be
assessed by mini-clinical evaluation exercise (mini-CEX), directly observed
procedural skills (DOPS) and 360 degree appraisal.
Each trainee will be appraised yearly by interview with the Postgraduate
Dean for South Trent (or his representative), together with the director of the
7. THE INDIVIDUAL UNITS
AND TRAINERS
a).
Leicestershire Health
Authority covers a population of 875,000 served by 3 teaching hospitals based
in the city and a number of community hospitals based around the county. Gastroenterology is based primarily at the
JAG (Joint Advisory
Group) Endoscopy courses are run in
i).
Gastroenterologists: Dr J F Mayberry
Dr
S Shah (currently locum consultant)
Dr
J S de Caestecker
Dr
R Robinson
This large acute teaching hospital has a complement of 950 beds.
Professorial departments of Nephrology and Elderly Care Medicine are on site.
Training is available in the full range of gastrointestinal disorders,
including specific training in upper GI endoscopy, colonoscopy, ERCP, and all
therapeutic endoscopy. All of the consultants partake in general acute medical
admissions.
There are 5 colorectal surgeons and two hepatobiliary surgeons who
compliment the medical gastroenterology services. Close working relationships
between physicians and surgeons allow for joint training in ERCPs and PEG insertion.
This takes place in a modern multi-room endoscopy suite with X ray screening
facilities in the nearby X ray department plus CCTV to a seminar room on the
day case unit for postgraduate teaching purposes. More than 6000 endoscopic
procedures a year are undertaken. There is a dedicated GI radiologist (Dr R
Verma) and 1 GI/liver histopathologist (Dr R Harrison, with 2 others having a
major interest).
In addition, this is a major centre for GI research. Achievements
include an annual output of more than 20 publications and major grants from the
ICRF/MRC, the British Digestive Foundation and NACC, together with other
research bodies. During the last 5 years, the main commitment has been to
epidemiological studies.
Weekly
timetable:
There are 4 posts available with Drs Mayberry / Shah / De Caestecker /
Robinson. The work schedules for the
posts are similar, but the exact timetable will depend on the experience and
needs of the trainee.
·
2-3 endoscopy/colonoscopy lists per
week
·
ERCP training for selected trainees
(usually ST3 or above)
·
2-3 gastroenterology OP clinics per
week, including specialist IBD/coeliac/PEG clinics
·
1-2 consultant ward rounds per week
(The timetable is in the process of change which may give added training
opportunity).
Other activities:
·
Histology meetings
·
Endoscopy audit meetings quarterly
·
A joint medical/surgical GI meeting
every 2nd week (plans for a weekly meeting)
·
Weekly HPB MDT meeting is held on
this site
·
Weekly postgraduate meeting
(Thursday lunchtime)
·
Monthly Tuesday morning DDC meeting
at LRI (including external speakers and audit)
·
Options:
·
Abdominal ultrasonography and guided
liver biopsy (Dr Y Rees, Consultant Radiologist).
·
Inflammatory bowel disease (Dr
Mayberry or Dr Robinson)
·
Oesophageal functions tests (Dr de
Caestecker)
Special Interests:
·
Oesophageal disease, especially
oesophageal motility disorders, non cardiac chest pain and gastro-oesophageal
reflux disease. Oesophageal manometry and ano-rectal physiology is performed at
Glenfield (Dr de Caestecker)
·
Epidemiological aspects of
gastrointestinal disease, in particular inflammatory bowel disease. Patient
information and education programmes. (Dr Mayberry)
·
Inflammatory Bowel Disease. (Dr
Robinson)
ii). LEICESTER
ROYAL INFIRMARY
Gastroenterologists: Dr B J
Rathbone
Dr
J Stewart
Dr
P Wurm
Prof
J Jankowski
Dr
A Grant (Hepatology)
Dr
Delahooke (Hepatology)
This is an acute 1092 bedded teaching hospital with beds for all main
specialities and contains the only major Accident and Emergency Unit in the
district. The Clinical Sciences Block of the
The medical gastroenterology department is supported by 3 upper GI,
two hepatobiliary and 2 colorectal
surgeons. There are two specialist gastrointestinal radiologists and 2
histopathologists specialising in gut and liver pathology.
The Infirmary has a modern purpose-built endoscopy unit with up to date
video equipment carrying out all forms of diagnostic and therapeutic endoscopy.
Nurse endoscopists contribute to the service and carry out regular fibreoptic
sigmoidoscopies and upper GI endoscopies.
There are specialist liver and inflammatory bowel
disease clinics.
Professor Jankowski has a major interest in
Gastrointestinal Epithelial Biology and has a well funded research
programme. Trainees will be expected to
take an active role in research while working in the department.
Weekly timetable:
There are 6 posts available. The weekly timetable is similar for each
post, though the exact program would depend on the experience and needs of the
trainee.
·
2 endoscopy/colonoscopy lists
·
ERCP lists (available to those
showing interest and aptitude)
·
2 gastroenterology clinics
·
0.5 general medical clinic
·
2 consultant ward rounds
Other activities:
·
1 weekly GI radiology meeting – Monday Lunch time (1-2 pm)
·
1 weekly multidisciplinary clinical
meeting – Alternate Tuesday & Thursday (1-2 pm)
·
1 weekly general medical meeting –
Friday Lunch time ( 1-2 pm)
·
Weekly UGI MDT meeting
·
Monthly Tuesday morning DDC meeting
(including external speakers and audit)
Options:
·
Viral hepatitis and HIV clinics
(Drs. Grant/Delahooke/Wiselska)
·
Liver disease (Dr Grant/Dr
Delahooke)
·
Nutrition (Dr Stewart)
·
Helicobacter pylori research
techniques (Dr Rathbone)
·
Training in Advanced Chemoprevention
(Professor J Jankowski &
Professor W Steward)
Special interests:
Dr Rathbone has a special interest in H pylori, particularly in the field
of 3rd generation serology, pathogenicity and treatment.
