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Emergency Medicine at Chelsea and Westminster
Emergency Medicine at Chelsea and Westminster
Emergency Medicine at Chelsea and Westminster
Emergency Medicine at Chelsea and Westminster
Emergency Medicine at Chelsea and Westminster
Emergency Medicine at Chelsea and Westminster
Emergency Medicine at Chelsea and Westminster
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Emergency Medicine at Chelsea and Westminster

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  • 1. Emergency Medicine at Chelsea and Westminster The Foundation Year 2 post in emergency medicine comprises four months in the adult emergency dept. This block does not include paediatrics. The rota is full shift working nights and weekends. There are 13 SHOs of which 10 are foundation year 2 4 hours of teaching a week are covered by locums. Study leave is available for appropriate life support courses. Your role is to manage all presentations including medical, surgical, gynaecological and psychiatric emergencies as well as minor injuries and illness. You are supported by the 5 consultants, Ms Peta Longstaff, Mr Jeremy Booth, Dr Wendy Matthews, Ms Francesca Garnham and Dr Patrick Roberts. You are also supported by 8 middle grades who provide 24 hour shop floor presence. Care of the Elderly at Chelsea and Westminster The Chelsea and Westminster NHS Trust is a London teaching hospital that serves the populations of Chelsea, Westminster and Kensington as well as parts of Fulham, Putney, Wandsworth and Battersea. Within general medicine three megafirms provide ward-based care for inpatients. This post will be part of megafirm B. The consultants on the firm are Dr Peter Kroker and Dr Iñaki Bovill and have specialist interests in Geriatric and General Internal Medicine. Their work is supported by one registrar, one SHO one FY2 and an FY1. The FY2 has a 4 month block with the firm. The team is part of the acute on call for general medicine on a 1 in 9 unselective take. The on-call commitments are arranged as a full shift system; the SHO/FY2 shifts include a day, twilight and a night shift – the latter as a week of nights (to be changed to 3 and 4 nights). We also provide a liaison service to the surgical and orthopaedic teams and have general medicine, geriatric and falls clinics which the FY2 is encouraged to attend. Care of the Elderly at Chelsea and Westminster Consultant supervisor: Dr D. J. Richard Morgan – Consultant Physician (CCST in General Internal Medicine, Clinical Pharmacology & Geriatric Medicine). Time on attachment: 4 months as part of year placement, this includes 4 months A&E, and 4 months Gastro-enterology. On- call for all age General Medical admissions approximately 1 in 9. Fully EWTD/Junior Doctors hours compliant. Experience of acute emergency medicine including CCU, MAU and Level 1 care. Specialist Stroke unit responsibility of the firm. Full supporting team of SpR and FY1 house officer. Time is spent approximately 75% with ward work and 25% in outpatients. Outpatient clinics- twice a week, subject to on-call availability. Outpatient experience in General Medical and Medical Day Unit, where a variety of conditions are managed
  • 2. (Ward follow-ups, endocrine, cardiovascular and cerebro-vascular and respiratory medicine, and Memory clinic, adult spina bifida annual review clinic). Education opportunities: Weekly departmental meeting with case presentations, audit, journal reviews; weekly Grand round, weekly FY2 training session. Appointees are encouraged to attend ALS/ATLS courses and ALERT courses and other post- graduate training courses as appropriate. This post offers a good experience for a trainee wishing to pursue a career in Hospital Medicine specialties, providing a wide exposure in General and Geriatric Medicine and specialty experience necessary for any training doctor wishing to remain in secondary care. Diabetes and Endocrinology at Chelsea and Westminster The Chelsea and Westminster NHS Trust is a London teaching hospital that serves the populations of Chelsea, Westminster and Kensington as well as parts of Fulham, Putney, Wandsworth and Battersea. Within general medicine three megafirms each consisting of three firms provide ward-based care for inpatients. This post will be part of megafirm A (Respiratory Medicine, Rheumatology and Diabetes / Endocrinology). The consultants on the firm are Dr Michael Feher and Dr Kevin Shotliff and have specialist interests in Diabetes and Endocrinology. Their work is supported by a multi-disciplinary team based in the Beta Cell Diabetes Centre (including 1 DM + Endo. Specialist Registrar, 1 DM + Clinical Pharmacology Specialist Registrar, 1 FY2{this post} and 1 FY1). This post offers good exposure to general medicine. The spectrum of people with diabetes and a range of specialist endocrine cases with excellent laboratory services and departmental meetings support the extensive educational opportunities of the hospital. Attendance in Diabetes and Endocrinology Clinics is possible as past of the timetable for this post. GU Medicine at Chelsea and Westminster Name of consultant supervisor, Dr Fiona Boag. Other consultants Dr Simon Barton, Dr Ann Sullivan, Dr Sara Day & Dr David Hawkins. Four months attachment. On call commitment is 1:7 for HIV. The on call starts at 5.00 p.m and ends at 11.00 p.m during the week. Two hours of this time is spent working in Acute Medical Admissions. Weekend on call is 10.00 a.m until 11.00 p.m, HIV only. The working day is divided between GU Medicine outpatients, management of results and sitting in specialist clinics such as HIV, dermatology, depending on the doctors training wishes. Wednesday morning is dedicated to HIV/GUM plus general medical education. All outpatient clinics are cancelled during this time.
