THE UNIVERSITY OF NOTTINGHAM
SCHOOL OF CLINICAL SCIENCES
CENTRE OF EVIDENCE-BASED DERMATOLOGY
Job Title: Academic Clinical...
The research component will be based at the Centre of Evidence-Based Dermatology at the
University of Nottingham, which is...
Assessment of Academic/Clinical competencies
In addition to clinical appraisals, there will be a formal annual academic ap...
SPECIALTY TRAINING PROGRAMME IN
GENERAL INTERNAL MEDICINE (CMT)
PROGRAMME DESCRIPTION
The general internal medicine progra...
Gastroenterology/HCE/ITU/Endocrinology
ITU/Cardiology/Haematology/Renal
Respiratory/HCE/ITU/Haem
Respiratory/HCE/Endocrino...
The Deanery is committed to developing postgraduate training programmes as laid down
by PMETB, Colleges and Faculties and ...
CLINICAL DERMATOLOGY SPECIALITY TRAINING
The Clinical Dermatology Department at Nottingham currently has 6 SpR posts dedic...
MAIN CONDITIONS OF SERVICE
The posts are whole-time and the appointments are subject to:-
a) The Terms and Conditions of S...
Similarly, in accordance with copyright law, any person involved in the illegal reproduction
of software or who makes, acq...
APPENDIX 1
NOTTINGHAM UNIVERSITY HOSPITAL (QUEEN’S MEDICAL CENTRE CAMPUS)
On the 1st
April 2006 the two hospitals in Notti...
Supervision
There are 26 supervising consultant physicians at QMC. The firm structure at present is
organised as follows: ...
APPENDIX 2
Nottingham University Hospital (City Campus)
As of 1st
April 2006 the two hospitals in Nottingham have merged i...
wards across the city. All stroke beds are now at City Campus and an acute stroke
intervention team has been established.
...
Renal Medicine
The Consultants are Drs R Burden, C Bebb, C Byrne, M Cassidy and S Roe. There are
four SHOs. The Renal Unit...
Appendix 3
Derby City Hospital
Inpatient Medicine
The Derby City Hospital is part of the Derby Hospitals Foundation Trust ...
Education/Facilities
The Trust adheres to the minimum standards of teaching agreed throughout the region,
which includes o...
Appendix 4
Grantham & District Hospital
Grantham & District Hospital is part of the United Lincolnshire Hospitals NHS Trus...
Educational activities
The Trust adheres to the minimum standards of teaching agreed throughout the region,
which includes...
Appendix 5
Kings Mill Hospital
King’s Mill Hospital (part of Sherwood Forest Hospitals NHS Trust) has an integrated
acute ...
Educational Supervision
The supervising consultants at Sherwood Forest Hospitals NHS Trust for the CMT
program are as foll...
Appendix 6
CHESTERFIELD
As in all modern hospitals, Chesterfield has followed the directive of the Royal College of
Physic...
Educational Supervision
The supervising consultants for the Chesterfield part of rotation will be as follows:
SHO Number 1...
Appendix 7
Pilgrim Hospital Boston
The Department of Medicine operates an integrated service for General Adult Medicine
an...
Clinical supervision
The clinical supervisors for the Boston part of the rotation are:
1 2
Dr Mangion,
Meacock or
Ihama
Dr...
Appendix 8
Lincoln County Hospital
Lincoln County Hospital has 4 general medical wards, two general care of the elderly, a...
In addition there are specific departmental teaching sessions e.g. cardiology have an
ECHO meeting – these are open sessio...
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  1. 1. THE UNIVERSITY OF NOTTINGHAM SCHOOL OF CLINICAL SCIENCES CENTRE OF EVIDENCE-BASED DERMATOLOGY Job Title: Academic Clinical Fellow (ACF) in Dermatology Contract Status: This post will be offered on a fixed-term contract for a maximum period of three years. General Description of ACF Posts and Academic Career Structure An exciting opportunity has arisen for young physicians wishing to pursue a career in academic dermatology. This post is the first stage of a new career path for a junior doctor aspiring to pursue a career as a clinical academic dermatologist, entering the programme at ST1 level. The trainee will spend 75% of their time gaining clinical experience in General Internal Medicine (for ST1) and Dermatology specialist training for ST3 and after. The remaining 25% of their time will be spent in academic training and research. How time is divided may change, but currently the academic time will be taken as a 4 month block during which the trainee will continue to do out of hours general medical duties during the general internal medicine years (thus equating to 3 months dedicated academic time), and as a day release arrangement during dermatology higher specialist training. A core expectation of these posts is that they should lead to successful application to the NIHR, MRC or Wellcome Trust (or equivalent research charity) for a Clinical Training Fellowship to support a period of two or more years of full-time research leading to a higher degree (usually a PhD or MD). After completing a successful Training Fellowship, most trainees would then be expected to apply for and gain a Clinical Lecturer post which would allow them to continue their research whilst completing their clinical training. The trainee would then be fully qualified to apply for Clinical Senior Lecturer / Honorary Consultant posts or other suitable posts for continuing clinical academic development such as the NIHR Clinician Scientist awards (see http://www.nccrcd.nhs.uk/natclinsciencescheme/ for further information). Clinical component of the ACF posts These are contained entirely in a separate document attached. Academic component of the ACF posts The academic part of the training will be tailored to the individual needs and interests of the trainee. In the first block of protected research time the ACF will learn more about the research opportunities in order to formulate an individual academic plan. The academic plan will address the following objectives: 1. Provide a broad background to clinical dermatology research. This will be achieved through • Meetings and visits to the different research groups and facilities • Attendance at dermatology clinical and research meetings • Attendance at other research meetings at the discretion of the trainee and supervisor 2. Perform a literature search and formulate a preliminary research plan. 3. Conduct preliminary research. 4. Publish at least one paper or at least two abstracts describing original research 5. Make a successful application for major external fellowship funding, with first submission usually within 24 months of being appointed. Research opportunities available at the Centre of Evidence-Based Dermatology
