SPECIALTY TRAINING PROGRAMME STARTING AT ST3
This training programme starts at ST3 level after the completion of Core Medical
Training and is aimed at doctors who can demonstrate the essential competencies
from the person specification to enter this level of training. The programme is
designed to provide the opportunities for the postholder to achieve the Level 2
medical competencies as described in the General Internal Medicine (Acute
Medicine) Curriculum and the Generic Curriculum for the Medical Specialities and
the competencies described in the specialty curriculum.
All the Mersey Deanery Medical training posts come under the organisation
framework of the Mersey Deanery School of Medicine from the Core Medical
Training (CMT) Scheme which was established in August 2005 and has been the
RCP pilot site for many aspects of CMT including the development of the e portfolio
and use of the curricula as a guide for learning in CMT.
It will be necessary throughout specialty training to demonstrate satisfactory
progress in workplace assessments of competence when these are reviewed at the
Annual Review of Competence Progression (ARCP). The milestones to be achieved
are described in latest version of the specialty specific ARCP decision aid on the
This is a Deanery Wide run through programme which includes all the hospitals
listed in the deanery. All the ST3 and subsequent ST4 – ST7 placements will be
allocated by the specialty programme director on behalf of the School of Medicine.
+ + +
Progress within the Training Programme is subject to an Annual Review carried out
by the Educational Supervisor, Programme Director (Dr R A Perry) and members of
the Specialist Training Committee. As well as confirming satisfactory progress, the
annual assessment will allow for flexibility within the Training Programme tailored to
suit each post holder.
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The Speciality Training Scheme in Cardiovascular Medicine is a 5 year training
programme (ST3 through to ST7) completion of which will allow the trainee to be
awarded with a Certificate of Completion of Training. The first two (ST3 & ST4)
years of training will be based in a District General Hospital under the supervision of
one or more Physicians with a major interest in Cardiology. During this period, there
will be continued exposure to General Medicine and District Centre Cardiology.
During this period the trainee will supervise medical takes. There will also be an
introduction to all aspects of modern cardiology in particular cardiac catheterisation
and permanent pacemaker implantation. Throughout this period, there will be close
links with the Regional Cardiac Centre (The Liverpool Heart and Chest Hospital
NHS Trust) and post holders will be encouraged to interact with the cardiac surgical
staff and attend meetings at the Liverpool Heart and Chest Hospital that they should
ST3 & ST4 Training will be principally undertaken at one of the following District
General Hospitals; Arrowe Park Hospital (Wirral), the Royal Liverpool University
Hospital, University Hospital Aintree (Fazakerley), the Countess of Chester Hospital,
Halton District General Hospital, Mid-Cheshire Hospitals NHS Trust (Leighton
Hospital), Whiston (St Helens and Knowsley) Hospital Trust and Macclesfield
This phase will last two years. Those wishing for dual certification will spend a
further year in subspecialty GIM/Cardiology during year five. A minimum of three
years training in GIM in total is required for CCT in GIM though this runs in parallel
with Cardiology training.
After satisfactory completion of the ST4, trainees will rotate to the Cardiothoracic
Centre, Liverpool for up to three years further training principally in tertiary centre
cardiology. During this period, there will be training in invasive and interventional
cardiology and day to day interaction with the cardiac surgical staff. The final year
of training will allow post holders to specialise in Interventional Cardiology,
Electrophysiology or other aspects of tertiary centre cardiology. As above those
training in GIM will have further subspecialty training in GIM.
The outline training posts are listed below by location and year of training. The
progression through posts can be varied year to year and the details of training
offered will be described further on in this document. There is likely to be
competitive entry in to subspecialty training in the final year based on a transparent
selection system reflecting achieved competencies, research output and technical
POST 1 2 3 4 5
HALTON LEIGHTON MACCLESFIELD
1 APH (GM) (GM) COCH (GM) (GM) (GM)
2 RLUH (GM) UHA (GM) APH (GM) (GM) WHISTON (GM)
3 RLUH UHA LHCH LHCH LHCH
4 LHCH LHCH LHCH LHCH LHCH
LHCH (Sub LHCH (Sub LHCH (Sub RLUH(GM or
5 PCI) PCI) EPS) Imaging) COCH (GM)
All rotation will be at the beginning of August and specific posts and training
requirements will have been discussed at the annual RITA assessment.
Post holders will be expected to develop a research interest throughout the training
scheme and retain a commitment to audit. A half day per week at all sites will be
allowed for carrying out and developing research. Post holders will be encouraged
to publish all data and present data nationally and internationally and the extent of
research will be closely followed and examined at the annual assessment.
Clinical duties throughout the rotations
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 Foundation trainees in the day-to-day management of
in-patients in posts with a foundation trainee.
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. Teach medical students as directed.
11. Co-operate with members of the personnel department when monitoring hours of work
and other personnel issues.
12. Attend induction in each hospital or new department
13. Comply with all local policies including dress code, annual and study leave
STUDY AND TRAINING
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 the 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 is subject to the maintenance
of the service.
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
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
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)
The current nationally agreed pay scale for this grade is payable.
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
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.
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.
For a detailed person specification for these posts see MMC website at:
Number of Posts
For detailed information about the number of posts currently available please see the job
Further information about the Mersey Deanery and the Mersey Deanery School of
Medicine is posted on the Mersey Deanery website at:
Liverpool is a dynamic city which has experienced a major revival over the past 10 years.
The county abounds with fine architecture, cultural pursuits and outstanding sporting
facilities. Several million people visit the city each year attracted by the city’s history and the
areas natural and man made assets. Merseyside’s Theatres, Museums and Art Collections
are famous while the Philharmonic Orchestra is nationally acclaimed. The city is alive with
Independent Theatre and Dance Groups, Authors, Poets, Photographers, Sculptors and
other artists. The extent of development of Liverpool’s waterfront and, in particular, the
restoration of the Albert Dock has greatly enhanced the life and interest in the City. Liverpool
was the European Capital of Culture in 2008.
There are both Anglican and Catholic Cathedrals facilities for worshipping all faiths. There
are good schools in both the private and state sectors and a variety of denominational
Merseyside is well served by motorways with the M62 leading towards the city centre, the
M53 serving the Wirral. Both of these linking with the M6 North and South Bound. Liverpool
is a main line intercity station with regular services to most major cities and there is also a
modern underground railway station linking both sides of the river. Liverpool has a small
airport and Manchester International Airport is about 40 minutes drive.
For further information please contact Dr R A Perry, Consultant Cardiologist/Programme
Director and Regional Specialist Advisor, The Cardiothoracic Centre - Liverpool NHS Trust,
Thomas Drive, Liverpool, L14 3PE. Tel: (0151) 293 2399, Fax: (0151) 293 2429
ST3 & ST4
SPECIALTY REGISTRAR TRAINING IN CARDIOVASCULAR MEDICINE
Below are descriptions of training facilities in the DGHs involved in the training
ST3 & ST4 - Arrowe Park Hospital
There are comprehensive training facilities for ST3 & ST4 of Higher Medical Training
and also offer facilities for some candidates seeking a slot for ST7 (General
Training in General Medicine
Each Consultant in Cardiology/Medicine plays an integral part in the medical rota and
the Specialist Registrar would participate in a busy unselected 1 in 8 resident on-
take. All medical patients admitted by the medical Registrars to their wards or out-
lying wards are then looked after by their team until the patient is discharged and
there are therefore a great variety of medical problems to deal with.
