Southampton University Hospitals NHS Trust


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Southampton University Hospitals NHS Trust

  1. 1. LAT Dermatology Wessex Rotation Southampton University Hospitals NHS Trust Poole Hospital NHS Trust Portsmouth Hospitals NHS Trust Royal Bournemouth & Christchurch Hospitals NHS Trust Introduction This is a 4 year training rotation which fulfils the training criteria for accreditation as a Specialist in Dermatology. The rotation includes periods in the main hospitals of the Wessex Dermatology Rotation: ♦ Portsmouth ♦ Bournemouth/Southampton ♦ Southampton ♦ Poole (awaiting Educational Approval) The timing of the points on the rotation is subject to review and modification as training needs require and as vacancies arise. The job description may change in the future with the introduction of the Poole component of the rotation. The training scheme in Wessex has been developed to cover all the training requirements expected of a Calman trainee as specified by the SAC in Dermatology. Those applying for the post should have undertaken 2 years of general medicine and it is essential to have obtained the MRCP. General Description of Higher Medical Training In-Patient and Day Care Treatment The appointees have in-patient responsibilities in all Hospitals. The on-call duties and rotas are presently under review. Training will be under the supervision of the relevant Consultants. Similarly, day-care is given in all the hospitals Dermatology Out-Patient Clinics The trainee will do different combinations of outpatient clinics in each point of the rotation. It is intended that the Specialist Registrar should progressively develop their skills under supervision with the aim of being able to deal with all common dermatoses with confidence by the end of the second year of training. A variety of more specialised clinics including contact allergy patch testing, paediatric dermatology, skin oncology and joint clinics with other specialties are undertaken throughout the rotation. Dermatological Surgery The trainee will be instructed in and carry out simple cutaneous surgery such as electrocautery, diathermy, shave excision and elliptical excision, and will have the opportunity to observe more complex surgery, such as flaps and grafts. Formal training in more advanced Dermatological Surgery techniques will be given during the last 3 years of the rotation. The trainees will be expected to attend a recognised course in dermatological surgery in the first two years. Practical Skills Practical training in dressings and wound care, dermatological formulation and prescribing, dermatological surgery and patch-testing is offered. The trainee will attend journal clubs and research meetings and receive training in computing, data processing, statistics and research methods. Curriculum Skin Biology The trainees will attend a recognised course on the biology of the skin in the first year which will be complemented by in-house training. 03060205/DERMATOLOGY 1
  2. 2. LAT Dermatology Wessex Rotation General Dermatology The trainees will become familiar progressively with the diagnosis and management of the full range of dermatoses which may present to the Dermatologist. Discussion in clinics and ward rounds is encouraged and difficult or classic cases are regularly presented at the Departmental Academic Meetings. Dermapathology Weekly histopathology sessions are held in Bournemouth and there are monthly sessions in Southampton with a Consultant Histopathologist with a special interest in skin disease. In the later years of the 4 year Calman plan training will continue in Southampton. Training will be given in correct biopsy technique, orientation, preparation and diagnosis. Special investigative methods, such as immunohistochemistry will be taught. The trainee will attend a recognised course in histopathology in the second year of training. Photodermatology (including phototherapy) Phototherapy including PUVA and narrow band UVB is available in Christchurch, Portsmouth and Southampton. Paediatric Dermatology New and follow-up paediatric patients are seen in dedicated clinics in Southampton and Christchurch, while children are seen in general dermatology clinics in Portsmouth. Infectious Diseases and Infestations affecting the Skin The Southampton Department has special interests in viral, fungal and bacterial infections of the skin. Training in all aspects of infectious disease and infestations is offered. Genito-Urinary Medicine There is good liaison with the Departments of Genito-Urinary Medicine in Southampton and Christchurch, who are able and willing to offer teaching to Dermatology trainees. Formal attachments to these departments will