  2. 2. The research component will be based at the Centre of Evidence-Based Dermatology at the University of Nottingham, which is part of the Institute of Clinical Research. The Centre is directed by Professor Hywel Williams, supported by two other senior academics and twenty three research staff. The internationally strong Centre is composed of the editorial base of the Cochrane Skin Group (providing training in critical appraisal skills in clinical trials and systematic reviews), the UK Dermatology Clinical Trials Network (which offers training in clinical trial design and conduct) and the National Library of Health Skin Disorders Specialist Library (offering training in clinical information management and dissemination to the NHS). In addition to running three national NIHR clinical trials, the Centre was also awarded a five year NIHR Programme Grant in Applied Research in September 2008. The Programme grant work themes include eczema prevention, eczema treatment, cutaneous squamous cell carcinoma, interventions for vitiligo, a national randomized controlled trial in pyoderma gangrenosum and a pathway for working with industry. These themes will deliver new systematic reviews early on in the Programme which will provide a rich source of material for an ACF to pick up and gather publishable data from pilot studies which will put them in a competitive position to win an external from the NIHR (NIHR research training fellowship), MRC (Clinical Research Training Fellowship or Health Services and Health of the Public Research Fellowship depending on scope of research), or the Wellcome Trust (Research Training Fellowship for Medical Graduates). The Centre is perhaps best known for its work on childhood eczema, and it is likely that the ACF would work in this area, especially in the area of house dust mite reduction, which might paradoxically makes eczema worse rather than better. The ACF will also have an opportunity to learn about clinical trial prioritization through our work with the James Lind Alliance and also to learn about genuine user involvement in research through engagement with the five consumer groups attached to our work programme. The training and theme in clinical trials will be further enhanced by the fact the research supervisor (Hywel Williams) is also clinical director of the Nottingham Clinical Trials Unit which will offer training in trials management, organization and governance. There would also be plenty of opportunity for the ACF to collaborate with other research strengths at Nottingham such as National Database research, as well as translational research in immunology and cell biology if appropriate. The ACF would also slot into other well developed generic research training opportunities run by the Staff and Educational Development Unit at Nottingham, providing skills in data management, word processing, presentation skills, statistics and report writing. The Centre is internationally renowned for its work, and produces over 20 peer-reviewed papers per year. The Centre organises national and international meetings and has raised over £7 million in external non-commercial research funding over the last 7 years in open competition. Hywel Williams is an NIHR Senior Investigator and is also chair of the National Dermatology Specialist Interest Group. He also is a member of the HTA Board and chairs the East Midlands Research for Patient Benefit scheme. Further information about the work of the Centre of Evidence-Based Dermatology can be found at: www.nottingham.ac.uk/dermatology Mentoring and supervisory arrangements for the Academic Clinical Fellow The ACF will receive academic supervision from Professor Hywel Williams. An academic co- supervisor will be identified when the applicant is registering for a higher degree. The ACF will also be mentored by a more experienced researcher at the Centre of Evidence-Based dermatology. Joint academic appraisal (ARCP will be carried out in accordance with the Supplementary Guidelines for the Annual Review of Competence Progression (ARCP) for Specialty Registrars undertaking jointclinical and academic training programmes As for all clinical STs on the programme, clinical training will be co-ordinated by the Clinical Training lead in the hospital in which the ACF is working. It will be organised in conjunction with the academic supervisor. During dermatology specialist training, the educational supervisor will be consultant dermatologist Dr. Janet Angus, with Dr. John English as clinical supervisor. The dermatology training programme director is Dr. Ruth Murphy ruth.murphy@nuh.nhs.uk Tel: 0115 9249924 ext 61908, Fax: 0115 8493299 2
  3. 3. Assessment of Academic/Clinical competencies In addition to clinical appraisals, there will be a formal annual academic appraisal of the ACF to monitor progress and expectations. The academic report will also be submitted to and considered by the clinical appraisers. Joint academic appraisal (ARCP will be carried out in accordance with the Supplementary Guidlelines for the Annual Review of Competence Progression (ARCP) for Speciality registrars undertaking joint clinical and academic training programmes If a trainee fails to make adequate progress or is not successful in securing funding from NIHR, the MRC or Welcome Trust they will relinquish their ACF post and join the Mid-Trent Training Programme at the appropriate level. As currently with those on Out of Programme Experience, every opportunity will be taken to ensure a smooth transition with the clinical programme. Anticipated Academic Milestones First year: Project area decided (within 2 months of academic placement) and scoping literature review completed, precise research aims clear. Some research will be initiated. Second year: Preliminary data gathered and first Research Training Fellowship application completed. Third year: Research Training Fellowship funded and PhD programme started. First paper written. Most will leave the programme now, but ACFS can continue to 36 months, e.g. if their first funding application is unsuccessful. Contact details Any questions on the academic component of theses ACF posts may be addressed to Professor Hywel Williams Hywel.williams@nottingham.ac.uk or tel 0115 82 31048 (Margaret Whittingham, administrator to Prof Williams) 3
  4. 4. SPECIALTY TRAINING PROGRAMME IN GENERAL INTERNAL MEDICINE (CMT) PROGRAMME DESCRIPTION The general internal medicine programme is a two-year training programme which is generic to the ACFs joining Nottingham at various stages. It is aimed at doctors who can demonstrate the essential competencies to enter this level of training. The programme is designed to support training for a CCT in any of the general internal medical specialties and also includes a themed neurology rotation that will be part of a neurology run-through grade. All other rotations our generic in nature and choice of a rotation at CMT grade will have no influence on selection to a specialty at HST level. The emphasis in this program is on training and there is a comprehensive educational programme. All trusts within the Deanery have agreed to provide a comprehensive teaching program, including bleep-free half-day teaching, teaching for Part 1 and PACES, emergency medicine teaching and experience in the state of the art medical simulation centre. In addition, robust appraisal and feedback arrangements will help ensure that you gain the most from the educational opportunities provided. The trusts within the Trent region have a long history of post- graduate educational programmes leading to pass rates of up to 100% in the MRCP(UK) examination. The programme is based in the following hospitals in the Deanery: ♦ Nottingham University Hospitals NHS Trust ♦ Derby Hospitals NHS Foundation Trust ♦ Sherwood