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  1. 1. WALES HIGHER TRAINING PROGRAMME SPECIALIST TRAINEE in ACUTE MEDICINE JOB DESCRIPTION Background A further Specialist Training post (ST3) has been created by the Welsh Deanery in Acute Medicine as part of the expansion of training posts in this evolving field and in recognition of the increasing number of appointments of Acute Physicians nationally Entry Criteria The minimum educational requirement for entry to the program is MRCP (1). The minimum experience in core medical training (CMT) posts in Medicine is 24 months, or 24-36 months Acute care common stem (ACCS). The other qualities considered essential or desirable are detailed in the attached Person Specification. Objectives of the Training Programme 1. To obtain level 3 competencies in Acute Medicine in order to achieve a CCT for the high quality medical care of acutely ill medical patients. 2. To provide the appropriate level of training for the daily management and development of Acute Medical Units (AMUs). 3. To provide Special Skills training in a variety of associated medical conditions. 4. To prepare trainees for Consultant responsibility. The Training Program The four-year training program organised by the Welsh Speciality Training Committee in Acute Medicine will fulfil all the recommendations of the Royal College of Physicians and PMETB for accreditation in this specialty. An option for a fifth year in General Internal Medicine (GIM) for dual accreditation will be available. . Each trainee will have two nominated supervisors, one clinical and one educational, who will change with the various placements. The trainee will be required to take part in organised, relevant courses particularly those which form part of the Core Curriculum, and the regional G(I)M Training sessions. 1
  2. 2. The trainee will be expected to keep abreast of current developments within the speciality, to practice evidence based medicine and to help to change practice within the department where appropriate. Computer literacy is essential in order to ensure effective audit of all clinical/managerial aspects of the work of the department The program has been constructed to ensure exposure to specialities relevant to Acute Medicine. Training is provided in The Royal Glamorgan Hospital, the University Hospital of Wales and at one or more other sites in South Wales. The trainees will gain experience in the following fields: General (Internal) Medicine, including acute non-selected takes Acute Care Medicine, including experience working in • Acute Medical units (AMUs) • Ambulatory care • Rapid Access Medical outpatient clinics Critical Care (ITU, HDU, CCU and A/E) Cardiology, Respiratory Medicine and Medicine for the Elderly Out Patient experience • Rapid Access Medical outpatient clinics • Speciality based clinics - Cardiology, Respiratory Medicine, and Medicine for the Elderly Practical skills in defined clinical procedures Special Skills Training, which might include • Echocardiography • Medical Management/Education • Toxicology 2
  3. 3. Clinical The trainee will be a fully integrated member of the team and will undertake clinical duties as agreed between their educational supervisor and the Clinical Director of the host discipline. The trainee will be expected to teach junior doctors, nurses and medical students and this will be done both formally in lectures and tutorials and informally on the departmental floor. The trainee will be expected to take part in formal audit and also to supervise and improve the standard of typical work of the junior staff. The Participating Hospitals The University Hospital of Wales is an 800 bedded teaching hospital, completed in 1971 and incorporating Cardiff University, Wales College of Medicine, Biology, Life & Health Sciences. The hospital serves Cardiff and the Vale of Glamorgan. Placements here are in Cardiology - a tertiary referral centre, Intensive Care – the largest Unit in Wales, and in A&E medicine – two of the consultants having a medical background. The Royal Glamorgan Hospital is a busy District General Hospital, commissioned in 1999 and serving a population of approximately 180,000 in the Pontypridd and Rhondda areas. The hospital has over 500 beds with all major specialities represented. Placements here are in Acute Care Medicine – one of the first Medical Assessment Units, Respiratory Medicine and Elderly Care Medicine Princess of Wales Hospital Bridgend is a district general hospital. Opened in 1985, the Hospital is located on the outskirts of Bridgend town in South Wales, and provides modern, purpose-built accommodation for the provision of acute health services to the local population of approximately 160,000 people. The Hospital provides a comprehensive range of