be offered in the latter years of the 4 year training period. Radiotherapy and Dermatological Oncology Joint clinics with a Consultant Radiotherapist/Oncologist take place in Southampton and Portsmouth. The Departments in Portsmouth and Southampton have a special interest in melanoma, while the Southampton Department has special interests in cutaneous T cell lymphoma and is involved in major trials of new agents. Dermatology and Primary Health Care It is anticipated that trainees should do some clinics in GP Health Centres during the 4 year training period, but this will be deferred to the later years. Clinical and Laboratory Research/Further Specialist Training It is anticipated that at least one session per week of protected time will be devoted to research or special training, and the possibility of a prolonged, dedicated period of study or training in a particular field will be encouraged in the latter part of the 4 year training programme. The Southampton Department has research interests in inflammatory Dermatoses, Drug Reactions, Melanoma, Lymphoma and Epidemiology. Previous trainees have been encouraged to undertake a period of special training in a particular field. Teaching and Communication Skills The Southampton Department has a particular interest in teaching, being responsible for the teaching of Dermatology to Southampton medical students and the focus of postgraduate training in Dermatology in the Region. The trainees will have regular commitments to teach undergraduates and postgraduates, including nurses and paramedical staff. They will be supported by an excellent Teaching Media Department and medical photography service. 03060205/DERMATOLOGY 2
  3. 3. LAT Dermatology Wessex Rotation Management and Marketing Skills Attendance at Southampton Departmental Business Meetings is expected. Involvement in business planning and personnel selection is encouraged, as is attendance of an approved management course. Audit There is an active clinical audit programme in Southampton and Portsmouth to which all trainees are required to participate. In addition, sub-regional audit is carried out with other hospitals in the Solent area. Hours Junior Doctors hours are constantly under review throughout all hospitals in Wessex; on call / shift commitments are therefore subject to change. Banding arrangements may differ as individual Trusts determine rotas at local level. Full details of banding are available from the Medical Personnel Department of the relevant Trust. Emergencies The Registrar accepts that he/she will also perform duties in occasional emergencies and unforeseen circumstances at the request of the appropriate Consultant, in consultation where practicable with his/her colleagues both senior and junior. It has been agreed between the professions and the Department that while juniors accept that they will perform such duties, the Secretary of State stresses that additional commitments arising under this sub-section are exceptional and in particular, that juniors should not be required to undertake work of this kind for prolonged periods or on a regular basis. Visiting Arrangements for visits can be made by contacting the Consultants’ secretaries: Southampton Tel: 023 8082 5458 Portsmouth Tel: 023 9286 6073 Bournemouth Tel: 01202 336262 Poole Tel: 01202 448148 Portsmouth Hospitals NHS Trust Department of Dermatology The Dermatology Department is a dedicated unit located on the West Wing of St Mary’s Hospital. It consists of consulting suites, 5 surgical theatres, day treatment and PUVA suites and administrative offices. The department includes a dedicated team of administrative staff and dermatology nurses. The latter are led by a Senior Staff Nurse; in addition we have two Nurse Specialists, who are senior sisters. Two secretaries and four audio typists support the clinicians. The majority of outpatients are seen at St Mary’s, but clinics are also held at Queen Alexandra Hospital, Gosport, Petersfield and Fareham. Joint clinics are undertaken with Rheumatology, Genito-Urinary Medicine, Gynae Oncology, Oncology, Radiotherapy, Plastic surgery and Paediatrics. There is a substantial unit at the Haslar Hospital site in Gosport. There are six ring fenced Dermatology beds on B3 medical ward at St Mary’s, as well as 6 shared care medical beds to which we have access when necessary. Access is available to Paediatric beds at St Mary’s and in-patients are managed jointly with the paediatricians. Portsmouth purchasers are committed to investment in Dermatology to improve local access times and make progress toward Health of the Nation targets in relation to skin cancer. Dermatology is part of the Medical Services Directorate with the current Divisional Director, and the Clinical Director for Dermatology. Departmental Statistics In 1998/9 the department saw 6380 new patients with a total outpatient activity of 23670 patient attendances. There were 180 inpatient admissions. The Department deals with a higher than average number of skin malignancies and as a consequence undertakes a significant amount of 03060205/DERMATOLOGY 3