Forest Hospitals NHS Foundation Trust (King’s Mill Hospital, Mansfield) ♦ Chesterfield Royal Hospital NHS Foundation Trust ♦ United Lincolnshire Hospitals NHS Trust – including Lincoln County Hospital, Grantham & District General Hospital and Pilgrim Hospital, Boston Trainees will work in two hospitals or groups, and as far as possible, will undertake consecutive placements in each hospital so requiring one move during the two-year program. At the end of the first year, following a satisfactory RITA, trainees will enter the second year of CMT training. All trainees will work in both district general hospital and teaching hospital environments. The program is divided into four-month posts. All trainees will undertake at least two of the following: - Cardiology - Diabetes and Endocrinology - Health Care of the Elderly - Respiratory Medicine - Gastroenterology Other four months attachments available include: - Renal medicine - Neurology - Infectious Diseases - Oncology - Haematology - Dermatology - Rheumatology - Palliative Care - High Dependency Medicine - Intensive Care Medicine The program includes the following linked posts: Nottingham University Hospital Respiratory/HCE/Gastroenterology/Cardiology Haematology/Palliative care/Respiratory/Cardiology/ 4
  5. 5. Gastroenterology/HCE/ITU/Endocrinology ITU/Cardiology/Haematology/Renal Respiratory/HCE/ITU/Haem Respiratory/HCE/Endocrinology/ITU Infectious diseases/CCU/HCE/Renal Gastroenterology/Haematology/Renal/Cardiology Gastroenterology/Cardiology/Oncology/HDU Gastroenterology/Endocrinology/Renal/Oncology Oncology/Cardiology/Rheumatology/Endocrinology Gastroenterology/Palliative care/Respiratory/Rheumatology Endocrinology/Neurology/Dermatology Grantham Hospital Cardiology/Respiratory HCE/Respiratory HCE/Cardiology Lincoln Hospital ITU/Renal Cardiology/Endocrinology Cardiology/Haematology HCE/Respiratory Cardiology/Gastroenterology Respiratory Pilgrim Hospital Boston Endocrinology/Gastroenterology Gastroenterology/HCE Respiratory/Cardiology HCE/Respiratory Haematology and oncology/Cadriology Derby Hospitals Trust Endocrinology/Gastroenterology/Renal Respiratory/ITU/Gastroentrology/Renal HCE/CCU/Respiratory Renal/Haematology/Neurology and stroke Respiratory/HCE/Cardiology Kings Mill Hospital HCE/Cardiology Gastroenterology/Haematology/Endocrinology HCE/Cardiology/Respiratory Gastroenterology/Rheumatology/Endocrinology Chesterfield Royal Hospital Cardiology/HCE/Respiratory STUDY AND TRAINING There is a region-wide syllabus and minimum standards of education agreed by all trusts within the rotation. This includes one half day per week bleep-free teaching sessions, preparation for Part 1 and PACES, the possibility of elective periods, an emergency medicine course and use of a state of the art medical simulation centre. 5
  6. 6. The Deanery is committed to developing postgraduate training programmes as laid down by PMETB, Colleges and Faculties and by the Postgraduate Dean’s Network. At local level, college/specialty tutors work with Unit Director or Postgraduate Education in supervising these programmes. Trainees will be expected to take part in these programmes (including audit) and to attend counselling sessions/professional review. Study leave will form part of these education programmes and will be arranged in conjunction with the appropriate tutor. All posts are recognised for postgraduate training. Study leave is granted in accordance with Deanery policy and are subject to the maintenance of the service. CLINICAL DUTIES THROUGHOUT THE ROTATION All posts have a service element and the following covers the majority of duties. There will be minor variations in different posts in different hospitals but this list is aimed at covering the majority of duties: 1. Supervise, monitor and assist the House Officer (F1) in the day-to-day management of in-patients in posts with an attached PRHO. 2. Liaise between nurses, PRHO (F1 and F2), patients, relatives and senior medical staff. 3. Attend and participate in ward rounds as timetabled 4. Attend outpatient clinics. 5. Take part in rostered emergency work. 6. Dictate discharge summaries. 7. Study for higher examination and maintain continued professional development. 8. Attend weekly educational and multidisciplinary sessions. 9. Undertake audit at various times throughout the rotations. 10.Attend post mortem demonstrations - when required. 11.Teach medical students as directed. 12.Co-operate with members of the personnel department when monitoring hours of work and other personnel issues. 13.Attend induction in each hospital or new department 14.Comply with all local policies including dress code, annual and study leave 6
  7. 7. CLINICAL DERMATOLOGY SPECIALITY TRAINING The Clinical Dermatology Department at Nottingham currently has 6 SpR posts dedicated to Dermatology, and ten consultants, offering a critical mass of skills that cover the entire range of general and special training requirements of the dermatology higher specialist training programme. Dermatology at Nottingham is renowned for its innovative approach to patient care and close collaboration with dermatology specialist nurses who provide an integrated care pathway within the community. There is ample opportunity to gain special skills in skin and systemic disease, basic and advanced surgery (including Mohs micrographic surgery), photobiology, contact dermatitis, paediatric dermatology, vulval diseases, cytotoxic and biologic therapies, histopathology, genodermatoses and psychodermatology. Regional training days are also held twice each year. The ACF will have access to state of the art equipment at the newly built Day Treatment Centre (adults) and the newly configured paediatric dermatology service. Nottingham also offers additional opportunities for training in sexually transmitted diseases, pathology and dermatology seen in general practice. For year one of the ACF (for a CMT2 entry), the trainee will be placed in the existing CMT program in the East Midlands (North) which covers all the major medical specialties. As a run- through in ACF they will b e issued with an NTN(A). The ACF will complete 4-month rotations at ST1 level in two medical specialties.. This first year will include a 4 month block of pure research at the Centre of Evidence-Based Dermatology to concentrate on identifying a suitable research project and to carry out initial scoping. During that time, the postholder will also be required to be on call as part of the general medical rotation. In year 2, the ACF (now ST3) will slot into the existing specialist dermatology training programme ,with day release for research and training needs as required. The ACF will have an educational supervisor (Dr. Janet Angus), a clinical supervisor (Dr. John English) and an academic supervisor (Prof. Hywel Williams). Assessment processes will be in line with those that other SpRs undergo in order to progress their clinical training (the ARCP which now incorporates workplace-based assessment tools including the miniCEX clinical examination exercise, direct observation of procedural skills and multisource feedback). 7