The Specialist Registrar would undertake two medical clinics each week, which
would have a significant proportion of medical as well as cardiology patients. There
are Special Interest clinics in the Cardiovascular Department dealing specifically with
preventive cardiovascular medicine (lipids and/or hypertension) and the Specialist
Registrar would be able to participate in these clinics. Attendance at other medical
clinics at the hospital could be arranged if the post holder wished to expand their
experience in other medical specialties.
There is an excellent Postgraduate Centre at Arrowe Park Hospital with a well-
stocked Library. There are lunchtime Clinical Meetings on almost every day of the
week. All specialties are well represented on-site at Arrowe Park (apart from Visiting
specialties in Neurology) and there are, therefore, opportunities each week to
experience an update in other medical specialties.
Current Staffing in the Cardiovascular Department
Dr J H Silas (Physician/Cardiologist)
Dr P Currie (Physician/Cardiologist)
Dr D Rittoo (Physician/Cardiologist)
Dr N Newall (Physician/Cardiologist)
Dr D King (Physician/Cardiologist)
Dr D Nethercutt (Chemical Pathology)
Mr M Greaney (Vascular Surgeon)
Mr S Blair (Vascular Surgeon)
2 Specialist Registrars
1 CCU SHO
3 House Physicians
5 Clinical Assistants
Non -Invasive Training in Cardiology
There is a busy nine-bedded Cardiac Care Unit in Arrowe Park and the Specialist
Registrar would undertake daily ward rounds on the CCU. There are facilities for
invasive haemodynamic monitoring and transvenous or external temporary pacing.
The Cardiovascular Department at Arrowe Park Hospital has been recently developed
and is equipped with substantial non-invasive facilities including four echo machines
and two exercise treadmills. The Specialist Registrar would receive training in
Transthoracic Echocardiography from experienced cardiac technicians.
Transoesophageal Echocardiography is also available at Arrowe Park and the post
holder would learn this technique (or alternatively add to their experience in Phase 4
of their training). The Specialist Registrar is also expected to supervise the stress
echocardiogram service each week.
There is an active programme of Cardiac Rehabilitation in Wirral and there are
increasingly close links between Cardiology and Rehabilitation. The Specialist
Registrar would be encouraged to take an active interest in Cardiac Rehabilitation.
Invasive Training in Cardiology
There is a dedicated Catheter Laboratory at Arrowe Park that will have sufficient
throughput of patients to allow Specialist Registrars in Cardiology to begin learning
Cardiac Catheterisation on site under close supervision from the Consultant
There will be an opportunity to gain some experience in permanent pacemaker
implantation on-site at Arrowe Park and also pacemaker follow up.
There are monthly audit meetings in the Medical Directorate which are well
presented and well attended. The Specialist Registrar would be expected to take an
active part in audit.
ST3 & ST4- Royal Liverpool University Hospital
The hospital was opened in 1978 as a teaching hospital in the Mersey Region as well
as functioning as a District General Hospital. It is approximately 820 beds of which
approximately 230 are established for General Medicine and allied specialties. The
Trust merged with Broadgreen Hospital NHS Trust (sited 4 miles away) in April 1996.
It is anticipated that within the General Medicine Directorate, there will be six
medical teaching firms. One of these will be Cardiology/General Medicine Firm
comprising of Dr Stephen Saltissi (Consultant Physician/Cardiologist), Dr M Fisher(7
sessions and 3 sessions CTC), Professor George Hart(five sessions), Dr J Hobbs(7
sessions and 3 sessions CTC), Dr J Pyatt (7 sessions and 3 sessions CTC), and Dr A
Chenzbraun. In the coming months a Senior Lecturer post under Professor Hart will
The Royal Liverpool Hospital is situated in the same campus as the University of
Liverpool Medical School. The adjacent University Clinical Department includes
Professorial staff in Medicine, Geriatrics, Clinical Pharmacology, Dermatology,
Haematology, General Surgery, Psychiatry and ENT. The Hospital also has Regional
Units for Chemical Pathology, Immunology, Nuclear Medicine, Nephrology and Renal
Transplantation, plus CT and Nuclear Magnetic Resonance Image Scanning. Within
the Royal there is a large Intensive Therapy Unit, a Large Renal Dialysis Unit, a 5-
bedded Coronary Care Unit and several 6 bedded High Depending Units. There is
also a new Heart Emergency Centre as part of the A& E department.
The Royal Liverpool University Hospital has merged with Broadgreen Hospital and
the cardiac firm run by the Physicians/Cardiologists will span both hospital sites and
will involve rotation of staff between both in order to increase experience and
education. Similarly, all the other firms will be specialty based and span the two
The post offers a full range of general medicine in all it facets. The trainee will be 1
in 11 partial shift resident on-calls. All bar one of the Cardiologists see general
medical new and follow up patients in our outpatient clinics as well as looking after
the day to day care of the general medical in-patients.
The training in general medicine will include acute on-take, post-take ward round
and the continuing care for the general medical patients left on the firm.
Responsibility is for in-patient cardiology on the firm and referrals from all
other Consultants within the Hospital, one outpatient cardiology clinic per
week, and involvement in the chest pain assessment clinics. The trainee will
be involved in and play an important role in the running of the CCU with
regular daily ward rounds.
There is a busy Heart Emergency Centre as part of the A & E and the trainees
take part in the early assessment of acute cardiac cases and arrange
2. Invasive Cardiology
Facilities are fully functional within the RLUH for invasive procedures including
LV Cines, Coronary Angiography, and Right Heart Catheterisation etc. There
are two/three catheter sessions weekly. The trainee would be able to
participate in this and start his/her invasive cardiological training. In addition
there is a regular bedside (Swan Ganz) Catheterisation and frequent
transvenous temporary pacing. At present there is no permanent pacing at
the Royal. Sessions in permanent pacemaker implantation will be available.
The appointee would have training in the interpretation of 12 lead ECGs and
the management of arrhythmia. There is also 24-hour Holter monitoring set
up for arrhythmias, ST segment monitoring and occasional heart rate
variability, and cardiomemo devices.
4. Exercise Testing
There is an active exercise lab at the Royal with daily testing. The trainee
would be involved in the performance and reporting of these tests. A number
of different protocols are involved and the equipment is available for cardio
respiratory exercise test with measurement of gas exchange if required.
There is an active echo lab with experienced Consultants and technicians. A
full range of work is carried out including M-mode, two dimensional, Doppler,
colour flow mapping, stress, echo etc. In addition, there is an established
transoesophageal echo service using an omniplane probe for routine (weekly)
work and additional urgent cases. The trainee would be able to commence
training in TOE.
6. Nuclear Cardiology
There is a regional nuclear cardiology service. This involves stress myocardial
perfusion scanning with technetium MIBI and either exercise, dipyridamole or
Dobutamine, radionuclide angiography (MUGA scanning), hot spot scanning
with technetium pyrophosphate and first passes radionuclide angiography.
The nuclear medicine department has had up to date equipment allowing
SPECT imaging as routine. There will be abundant opportunity for the trainee
to be involved in this work.
7. Cardiac Rehabilitation
There is active and long established comprehensive cardiac rehabilitation
programme at the RLUH. This will be interfaced with the more recently
established programme at BGH. Again the trainee would be involved in the
assessment, preparation and review of the patients in this programme.
