Portsmouth Hospitals NHS Trust – Queen Alexandra Hospital


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Portsmouth Hospitals NHS Trust – Queen Alexandra Hospital

  1. 1. SpR Renal and General Medicine Wessex Deanery Specifications and Organisation The Specialist Registrar training scheme in Renal Medicine and Transplantation for Wessex, aims to provide first class clinical training designed to meet the standards of Higher Medical Training, as recommended by the Royal College of Physicians, leading to the achievement of CCT with dual accreditation in Nephrology and General (Internal) Medicine. This is a five year appointment as Specialist Registrar at Queen Alexandra Hospital, Portsmouth rotating between Nephrology and General Internal Medicine (at Portsmouth or Southampton University Hospitals NHS Trust). The posts have been approved by the Royal College of Physicians for training towards the achievement of Certificate of Completion of Training (CCT) in both Nephrology / Renal Medicine and General (Internal) Medicine. The usual distribution of the rotation is as follows (though there is flexibility in the arrangements to meet individual needs). The training is structured and devised according to the JCHMT guidelines on Higher Specialist Training in Renal Medicine and General (Internal) Medicine, issued by the Royal Colleges of Physicians. Record of In-Training Assessment (RITA) reviews are held in November each year. Consultant Trainers / Educational Supervisors Portsmouth Hospitals NHS Trust – Queen Alexandra Hospital 6 Consultant Nephrologists 2 Consultants in General Medicine + Cardiology/Endocrinology Associate Trainers 4 Consultant Transplant Surgeons, Portsmouth 3 Consultant Radiologists, Portsmouth 2 Consultant Histopathologists, Portsmouth 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. Southampton University Hospitals NHS Trust Clinical Duties of the Post This is a one year post within the Wessex Renal Specialist Registrar Scheme. The Specialist Registrar is responsible for the care of inpatients and outpatients under the care of Consultants, with their supervision and with the help of the SHO and House Physician. Consultant Ward rounds and outpatient clinics are detailed in the accompanying timetable. Teaching Both third and fifth year undergraduate students are regularly attached to the firm. The Specialist Registrar is expected to assist in ward-based teaching. In addition there are teaching programmes for undergraduate and postgraduate students and teaching of nurse and other professions allied to medicine is expected. Education and Research 0806/HCWI_JOBS_RENAL_JD 1_
  2. 2. SpR Renal and General Medicine Wessex Institute Half days are allocated for each of these activities. The education session is fixed but the Research / Study session may be flexible to accommodate clinical commitments. Opportunity for research is available in collaboration with the University Departments of Medicine, Public Health and the departments of Histopathology, Immunology etc. Study and Training The post is recognised for Higher Professional Training by the Royal College of Physicians. There are educational activities almost every day for all groups of graduates at all stages of their careers. There are also departmental teaching sessions and conferences. Provisional Timetable AM PM Monday SpR Ward Round Consultant Ward Round Third Year Teaching Renal Biopsy meeting (alternate weeks) Tuesday Consultant Ward Round Research Wednesday Outpatients New (GIM / Vasculitis Grand Round (alternate Weeks) Education Thursday SpR Ward Round Outpatient GIM/Renal Friday Consultant Ward Round Ward work/Teaching Portsmouth Hospitals NHS Trust Nephrology The Wessex Renal and Transplant Unit, located at Queen Alexandra Hospital, Portsmouth, is a very busy and active department currently providing a comprehensive renal service to a population of approximately 2 million. In addition to the Wessex Region (including Hampshire, Isle of Wight, Wiltshire, excluding Dorset) the Unit also provides renal services to the adjacent part of West Sussex. All aspects of renal disease are referred and treated. There are approximately 450 patients in the dialysis programme (330 on haemodialysis and 120 on CAPD) and 650 patients with functioning transplants. The Unit aims to undertake 60-70 renal transplants per year. Outpatient clinics in Nephrology (including General Nephrology, haemodialysis, CAPD and transplant review) and Renal / Transplant surgery run on every day of the week. In addition, the Consultant Nephrologists are responsible for peripheral clinics in Chichester, Southampton, Basingstoke, Salisbury, Winchester, Bognor Regis, and the Isle of Wight. A number of staffed satellite haemodialysis units have been established, in Totton, Isle of Wight, Basingstoke and Bognor Regis. Further Units are planned over the next 2-3 years. The Unit