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  1. 1. MERSEY DEANERY SPECIALTY TRAINING PROGRAMME STARTING AT ST3 In CARDIOLOGY PROGRAMME DESCRIPTION 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 JRCPTB website. 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. + + + 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
  2. 2. 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 so wish. 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 General Hospital 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 skills. POST 1 2 3 4 5 YEAR HALTON LEIGHTON MACCLESFIELD 1 APH (GM) (GM) COCH (GM) (GM) (GM) LEIGHTON 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. RESEARCH 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
  3. 3. 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 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
  4. 4. 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 pay scale for this grade is payable. Unforeseen Circumstances In accordance with the Terms and Conditions of Service of Hospital Medical and Dental Staff (England and Wales) paragraph 110, Junior Doctors shall be expected in the run of their duties and within their contact and job description, to cover for the occasional and brief absence of colleagues as far as is practicable. European Working Time Directive (EWTD) All posts on the rotation comply with European Working Time Directive regulations. Junior Doctors’ Monitoring From 1 December 2000 there is a contractual obligation to monitor junior doctors’ New Deal compliance. In accordance with Health Service Circular 2000/031 junior doctors have a contractual obligation to monitor hours on request; this will include participation in local monitoring exercises. Removal expenses The removal expenses applicable to this post will be the policies issued by the Administrative Trust. You should not commit yourself to any expenditure in connection with relocation before first obtaining advice and approval from the Personnel Department at your Administrative Trust, otherwise you may incur costs, which you will be unable to claim. Use of Information Technology Under the Computer Misuse Act 1990, any individual who knowingly attempts to gain unauthorised access to any programme or data held on a computer can be prosecuted. An individual who modifies any programme or data in a computer which they are unauthorised so to do, is also liable under the Act. If found guilty of these offences a person may be given a custodial sentence of up to six months or a fine or both. The person would also be subject to disciplinary action which may result is dismissal. 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. Person Specification For a detailed person specification for these posts see MMC website at: http://www.mmc.nhs.uk/default.aspx?page=478 Number of Posts
  5. 5. For detailed information about the number of posts currently available please see the job advertisement. Further information about the Mersey Deanery and the Mersey Deanery School of Medicine is posted on the Mersey Deanery website at: www.merseydeanery.nhs.uk MERSEYSIDE 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 schools. 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. FURTHER INFORMATION 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
  6. 6. ST3 & ST4 SPECIALTY REGISTRAR TRAINING IN CARDIOVASCULAR MEDICINE Below are descriptions of training facilities in the DGHs involved in the training scheme. 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 Medicine/Cardiology) training. 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 Consultants 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)
  7. 7. 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 Cardiologists. There will be an opportunity to gain some experience in permanent pacemaker implantation on-site at Arrowe Park and also pacemaker follow up. Clinical Audit 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.
  8. 8. 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 be filled 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. General Medicine 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 sites. 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. Cardiology 1. Clinical 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
  9. 9. 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 appropriate management. 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. 3. ECGs 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. 5. Echocardiography 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
  10. 10. 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 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. Teaching 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 admitted patients.
  11. 11. 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 Grade Doctors. 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 Cardiologists. Further details of the facilities available for cardiology training are described in full on the following page.
  12. 12. 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 system. 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 computer facilities.
  13. 13. 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 interests. 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.
  14. 14. 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 Consultant Staff, 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. Out-Patient Clinics 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- ups. Non-Invasive Testing 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.
  15. 15. Audit There are excellent facilities in Halton for Clinical Audit and the trainee would clearly be expected to become closely involved. Research 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 management. Teaching 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 Training.
  16. 16. ST3 &ST4 - Countess of Chester Hospital NHS Foundation Trust General Medicine 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. Cardiology 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.
  17. 17. 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 patients. 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 rehabilitation. 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 pacing. 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.
  18. 18. Management 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.
  19. 19. 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 appropriate. There is an excellent Postgraduate Medical Centre including library facilities at Leighton Hospital. Single and married accommodation is available.
  20. 20. ST3 &ST4 - EAST CHESHIRE NHS TRUST – MACCLESFIELD DISTRICT GENERAL HOSPITAL INTRODUCTION: 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. Clinical Team: 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 station. 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:
  21. 21. ECGs Exercise ECGs Holter monitors King of Hearts loop recorders Rhythm Card monitors 7-day Novacor recorders 7-day LifeCard recorders Ambulatory BP monitors Transthoracic echocardiography Dobutamine stress echocardiography Trans-oesophageal 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 Hospital. 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 professions. FACILITIES IN THE DIVISION OF MEDICINE: General 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 Ward 7 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.
  22. 22. 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
  23. 23. 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. Junior Staff 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. CLINICAL GOVERNANCE 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
  24. 24. Clinical Effectiveness Department which offers advice and support on developing audit systems. 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 been introduced.
  25. 25. ST3 & ST4 – St Helens & Knowsley, Whiston Hospital INTRODUCTION 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 speciality interests: 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
  26. 26. 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 programme. Inpatient/Outpatient Facilities 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 site. 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
  27. 27. 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 Unit. 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. Cardiac Rehabilitation 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.
  28. 28. Research and Audit The Department of Cardiology is involved in several areas of research at present. 1. ASSENT III The Hospital was a centre for recruitment of patients to this international multicentre trial of thrombolytics. 2. SEARCH 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 with hypercholesterolaemia. 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 proposals. THE POSITION Title: ST3 or ST4 in General Medicine and Cardiology Timetable: 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. Clinical Training: 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.
  29. 29. 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 ECG interpretation, Analysis of ambulatory ECG recordings, Analysis of ambulatory blood pressure recordings, Exercise electrocardiography, Transthoracic echocardiography (from the basics of M-mode to 2-D, spectral Doppler and colour flow Doppler), Stress and transoesophageal echocardiography (depending upon experience) Invasive monitoring by Swan-Ganz catheterisation (depending upon experience) 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. Research/Audit/Education: 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 programme.
  30. 30. 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.
  31. 31. 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 tertiary setting.
  32. 32. CTC Staffing Cardiology/Thoracic Medicine:- 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) Consultant Cardiologists 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 TBA Imaging Cardiothoracic Surgery:-
  33. 33. 12 Consultants (Cardiac Surgery) 4 Consultants (Thoracic Surgery) 7 Senior House Officers 6 Specialist Registrars (3 of which are overseas posts) 3 Clinical Fellows Anaesthetics:- 12 Consultants 7 Specialist Registrars (including 1 Senior Lecturer) Also:- 4 Consultant Radiologists 1 Principal Biochemist 1 Senior Biochemist
  34. 34. 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. ST5 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 CTC. 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. . ST6 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. ST7 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.
  35. 35. 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 clinics. 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. Research/Teaching 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 programme. 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.
  36. 36. 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 Tutor. CURRICULUM TRAINING 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.

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