  4. 4. LAT Dermatology Wessex Rotation surgery (2465 surgical procedures). Portsmouth has a large renal unit and a significant number of transplant patients develop malignancy. Dermatology Service Medical Staff Establishment Portsmouth Hospitals NHS Trust 4 Consultants 3 Specialist Registrars (on Wessex Rotation) Haslar Hospital 2 Consultants 1 Visiting Registrar 3 Clinical Assistants 3/4 Specialist Registrars based at Portsmouth including Haslar Hospital 4 days a week 1/2 Specialist Registrars: Calman training programme year 1 and 2. Seconded one day per week to Southampton SHO: 4 monthly - on medical rotation 2 Hospital Practitioners Clinical Assistant: 12 sessions In-Patients and Day Care Treatment The Portsmouth department has 6 designated dermatology beds and 6 shared care beds on a medical ward. There is a day treatment area run by specialist nurses and they also run the Phototherapy unit. Consultant ward rounds are run once weekly as a combined ward round on Tuesday mornings. The trainees are expected to take responsibility with the Senior House Officer for care of the in-patients. Paediatric patients are admitted under the joint care of the Dermatologists and Paediatricians onto a paediatric ward. Ward Referrals: The departments deal with ward referrals from acute hospitals and also community hospitals in Gosport, Petersfield, Emsworth, Havant, Coldeast and Knowle. There will be some ward referral duties when on-call in Southampton. Out-Patient Dermatology Most of the general Dermatology clinics are held at St Mary’s but clinics are also held at Queen Alexandra Hospital, Gosport, Petersfield, and Fareham. The attachment includes involvement in both the general and specialist clinics, including all the multidisciplinary clinics. Dermatological Surgery Portsmouth has a higher than average registration for all forms of skin cancer (melanoma, BCC and SCC). A large number of these tumours are dealt with in the department. Minor surgery is undertaken throughout the week by all six Consultants and Clinical Assistants. There is opportunity to have exposure to and undertake more advanced techniques with Consultants who have a particular interest in surgery. There is good liaison with a Consultant oncological and plastic surgeon, for management of melanoma. The trainee will be expected to attend a recognised course in dematological surgery in the first two years. Mohs surgery is undertaken at Portsmouth. Contact and Occupational Dermatitis Patch testing is undertaken within the department. Advanced training will be offered in Southampton later in the 4 year Calman programme. 03060205/DERMATOLOGY 4
  5. 5. LAT Dermatology Wessex Rotation Dermatopathology A joint weekly meeting occurs between the Dermatology Consultants and a pathologist with a specialist interest in skin disease. Further training is offered in Southampton once a month at the Southampton Dermatology Academic Meeting. In the later years of the 4 year Calman plan, training will continue in Southampton. Training will be given in correct biopsy technique, orientation, preparation and diagnosis. Special investigative methods, such as immunohistochemistry will be taught. The trainee will attend a recognised course in histopathology in the second year of training. Research There are opportunities in Portsmouth to become involved in research. A number of projects are being pursued in Portsmouth in collaboration with Portsmouth University including assessment of digital imaging fibre optic microscopy in the early diagnosis of pigmented lesions. A number of clinical trials are in progress. There is an active programme of research in health promotion and education. There would be opportunities for becoming involved in projects at Southampton University. Audit There are monthly audit meetings within the Portsmouth department which involve medical staff, nurses and administrative and secretarial staff. Sub-regional audit is carried out with dermatologists from other hospitals in the Solent area. Audit meetings in Southampton are held as part of the Departmental Academic Meetings. Management Monthly management meetings are held at Portsmouth. The Specialist Registrar is expected to attend these sessions. Provisional Timetable – Specialist Registrar at Portsmouth/Southampton AM PM Monday Clinic Clinic Tuesday Histopathology Meeting Ward Round Journal Club/Clinical Meeting Clinic Wednesday Tutorial/SHO teaching PUVA/Day Treatment Clinic. Cutaneous Surgery Thursday Clinic Southampton Postgraduate Education, St John’s, 4th & 5th Research) Friday Research Administration/Research Provisional Timetable – Specialist Registrar at Portsmouth AM PM Monday Clinic Lasers / Mohs Tuesday Histopathology Meeting Ward Round Journal Club/Clinical Meeting Clinic Wednesday Research Research Thursday Clinic Postgraduate Education, St John’s, 4th & 5th Research) Friday Clinic and Ward Round Ward Round SHO teaching/referrals. 03060205/DERMATOLOGY 5