Research at the RLUH is both active and increasing. There is an established track
record of research maturing to produce MD Thesis, original contributions to
respected journals and invited reviews. Strong links exist with other specialties in
clinical medicine and with the University. Abundant opportunity exists for
collaboration with these other departments including the use of the facilities of the
Professorial Department of Medicine. We would expect and require the trainee to be
involved in closely supervised research and one day a week is set aside for this.
Management and Audit
The trainee would be obliged to participate in audit both within the cardiac
department and within the medical directorate. Appropriate management training
and involvement will be available.
The trainee would be involved in the teaching of General Medicine and Cardiology to
undergraduates as well as to Junior Doctors on the Firm. He/she will be required to
oversee the day to day work of the housemen as well as reviewing the acutely
ST3 & ST4 - University Hospital Aintree NHS Trust
Aintree Hospitals - Cardiology Department
University Hospital Aintree NHS Trust comprises of 2 large hospitals Walton and
Fazakerley situated 3 miles apart. The Aintree Cardiac Centre is located on the
Fazakerley Hospital site. Fazakerley Hospitals is a teaching hospital for the
University of Liverpool, with a total bed compliment of 1050. It houses one of the
largest Accident & Emergency Departments in the country, and all major acute
specialties are represented.
The Cardiology Department consists of an 8-bedded Cardiac Care Unit, a dedicated
36 bedded Cardiology ward, fully equipped cardiac laboratory carrying out all
necessary investigations for both in-patients and providing services for a large
cardiology outpatient throughput. There is also a very active cardiac rehabilitation
programme provided for patients following myocardial infarction, and those
recovering from coronary artery bypass surgery. Plans are in place for the siting of
an invasive catheter laboratory on site.
Current staffing arrangements in the Aintree Cardiac Centre
The medical staff consists of 7 Consultant Cardiologists, Dr E Rodriguez (Clinical
Director), Dr R S Hornung, Dr A Amadi, Dr K W Clarke, Dr S Wong, Dr G Davis, Dr E
Chua, 2 Specialist Registrars, 3 Senior House Officers, 2 House Officers and 4 Staff
Training for Specialist Registrars in Cardiology
The post holders will work with Dr Rodriguez or Dr Amadi and will be involved in the
care of cardiac and general medical patients on the Cardiology firm with the support
of the other junior staff. The main base will be on the 36-bedded cardiology ward
with responsibility for outlying medical patients at varying times.
There are 3-4 Cardiology/General Medical outpatient clinics to attend each week,
seeing both new and follow-up patients under the supervision of the Consultant
Cardiologist. The Specialist Registrars will also be expected to supervise the work of
the junior doctors on the firm and carry out his own ward round weekly.
In addition to taking part in the Consultant ward rounds, there will also be close
involvement in the Coronary Care Unit, which is equipped for cardiac monitoring,
temporary pacing and invasive haemodynamic monitoring.
The post holder will have the opportunity to gain exposure and training in all aspects
of investigative cardiology which will be carefully supervised by the Consultant
Further details of the facilities available for cardiology training are described in full
on the following page.
Non-Invasive Cardiology Training
Within the Aintree Cardiac Centre there is a modern non-invasive cardiac laboratory
with full facilities including:-
1. Computerised treadmill exercise testing utilising the Marquette case 14
2. Ambulatory ECG record/Reynolds medical pathfinder III analysis system for
arrhythmia and ST segment monitoring.
3. Transtelephonic Cardiac Arrhythmia Event Recording.
4. High-resolution signal averaged ECG recording (Marquette Electronics).
5. Colour flow Doppler echocardiography including biplane transoesophageal
echocardiography (Hewlett Packard) and stress echocardiography.
6. Ambulatory blood pressure monitoring (Accutracker II).
7. Tilt table testing and autonomic function testing.
Further facilities on the Coronary Care Unit include full temporary pacing facilities
and invasive haemodynamic monitoring (Marquette Electronics) ECG telemetry for
monitoring patients on the Cardiology ward.
Training in Permanent Pacing and Cardiac Catheterisation
There is on site permanent pacemaker implantation with 2 theatre sessions weekly.
This will provide a valuable opportunity for the Specialist Registrar to gain
experience in permanent pacing techniques, and in pacemaker follow up.
There is an onsite Catheter Laboratory and full training in Cardiac Catheterization
and coronary angiography training will be available
General Medical Experience and on-call commitments
There is considerable exposure to acute General Medicine mainly due to the large
numbers of patients being admitted by the Accident and Emergency Department.
There is an Admissions Ward supervised by the Consultant in Emergency Medicine,
together with his junior staff.
Postgraduate Meetings, Audit, Teaching and Research
Postgraduate Clinical Meetings and Grand Rounds are held weekly in the
Postgraduate Centre, which also comprises of a fully equipped Library with on-line
A weekly clinical cardiology meeting also takes place, organised by the Registrar and
attended by the Consultant Cardiologists.
The aim of these meetings is to discuss clinical cases of interest as an educational
exercise for junior medical staff. Several other specialty meetings are held weekly
which offer continued training in General Medicine. The Specialist Registrar is also
expected to be involved in the on-going research projects within the Cardiology
department. There is an active clinical research programme, which the Specialist
Registrar is able to participate in, but is also encouraged to develop his/her own
This is a teaching hospital and therefore the post holder will also be expected to
participate in the undergraduate teaching programmes, mainly involving bedside
clinical teaching to final year medical students. There are also active teaching
programmes for both nursing and technical staff and ambulance paramedical staff.
An active clinical audit programme is also regularly undertaken and topics of interest
are incorporated into the Clinical Cardiology Meetings.
It is considered essential that the postholder has time available for carrying out his
own research and self-education. Study leave is given in accordance with the
postholders’ contract and normal Terms and Conditions of Service.
ST3 & ST4 – Warrington and Halton Hospitals NHS Foundation Trust
NCH Trust comprises the two separate sites of Halton and Warrington District
General Hospitals and was formed in April 2001. The cardiac department covers
both sites and all acute medicine is now at the Warrington site and at present three
Dr E Rose and
Dr S Osula, Physician/Cardiologists and
Dr S Virk, Cardiologist.
General Medical Intake
Trainees undertake their GIM training at Warrington General Hospital where there is
an appropriate unselected general medical intake under supervision of Dr Rose and
the new appointee. There is very little initial specialty triage and there is not a
separate GI Unit, Diabetic Unit, Chest Unit etc. The trainee would have continuing in
patient responsibility for those admitted, very few patients are handed over to other
teams, though there is easy access to advice from colleagues.
The trainee would attend two to three clinics per week, currently 75% of the new
patient workload would be described as Cardiology, with about 25% general
medicine, a slightly larger portion of follow-ups, particularly those following ward
discharges are general medicine. There are no sub-specialist clinics in this District
General Hospital. Within Cardiology Clinics there are multiple pathologies and active
assessments and intervention in cardiac risk factors. There is a rehabilitation
programme for all patients post-myocardial infarction, coronary bypass grafting or
angioplasty. This is currently expanding to include and exercise component. The
rehabilitation team also attends clinics during time allocated for Cardiology follow-
There are the usual facilities for exercise ECG and ambulatory ECG and cardio-memo
recordings. Clearly, this involves a large amount of the workload. Whilst nuclear
cardiology is not available within the hospital, there is considerable expertise in
nuclear cardiological techniques. There would also be training in transthoracic
echocardiography and a stress echo facility.