  8. 8. MAIN CONDITIONS OF SERVICE The posts are whole-time and the appointments are subject to:- a) The Terms and Conditions of Service for Hospital Medical and Dental Staff (England and Wales) b) Satisfactory registration with the General Medical Council (London) c) Medical Fitness – You may be required to undergo a medical examination and chest x- ray. Potential applicants should be aware of the Department of Health and GMC/GDC requirements with regards to HIV/AIDS and Hepatitis viruses. Candidates must be immune to Hepatitis B. You will be required to provide, in advance of appointment, evidence of immunity or have a local blood test (as deemed necessary by the Occupational Health Department) Salary Scale The current nationally agreed payscale for this grade is payable. Unforeseen Circumstances In accordance with the Terms and Conditions of Service of Hospital Medical and Dental Staff (England and Wales) paragraph 110, Junior Doctors shall be expected in the run of their duties and within their contact and job description, to cover for the occasional and brief absence of colleagues as far as is practicable. European Working Time Directive (EWTD) All posts on the rotation comply with European Working Time Directive regulations. Junior Doctors’ Monitoring From 1 December 2000 there is a contractual obligation to monitor junior doctors’ New Deal compliance. In accordance with Health Service Circular 2000/031 junior doctors have a contractual obligation to monitor hours on request; this will include participation in local monitoring exercises. Removal expenses The removal expenses applicable to this post will be the policies issued by the Administrative Trust. You should not commit yourself to any expenditure in connection with relocation before first obtaining advice and approval from the Personnel Department at your Administrative Trust, otherwise you may incur costs, which you will be unable to claim. Use of Information Technology Under the Computer Misuse Act 1990, any individual who knowingly attempts to gain unauthorised access to any programme or data held on a computer can be prosecuted. An individual who modifies any programme or data in a computer which they are unauthorised so to do, is also liable under the Act. If found guilty of these offences a person may be given a custodial sentence of up to six months or a fine or both. The person would also be subject to disciplinary action which may result is dismissal. 8
  9. 9. Similarly, in accordance with copyright law, any person involved in the illegal reproduction of software or who makes, acquires or uses unauthorised copies of computer software, will be subject to disciplinary action, which may lead to dismissal. Notification of Termination of Employment At least six weeks notice must be given of termination of employment. 9
  10. 10. APPENDIX 1 NOTTINGHAM UNIVERSITY HOSPITAL (QUEEN’S MEDICAL CENTRE CAMPUS) On the 1st April 2006 the two hospitals in Nottingham merged into a single Trust to form Nottingham University Hospitals (City and Queen’s Medical Centre campuses). Together with the City Hospital Campus, the Queen’s Medical Centre provides acute medical care to a population of 616,000 and specialist care to a population of greater than one million. On the Queen’s Medical Centre Campus there are five general medical teams, each with a specialty interest (cardiology, gastroenterology, respiratory, diabetes and endocrinology and Health Care of the Elderly). There is a separate directorate of neurosciences. Medical teams are ward based and each specialty is responsible for one main ward and 1- 2 outlying wards. As far as possible patients are admitted to the most appropriate ward following their initial assessment on the acute medical unit. Consultants in specialty teams spend time on and off the wards, and trainees may be working for more than one consultant per specialty. Supervising consultants have a minimum of 2 formal ward rounds per week and usually also have a daily presence on the wards. All teams have specialist registrar cover. Arrangements for Admitting Medical Emergencies Because of the busy nature of the medical take (one of the busiest in Europe), all patients referred for possible admission, by both GPs and the Emergency Department, are admitted through the Acute Medical Unit. This unit is managed by four full-time acute physicians and there are two full time acute medicine Specialist Registrars. During the day the unit is staffed by two consultants, two specialist registrars, and up to five CMTs and two F2s. At night there is one medical SpRs, three CMTs and one F1, though these arrangements are currently under review. All patients get senior review once admitted and there are twice daily consultant ward rounds. Education/Facilities This is a vital aspect of training. There is a grand round every Wednesday lunchtime and a full audit program. The Trust adheres to the minimum standards of teaching agreed throughout the region which includes one half-day a week bleep free teaching sessions, preparation for Part 1 and PACES and an emergency medicine course. There is a well- stocked medical library, an on-site clinical simulation centre and all doctors have easy access to the internet. All specialties have weekly clinical and radiological meetings. 10
  11. 11. Supervision There are 26 supervising consultant physicians at QMC. The firm structure at present is organised as follows: - 1. Professor R G Wilcox (academic cardiology, cardiovascular disease) Dr D Gray (academic cardiology, cardiovascular disease) Dr J T Walsh (heart failure and imaging) Dr Alun Harcombe (coronary Intervention) Dr Andrew Staniforth (pacing, device therapy and electrophysiology) 2. Dr I D A Johnston (lung cancer, interstitial lung disease,TB) Dr W J M Kinnear (respiratory muscle disease, sleep, MHDU) Professor I P Hall (asthma) and Trust Research and Development Director Dr J Corne (asthma, COPD, occupational lung disease and lung cancer) Dr S Johnson (interstitial lung disease, orphan lung diseases) Dr S Wharton (MHDU and sleep) 3. Professor CJ Hawkey (gastroenterology) Professor R C Spiller (gastroenterology) Dr K Ragunath (gastroenterology) Dr S D Ryder (hepatology and gastroenterology) and Assistant Medical Director Dr Y R Mahida (gastroenterology) Dr Jawahari (gastroenterology) Dr G Aithal (hepatobiliary) Professor P C Rubin (clinical pharmacology) 4. Dr S R Page (diabetes and endocrinology) Dr P Mansell (diabetes and endocrinology) Dr L Kennedy (diabetes and endocrinology) Dr T Gazis (diabetes and endocrinology) Dr T Bowling (clinical nutrition) Dr G Tan (diabetes and endocrinology) 5. Dr M Culshaw (acute medicine) Dr C Fraser-Moodie (acute medicine and gastroenterology) Dr R Kupfer (acute medicine and health care of the elderly) Dr I Le Jeune (acute medicine and respiratory disease) 6 Prof J Gladman (community geriatric medicine) Dr P Kumar (falls and syncope) Dr T Masud (falls, syncope and osteoporosis) Dr J Morrant (parkinsons disease) Dr R Morris (falls, syncope and parkinsons disease) Dr O Sahota (orthogeriatrics, falls and osteoporosis) Dr D Seddon (stroke) Each trainee has a dedicated clinical supervisor and appraiser. The clinical supervisor for each individual post meets the Trainee at the beginning of each attachment to agree specific learning objectives. These are reviewed at the mid-attachment meeting and at the end of the attachment there is formal feedback and a chance to review progress. 11