  6. 6. LAT Dermatology Wessex Rotation Specialist Clinics: Pigmented Lesion Clinic Surgery/Radiotherapy/Dermatology Clinic Dermatology/Rheumatology Clinic Dermatology/GU Medicine/Gynaecology Clinic Patch Test Clinic Royal Bournemouth & Christchurch Hospitals NHS Trust Dermatology Department Facilities The Dermatology Resource Unit housing an 8 bed dedicated dermatology ward, Day Treatment facilities, a dedicated dermatology minor operating theatre, Phototherapy Unit, Outpatient Clinics and offices. There is also a hospital library taking leading Dermatological journals and a Medical Photography Department. The following services are provided: ♦ Inpatient care of adults and children. ♦ Daily outpatient clinics for emergency and routine referrals. ♦ Day Treatment ♦ Patch testing. ♦ Leg ulcer clinic run by nurses. ♦ Dermatological Surgery. ♦ Daily UVB AND PUVA therapy. Departmental Staff 2 Consultants Senior House Officer: Six monthly on GP rotation scheme Clinical Assistants 5 sessions Nursing Staff The department has its own dedicated and trained team of nurses for inpatient care, working under the supervision of the ward sister. There is also a Paediatric Nurse Specialist. Specialty Statistics Available Beds 8 Average Daily Bed Occupation 100% Waiting List 12 weeks New Outpatient Attendances 2,712 Total Outpatient Attendances 8,949 These figures do not include ward attenders or PUVA patients. Details of the Post This whole-time appointment is dermatology based at the Royal South Hants Hospital and Christchurch Hospital, Bournemouth. 03060205/DERMATOLOGY 6
  7. 7. LAT Dermatology Wessex Rotation Clinical Duties AM PM Monday Out-Patients - RSH Research Tuesday Out-Patients – Christchurch Research Wednesday Ward Round Out-Patients – Christchurch Out-Patients - Christchurch Thursday Minor Ops - RSH Post Graduate Education SSS Meetings Academy Meetings Friday Minor Ops Special Clinic Eg: Vascular Clinic and General Clinic ♦ Dermapathology at Bournemouth on Wednesday lunchtime. ♦ Journal Club in Southampton on Monday lunchtime. ♦ Research and Audit Meetings as part of the Southampton Departmental Academic Meetings. Monday evening once a month at 5.30 pm there is a Southampton Departmental Business Meeting which the Specialist Registrar is encouraged to attend. It is anticipated that the sessions for teaching, audit and postgraduate education will be used flexibly. It is also anticipated that in the second year one session per week will be devoted to research replacing one of the general clinics. Southampton University Hospitals NHS Trust Dermatology Department Facilities ♦ 5 Dermatology beds on a joint ward with Rheumatology and General Medicine at Southampton General Hospital. ♦ A new Dermatology Diagnosis and Treatment Centre at the Royal South Hants Hospital which incorporates: ♦ A Day Treatment Unit including UVB, PUVA and hand and foot PUVA at Southampton General Hospital. ♦ 3 dedicated minor operating rooms at Royal South Hants Hospital. ♦ Patch testing room at Royal South Hants Hospital. ♦ Research room at RSH. ♦ Day Theatre facilities for complex surgery at RSH. ♦ Office space for Consultants, junior staff and secretaries at RSH. ♦ Small department library at RSH, and larger hospital library, taking all leading dermatological journals. ♦ Medical photography. The following services are provided: ♦ Inpatient care of adults and children. 03060205/DERMATOLOGY 7