medicine for patients of all ages, including inpatient, outpatient and day services. Nevill Hall Hospital Abergavenny is a busy DGH serving a population of 200 000. It’s catchment area extends from LLandrindod Wells in Powys as far South as Pontypool and East as far as Monmouth and encompasses several of the Welsh valleys. It has over 500 beds with all the major specialties represented and a new Emergency Admissions Unit (EAU) which takes both medical and surgical admissions. Royal Gwent Hospital Newport is a very busy DGH with more than 600 beds and serving the Newport and Cwmbran population. Medical intakes are frequently over 60 per 24 hours and the placement is within the Medical Assessment Unit (MAU) where a wealth of experience will be obtained. 3
  4. 4. Wrexham General Hospital Wrexham is the largest town in North Wales (pop 70,000) and is situated near to the Welsh/English border, being approximately 10 miles from the Heritage City of Chester. The Acute Medicine curriculum Much of the training relevant to this curriculum is organised by the School of Postgraduate Medical and Dental Education at the University Hospital of Wales, and takes place throughout the 4 years of the training programme. It has been recently rewritten in line with PMETB recommendations and serves to provide trainees with the skills to obtain level 3 competencies in Acute Medicine for the provision of high quality medical care to acutely ill patients and provide trainees with the managerial skills to run and develop AMUs. Appraisal and assessment The trainee will have regular review of progress with the consultant educational supervisor for each post. Structured appraisal sessions will include discussion of educational objectives in the post, review of the trainee’s own appraisal record and maintenance of a portfolio. At the end of each year the trainee will meet with the Assessment Panel of the Speciality Training Committee to review progress over the previous year (ARCPs). This meeting will also provide the trainee with the opportunity to discuss their future training needs and they will also have the opportunity to comment absolutely frankly on the quality of the training he or she is receiving without fear of subsequent discrimination. After satisfactory completion of the 4 year Specialist Training program the trainee will obtain a CCST in Acute Medicine. There will be an opportunity for a further 1 years training to dually accredit in GIM. Pastoral Care In each post the trainee will have a consultant educational supervisor who will change with different placements. We encourage each Specialist Trainee to have a consultant mentor throughout the training program. This could be the Program Director or another consultant chosen by the Specialist Registrar and agreed with the Specialty Training Committee. The mentor should be available for informal discussion regarding progress and training needs, and should be able to provide continuity of support throughout the program. Discussions with the mentor should be completely confidential. There is also in each hospital a tutor of the Royal College of Physicians, who is available for discussion. In addition the following may be contacted for discussion and advice: Regional Adviser to the Royal College of Physicians 4
  5. 5. - Dr Richard Moore, University Hospital of Wales, Cardiff Program Director for Higher Specialist Training in Acute Medicine - Dr Mike Webberley, Nevill Hall Hospital Abergavenny Postgraduate Dean - Professor Derek Gallen, PGMDE, Cardiff Audit and Research The trainee will undertake regular audit including completing the audit cycle and have presented the work to the relevant clinical groups. Research experience including research methods will be encouraged. Working pattern including out-of hours commitment The Trusts are currently working towards compliance with the New Deal and European Working Time Directive on Junior Doctors hours for all training posts. You will be advised of the working pattern for this post prior to taking up your appointment. Specialist trainees will be required to be resident on-call whilst working in certain disciplines but may be on-call from home whilst working in others. Conditions of Appointment The post is subject to annual review. The Welsh Deanery is committed to ensuring that all posts in Wales comply with both the New Deal and the Working Time Directive. It has been a contractual requirement that posts comply with the New Deal since August 2003. It is essential that doctors entering a rotation assume that their posts are within the New Deal already or are in the process of being made compliant with the New Deal. The completion of satisfactory health declaration questionnaire is a condition of appointment. 5