  12. 12. APPENDIX 2 Nottingham University Hospital (City Campus) As of 1st April 2006 the two hospitals in Nottingham have merged into a single Trust on two sites to form Nottingham University Hospitals (City and Queen’s Medical Centre campuses). City Campus is a large friendly campus situated in the northern part of the city. It was built in 1897 and developed into a major teaching hospital when Nottingham Medical School was founded in the early 1970s. The two hospitals also share the bulk of the teaching of medical undergraduates, although medical students are also attached to the hospitals in Mansfield and Derby, as well as elsewhere. Together with the Queen’s Medical Centre Campus, the City Campus provides acute medical care to a population of 616,000 and specialist care to a population of greater than one million. It currently has over a thousand beds. A wide range of clinical services is provided, including several regional and sub-regional specialities: thoracic and cardiac surgery, renal dialysis and transplantation, burns and plastics, cytogenetics, rheumatology, neonatal medicine and oncology. The following University Departments are on campus: Respiratory Medicine, Surgical Sciences, Clinical Genetics, Oncology, Infectious Diseases, Obstetrics and Gynaecology and Stroke Medicine. The City Campus features buildings of various styles and ages, but it remains spacious and well-landscaped. It has an enduring reputation as a friendly hospital and is popular with local people. The campus includes a progressive postgraduate centre, leisure club, mess and an excellent staff restaurant. The self-contained residential accommodation is of a good standard. Hospital at Night Since August 2006 City Campus has run a Hospital at Night system. Junior doctors are drawn from all the specialties and are allocated tasks by a team co-ordinator according to seniority and experience. Thus juniors may contribute to the acute, unselected medical take or review sick, specialty patients on wards. Education/Facilities This is a vital aspect of training. The Trust adheres to the minimum standards of teaching agreed throughout the region which includes one half-day a week bleep free teaching sessions, preparation for Part 1 and PACES and an emergency medicine course. There is a well-stocked library and all doctors have access to the internet. SPECIALTIES: Endocrinology The Consultants are Drs A Archer, F Game, W Jeffcoate, RCL Page and N Sturrock. They are based on Patience 1 and 2 Wards, where they are responsible for about 40 beds. The inpatients comprise a mixture of specialist endocrine and general medical patients. Gastroenterology The Consultants are Drs W Goddard, R Long, K Teahon and R Teli. They are based on Hogarth Ward, which has 18 beds and has purely gastroenterology inpatients. Stroke Medicine The Consultants are Prof P Bath, Dr H Mast, Prof R Harwood, Dr W Sunman and Dr S Munshi. Health Care of the Elderly and Stroke Medicine have recently re-configured their 12
  13. 13. wards across the city. All stroke beds are now at City Campus and an acute stroke intervention team has been established. Infectious Diseases The Consultants are Prof R Finch, Dr B Thomson, Dr P Venkatesan. Patients on this firm are cared for on Nightingale (13 beds) or Patience Wards (about 14 beds). The former is a 13 bedded specialist infectious diseases ward with negative pressure monitored, en-suite side-rooms. The ID unit provides a regional service. Respiratory The Consultants are Dr DR Baldwin, Professor J Britton, Dr J Dewar, Dr A Fogarty, Dr T Harrison, Prof R Hubbard, Dr G Jenkins, Professor A Knox, Prof J Macfarlane and Dr O Pirzada. Patients are cared for on Southwell (28 beds) and Fleming (32 beds) Wards. Beds on Fleming are shared with Oncology. The Academic department is actively involved in clinical and basic laboratory research Rheumatology The Consultants are Prof M Doherty, Dr AC Jones, Dr I Gaywood, Dr A Gupta, Dr J McHale, Dr I Pande and Dr P Courtney. Patients are cared for on Ashwell Ward which has 28 beds. Patients on the ward comprise a mixture of specialist rheumatology and general medical patients. Oncology The Consultants are Drs S Ahmed, EM Bessell, SY Chan, DAL Morgan, SA Morgan, P Lawton, M Sokal, Sundar, Potter and Prof Patel. There are five SHOs, four SpRs and one staff oncologist. The Department of Clinical Oncology is responsible for providing specialist cancer treatment facilities for a population of approximately 1.1 million people, receiving approximately 2,600 new referrals per year. Virtually all tumours and age-groups are treated by the Department using a full range of non-surgical treatments, principally radiotherapy and chemotherapy. The Academic department is actively involved in clinical and basic laboratory research. The Department has two wards with a total of 40 patients. Clinical nurse specialists administer routine chemotherapy, research nurses perform procedures related to clinical research and there is specialist pharmacy support. Haematology The Consultants are Prof N Russell, A Haynes, J Byrne and A MacMillan, together with a lecturer and two SpRs. Three senior house officers work on the unit and the period is split in two with the emphasis on inpatient care for six weeks and daycase and outpatient care for the remainder. There is a particular interest in the care of patients with haematological malignancies, and the ward includes the bone marrow transplant centre. 13
  14. 14. Renal Medicine The Consultants are Drs R Burden, C Bebb, C Byrne, M Cassidy and S Roe. There are four SHOs. The Renal Unit consists of two wards, an outpatient clinic and a haemodialysis unit, all of which have been designed specifically for renal patients. The new unit was opened in 1993 and includes an office and on-call room for SHOs. Training and experience will be gained in the management of acute and chronic renal disorders, fluid and electrolyte problems, hypertension, nutrition and renal transplantation. In addition renal patients present with a wide variety of general medical problems. There is a well established computer system and an active audit programme. Cardiology The Consultants are Drs A Ahsan, K Baig, R Henderson, T Mathew and W Smith. Cardiology is now housed in a new regional Trent Cardiac Centre. There are three SHOs. Cardiology cares for approximately 1000 inpatients, 1200 new and 5500 follow-up outpatients per annum. SHOs have the opportunity to attend outpatient clinics, cardiac catheterisation, echocardiograph and pacemaker sessions. Intensive Care The Adult Intensive Care Unit is staffed by five Consultant Anaesthetists. The 7 bedded unit accepts adult patients from all specialities within the City Hospital and has an annual throughput of around 350 patients per year. There is also a high dependency unit adjacent to the AICU. Training and experience in the management of critically ill medical and surgical patients, including burns and oncology patients, is given. A structured teaching programme for trainees is in operation, covering both theoretical and practical aspects of Intensive Care Medicine. Attendance is compulsory. The training opportunities are tailored to the needs of the individual SHO with experience in airway management, intubation, ventilation and cannulation provided as required. Half day attachments with anaesthetists in the operating theatres can be arranged. Adequate time for personal study is available. 14
