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  1. 1. SPECIALTY TRAINING PROGRAMME IN GENERAL INTERNAL MEDICINE (CMT GRADE) EAST MIDLANDS HEALTHCARE WORKFORCE DEANERY PROGRAMME DESCRIPTION (Please see our website on CMT Programme Outline for full details of this programme). This is a two year core training programme in general internal medicine aimed at doctors who can demonstrate the essential competencies to enter this level of training. The programme is designed to provide the core medical training component for a CCT in any of the general internal medical specialties. All rotations are 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 programme is on training and there is a comprehensive educational programme outlined on our website, East Midlands Deanery CMT Homepage. All trusts within the East Midlands Deanery have agreed to provide a comprehensive teaching programme, including bleep-free half-day teaching, exam based teaching, 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 East Midlands region have a long history of post-graduate educational programmes leading to a pass rates of up to 100% in the MRCP(UK) examination. Full details of the programme, educational opportunities, trainees’ comments and details of the employing trusts can be found on the East Midlands Deanery CMT Homepage. The programme is based in the following hospitals in the East Midlands Healthcare Workforce Deanery (North): ♦ Nottingham University Hospitals Trust ♦ Derby Hospitals Trust ♦ Grantham Hospital ♦ Lincoln Hospital ♦ Kings Mill Hospital, Mansfield ♦ Pilgrim Hospital, Boston ♦ Chesterfield District General Hospital Trainees will work in both teaching hospital and district general hospital environments with at least one year of the two year programme being spent in a teaching hospital environment. Ideally during the rotation trainees will work in only two hospitals/groups. At the end of the first year, following a satisfactory ARCP, trainees will enter the second year of CMT training. The programme is divided into six four-month posts (if starting at CT1). Al trainees will undertake at least three of; - Cardiology - Diabetes and Endocrinology - Health Care of the Elderly - Respiratory Medicine - Gastroenterology Other four months attachments available include: - Renal medicine - Neurology
  2. 2. - Infectious Diseases - Oncology - Haematology - Dermatology - Rheumatology - Palliative Care - High Dependency Medicine - Intensive Care Medicine Full details of the programme, and job descriptions for individual posts, can be found on the East Midlands Deanery CMT Homepage. Nottingham University Hospitals is linked to Grantham, Lincoln and Pilgrim Hospital Boston, and Derby Hospitals Trust is linked to Kings Mill Hospital Mansfield and Chesterfield District General Hospital. The programme includes the following posts. These posts may be subject to change: Nottingham University Hospital Respiratory/HCE/Gastroenterology/Cardiology Haematology/Palliative care/Respiratory/Cardiology/ 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 CCU Haematology Respiratory Gastroenterology Pilgrim Hospital Boston Endocrinology/Gastroenterology Gastroenterology/HCE Respiratory/Cardiology HCE/Respiratory Haematology and oncology/Cardiology Derby Hospitals Trust Endocrinology/Gastroenterology/Renal Respiratory/ITU/Gastroentrology 2
  3. 3. HCE/CCU/Respiratory Renal/Haematology/Neurology and stroke Respiratory/HCE/Cardiology Kings Mill Hospital Gastroenterology/Haematology/Endocrinology HCE/Cardiology/Respiratory Gastroenterology/Rheumatology/Endocrinolgy Chesterfield Royal Hospital Cardiology/HCE/Respiratory STUDY AND TRAINING The primary aim of all posts is training and details of our commitment to training can be found on the East Midlands Deanery CMT Homepage. 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. 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 The primary aim of all posts is training and details of our commitment to training can be found on the East Midlands Deanery CMT Homepage. 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. 3
  4. 4. 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 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 4
  5. 5. 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. 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. APPENDICES – HOSPITAL DESCRIPTIONS Full details of employing trusts can be found on our website at East Midlands Deanery CMT Homepage. This site also contains detailed descriptions of all posts within the trusts and the learning objectives of each of these posts. The following appendices cover the arrangements for medicine in each of the employing trusts. 5
  6. 6. 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 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 StRs/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 programme. The trust adheres to the minimum standards of teaching agreed throughout the region (East Midlands Deanery CMT Homepage) 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. Supervision There are 26 supervising consultant physicians at QMC. The firm structure at present is organised as follows with the caveat that most cardiology has now moved to the Trent cardiac centre at Nottingham City Campus. 6
  7. 7. 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) 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 T Gazis (diabetes and endocrinology) Dr T Bowling (clinical nutrition) 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) Dr R Hawkins (acute medicine and Healthcare of the Elderly) 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. 7
  8. 8. 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 (East Midlands Deanery CMT Homepage), 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. 8
  9. 9. 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 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 CT1&2/SHOs, four StR/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 StR/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. 9