works in close co-operation with other departments in the hospital - Urology (on site lithotripter), the Intensive Therapy Unit, Radiology, Nuclear Medicine and Pathology. There are five dedicated inpatient wards (one each for transplantation / surgery, high-care, step-down, peritoneal dialysis and general nephrology), although the division of work is not rigidly adhered to, with a complement of 42 beds. There is, in addition, an outpatient haemodialysis ward with 25 stations and a day ward with 6 beds. The Unit also has its own integral Outpatient Department with 6 consulting suites, where clinics are run, and programme patients may be seen during the day in this department. All nursing staff on the wards are Nephrology trained and there is a locally run ENB Renal Nursing Course. 0806/HCWI_JOBS_RENAL_JD 2
  3. 3. SpR Renal and General Medicine Wessex Institute Within the Unit are based five transplant co-ordinators, 3 dieticians, a renal pharmacist, a social worker, a physiotherapist, a General Manager, a Nurse Manager and allied administrative staff. The Unit incorporates a University Research Laboratory and a Clinical Research (‘Hypertension’} Laboratory. Being affiliated to the Southampton University Faculty of Medicine, there is a regular commitment to undergraduate and postgraduate teaching, and research. Registrars are strongly encouraged to maintain and develop ongoing links with the University. Nephrology Medical Staff Establishment 6 Consultant Nephrologists 5 Specialist Registrars 1 Visiting Specialist Registrar (FTTA) 6 Senior House Officers Duties of the Post The Specialist Registrar and Senior House Officers share responsibility for the day to day care of the patients on the Renal Unit, including those on the Acute Nephrology and Dialysis wards, the Transplant and Surgical ward, and the chronic Haemodialysis Unit. There are at least 3 Consultant ward rounds per week, a weekly Monday morning Multi-disciplinary Unit meeting and a weekly Educational afternoon, which incorporates Histopathology, audit and seminars. There will be 3 ward-based Registrars, who will be expected to carry out a daily morning round on the transplant patients, followed by a a lunch-time round with a Consultant Surgeon and Physician, along with the senior nurse. Two other Registrars will cover Outpatients and 1 covers the Haemodialysis Unit. Posts will rotate at 3-4 monthly intervals. The Specialist Registrars are expected to become competent in setting up and managing all current dialysis procedures, and in all practical procedures such as vascular catheterization (temporary and tunneled), renal biopsy (native and transplant) and CAPD catheter insertions. The Specialist Registrars will undertake 2-3 out-patient clinics each week. on average. Research and Audit Specialist Registrars are strongly encouraged to take part in research. There are ample facilities and opportunities within the Department, which also hosts a laboratory arm of the University of Southampton. Over and above the Educational sessions, the Specialist Registrars will be allowed a further half-day per week for research. A number of studies are currently ongoing, with emphasis on clinical research. The current research interests are in the following fields: ♦ Referrals for chronic renal failure ♦ Proximal tubular cell culture ♦ Transplantation ♦ Renal anaemia ♦ Vasculitis ♦ Hypertension Clinical audit is strongly encouraged and it is expected that each Specialist Registrar will undertake at least one audit project. Regular multi-professional audit is undertaken, of important issues such as transplantation results, CAPD peritonitis, etc. Education There is a weekly Renal study afternoon on Wednesdays, including joint sessions with Urology and Intensive Care. The Registrar will be expected to attend a Regional Training Day every 2 months, in conjunction with Registrars from the South Thames Training Scheme. There are monthly Integrated General Medicine afternoons and all members of junior medical staff are expected to attend. There is a weekly Radiology meetings. Full details are under the relevant section in the prospectus. 0806/HCWI_JOBS_RENAL_JD 3
  4. 4. SpR Renal and General Medicine Wessex Institute Sample weekly time table AM PM Monday Ward rounds Clinic Tuesday Ward rounds Research Wednesday Clinic Education Thursday Ward work Administration Friday Clinic Ward work General Medicine Three hospitals are managed as one Trust, and all acute admissions come in through the MAU at Queen Alexandra Hospital. This post is attached to one of 2 firms: Acute General Medicine at QAH & Cardiology, or Acute General Medicine & Diabetes-Endocrinolgy. The Specialist Registrar will be responsible for the day to day management of the patients under the care of the Team. The Specialist Registrar will supervise the Team’s Senior House Officer and House Officers. He/she will be required to