  15. 15. Appendix 3 Derby City Hospital Inpatient Medicine The Derby City Hospital is part of the Derby Hospitals Foundation Trust and works closely with Derbyshire Royal Infirmary. At the DCGH the Medical Directorate has approximately 201 medical beds. The wards are arranged as follows: Medical Assessment Unit (MAU) 25 beds Ward 3 - 28 beds (respiratory medicine, medicine for the elderly) Ward 409 - 28 beds (respiratory medicine, medicine for the elderly) Ward 307 - 28 beds (gastroenterology, medicine for the elderly,) Ward 30 – 28 beds (hepatology, medicine for the elderly) Ward 4 07 -24 beds (renal medicine,) Ward 31 28 ( medicine for the elderly) All teams are ward based. Patients re allocated to the appropriate specialty on the MAU. Teams mainly take in their own specialty, but take general medical cases also when the team consultants are on take (1 in 17). Consultants in specialty teams spend time on and off the wards, and trainees may be working for more than one consultant per specialty. Supervising consultants have a minimum of 2 formal ward rounds per week and usually also have a daily presence on the wards. All teams have some specialist registrar cover. Excluding SpRs, the average number of patients per junior doctor is around 10, but this number increases when covering for absent colleagues. Outpatient medicine All teams encourage their SHO to attend outpatient clinics, usually as a supernumerary. This is a good environment for consultants to observe trainees’ communication skills and examination technique. It is therefore a good environment for the completion of mini-CEX assessments. Although many clinics are specialised, the rotational nature of the trainee programmes ensures a broad general medical experience. Training and feedback on written communication to GPs is provided. Arrangements for admitting medical emergencies Patients requiring admission are admitted to the Medical Assessment Unit. During the day the MAU is staffed by one FY1 trainee, one FY2/ST1/ST1 trainee and one SpR. The night-time Team consists of one FY2/ST1/ST1 trainee and one SpR. Consultant ward rounds are held twice daily for consultants on take. Several specialty teams also do daily MAU rounds for their specialty (staffed by that teams’ trainees). 15
  16. 16. Education/Facilities The Trust adheres to the minimum standards of teaching agreed throughout the region, which includes one half-day a week bleep free teaching sessions, preparation for Part 1 and PACES and an emergency medicine course. .A weekly physicians educational meeting is held on Friday mornings. Once a month this is a Mortality/Audit meeting. Once a month trainees have an opportunity to choose and present cases. Each department within the Directorate has an opportunity to present cases, or seminars at this meeting. Feedback is collated by the Postgraduate staff and returned to the presenters. This is useful in maintaining a high quality educational experience. The various specialist departments also have weekly educational meetings for their specialties. Once a month there is a Grand Round held on alternate sites open to all specialties in the hospital. The Trust has Libraries on both sites in Derby, which are available to all medical employees. The Library service also has a number of on-line journals. The Trust has a system in place for ensuring resuscitation training is provided and competencies met. Educational Supervision The 2 Royal College of Physicians Tutors in Derby conduct twice-yearly appraisals for all the Medical SHOs, and will do so for the Core Medical Trainees. Currently, the College Tutors are Dr Andrew Goddard and Dr Rob Skelly. The current clinical supervisors at the DCGH are: Gastroenterology - Dr J Freeman, Dr A Cole, Dr B Norton, Dr A Goddard, Dr A Austin, Dr R Cunliffe, Dr V Lai Renal medicine – Dr R Fluck, Dr C McIntyre, Dr M Taal, Dr J Leung, Dr Khole Respiratory medicine – Dr I Wahedna, Dr R Berg Medicine for the elderly – Dr N Mylvahan, Dr J Birtwell, Dr K Muhiddin, Dr I Del Rio, Dr A Agarwal The Clinical Supervisor (supervising Consultant) for each individual post meets the Trainee at the beginning of each attachment to agree specific learning objectives, and at the end of the attachment to feedback and make further recommendations. A mid- attachment meeting may also take place. 16
  17. 17. Appendix 4 Grantham & District Hospital Grantham & District Hospital is part of the United Lincolnshire Hospitals NHS Trust. There are 7 Consultant Physician, in the following specialists: DR CR Birch Consultant Physician with interest in Diabetes Clinical Director Dr J H Campbell Consultant Respiratory Physician Dr A R Houghton Consultant Cardiologist Dr S K Matsiko Consultant Physician/Gastroenterologist Dr P R Sensky Consultant in Acute Medicine and Cardiology Dr V P Sood Consultant Physician/Health Care of the Elderly Royal College of Physicians Tutor Dr U D Wijayawardhana Consultant Physician/Cardiologist In addition the Department works closely with Dr V Tringham, Consultant Haematologist and Dr B Stoddard, Consultant Microbiologist. Inpatient Medicine Coronary care unit and high dependency - 8 beds Emergency assessment unit - 25 beds Ward 1 - 26 beds Ward 2 - 28 beds The Emergency Assessment Unit is led by a Consultant in Acute Medicine supported by dedicated Consultant sessions throughout the working week. There are daily advisory cardiology ward rounds on CCU. Trainees are largely ward based and see specialty and general medical cases. There are 2 formal Consultant ward rounds per week with ad hoc Consultant ward review as required. Outpatients There are weekly clinics in all the main specialties. CMT trainees are supernumerary but are strongly encouraged to attend. There are excellent opportunities to see the broad range of specialty work and to work closely with your supervising consultant. 17
  18. 18. Educational activities The Trust adheres to the minimum standards of teaching agreed throughout the region, which includes one half-day a week bleep free teaching sessions, preparation for Part 1 and PACES and an emergency medicine course. There is a very active educational programme led by the current RCP tutor, Dr Vijay Sood. There are also weekly X-ray meeting and postgraduate lectures. In addition there is a bimonthly half-day session dedicated to clinical audit. From August 2007 the current SHO training programme will be replaced by the Core Medical Training educational programme. Much of this will be delivered locally but some will be delivered centrally by the Mid - Trent School of Medicine. There are excellent on site library facilities and access to on line learning. Educational Supervision Each trainee has a dedicated clinical supervisor and appraiser. The clinical supervisor for each individual post meets the Trainee at the beginning of each attachment to agree specific learning objectives. These are reviewed at the mid-attachment meeting and at the end of the attachment there is formal feedback and a chance to review progress. 18