Dr Stewart is interested in enteral/parenteral nutrition, audit,
clinical governance and legal medicine
Professor Jankowski has interests in Cancer
Surveillance and Chemoprevention.
Drs Delahooke and Grant are interested in all aspects
of liver disease
b).
Gastroenterologists: Dr J G Freeman
Dr
A T Cole
Dr
A F Goddard
Dr
Cunliffe
Dr
Holmes
Dr Norton
Dr
Austin
Dr
Lai
This is one of two large Teaching Hospitals serving the population of
A Professorial Chair in Rehabilitation medicine was established in 1995,
and in the following year Chairs of Paediatrics and Obstetrics and Gynaecology
were established. There is a Chair of
Medicine (Vascular Medicine) at the Derbyshire Royal Infirmary. A
Chair of Gastrointestinal Surgery is established at the
The Gastroenterology Department is an active and expanding unit offering
training in all upper GI and colonic endoscopy, together with ERCP and endoscopic
ultrasound. Training and experience in all forms of therapeutic endoscopy will
be provided. There is a particular interest in laser work, with referrals from
the East and
Drs Freeman, Austin and Lai has an active interest in hepatology
including the care of patients with advanced liver disease, hepatitis C and
post liver transplant patients.
They are active contributors to the Trent Hepatitis C Research
Network. Drs Cole, Goddard, Norton and
Holmes provide care for patients with inflammantory bowel disease and
nutritional problems.
Weekly timetable:
·
one colonoscopy list
·
one endoscopy/laser list
·
one ERCP list
·
three gastroenterology clinics
·
one or two consultant ward rounds
·
Clinical Nutrition Team Ward Round
Other activities:
·
one weekly GI radiology meeting
·
one weekly GI histology meeting
·
one weekly Grand Round
·
one audit meeting weekly
·
Medical/Surgical gastroenterology meeting
twice a month
·
Journal Clubs & Derby Medical
Society meetings
Options:
·
Advanced therapeutic endoscopy
including laser treatment of tumours, treatment of tumours with photodynamic
therapy and argon beaming, oesophageal stenting and enteroscopy
·
Advanced therapeutic ERCP
·
Management of advanced liver disease
·
Endoscopic ultrasound
On call commitments: 1 in 6 resident on call
Special interests:
There are special interests in laser treatment,
hepatobiliary disease and inflammatory bowel disease.
Current research in
c).
Gastroenterologists: Dr A P Chilton
Dr
A Hussain
Dr
A Steel
Kettering General Hospital (KGH) is a large DGH serving a
population of 320 000. It is estimated that this will have increased to 400 000
by the end of the decade. We currently have 900 beds, 232 of which are medical.
The GI unit is a productive environment dealing with greater than 6000 new and
follow up patients and caring out over 6000 endoscopies per annum. KGH is a
designated colorectal cancer centre, and there is close collaboration with the GI
surgeons.
The Endoscopy unit is JAG compliant.
We aim to provide broad and focused training in
gastroenterology and general medicine in a unit committed to the provision of
high quality GI services. The SpR responsibilities are for the day-to-day
management of inpatients and for the on going direct and planned support of
patient care and junior doctor supervision.
Training will be focused on the needs of the individual and
based on current competencies and agreed objectives.
A wide range of endoscopic services is provided in a modern
well-equipped unit with three endoscopy theatres with plans for further
expansion. Two nurse endoscopists support the endoscopy services.
We also have a part time CNS in gastroenterology, providing
the hepatitis C support and managing complex ambulatory GI care.
Our objective is to equip trainees with the necessary tools
to support them in their development into independent GI specialist.
Weekly timetable:
Additional Activities:
Options:
On-Call:
1 in 11 full shift
(may increase to 1:12)
Special Interests:
d).
Gastroenterologist: Dr M W Dronfield
Dr
P Nair
Dr
M Ninkovic
This is a modern district general hospital of 642 beds which provides
all acute medical services for
There are three Consultant Gastroenterologists, Dr Dronfield, Dr Nair
and Dr Ninkovic. The duties of the post are partly those of general medicine,
both emergency inpatient and outpatient. There is also an extensive experience
of gastroenterology, including diagnostic and therapeutic endoscopy, and an
inflammatory bowel disease clinic. The registrar will be encouraged to acquire
experience in this clinic of long-term management of IBD.
There is a well-equipped endoscopy unit with good teaching facilities:
registrars will be taught basic endoscopy and colonoscopic skills, with
opportunity also to learn ERCP techniques.
Weekly timetable:
·
2 endoscopy lists
·
1 general gastroenterology clinic
·
1 inflammatory bowel disease clinic
·
1 general medical clinic - option to
choose another speciality of trainee's choice.
·
2 consultant ward rounds
Other activities
·
weekly X-ray meeting
·
weekly grand round
·
weekly pathology meeting
·
weekly medical dept meeting
·
weekly MDT meetings
On call commitments: 1 in 6 resident on call
Research
There is a well-endowed research fund; trainees are encouraged and
supported in developing research interests. Two sessions are available for
research activities.
8. FURTHER
DETAILS
Further details may be obtained from :-
Dr J Stewart
Training Programme Director/Consultant Gastroenterologist
University Hospitals of
LE1 5WW
Tel: (0116) 2586480
August 2006