  • 3. Experience gained in this post is strong communication skills, time management, decision making and multidisciplinary team work, broad GU experience in managing acute presentations of GU conditions, chronic conditions and specialist multi- specialist clinics. The on call provides very extensive general medical experience as the HIV patients, as well as well as having opportunistic infections, have multiple co- morbidities, such as TB, septicaemia, cardiovascular disease, decompensated cirrhosis and the range of medical problems continues to expand. Gastroenterology at Chelsea and Westminster Chelsea & Westminster NHS Foundation Trust is a London teaching hospital that serves populations of Chelsea, Westminster and Kensington as well as parts of Fulham, Putney, Wandsworth and Battersea. Within general medicine there are 3 mega firms that provide ward-based care for inpatients. This post will be part of mega-firm C which is run by the gastroenterologists. Approximately 4 months will be spent within mega-firm C. The on-call rota is approximately a 1 in 7. he work comprises clinical ward work, dedicated teaching, an interactive Wednesday academic session, and time-permitting; helping with research projects. The consultants on the firm are Professor Gazzard, Professor of HIV Medicine; Dr Mike Anderson, Medical Director; and consultant Gastroenterologists Dr Matthew Banks, Dr Martin Benson, Dr Marcus Harbord and Dr Bobby Prasad. In addition there are 5 registrars supporting Gastroenterology, 3 SHOs and 3 FY1 posts. A specialist nurse in Inflammatory Bowel Disease is about to be appointed and there are 2 specialist nurses working in Hepatitis. We will endeavour to make sure that the time that you have with us both fun and educationally of benefit. Gastroenterology / Neurology at Chelsea and Westminster Name of Consultant Professor Brian Gazzard Time spent on attachment 4 months. On call commitments These are split evenly between all the junior staff who do a week of nights at a time. The rota is approximately one in seven to one in eight. The clinic work is all under supervision and is designed largely as a learning experience but opportunities are given both to see new general medical and gastroenterology utpatients. Ward work – the SHO on the firm runs the ward and can consult either with Professor Gazzard or with the Registrar about difficult problems and has a Houseman to assist him or her. Professor Gazzard also runs a large HIV team and opportunities during the attachment are given to learn about immunodeficiency diseases and various aspects of infectious disease for those who are interested.
  • 4. HIV Medicine at Chelsea and Westminster Consultant Supervisor, Dr Mark Nelson, Other consultants, Professor Gazzard & Dr Pozniak. Four months attachment. On call commitment is 1:7. On call for HIV. The on call starts at 5.00 p.m and ends at 11.00 p.m on weekdays. Two hours of this time, one is seconded to General Medicine on take working in A&E or where the General Medicine needs most help. Weekend work is 10.00 a.m in the morning until 11.00 p.m at night, - HIV only. The working day is divided between inpatient ward work, HIV Daycare and HIV walk in emergency service. There are teaching ward rounds, radiology meetings and multidisciplinary meetings. Wednesday morning is dedicated to HIV/GUM plus general medical education. All outpatient clinics are cancelled during this time. The HIV unit has a very rapid turnover of patients, most of whom are young and are admitted with opportunistic infections or acute general medical problems such as pulmonary emboli, septicaemia, TB and decompensated liver disease. In addition many of the patients have tumours; you are trained by Dr Mark Bower on the management of HIV associated tumours such as lymphoma and Hickman line sepsis, palliative care, symptom control, psychiatric care, pre and post natal HIV care are also part of your training. Intensive Care at the Royal Brompton Hospital The Adult Intensive Care Unit of the Royal Brompton Hospital has 20 beds and admits approximately 1200 patients per year with cardiothoracic illness. The unit has 8 Consultants: Professor Tim Evans (Professor of Intensive Care Medicine, Imperial College), Cliff Morgan (Clinical Director), Charles Gillbe, David Hunter, Mark Griffiths, Susanna Price, John Wort and Jeremy Cordingley. The 2 FY2 doctors are part of a team of 6 who participate in a full shift rota providing 24 hours a day cover for their 4 month attachment. There is always a resident SpR in Intensive Care Medicine to provide immediate support. A normal working day starts at 8 am with a consultant-led morning handover ward round. The morning is spent assessing patients, organising care and undertaking practical procedures. After lunch there is an X-ray round followed by the afternoon ward round. Teaching occurs during the working day and in formal tutorials. All FY2 doctors are expected to pass the SHO competency assessments of the Intercollegiate Board for Training in Intensive Care Medicine during their attachments.