  19. 19. Appendix 5 Kings Mill Hospital King’s Mill Hospital (part of Sherwood Forest Hospitals NHS Trust) has an integrated acute medical take ensuring equal access to diagnosis and treatment irrespective of age. There are 6 on take teams each with their own base ward(s)- Respiratory, Cardiology, Gastroenterology, Endocrinology (plus Haematology SHO), HCE (including Rheumatology SHO) and General Medicine. The junior doctors are encouraged to work as a team on their base ward, for instance on the Respiratory ward there are 4 consultants who have ‘paired up’. Each consultant pair has a team comprising of a SpR, SHO, F2 and F1 doctor. When one team is deplete it is expected that the other team will pitch in an help out. Arrangements for admitting Medical Emergencies Recently the take system was revised so that an F1, F2, SHO and SpR from one on take team are on call together, along with one of their consultants. This encourages team working and promotes continuity of care. All patients are admitted to the Acute Medical Unit (AMU) unless they require the cardiac ward or HDU/ITU. The day is split into 3 on call periods all covered by a different team- 07.30 – 14.30, 14.30 – 21.00 and 21.00 – 07.30. After 17.00 the wards are covered by the evening F1 on-call or the night team F2 or SHO. All patients admitted during the team’s period of on call is clerked by the team and reviewed by the consultant. Patients known to other teams are handed back. Patients with medical problem best looked after by a specialist team e.g. acute stroke or myocardial infarction are handed over to the appropriate team. Patients who are likely to be in hospital for less than 24 hours are transferred to the Short Stay Unit (SSU) under the admitting team. All other patients are kept by the admitting team. The aim is that all patients will be transferred to the team’s base ward although at busy periods this may not be possible. Education/Facilities The Trust adheres to the minimum standards of teaching agreed throughout the region which includes one half-day a week bleep free teaching sessions, preparation for Part 1 and PACES and an emergency medicine course. In addition there is a medical team grand round every Wednesday lunchtime. Monthly Clinical Governance meetings also encourage presentation of clinical audits. Currently there a a program of bleep free teaching every Wednesday morning. The timing of the bleep-free teaching is currently under review and may change to a Wednesday pm. It is a contractual obligation that SHOs attend teaching (unless on take, nights or annual leave/study leave). There is a weekly Radiology meeting for the Medical directorate and several of the firms have weekly Speciality meetings e.g. Endocrinology on Tuesdays, Respiratory on Thursdays. 19
  20. 20. Educational Supervision The supervising consultants at Sherwood Forest Hospitals NHS Trust for the CMT program are as follows- ST-1 HCE Dr S Rutter Cardiology Dr C Foster Gastroenterology Dr N Wight Haematology Dr E Logan Endocrinology Dr D Fernando ST-2 Cardiology Dr C Foster Respiratory Dr G Cox HCE Dr J Snape Gastroenterology Dr R Logan Rheumatology Dr K Lim Endocrinology Dr I Idris ACCS Respiratory Dr A Molyneux 20
  21. 21. Appendix 6 CHESTERFIELD As in all modern hospitals, Chesterfield has followed the directive of the Royal College of Physicians and integrated General Medicine with Health Care of the Elderly. This ensures that all patients have equal access to diagnostic and treatment facilities, irrespective of age. The broad arrangements are that on each ward there is a General Physician with a specific interest and a General Physician with special responsibility for Health Care of the Elderly. Patients are allocated to the Consultant most suited to supervise their needs. All Consultants are working as General Physicians and each has a good mix of patients. We encourage all Junior Doctors based on a particular ward to work as a team. There will, however, be leanings towards one particular Consultant, depending on the stage of training and the nature of the junior post. Team based working is at a greater stage of evolution on some wards more than others, but we would encourage its continued development. Junior doctors will look after patients only on their own ward. The Directorate has developed ward links with Surgical Wards so that specific teams take responsibility at times when we have outliers. It is, however, important that Consultants are notified if a patient normally under their care is admitted onto a ward other than their own. Arrangements for Admitting Medical Emergencies Patients requiring a possible admission are admitted to the Emergency Management Unit (EMU), where a member of the team of the day sees them. The team of the day consists of three doctors (two F2 SHO’s and PRHO) between 9am – 1:30pm and upto 7 doctors (Above-mentioned plus SpR, RMO and two PRHO’s) in the period between 1:30 and 5pm. Between 5pm and 10pm medical admissions and the patients on the ward are looked after by the team of the day, which consists of 5 doctors (SpR, 2 SHO’s and 2 PRHO’s). After 10pm the night team are responsible for medical admissions and emergencies as well as patients on the ward. The night team consists of a SpR, SHO and PRHO. Consultant ward round takes place at 8am, 7 days a week and at 5Pm on Fridays. In addition to the post-take consultant ward round, Dr Mansur Reza is available for up to six sessions a week in EMU (under review) Education/Facilities This is a vital aspect of training. There is a full Directorate clinical meeting held on Monday lunch times and once a month this slot is devoted to Directorate audit. A full audit program requiring ward team participation has been devised and the audit co- ordinator/RCP Tutor will ensure that all trainees have details of this. 21
  22. 22. Educational Supervision The supervising consultants for the Chesterfield part of rotation will be as follows: SHO Number 1 2 3 STREAM 1 Dr D A Sandler Dr R Robinson Dr D Chew or Dr P Medcalf General Medicine General Medicine General Medicine Cardiology Diabetes/Endocrine HCE SHO Number 4 5 6 STREAM 2 Gastro Triad (Drs Ashton, Dear, Another) John Hadfield/ SW Crooks MW Cooper General Medicine General Medicine General Medicine Gastroenterology Respiratory Medicine Stroke Medicine SHO Number 7 8 9 STREAM 3 J T Bourne M M Reza C J Cooke General Medicine General Medicine General Medicine Rheumatology HCE Cardiology 22