undertake a minimum of two ward rounds per week. The Registrar undertakes 2-3 outpatient clinics per week. Each morning there is a Post-Take Ward Round on the MAU, undertaken by 3 Consultants (2 Specialist Physicians and 1 Geriatrician) with triage of patients according to Subspecialty. The Registrar will play a key role in organizing the triage. Provisional weekly time table – QAH AM PM Monday Ward rounds Medical Clinic Tuesday Research Administration Wednesday Ward rounds Education Thursday Ward rounds Ward work Friday Endocrine Clinic Ward work There is a large clinical workload, with ample scope for audit and education. Trainees obtain excellent clinical experience which is both broad and deep. There are close working links with the Intensive Therapy Unit, Microbiology, Radiology and Urology. Educational Strategy We have devised a programme of education and training that is aimed at doctors ranging from Senior House Officer to Consultant, with special emphasis on Specialist Registrars. We aim to cover all of the Curriculum produced by the Royal College of Physicians, over the 5 years spent in Portsmouth. There is additional emphasis on multi-professional training, with joint meetings between clinical staff (including Transplant Surgeons), nurses, pharmacists and dietitians. The formal educational slot takes place every Wednesday afternoon, with breaks in April, August and December. This is mandatory for all Specialist Registrars in the Programme, and includes Histopathology. There is a Renal Radiology session on Thursday mornings. In addition, there is the conventional bedside teaching on ward rounds and in outpatient clinics. The usual Wednesday afternoon teaching session runs from 1300 till 1600. The draft format, which is flexible, is represented in the attached table. The Registrars are required to attend the Regional Study Day once every 2 months, in common with Registrars from the South Thames 0806/HCWI_JOBS_RENAL_JD 4
  5. 5. SpR Renal and General Medicine Wessex Institute Training Programme, which includes Brighton and Canterbury. This will cover the Core Curriculum as prescribed by the Royal College of Physicians of UK. Training in practical procedures is largely cascaded, with great success. The more senior Specialist Registrars instruct the new Specialist Registrars on procedures such as kidney biopsy, tunneled vascular catheter insertion and CAPD catheter insertion. All Specialist Registrars instruct SHOs on central venous cannulation. Consultants are always available to step in when Specialist Registrars face difficulties, and all Registrars will be ‘signed off’ in terms of their competencies. The Specialist Registrars are strongly encouraged to participate in audit and clinical research. As a matter of course, every Specialist Registrar is expected to carry out at least 2 research projects and 1 audit project during their stay. Regular 4-monthly appraisals are held between the trainees and their educational supervisors, as recommended by the Postgraduate Dean's Office. There is considerable support for attending and submitting Presentations at Specialty meetings both within UK (eg Renal Association) and abroad (eg European Renal Association, International Society of Nephrology). The Renal Research Fund is well endowed and is generally able to support the research activities from the financial standpoint. Education and Training in General Internal Medicine Portsmouth Hospitals NHS Trust is the leading provider of specialist care for the Portsmouth and South East Hants Health District. In addition, the Trust provides services to adjoining districts including West Sussex, Southampton and South West Hants, North Hampshire, Isle of Wight and the Channel Islands. We provide a comprehensive clinical service in all medical specialties, with integrated education and training. The activities are concentrated within the Medical Services Directorate. The specialties / departments are as follows: 1. Acute General Medicine 2. Cardiology 3. Respiratory Medicine 4. Gastroenterology 5. Diabetes and Endocrinology 6. Nephrology & Transplantation 7. Neurology 8. Dermatology 9. Haematology There are close working and training links with Rheumatology and Rehabilitation and Intensive Care, as well as with Geriatrics (East Hampshire Primary Care Trust). There are strong links with the Universities of Southampton and Portsmouth. The Trust is one of the major providers of undergraduate medical education for students from the University of Southampton. The Trust has two nominated Royal College Tutors. Educational Strategy We acknowledge the over-riding importance of good medical education and training at all stages of development. With this in mind we have devised a programme that is expected to provide high quality specialist training for all doctors in training, as well as CME for established specialists and consultants. Despite the many new innovations, we continue to place considerable emphasis on clinical teaching at the bedside, both inpatient and outpatient. We also recognise and encourage the time honoured teaching cascade, whereby every grade of junior medical staff continually teach and train their juniors. Formal educational sessions include a variety of formats, which we believe provides the best mixture of methods and content. There is a strong commitment to providing high quality training and education to the new grade of Specialist Registrars. A number of consultants from 0806/HCWI_JOBS_RENAL_JD 5