Cardiac Catheterisation and Cardiac Pacing
There is an on site Catheter Lab at Warrington and all the cardiologists undertake
diagnostic catheterisation. On site bradycardia pacing will be developed in 2007.
There are facilities for temporary pacing at Halton and Warrington and clearly the
trainee would have full access to and involvement in these procedures.
There are excellent facilities in Halton for Clinical Audit and the trainee would clearly
be expected to become closely involved.
Whilst research laboratory facilities are not available at Halton, there are
opportunities for research within the hospital, particularly based around our audit
procedures. There is involvement in a number of multi centre trials which are an
important part of the specialist training. In the recent past these include the ISIS IV
trial, the Oxford Heart Protection Study, two Thrombolytic trials INJECT and Cobalt.
On the general medical side there has been involvement in the International Stroke
Trial, for which we will start to recruit shortly. There is a good deal of support for
these sorts of activities by all other hospital staff, including the staff and
Halton General Hospital has an active MRCP Course and the Specialist Registrar
would be expected to be involved in the clinical teaching in particular and
preparation for PACES. There are regular lunchtime meetings which would be an
appropriate continuing part of the trainee’s education. On Monday, a General
Medical X-Ray Meeting, on Tuesday a Medical Round at which the trainee would be
able to take his/her turn at presenting cases, CPC etc, on Wednesday a General
Hospital and General Practice Grand Round with invited speakers, on Friday
lunchtime Journal Club covering all aspects of General Medicine.
There is an enclosed copy of the proposed timetable for the Specialist Registrar
ST3 &ST4 - Countess of Chester Hospital NHS Foundation Trust
The hospital provides a comprehensive general medical service. With recent
appointments the Unit has four Physicians each with a special interest in Cardiology.
There are also physicians in Respiratory Medicine, Diabetes and Endocrinology and
Gastroenterology. All of these physicians will participate in acute general medicine
as will a third appointee in Geriatrics. In addition the trust has two full time
Hematologists, a Dermatologist and a Rheumatologist. Two Consultant Neurologists
visit weekly from Walton Hospital to perform out-patient clinics and provide in-
patient opinion. There is a full time Consultant in Genito-Urinary Medicine. A
Consultant Nephrologist shared with Arrowe Park Hospital and it is envisaged that
dialysis services will be developed within 12 months.
The unit has a busy acute general medical workload with an average of
approximately 25 admissions per day and peaks of over 40 admissions. An acute
admissions ward was opened in 1994. The majority of acute medical admissions are
admitted through this ward. Consultant Physicians take it in turn to be Physicians of
the week and perform twice daily ward rounds with the on-call Physician at night
performing an evening ward round. All patients are therefore seen within a matter
of hours of admission by a Consultant. This improves patient care and also provides
support and an excellent training opportunity for junior and middle grade staff.
Specialist Registrars are on a partial shift system and resident on-call. In order to
meet the training needs of a Specialist Registrar in the final year of his/her training,
such a trainee could share responsibility for supervision of the admissions ward and
the acute take with the Physicians of the week. The Cardiologists have also started
a Cardiologist of the week rota.
The hospital provides an excellent opportunity to gain experience in the in-patient
and out-patient management of patients in the main sub-specialties. These all have
the full range of support services including specialist nurses in respiratory medicine,
diabetes and haematology, a full range of investigative facilities including lung
function testing, bronchoscopy, gastroscopy, ERCP, colonoscopy etc. There is a full
range of laboratory and other support services including an expanding radiology
department. The department is equipped with CT and MR scanning, ultrasound and
colourflow Doppler imaging and radionuclide scanning. Regular X-ray meetings are
held between individual medical firms and Consultant Radiologists. There is a
growing interventional radiology service which will be supported by a new digital
vascular imaging laboratory.
The hospital has a busy 6 bedded Coronary Care Unit with 8 other centrally
monitored beds available. Approximately 400 patients with acute myocardial
infarction are treated annually. There is a high uptake of thrombolytic treatment,
the timeliness of which is regularly audited.
A first year Specialist Registrar would have full opportunity to participate in the
management of acute cardiac problems. If relevant to his/her training a final year
Specialist Registrar could contribute to the senior supervision of coronary care
There is an active on-site cardiac rehabilitation programme of recognised excellence
from which patients graduate to one member of the local community based
programmes. The hospital based programme is supervised by an experienced team
of a sister, physiotherapist and occupational therapist. The programme would offer
a trainee an excellent opportunity to gain some experience and training in cardiac
The Cardiorespiratory Department
There is a range of non-invasive investigative techniques including echocardiography
with continuous wave and colour flow doppler, stress testing, holter and cardiac
event recording with a trans-telephonic receiving station, 24 hour ambulatory BP
monitoring. There are facilities for tilt testing and the department has growing
experience of stress echocardiography. .
Depending on the purchasing decisions of the Chester Health Authority in the future,
there will be an opportunity for a Specialist Registrar to gain training in cardiac
catheterisation either at the Cardiothoracic Centre or locally in Chester.
A dedicated on site Catheter Laboratory opened at the COCH in 2006. Non-urgent
patients who require cardiac catheterisation are currently investigated at the COCH
by the Physician with an interest in Cardiology. Most urgent cases are transferred to
the Cardiothoracic Centre. All patients who require permanent pacing are currently
transferred to the Cardiothoracic Centre. However from mid 2007 a permanent
pacing service will be established locally. This will therefore provide the trainee with
the opportunity to gain initial training in permanent pacemaker insertion and follow-
up. As expected in any hospital with a busy coronary care unit there will be the
opportunity for the Specialist Registrar to extend his/her experience in temporary
The hospital has a Resuscitation Committee, a full time BHF funded Resuscitation
Training Officer and is fortunate to have several Consultants who are ALS
Instructors. Resuscitation training is provided regularly to all medical staff.
Audit and Research
Regular Audit Meetings are held as part of the Medical Directorates educational
programme. The hospital provides an excellent opportunity for clinically based
research. A Specialist Registrar with on-going research interests would be
encouraged to continue these. If this involved laboratory based work elsewhere,
then opportunity to continue this would be incorporated into the programme.
Regular Medical Directorate meetings are held with all staff. These would provide a
Specialist Registrar with an opportunity to recognize and grapple with the wide
range of management and administrative issues that is dealt with in a busy acute
general medical unit. If appropriate a final year trainee would be invited to
participate in the monthly meetings of all the Consultant Physicians with the
Directorate manager and nurse manager. Similarly depending on his/her interests
and training needs, there would be an opportunity for the trainee to attend any of
the other many committees held in the hospital e.g.: drug and therapeutic
committee, resuscitation committee.
Education and Library Facilities
The hospital has a full programme of education meetings and a well stocked library
based in the on-site Postgraduate Medical Centre.
ST3 & ST4 - Mid-Cheshire Hospitals NHS Trust - Leighton Hospital
Leighton Hospital is a large District General Hospital in South Cheshire serving a
population of 275, 000. The area is mainly rural but within its boundaries are the towns
of Crewe, Nantwich, Northwich, Middlewich and Sandbach. The hospital is situated 2
miles from the centre of Crewe, and such areas as Manchester, Liverpool, Wales and the
Pennines are within easy reach.