  23. 23. Appendix 7 Pilgrim Hospital Boston The Department of Medicine operates an integrated service for General Adult Medicine and Care of the Elderly. Patients admitted to a ward are under the care of one of the General physicians covering that ward. Where ever possible patients are sent to the ward covered by the consultant whose subspecialty is appropriate to the patient’s problems. Each of the surgical wards has an allocated covering Medical consultant and outlying medical patients on these wards are covered by that consultant and team. Junior medical staff have an allocated consultant as their clinical supervisor, however as several consultants share a ward and doctors are often not on the wards due to leave and emergency medicine cover, all junior doctors are encouraged to work as ward teams which means looking after other consultants patients in the absence of their junior doctors. The consultants within the department cover the major subspecialties, that’s to say, Cardiology, Diabetes, and Endocrinology, Gastroenterology, Respiratory Medicine and Care of the Elderly. In addition there are visiting consultants for Nephrology, Neurology, Dermatology and Oncology Arrangements for admitting Medical Emergencies Medical patients requiring emergency admission to hospital are referred directly by their GP or the A&E department to the Clinical decisions unit. This unit is a combined Medical and Surgical unit where they will be seen by a member of the medical on call team. This team consists of 1 F1 trainee, 2 F2 or CMT trainees and 1 Spr or equivalent between 9am and 9pm. In addition there is an additional CMT / F2 who works from 3pm to 11pm, who also covers the wards from 5pm onwards. The night team consists of 1 Spr or equivalent and 2 F2 or SHOs. The Acute Medicine consultant and the Medical Consultant on call conduct the morning post take ward round. There is also an evening ward round conducted by the Medical consultant on call. Education / Facilities The Trust adheres to the minimum standards of teaching agreed throughout the region, which includes one half-day a week bleep free teaching sessions, preparation for Part 1 and PACES and an emergency medicine course. In addition there is a grand round meeting that consists of case presentations on Thursday lunchtime. There is an x-ray meeting on Friday lunchtime. Directorate audit meetings occur 1 afternoon every 2 months. The hospital has a well stocked postgraduate library and all doctors have full access to the internet. 23
  24. 24. Clinical supervision The clinical supervisors for the Boston part of the rotation are: 1 2 Dr Mangion, Meacock or Ihama Dr Boldy or Clifton General Medicine General Medicine Elderly Care Respiratory Medicine 3 4 Dr Olczak Dr Jain or Perry General Medicine General Medicine Diabetes and Endocrinology Gastroenterology 5 6 Dr Boldy or Clifton Dr Nyman, Mates or Dobes General Medicine General Medicine Respiratory Medicine Cardiology 7 8 Dr Murray And Dr Sobolewski Dr Nyman, Mates or Dobes General Medicine General Medicine Haematology and Oncology Cardiology 9 10 Dr Jain or Perry Dr Mangion, Meacock or Ihama General Medicine General Medicine Gastroenterology Elderly Care 24
  25. 25. Appendix 8 Lincoln County Hospital Lincoln County Hospital has 4 general medical wards, two general care of the elderly, a coronary care unit, a stroke unit and an emergency assessment unit including a short stay ward. The general medical wards all take particular speciality patients in addition to general medicine (i.e. Dixon ward – gastroenterology, Burton ward – renal and diabetes, Carlton Coleby – respiratory, Johnson – cardiology). The ‘care of the elderly wards’ specialise in patients with complex medical needs and patients are allocated on the basis of this rather than age. All patients have equal access to diagnostic and treatment facilities, irrespective of age, in line with national guidance. All consultants take part in the general medical take, which is integrated, and wards will have a good mix of general medicine and speciality patients apart from the specialist units such as stroke. The medical directorate operates a ward-based system and teams of junior doctors are attached to consultants based on wards. Generally there are two consultants per ward (exceptions include the Care of the Elderly wards where there is only one per ward). The junior teams on the wards are expected to cross cover each other and to work as a team across the ward. The directorate has developed ward links with surgical wards so that specific teams take responsibility when we have outliers. Emergency Assessment and the ‘Take’ The emergency medical take operates through the emergency assessment unit which is a combined assessment unit with the general surgeons. The majority of GP admissions are referred directly to the unit. Surgical and medical patients are assessed by the relevant teams but it is expected that there will be a degree of joint working and cooperation. During normal working hours Mon-Fri the medical team on EAU consists of the EAU SHO (on rotation for 4 months), two EAU F2s (on rotation for 4 months) and an F1 (allocated in weekly blocks). In addition there is an on call medical SpR who is freed up from all other elective duties when on call. Between 5pm and 10pm (and 9am-10pm at the weekend) there is an on call team of the day (one SpR, two SHOs and an F1). Overnight there is a medical SpR and two SHOs. Overnight problems on the wards are looked after by the Hospital at Night team, the exception being CCU. There are two consultant ward rounds each day at 8am and 4.30pm. The round is done by the consultant of the day and the acute physician. Medical handover takes place at 9am, 4.30pm (weekdays) and 9pm. Education/Facilities This is a vital aspect of training. The Trust adheres to the minimum standards of teaching agreed throughout the region, which includes one half-day a week bleep free teaching sessions, preparation for Part 1 and PACES and an emergency medicine course. In addition there is Monday lunchtime: Medical clinical meeting – junior doctors are encouraged to present patients. Grand round: once a month at Lunchtime Multidisciplinary medical audit: one half day per two months All junior doctor teaching above is bleep free apart from for the on call team of the day. 25
  26. 26. In addition there are specific departmental teaching sessions e.g. cardiology have an ECHO meeting – these are open sessions and all are welcome to attend. Educational Supervision At present SHOs are allocated an educational supervisor for the length of their rotation and have a clinical supervisor in addition (the consultant for whom they are working). For CMT SHOs will work at Lincoln for a maximum of eight months in two 4 month blocks. It is anticipated that in this circumstance the educational supervisor will be the consultant for whom they work with the RCP tutor or CMT director taking overall responsibility. This will be as follows: Renal: Dr J Little EAU (ACCS): Dr R Gosseil ITU: Dr A Wolverson Gastro: Dr G Spencer Cardiology/CCU: Dr R Andrews Dr S Kelly Dr W Arthur Respiratory: Dr S Matusiewicz Dr I Paterson Health Care of: Dr S Patanwala Elderly Haematology: Dr D Prangnell Endocrine: New diabetes appointment (due to be appointed 8/2/07) 26

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