  10. 10. Renal Medicine The Consultants are Drs R Burden, C Bebb, C Byrne, M Cassidy and S Roe. There are four CT1&2/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 CT1&2/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 CT1&2/CT1&2/SHOs. Cardiology cares for approximately 1000 inpatients, 1200 new and 5500 follow-up outpatients per annum. CT1&2/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 CT1&2/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. 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) 10
  11. 11. 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 StR/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 CT1&2/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/CT1/CT2 trainee and one StR/SpR. The night-time Team consists of one FY2/CT1/CT2 trainee and one StR/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). Education/Facilities The trust adheres to the minimum standards of teaching agreed throughout the region (East Midlands Deanery CMT Homepage), which includes one half-day a week bleep free teaching sessions, preparation for Part 1 and PACES and an emergency medicine course. .A weekly physician’s 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 CT1&2/SHOs, and will do so for the Core Medical Trainees. Currently, the 11
  12. 12. 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. 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 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. 12
  13. 13. 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. Educational activities The trust adheres to the minimum standards of teaching agreed throughout the region (East Midlands Deanery CMT Homepage), 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 CT1&2/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. 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 5 on take teams each with their own base ward(s)- Respiratory, Cardiology, Gastroenterology, Endocrinology (plus Haematology CT1&2/SHO), HCE (including Rheumatology CT1&2/SHO). 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 StR/SpR, CT1&2/SHO, F2 and F1 doctor. When one team is depleted it is expected that the other team will pitch in and help out. Arrangements for admitting Medical Emergencies Recently the take system was revised so that an F1, F2, CT1&2/SHO and StR/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 13
  14. 14. and 21.00 – 07.30. After 17.00 the wards are covered by the evening F1 on-call or the night team F2 or CT1&2/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 (East Midlands Deanery CMT Homepage), 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 is a programme 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 CT1&2/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. Educational Supervision The supervising consultants at Sherwood Forest Hospitals NHS Trust for the CMT programme are as follows- CT-1 Gastroenterology Dr N Wight Haematology Dr T Moorby Endocrinology Dr D Fernando CT-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 HCE Dr S Rutter 14
  15. 15. Cardiology Dr C Foster 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 CT1&2/SHO’s and PRHO) between 9am – 1:30pm and upto 7 doctors (Above-mentioned plus StR/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 (StR/SpR, 2 CT1&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 StR/SpR, CT1&2/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 programme requiring ward team participation has been devised and the audit co-ordinator/ RCP Tutor will ensure that all trainees have details of this. Educational Supervision The supervising consultants for the Chesterfield part of rotation will be as follows: 15
  16. 16. CT1&2/SHO 1 2 3 Number 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 CT1&2/SHO 4 5 6 Number STREAM 2 Gastro Triad (Drs John Hadfield/ MW Cooper Ashton, Dear, Another) SW Crooks General Medicine General Medicine General Medicine Gastroenterology Respiratory Medicine Stroke Medicine CT1&2/SHO 7 8 9 Number STREAM 3 J T Bourne M M Reza C J Cooke General Medicine General Medicine General Medicine Rheumatology HCE Cardiology 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 16
  17. 17. team consists of 1 F1 trainee, 2 F2 or CMT trainees and 1 StR/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 StR/SpR or equivalent and 2 F2 or CT1&2/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 (East Midlands Deanery CMT Homepage), 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. Clinical supervision The clinical supervisors for the Boston part of the rotation are: 1 2 Dr Mangion Dr Boldy General Medicine General Medicine Elderly Care Respiratory Medicine 3 4 Dr Olczak Dr Jain or Perry General Medicine General Medicine Diabetes and Gastroenterology Endocrinology 5 6 Dr Clifton Consultant Haematologist (currently locum) General Medicine General Medicine Respiratory Haematology Medicine 7 8 Dr Murray and Dr Dobes Consultant Haematologist (currently locum) 17
  18. 18. General Medicine General Medicine Haematology and Cardiology Oncology 9 10 Dr Perry Dr Szczerbinska General Medicine General Medicine Gastroenterology Acute Medicine 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 CT1&2/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 StR/SpR who is freed up from all other elective duties when on call. Between 5pm and 9.30pm (and 9am-9.30pm at the weekend) there is an on call team of the day (one StR/SpR, two CT1&2/SHOs and an F1). Overnight there is a medical StR/SpR and two CT1&2/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. 18
  19. 19. Medical handover takes place at 9am, 4.30pm (weekdays) and 9pm. 19
  20. 20. Education/Facilities This is a vital aspect of training. The trust adheres to the minimum standards of teaching agreed throughout the region (East Midlands Deanery CMT Homepage), 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. 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 CT1&2/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 CT1&2/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 Feerick Gastro: Dr G Spencer Cardiology/CCU: Dr R Andrews Dr S Kelly Dr W Arthur Dr O’Brien Respiratory: Dr S Matusiewicz Haematology: Dr K Saravanamuttu 20

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