The medical directorate at Leighton Hospital consists of 202 beds including a 4 bedded
fully equipped Coronary Care Unit with facilities for invasive pressure monitoring. There is
also a Medical Admissions Unit and the hospital contains a separate 4 bedded Intensive
Care Unit. Staffing on the medical unit includes 10 Consultants, 4 Staff Grade Physicians,
7 Specialist Registrars, 8 Senior House Officers and 6 House Officers. The staff are
organised into separate teams with responsibility for approximately 30 beds. The post
holder will work for Dr P A Dodds in a firm also including a Senior House Officer and Pre
Registration House Officer. Trainees may also be responsible to Dr J Trelawney and DR
Paul Mann, both Physicians with an interest in Cardiology.
The clinical duties of the post include the day to day management of the in-patients under
the care of the cardiologists, and the supervision of the Senior House Officer and House
Officer. The post holder will attend 2 out-patient clinics per week seeing both new and
follow up patients, the vast majority of which have cardiological conditions. Dr Dodds has
a weekly angiography session at Wythenshawe Hospital in Manchester, and the post
holder will be expected to attend this session to gain exposure and experience in left and
right heart catheterisation. The post holder will also have the opportunity to gain
exposure to all aspects of non-invasive cardiology in a fully equipped ECG department
including Doppler echocardiography, treadmill exercise testing, Holter and ambulatory
blood pressure monitoring, and cardio memo recording. One half day per week the post
holder will attend the Wythenshawe Hospital with Dr Mann to gain exposure and
experience in permanent pacemaker implantation. There is also a day allocated to
research each week (see timetable).
When on-call duties include the supervision of the acute medical take and the provision of
a medical opinion for other specialties when requested. Colleague’s on-call with the post
holder includes a Consultant, 1 Senior House Officer and 1 House Officer (the SHO and
HO work a partial shift system). The post holder will be expected to provide prospective
cover for Specialist Registrar colleagues for annual and study leave when requested.
Administration duties of the post include shared responsibility with the Senior House
Officer for discharge summaries and letters concerning out patients. The post holder will
be expected to teach junior colleagues, nursing staff and medical students whenever
There is an excellent Postgraduate Medical Centre including library facilities at Leighton
Hospital. Single and married accommodation is available.
ST3 &ST4 - EAST CHESHIRE NHS TRUST – MACCLESFIELD DISTRICT
The East Cheshire NHS Trust was established in 1993 to provide community health
care, hospital and mental health services for people for people in Macclesfield,
Knutsford, Wilmslow, Handforth, Poynton, Congleton and the surrounding areas.
Four hundred and forty-six beds are available for general and acute services across
the Trust. The District General Hospital has an active accident and emergency
department, and a day suite for treatments not requiring an overnight stay. There is
a medical assessment area in A&E and a discharge lounge to assist with effective
patient management. The Trust has inpatient beds at Congleton War Memorial
Hospital, and Knutsford and District Community Hospital. Minor injuries units are
also based at these two local community hospitals.
Each year, staff treat around 20,000 patients in our hospitals, see over 116,000
outpatients, and deal with 47,000 attendances in the A&E department.
Specialist Registrar (SpR) in Cardiology and General Medicine:
Educational Supervisors: Dr A A Cubukcu
Dr R M Egdell
There is a small and friendly cardiology unit at Macclesfield, aiming to meet the
secondary care needs of all adult cardiology patients in East Cheshire.
2 Consultant Cardiologists
1 Specialist Registrar (Mersey rotation) – this post
1 Specialist Registrar (Northwest rotation)
1 Senior House Officer
1 Foundation Yr 2 doctor (pilot scheme, SHO grade)
1 Specialist Nurse
Cardiology inpatients occupy a four-bedded Cardiac Care Unit and half to two thirds
of the adjacent ward 7. The remainder of ward 7 is occupied by general medical
inpatients, for whom the cardiology SpRs have some cross-covering responsibilities.
The cardiology SpRs also look after occasional cardiology patients outlying on other
medical and surgical wards.
The Cardiac Care Unit has an en suite facility for the siting of temporary pacing
wires. All CCU beds are equipped with facilities for full invasive pressure and cardiac
output monitoring. Non-invasive cardiac output monitoring (using transthoracic
impedance) and CPAP are available on CCU. Cardiac rhythm monitoring on the
medical wards is by an eight-channel telemetry system, displayed at the CCU base
There is a well-staffed Cardio respiratory Department, adjacent to ward 7 and CCU,
where a full range of non-invasive cardiac testing is undertaken, including:
King of Hearts loop recorders
Rhythm Card monitors
7-day Novacor recorders
7-day LifeCard recorders
Ambulatory BP monitors
Dobutamine stress echocardiography
Cavity-opacification contrast and myocardial contrast echocardiography
The weekly out-patient activity comprises three general cardiology clinics, one
general cardiology satellite clinic (at Knutsford District & Community Hospital), three
nurse-led rapid access chest pain clinics, three nurse-led heart failure clinics, one
technician-led pacemaker follow-up clinic. In addition there is a monthly paediatric
cardiology clinic led by a visiting paediatric cardiologist.
There are two weekly sessions of diagnostic cardiac catheterisation, performed by
Macclesfield cardiologists at the local tertiary centre, South Manchester University
In addition to the training opportunities available through the above clinical activity,
SpRs wishing to arrange ad hoc or regular external training sessions in other areas
of interest in tertiary care cardiology will be supported.
From August 2004, nine middle grade doctors will share a full shift resident on call
rota covering the acute medical take.
SpRs are encouraged to attend their regional study days. Within the hospital,
opportunities for formal education include a weekly grand round and a weekly
Medicine case presentation/journal club. The SpRs are expected to contribute to the
formal and informal teaching of SHOs, PRHOs, medical students and allied
FACILITIES IN THE DIVISION OF MEDICINE:
There are currently 112 acute medical beds situated in four wards (4,7,8,9) opened within the District
General Hospital in November 1991. Specialties are allocated to wards as follows:
Respiratory Medicine Ward 4 Cardiology / General Medicine
Gastroenterology Ward 8 Diabetes/Stroke Unit Ward 9.
The Division has an integrated approach for acute medicine and care of the elderly
without age-related policies.
The Outpatient Department is in the District General Hospital and clinics
are also held in modern accommodation at Congleton, Knutsford,
Handforth and Poynton.
Older Peoples Services: There are no specific elderly care wards at the Trust as
we offer a needs related service. A specialist acute stroke unit has been developed
on Ward 9.
Rehabilitation: There are 52 Rehabilitation beds in the DGH on the West Park Site
in purpose-built wards opened in 1979(Langley Unit). These are divided into a 24
bedded stroke/ neuro rehab ward supported by therapists with a special interest in
stroke rehabilitation and a 28 bedded general rehab ward.
There are two community hospitals at Knutsford (18 beds) and Congleton (28 beds)
which are each supported by a Hospital Practitioner.
Diabetes and Endocrinology: The Trust was one of the first in the region to appoint a specialist
nurse in diabetes and 2.1 wte diabetes specialist nurses covering all ages now support the service. A
podiatrist and a dietician also support the diabetic clinic.