  6. 6. SpR Renal and General Medicine Wessex Institute the directorate play key roles as Chairmen of the Regional Specialist Training Committees / College Specialty Advisers. Format of Educational Sessions We engage in a very wide variety of formal educational activity, many of which are open to all grades of doctors, as well as undergraduate medical students. The following list only includes sessions targeted at qualified doctors (excluding undergraduate medical students). The aggregate value of these educational sessions amount to 4 hours per week for all grades of doctors in training (in protected time). The sessions also offer the opportunity of 2 hours per week of internal CME for consultants and specialists. Regular appraisals are held between the trainees and their educational supervisors, as recommended by the Postgraduate Dean's Office. Below is a list and description of the various educational sessions that are applicable and recommended for Specialist Registrars in this programme. 1. Core Curriculum Training in General Medicine for Specialist Registrars These sessions are held for 4 hours once a month as a rolling half-day, Tuesday to Thursday afternoons 1-5 pm. They are intended to provide an adequate level of education that would be required for the Specialist Registrar seeking dual accreditation. Each session is covered by one particular medical sub-specialty, and the programme is cycled every 24 months. SpRs will be expected to teach their own specialty topics to those from other specialties, as part of their teaching experience (once a year). These sessions are integrated with Consultants as part of their CME requirements. 2. Renal / Vascular Radiology These sessions run from 0830 to 0930 on Thursdays and are targeted at doctors in training, as well as Consultants on the Renal Unit.. 3. Wessex MRCP Training Courses Courses are held on a region wide basis for both parts of the MRCP exam. The Part I course is held 3 times a year, centrally in Southampton. The Part II course is also held 3 times a year, rotating between Portsmouth, Southampton and Bournemouth. Specialist Registrars participate in the teaching / examination sessions, which are considered valuable experience. Visiting Visits to the Unit are welcome and/or further information may be obtained by contacting the secretary to Dr G Venkat-Raman (023-9228 6000 Ext 1003) or one of the other Consultants at Queen Alexandra Hospital (023- 9228 6000). 0806/HCWI_JOBS_RENAL_JD 6
  7. 7. SpR Renal and General Medicine Wessex Institute Appendix 1 Core Curriculum for Specialist Registrars in General Medicine Each session will be for 4 hours, once a month (rolling Tuesday to Thursday afternoons) and the topics will be cycled every 2 years. There are 20 sessions, with a break in July and August when there will be no sessions. The topics correspond to those recommended by the JCHMT Month Specialty Year 1 Specialty Year 2 January Cardiology Cardiology February Gastroenterology Gastroenterology March Nephrology Vascular Medicine April Intensive Care Medicine Dermatology May Rheumatology Rheumatology June Respiratory Medicine Respiratory Medicine September Intensive Care Medicine Neurology October Haematology Surgical Specialties November Geriatric Medicine Chemical Pathology December Diabetes/Endocrinology Diabetes/Endocrinology 0806/HCWI_JOBS_RENAL_JD 7
  8. 8. SpR Renal and General Medicine Wessex Institute Appendix 2 Renal Education & Training Programme at Portsmouth 1st Wednesday 1300 Transplant multidisciplinary meeting 1400 Histopathology 1500 Topic review 2nd Wednesday 1300 Transplant multidisciplinary meeting 1400 Nephrology Journal Club 1500 Research Presentations 3rd Wednesday 1300 Transplant multidisciplinary meeting 1400 Histopathology 1500 Case presentation 4th Wednesday 1300 Transplant multidisciplinary meeting 1400 Inter-Disciplinary meetings 5th Wednesday 1300 Transplant multidisciplinary meeting 1400 Histopathology 1500 Clinical Audit / Deaths & Complications Regional Study Day (Combined with South Thames Deanery, Brighton & Canterbury) One Wednesday every 2 months (7 sessions per year} – venue rotates around the 7 participating centres. Topics cover the Core Curriculum in Nephrology, as prescribed by the Royal College of Physicians of UK. 0806/HCWI_JOBS_RENAL_JD 8