  • 5. Critical Care Medicine at the Royal Marsden Hospital (Chelsea Site) The Critical Care Unit of the Royal Marsden Hospital is a modern 11 bedded facility opened in October 2004 which runs as a mixed HDU/ICU. We have a roughly 40:60 mix of medical and surgical (post-op) admissions, with a total of 900 patients passing through the unit/yr Senior medical cover is provided by one of 7 intensive care consultants who undertake on-call duties on a weekly roster. They provide dedicated cover to the unit undertaking morning and evening ward rounds. Middle grade cover is provided by 12 specialist registrars in anaesthesia who provide cover 24 hours per day on a rolling 13 hour shift pattern. The role of the F2 trainee is to 1) Assist the duty consultant and SpR in the general running of the unit 2) To gain knowledge and experience in the recognition, assessment and management of patients with, or at risk of, developing critical illness and organ failure. 3) To learn to accurately interpret simple investigative tests commonly undertaken in critically ill patients and to respond appropriately in response to abnormal results 4) To gain practical skills to facilitate appropriate monitoring of critically ill patients We offer a formal training program consisting of weekly teaching sessions, an audit for each trainee and guaranteed presentation opportunities. Trainees are required to complete a logbook demonstrating that sufficient experience has been gained in practical procedures, and are encouraged to attend theatres with their clinical mentor to aid in this. In addition there is a requirement to discuss 5 case histories with the mentor. Break down of an average day 1) Attendance at 0800 consultant led ward round 2) Routine admission and Clerking of patients 3) Daily examination, assessment and review of patients in conjunction with the rest of the medical team 4) Placement of IV, Central Venous and arterial cannulae under appropriate supervision 5) Attendance at the twice weekly radiology seminar 6) Attendance at the weekly MDT 7) Attendance at the weekly F2 teaching session 8) Attendance at the 1700 consultant ward round
  • 6. Rota Template SHO Mon Tues Weds Thurs Fri Sat Sun Hours 1. OFF LD LD LD D OFF OFF 44hrs 2. OFF OFF OFF LD LD D D 42hours 3. LD LD D OFF OFF OFF OFF 34hours LD=08- 2000 D=08- 1800 120hrs=40/wk The rota incorporates annual and study leave. Consultants in CCU 1. Dr Craig Carr (Clinical Director) 2. Dr Tim Wigmore 3. Dr Matthew Hacking 4. Dr Colm Irving 5. Dr Gary Brown 6. Dr Paul Farquhar-Smith 7. Dr Ravi Raobikady Paediatrics at Chelsea and Westminster There are 4 children's wards: Neptune = 25 beds Mercury = 20 beds Jupiter (Adolescents) = 10 beds Saturn (day case) = 5 beds The ward SHOs work on Neptune, Mercury or Jupiter ward, with cover for the day case ward and floating SHO to cover leave. The ward duties are variable, being involved in the day to day care of inpatients. In addition they include clerking acute and elective admissions (excluding routine surgical cases), arranging all relevant investigations, and co-ordinating interdisciplinary care. Specific skills may be obtained depending on the ward e.g. pH monitoring. The gastroenterology patients are managed on Mercury and Pluto, the neurology children are cared for on Neptune. Ward rounds are held daily either under the direction of a ward based specialist registrar, in addition to regular formal consultant rounds. There is a consultant presence on the morning handover rounds and one named consultant who is responsible for the day top day running of the wards. SHO are also expected to attend paediatric outpatient clinics on a regular basis. The rota is a full shift system with 9 SHO’s and will be paid on Band 1A. (note this is from Feb 2007 - currently there are 8 on the shift paid at band 2A).
  • 7. Paediatric Wards shift template Week Mon Tue Wed Thu Fri Sat Sun 1 4 1 1 4 1 2 7 7 7 Off Off 3 5 1 4 1 1 4 1 4 1 5 1 1 5 5 1 4 5 1 4 1 4 6 Off Off 1 5 1 7 1 1 Off 7 7 7 7 8 Off Off Off Off Off 9 H H H H H Average: 47 hours / week – band 1A Shifts: 1 08.30-17.00 2 08.30-17.00 3 08.30-17.00 4.08.30-21.00 5.08.30-16.30 (OPD) then 16.30-19.30 Paed A&E / Gastro 6 08.30-13.00 wards, then 13.00-17.00 Paed A&E 7 Nights 20.30-09.00 (& assist in A&E) H Holiday Plastic Surgery at Chelsea and Westminster The Firm’s Consultants are: Mr Greg Williams, Mr Mohammed Jawad, Mr Henck Scheepers, Mr Lucian Ion, Mr Martin Kelly, Mr Niall Kirkpatrick, Mr Henry Thuau, Mr Simon Eccles, Mr Rupert Eckersley, Mr Giles Bantick, Mr David Martin, Ms Barbara Jemec, Ms Effie Katsarma, Ms Alice Bremner-Smith Time spent on attachment: 4 months. On-call commitments are 1:6 and 1 week of nights with one week off The weekly timetable consists of covering wards, attending clinics, assisting in theatre and on-call commitments The 4 month job gives you exposure to management of acute burns, hand and craniofacial trauma. In addition there are elective hand lists, general plastic lists and craniofacial and burns reconstruction and acute burn surgical lists. The job will be a good introduction to Plastic Surgery as a specialty and also to surgery as it enables the trainee to assess acute surgical cases and management of the cases. There is also the opportunity to learn surgical skills useful for all specialties. In addition there is the opportunity to complete audit project and to be involved in departmental research projects which include presenting and publishing

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