Respiratory Medicine: Facilities for fibreoptic bronchoscopy are provided in the purpose-built Day
Suite. Clinical oncologists from Christie Hospital hold weekly clinics at MDGH.
Gastroenterology: A comprehensive DGH gastroenterology service is provided including the full
range of upper and lower GI endoscopy and insertion of feeding gastrostomies.
Intensive Care / High Dependency Unit: There has been a major upgrade of intensive care
services within the Trust and a consultant anaesthetist accredited in intensive care leads the service.
Patients in intensive care are under the joint supervision of the admitting consultant and anaesthetist,
whereas those in high dependency remain under the care of the admitting consultant. The unit has
six beds used flexibly between intensive care and high dependency. A full range of support services
is available including haemofiltration.
Pathology: An excellent Pathology service is provided under the supervision of
consultants in histopathology, haematology, microbiology and biochemistry.
Radiology: An excellent Radiology department is staffed by six Consultant
Radiologists who undertake a full range of investigations, including CT, MR,
ultrasound, isotope imaging and non-cardiac angiography. A helical CT scanner was
installed during 2001. Radiology departments are also situated at the community
hospitals and Handforth Clinic.
Consultant Staff within the Division of Medical Specialties:
The following general physicians with special interests are on the acute general
medical on-call rota:
Dr R J Stead Respiratory Medicine and Clinical Director
Dr M Babores Respiratory Medicine
Dr D J Walker Older People and Rehabilitation
Dr C E Davison Older People and Rehabilitation
Dr Ravindra Older People and Rehabilitation
Dr P N Foster Gastroenterology
Dr J V E Roche Gastroenterology
Dr A A Çubukçu Cardiology
Dr R M Egdell Cardiology
Dr P P Wai Diabetes and Endocrinology
Vacant Post Diabetes and Endocrinology
The two cardiologists share a slot on the rota.
Other physicians within the Division are as follows:
Dr T P Kingston Dermatology
Dr T Griffiths Dermatology
Dr S M Knight Rheumatology
Prof D P M Symmons Rheumatology
Dr A Barton Rheumatology
Dr T Rimmer Palliative Medicine
Dr J Hudson Haematology
Dr S Srivastava Associate Specialist
Visiting Consultants provide outpatient services for genitourinary medicine,
neurology, nephrology and clinical oncology.
SpRs, SHOs and PRHOs work shifts to comply with the ‘New Deal’ and ‘European
Working Time Directive’. Junior medical staff are ward-based and SHOs and PRHOs
assigned to a ward operate as a team to provide inpatient care covering the ward.
The junior staff complement currently comprises:
1 staff grade
8 specialist registrars (including this post)
6 senior house officers
4 second year foundation programme doctors
7 pre-registration house officers.
POSTGRADUATE EDUCATION, RESEARCH and AUDIT:
A multi-professional Education & Training Centre was opened in September 2000.
The centre has a highly equipped lecture theatre and suite of training rooms, all with
access to an extensive range of audio-visual equipment, including video
conferencing facilities. A new Clinical Skills Laboratory supports a wide range of
practical skills training including resuscitation. There is also a dedicated dining
room and catering facility.
The Health Sciences Library is fully multi-professional and supports evidence-based patient and health
care, together with all aspects of clinical governance. Networked PCs allow access to major
databases and with over 125 current journal titles and extensive collection of other media, the library
provides a comprehensive information resource.
The Trust and Directorate are developing arrangements for taking forward the
clinical governance agenda building on existing frameworks. The Directorate holds a
monthly multidisciplinary audit meeting to which all staff are invited. The Trust has a
Clinical Effectiveness Department which offers advice and support on developing
The Trust is committed to providing safe and effective care for patients. To ensure
this, there is an agreed procedure for medical staff which enables them to report,
quickly and confidentially, concerns about the conduct, performance or health or
medical colleagues (Chief Medical Officer, 1996). All medical staff practicing in the
Trust should ensure that they are familiar with the procedure and apply it.
Patient Based Information Systems
The NHS has recognised that IM&T serves an increasingly important role and is
undertaking an extensive and wide-ranging implementation of patient-based
information systems. Critical to this is the electronic patient record in both
secondary and primary care. This system will build to include the patient’s radiology,
pathology, pharmacy and theatre history together with decision support software
and specialty systems. ‘Direct booking’ systems are being implemented to improve
links with the primary care sector. All clinical staff now have email and internet
access as part of the Trust’s own IM&T strategy. A Trust-wide Intranet has recently
ST3 & ST4 – St Helens & Knowsley, Whiston Hospital
This job outline is intended to be flexible to meet the requirements of a
Specialist Registrar in either ST3/ST4 or ST7. The Specialist Registrar will be
working with Dr J Ball (educational supervisor). Whenever Dr Ball is taking leave,
one of the other consultants will act as educational supervisor.
THE MEDICAL DIRECTORATE
The General Medicine Directorate has 27 Consultants with the following
Cardiology Dr JB Ball (Head of Service)
Dr C Hammond
Dr H Shabaan (Locum)
Locum of substantive post TBA>
Diabetes Dr K Hardy (Head of Service)
Dr KS Long
Dermatology Dr G Curley
Gastroenterology Dr J McLindon
Dr C Francis
Dr K Padmakumar
Dr R Chandy
General Medicine Dr P Mishra (Clinical Director)
Haematology/Oncology Dr JA Tappin (Clinical Director)
Dr G Satchi
Dr E Marshall
Palliative Care Dr C Littlewood
Respiratory Medicine Dr S Church
Dr J Hendry
Dr J Corless
Dr ST Atherton (Medical Director)
Dr JB Ridyard (Part time)
Rheumatology Dr MP Lynch
Dr VE Abernethy
Care of the Elderly Dr J Abrams
Dr DK Banerjee
Dr T Smith
Dr DN Carmichael
Dr A Capewell
In addition, there is a visiting Neurologist, Dr M Steiger, and five staff physicians,
two with a particular interest in cardiology.
Junior cover for the Directorate includes 6 Specialist Registrars, 12 Senior House
Officers and 13 House Officers.
The Department of Medicine is a busy unit with a significant emergency admission
workload. Despite this there are many active sub-speciality departments involved in
new developments, e.g. Stroke Unit, Diabetes Centre, Rapid Access Pulmonary
Shadowing Clinic, COPD Hotline. There is also a thriving research and audit
The general Medicine Directorate has 11 acute medical wards at Whiston (300
beds) including two wards for the management of emergency admission, the Medical
Assessment Unit. Most new admissions are admitted her for initial assessment and
management, then moved on to appropriate medical wards or discharged. There is
a full endoscopy suite at Whiston and all acute beds are confined to the Whiston
Outpatient clinics are held at Whiston, ST Helens and Newton Hospital, but
the majority of outpatient workload is within the new outpatient department,
Stephenson House at Whiston Hospital.
Whiston Hospital is being developed as the centre for Medicine, supported by
St Helens Hospital, which is a non-acute hospital with its major emphasis on
rehabilitation and day surgery. Whiston Hospital is a very large District General
Hospital of 757 beds and houses the Regional Burns & Plastic Surgery Unit. It
serves a catchment population of about 350,000 covering St Helens & Knowsley and
areas of Liverpool and Cheshire.
THE CARDIOLOGY DEPARTMENT
At present the care of inpatients and outpatients with cardiology problems is
spread across the Medical Directorate.