  6. 6. Hepatitis B You must provide us with evidence, which is acceptable to the Occupational Health Department, that you have been immunised against Hepatitis B. This would normally be a pathology report from a laboratory in the UK or alternatively a report from another NHS Occupational Health Department within the UK. It will not be possible to confirm this appointment unless this condition is met. Before starting work you may therefore need to attend the Occupational Health Department for assessment. If this is not possible, then you must attend on the day you start work. The Ionising Radiation (Protection of Persons Undergoing Medical Examination or Treatment) Regulations 1988 This post may involve the direction of medical exposure of ionising radiation. The Ionising Radiation (Protection of Persons Undergoing Medical Examination or Treatment) Regulations 1988 impose a legal responsibility on employers to limit clinical or physical direction of a medical exposure to ionising radiation for a diagnostic or therapeutic purpose to employees adequately trained in Radiation Protection. The University Hospital of Wales Healthcare NHS Trust will accept a certificate issued by a competent Institute attesting receipt of tuition in Radiation Protection as proof of adequate training. Sight of such a certificate is therefore required before the commencement of your employment or (without exception) before you will be allowed to clinically or physically direct a medical exposure. 'Please note that PHYSICAL DIRECTING means effecting the medical exposure i.e. pushing the button on a foot switch or injecting a radio-pharmaceutical. CLINICALLY DIRECTING means having the clinical responsibility for the decision to effect a medical exposure (i.e. worker to inject a radio-pharmaceutical). Clinically directing DOES NOT include requesting a radiology department for an examination as acceptance of such requests normally transfers clinical responsibility to a radiologist'. Rehabilitation of the Offenders Act 1974 Because of the nature of the work of post it is exempt from the provisions of section 4(2) of the Rehabilitation of the Offenders Act 1974 (Exemption Order 1975). Employees are therefore not entitled to withhold information about convictions of the Act, and any failure to disclose such convictions could result in dismissal or disciplinary action. Any information given will be completely confidential and will be considered in relation to the position to which the order implies. 6
  7. 7. Conditions of Service The post is covered by the Terms and Conditions of Service for Hospital and Dental Staff (England and Wales) and the General Whitley Council Terms and Conditions of Service as amended from time to time. At no time should the trainee work at a level exceeding their competence. All medical staff therefore have a responsibility to inform those supervising their duties if they have any concerns regarding this or if they feel that they are not competent to perform a particular duty. It will be possible for a post holder to apply for flexible training if he/she so desires by application to the Postgraduate Dean. 7
  8. 8. General (Internal) Medicine and Acute Medicine Programme (Starting 2006) Year Rotation Practical Procedure training throughout training period Training in Upper GI endoscopy or echo- cardiography starts in the first appointment with the intention of BGS or BSE accreditation respectively Research Project and participation in audit throughout training period Courses to attend 1st 8 months Admission Unit & Ambulatory Care, 1 Rapid Access clinic weekly 1 General Medical clinic weekly Full shift G(I)M on-call 4 months Gastroenterology 2 General Medical clinic weekly Full shift G(I)M on-call Royal Glamorgan Hospital ALS Course in management of acutely ill e.g. IMPACT ALERT or other approved course 2nd 6 months Cardiology 2 Cardiology clinics weekly Full shift Cardiology on-call University Hospital of Wales 6 months Intensive Care Medicine ICU on-call University Hospital of Wales Clinical Effectiveness, module 1 Health Informatics 3rd 4 months Accident & Emergency Medicine Full shift G(I)M on-call Royal Glamorgan Hospital 4 months Care of the Elderly 1 General Medical clinic, 1 day hospital session weekly Full shift G(I)M on-call Royal Glamorgan Hospital 4 months Respiratory Medicine 2 General Medical clinics weekly Full shift G(I)M on-call Royal Glamorgan Hospital Management, module 1 Medical ethics Medical law Teaching techniques 4th 6 months elective period Full shift G(I)M on-call 6 months Admission Unit , with attachment to an appropriate medical firm 1 Admission Unit follow-up Clinic weekly 1 General Medical Clinic weekly Full shift G(I)M on-call Royal Glamorgan Hospital Management module 3 Clinical effectiveness module 2 Management module 3 8