  8. 8. LAT Dermatology Wessex Rotation ♦ Daily outpatient clinics for emergency and routine referrals. ♦ Skin cancer screening clinic. ♦ Contact Dermatitis Clinics. ♦ Paediatric Dermatology Clinic (at Southampton General Hospital) ♦ Hand Clinic ♦ Dermatological Surgery ♦ Daily UVB and PUVA therapy run by nurses with MED and MPD testing. The clinical facilities are based on two sites. Inpatients (5 ring-fenced beds) are at Southampton General Hospital, and the Dermatology Diagnosis and Treatment Centre (Outpatient activities) is at the Royal South Hants Hospital. Activity: The department sees 5-6000 new patients annually with up to 22,000 outpatient attendances. The department has been a major beneficiary of “Action-on” funding, which has enabled developments in nurse-led clinics, nurse-led surgery, GPs with special interest in Dermatology and the development of the new facilities. The special interests of the senior staff include atopic eczema, psoriasis and adverse drug reactions, lymphoma, genetics, disorders of pigmentation, paediatric dermatology, cutaneous surgery, skin cancer and contact dermatitis and photobiology. The Academic Dermatology Department Southampton is one of a handful of Medical Schools that have a research based professorial dermatology department with 2 Professors and a Senior Lecturer. The research base is in the General Hospital (Dermatopharmacology Unit) where a team of more than 20 scientists are studying a range of problems in the skin. Some of the main themes are mechanisms underlying allergic and inflammatory processes in skin, including contact dermatitis, drug allergy and atopic dermatitis and investigation of factors affecting susceptibility to skin cancer. Clinical in vivo studies are coupled to laboratory based cell and molecular investigations. There is scope for registrars to get involved in the departmental research programme and this may lead to applications for research fellowships to allow periods of full time research. Department Staff 7 Consultants 5 Full-time Specialist Registrars and 2 Part-time Flexible Specialist Registrars. 1 SHO has responsibility for day to day care of inpatients and assists with outpatients. 2 General Practitioners with special interest Nursing Staff Ward Sister and support staff Specialist Dermatology Nurse Specialist Paediatric Dermatology Nurse Secretarial Staff There are two departmental secretaries, and additional typing support. 03060205/DERMATOLOGY 8
  9. 9. LAT Dermatology Wessex Rotation Person Specification Any attributes which are evaluated on the basis of the application form alone may be further explored at the interview stage. Essential Desirable Qualifications Eligible for registration with GMC MB BS (or equivalent) MRCP (UK) or (I) or equivalent BSc (or other intercalated degree) Other degrees/qualifications Clinical Experience Relevant post reg experience A minimum of 2 years in approved posts including 18 months etc. 6/12 unselected take Experience in other related specialties eg General Medicine, GU Medicine, Rheumatology, Immunology, Paediatrics. SHO post in Dermatology Clinical skills Understanding of clinical risk management Competent to work without direct supervision where appropriate. Clear, logical thinking, showing an analytical / scientific approach. Good manual dexterity and hand / eye co-ordination. Defined procedures Experience of clinical risk management Knowledge Appropriate level of clinical knowledge, as defined by the RCP SHO curriculum. Shows knowledge of evidence- informed practice Shows awareness of own limitations. Demonstrates breadth of experience and awareness in and outside specialty/medicine Demonstrates use of evidence- informed practice Organisation & Planning Ability to prioritise clinical need Ability to organise oneself & own work Evidence of participation in audit Experience and ability to work in multi-professional teams Understanding of NHS, clinical governance & resource constraints; mgmt / financial awareness, experience of committee work Active involvement in audit Information technology skills 03060205/DERMATOLOGY 9
  10. 10. LAT Dermatology Wessex Rotation Essential Desirable Teaching Skills Evidence of teaching experience Teaching experience Enthusiasm for teaching; exposure to different groups/ teaching methods Academic / Research Understanding of the principles of research Research experience, presentations, publications, prizes and honours. Career Progressio n Progression of career consistent with personal circumstances. Personal skills Communication & Language Skills (Ability to communicate with clarity and intelligibility in written and spoken English; ability to build rapport, listen, persuade, negotiate) The ability to produce legible notes. Decisiveness / Accountability Interpersonal Skills (see patients as people, empathise, work co-operatively with others). Flexibility (able to change and adapt, respond to rapidly changing circumstances) Resilience (able to operate under pressure, cope with setbacks, self-aware) Thoroughness (is well prepared, shows self-discipline/ commitment, is punctual and meets deadlines) Shows Initiative/ Drive/ Enthusiasm (self-starter, motivated, shows curiosity, initiative) Ability to take responsibility, show leadership, make decisions, exert appropriate authority. Open and non-defensive sense of humour. Physical requirements Meets professional health requirements 03060205/DERMATOLOGY 10