Coronary Care Unit (CCU)
The purpose-built ten-bedded Coronary Care Unit is an integral part of the
Critical Care building, a £9 million development, which was opened in 1996. This 3-
storey building houses the Accident & Emergency Department with full back up
including x-ray and an observation ward. The second floor houses the 10-bedded
CCU, a 5-bedded telemetry unit, a 6-bedded HDU and an 8-n#bedded intensive Care
The Coronary Care Unit is supported by excellent nursing who are closely
involved in clinical and research developments within the Unit. A dedicated CCU
SHO provides medical cover during the day with out-of-hours cover provided by
medical SpRs and SHOs. The Consultant Cardiologists undertake daily ward rounds
and provide out-of-hours consultants cover.
The CCU has the usual facilities for invasive monitoring, echocardiography
and telemetry together with continuous 12-lead ST segments monitoring. In
addition there is a dedicated ‘procedures’ room for temporary pacing wire insertion,
DC cardioversion, pericardial aspiration, etc.
Cardio respiratory Department
The technical staff within the Department perform cardiological investigations.
The inpatient ECG service provides 24-hour for all Departments including the
Accident & Emergency Department. In addition to the usual noninvasive
investigations such as ambulatory ECG and BP monitoring, Transtelephonic cardiac
arrhythmia recording, echocardiography and exercise testing, the Department
provides a transoesophageal echocardiography service and uses state-of-the-art
digital archiving for all echocardiography. A stress echocardiography service is being
developed. The Department has three treadmills and three cardiac ultrasound
machines. The staff are highly motivated and keen to develop the role of the
Department further. The Department also provides full pulmonary function testing
and blood gas analysis facilities.
General Cardiology outpatient clinics are held at Stephenson House.
However, ‘Rapid Access Chest Pain’ clinic and ‘Post-MI’ clinics are held in the
Cardiorespiratory Department. Direct access services for echocardiography are
being developed. Nuclear cardiology services are being developed in association
with the Department of Radiology.
The Cardiac Rehabilitation Service comprises two hospital-based nurse
specialists and twelve community-based nurse specialists including a coordinator.
The objective is to provide a comprehensive service to all patients with coronary
heart disease in St Helens and Knowsley implementing secondary prevention
interventions that are of proven benefit. In the community, nurse specialists run
secondary and primary prevention clinics from primary care facilities. Interventions
include; the appropriate use of aspirin, beta-blockers, statins and ACE inhibitors; and
education with regard to smoking cessation, diet, weight reduction and exercise.
Individually prescribed exercise programmes are provided for all patients recovering
from myocardial infarction or revascularisation procedure (PTCA and CABG) and
certain patients with chronic stable angina and heart failure.
Research and Audit
The Department of Cardiology is involved in several areas of research at
1. ASSENT III
The Hospital was a centre for recruitment of patients to this international
multicentre trial of thrombolytics.
The Hospital is a centre for recruitment of patients to this national multicentre
trail of high-dose simvastatin and homocysteine lowering therapy in post-MI patients
3. RITA III
The Hospital is a centre for recruitment of patients to this national multicentre
trial of usual versus early aggressive therapy in unstable angina and non-Q wave MI.
The Department is keen to continue this involvement but also to develop a
local research programme and applications have been made for funding of research
Title: ST3 or ST4 in General Medicine and Cardiology
The clinical timetable has been designed to be flexible in order to meet the
requirements of a Specialist Registrar in any phase of specialist training.
Responsibilities will be tailored to the experience of the trainee. The supervising
consultants will be readily available for advice and assistance. Whiston Hospital will
provide dual training in Cardiology and General Medicine.
The trainee will accompany the Consultant Cardiologist on daily ward rounds
of the CCU and twice weekly ward rounds of 20-25 medical in-patients. Two staff
physicians, two senior house officers and a pre-registration house officer support the
Consultants and trainee. Outpatient training will also take part in a busy unselected
acute medical take with the other Specialist Registrars on a 1 in 7 basis. The
trainee will be resident when on-call and responsibilities will include an evening ward
round on the Medical Admissions Unit and participation in the consultant-led
teaching post-take ward round commencing at 9.00 am. In addition, there is a well
established intensive Therapy Unit (ITU) with a significant medical input and the
trainee in General Medicine/Cardiology will be encouraged to obtain experience and
develop skills by attachment to the ITU.
The trainee will be expected to gain experience of the unique Secondary
Prevention Programme provided by the Cardiac Nurses.
Training in Cardiological Techniques:
Training will be provided at Whiston Hospital in
Analysis of ambulatory ECG recordings,
Analysis of ambulatory blood pressure recordings,
Transthoracic echocardiography (from the basics of M-mode to 2-D,
spectral Doppler and colour flow Doppler),
Stress and transoesophageal echocardiography (depending upon
Invasive monitoring by Swan-Ganz catheterisation (depending upon
Temporary pacing catheter placement (depending upon experience)
Pericardiocentesis (depending upon experience)
The trainee will accompany the Consultant Cardiologists to Warrington
Hospital Cath Lab for training in cardiac catheterisation and coronary
angiography procedures. The trainee will also attend the Cardiothoracic
Centre for training in permanent pacing procedures though this will be
developed at Warrington .n 2007.
The trainee will have a protected session for research. Projects have been
designed within the Department, but the trainee will be allowed to design his/her
own project where reasonable.
The Trust has an active and enthusiastic Audit Department that provides
invaluable support to the monthly clinical audit programme. The trainee will be
expected to participate in audit projects.
The Trust also has an excellent educational programme. There is a weekly
‘Grand Round’ that is well attended by all specialities. The Medical Directorate also
holds weekly cardiac and radiological meetings and monthly 'Journal Club’ meetings.
The trainee will be expected to attend the meetings of the regional teaching
ST5, ST6 & ST7
Specialist Registrar Training - The Cardiothoracic Centre NHS Trust
The Cardiothoracic Centre (CTC) is the regional tertiary referral centre for the adult
population of Merseyside, Cheshire, North Wales and the Isle of Man and is situated
on the Broadgreen Hospital site at the end of the M62 motorway and is well served
by public transport being just 5 miles away from Liverpool City Centre.
The CTC is contained in a purpose built modern building and provides a full range of
invasive and non-invasive diagnostic cardio-pulmonary facilities. There are 6 cardiac
catheterisation laboratories for diagnostic procedures, interventional cardiology and
electrophysiological work and a dedicated pacing service with 14 sessions of pacing
and device therapy.
Over 2000 Angioplasties and other interventions including all forms of atherectomy
and intracoronary ultrasound are performed each year and over 900 new pacing
systems (60 – 80 biventricular) are implanted annually and 140 ICDs. In addition
there are 300 pacemaker box changes and a programme of laser lead extraction.
There is a rapidly expanding electrophysiological service with training in all the
modern techniques of mapping and ablation. There is an extensive
echocardiographic service with 4 Hewlett Packard 5500 Echo Machines with the
facilities for stress echocardiography and Omniplane Transoesphageal
Echocardiography. There are three separate machines and probes for intraoperative
TOE. There are currently 81 beds for Cardiology and Thoracic Medicine with an 10-
bedded Coronary Care Unit.
The Centre undertakes teaching of final year under graduates from the University
from Liverpool Medical School and is also recognised for the training of nurses and
other professional and technical staff. A regular programme of conferences, lectures
and seminars takes place within the Cardiothoracic Centre. The Centre is committed
to the principal and practice of clinical audit in which all medical staff are expected
to participate. There is a large department of clinical audit under the direction of Dr
Mark Jackson, Head of Clinical Governance. The Centre has a specialist library with a
wide range of cardiothoracic journals and books for all members of staff. There is
also a fully equipped Lecture Theatre and a Full time Manager of Postgraduate
Facilities as well as a full time Librarian.
There is a dedicated Research Laboratory on site staffed by a Principal Biochemist
and a Senior Biochemist. The Laboratory is capable of carrying out a variety of
biochemical assay and there are excellent computing facilities within the Library
including Silver Platter CD-ROM Medline Search, Cochrane Library and has recently
been linked to the Internet.
There is also a newly purpose built doctors mess, including office space, computing
facilities and recreational facilities.
The CTC has expanded over the last four years with with a large capital building
program to double the capacity and to include many non invasive imaging modalities
i.e. MR, Nuclear and Cardiac CT.
At all times during the period at CTC, there is involvement with the Cardiac Surgical
teams and the selection of patients for interventional or surgical treatment plays a
major role in the training during this period. There will be exposure to management
of post operative complications in a wide variety of clinical settings. There will be
regular emergency cover which will be closely supervised by Consultant staff and the
trainee will gain considerable experience of the management of cardiac patients in a
9 Consultants (Cardiology)
4 Consultants (Thoracic Medicine)
11 Senior House Officers (Cardiology/Thoracic Medicine)
9 Specialist Registrars (Cardiology)
2 Specialist Registrars (Thoracic Medicine)
2 Clinical Registrars (Cardiology)
Dr R A Perry Coronary Intervention/TOE (Clinical Director)
Dr W L Morrison Coronary Intervention/TOE
Dr R H Stables Coronary Intervention
Dr D R Ramsdale Coronary Intervention
Dr N D Palmer Coronary Intervention
Dr J L Morris Coronary Intervention (RCP Tutor)
Dr J Mills Coronary Intervention
Dr D M Todd Electrophysiology/Device Therapy
Dr D J Wright Device Therapy/Heart Failure
Dr J E P Waktare Electrophysiology/Device Therapy
Dr D Gupta Electrophysiology/Device Therapy
Dr M Hall Electrophysiology/Device Therapy
12 Consultants (Cardiac Surgery)
4 Consultants (Thoracic Surgery)
7 Senior House Officers
6 Specialist Registrars (3 of which are overseas posts)
3 Clinical Fellows
7 Specialist Registrars (including 1 Senior Lecturer)
4 Consultant Radiologists
1 Principal Biochemist
1 Senior Biochemist
TRAINING PROGRAMME ST5, ST6, & ST7
The whole of the training programme is modular and builds on the initial training in
the DGH setting. Training opportunities will be flexible and tailored to the needs of
the individual postholder. The final year should allow the trainee to specialise
further in any subspecialty (PCI, EPS, Device Therapy and Imaging) or in GIM should
they require dual certification.
The third year of higher specialist training will either be based at the CTC or in a
pure cardiology post at the Royal Liverpool University Hospital or University Hospital
Aintree. There will be three four month blocks. One block gives increased catheter
laboratory training to allow consolidation of diagnostic catheterisation and an
exposure to PCI. One is based in the pacing laboratory and pacing clinic with some
exposure to EPS. The final block is in cardiac imaging with an emphasis on
echocardiography as well as cardiac MRI, CT and nuclear cardiology. During the
imaging block there will be exposure to GUCH and other specialist clinics. The posts
based at RLUH and UHA will provide the same exposure with appropriate linkage to
At the end of the year it is anticipated that trainees would be independent operators
in diagnostic angiography, basic pacing and have had the opportunity to gather
cases for the British Society of Echocardiography accreditation.
All the posts in this year of training will be based at the CTC. It is anticipated that
trainees will make some basic choices over possible subspecialty training in the final
year to guide them as to which post would be best for their future career. There will
be three posts concentrating on catheter laboratory training and increased exposure
to PCI. Two posts will offer further exposure to EPS, advanced pacing and device
therapy. Hybrid combinations of the posts are available in six month blocks and
further training in imaging will be given throughout the year.
In the final year there will be three posts at CTC for subspecialty training in
cardiology. There will also be two posts (RLUH & COCH) for further Cardiology and
training and GIM. The CTC posts will principally be in PCI and EPS/Device Therapy
though a post can be used for advanced training in cardiac imaging. Also the post
at the RLUH can be combined with advance imaging rather than GIM.
Subspecialty training posts are likely to be by competitive entry with selection taking
place around May/June. A transparent process for selection will be advertised at the
end of year three and potential trainees can identify themselves via the RITA
process and their educational supervisor.
In addition to the targeted training post holders will also general training
opportunities throughout the ST5-ST7 years.
Out Patients The trainees will attend clinics throughout with more out patient
work being concentrated in ST5 &ST6. There will be exposure
to a variety of specialist clinics and regular attendance at pacing
Ward Work The trainee will attend 1 Consultant ward round per week
and will supervise the day to day work of the Senior House
Officers as well as having a fixed ward round of their own.
The trainee will be expected to undertake a half day of
research/private study each week and throughout the 3 year
period develop a research interest leading to publications.
Attendance at National and International meetings will be
encouraged, particularly for presentation of data. Trainees will
be involved in teaching medical students and other junior
doctors and be expected to participate in the weekly
postgraduate seminars and other departmental meetings.
There will be administrative involvement in managing on-call
rotas, pacing lists and there will be ongoing involvement in the
work of the audit department under the direction of Mr. Tony
Grayson (Audit coordinator) as well as clinical audits on a day to
day basis. There will be continued commitment to teaching of
final year medical students and junior medical staff and other
members of the CTC with post holders being heavily involved in
the administration and running of the student teaching
Administration Trainees in the final phase of training will be expected to be
involved with the day to day running of the unit and will have
attended a suitable management course during this period.
They will be responsible for overseeing all the junior doctors’
rotas, and managing junior doctors’ study and annual leave.
There will be an opportunity for trainees to attend directorate
meetings and other committees.
RECORD OF TRAINING
All trainees will be expected to keep their training manual up to date and to maintain their
portfolios. There will be regular competency based assessment which will need to
evidence the progress in training against the national curriculum. Trainees will also be
expected to keep a Log Book of all practical procedures undertaken, available from the
British Cardiac Society; this should be regularly reviewed by their supervising consultant
and signed accordingly. Failure to keep accurate log data or fulfilling the minimum
number of competency based assessment may result in failure to progress
All training is subject to annual assessment by the Educational Supervisor and Programme
Director in conjunction with the Postgraduate Dean. As well as serving as a review and
training, this will allow planning and flexibility within any trainees programme and will
allow for career advice and development of specific interests accordingly.
All trainees will be expected to attend and take part in the various educational meetings.
They will be expected to present cases, develop a audit interest and present the data
locally. Attendance at educational meetings will be logged by the Postgraduate Clinical
There will be an establishing teaching programme for all trainees spanning three years
starting in October 2006. There will be a fixed afternoon once a month and trainees will
not be expected to undertake clinical duties during these teaching sessions. In addition
there is a bimonthly training day in GIM for ST3 and ST4 trainees also those n ST7
training in GIM.