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presentation 3

  1. 1. Stroke Supspecialty Training Niall Hughes Stroke Consultant NHS Lanarkshire
  2. 2. How did I get here……..? <ul><li>Graduated 1997 </li></ul><ul><li>JHO, SHO1 Dublin (3/12 geris) </li></ul><ul><li>SHO2 Aberdeen (3/12 geris) </li></ul><ul><li>SHO3 Aberdeen geris </li></ul><ul><li>SpR training geris/GIM Northeast </li></ul><ul><li>Stroke training year Aberdeen 2006 </li></ul><ul><li>Consultant post 2007 </li></ul>
  3. 3. Why bother doing stroke subspecialty training? <ul><li>“ I know all there is to no about stroke care……..” </li></ul><ul><li>Stroke is included in NSF for older people </li></ul><ul><li>“ Up to ¼ of strokes occur in younger patients who may have different needs” </li></ul><ul><li>“ Encompasses elements of neurology, cardiovascular disease, ageing and rehabilitation” </li></ul>
  4. 4. Current curriculum (JRCPTB) <ul><li>“ This programme is open to all trainees holding MRCP (UK) or equivalent and an NTN in a relevant medical specialty, namely </li></ul><ul><li>- Geriatric Medicine </li></ul><ul><ul><ul><li>Neurology </li></ul></ul></ul><ul><ul><ul><li>Rehabilitation Medicine </li></ul></ul></ul><ul><ul><ul><li>Cardiology </li></ul></ul></ul><ul><ul><ul><li>Clinical Pharmacology and Therapeutics </li></ul></ul></ul><ul><ul><ul><li>General (Internal) Medicine” </li></ul></ul></ul>
  5. 5. <ul><li>“ safe and appropriate management of acute stroke and non-stroke illnesses” (mimics) </li></ul><ul><li>“ develop management plans for people living with stroke illness including treatment, rehabilitation, health promotion, secondary prevention and long-standing support” </li></ul><ul><li>“ develop the attitude and communication skills to contribute to a comprehensive multi-disciplinary stroke service in hospital and/or community and to work closely with other agencies” </li></ul><ul><li>“ the abilities to advise, develop and evaluate district stroke services in partnership with local health and stroke care communities” </li></ul>
  6. 6. How long and what will I do? <ul><li>“ designed to be adaptable to meet the needs of trainees from a variety of backgrounds, and the impact of sub-specialties on the duration of the parent specialty will be a matter for the parent specialty” – i.e. depends on you </li></ul><ul><li>Depends on the unit you train in </li></ul><ul><li>“ Minimum of one year for trainees with some experience of stroke in parent specialty” </li></ul>
  7. 7. “ Essential components of training” <ul><li>Demonstrate knowledge, skills, attitudes in - acute stroke - stroke rehabilitation - stroke prevention </li></ul><ul><li>Approx 1/3 devoted to each module </li></ul><ul><li>Core attachments to acute stroke units, neurovascular clinics and stroke rehab units +/- specialty attachments e.g neurosurg </li></ul>
  8. 8. Generic skills, research and audit <ul><li>Conducting a stroke research audit expected </li></ul><ul><li>Exposure to stroke-related research encouraged, not more than one half day a week </li></ul><ul><li>Keep up to date with relevant research findings </li></ul><ul><li>Skills in - service development - team working - teaching - critical appraisal - service evaluation </li></ul>
  9. 9. Appraisals <ul><li>Early meeting educ supervisor (how sympathetic to training needs?) </li></ul><ul><li>Interim appraisal meetings, min 3 monthly intervals </li></ul><ul><li>Sub-specialty appraisal meeting organised by deanery with rep from stroke medicine SSAC </li></ul><ul><li>3/12 before end of training period, agree achieved learning goals and any outstanding goals </li></ul>
  10. 10. Assessment <ul><li>“ Standard work-based assessments including - mini-CEX - DOPS - MSF - CBD - teaching presentation - audit - feedback from patients obtained from patient surveys and similar documents </li></ul><ul><li>Annual review prior to RITA and PYA processes” </li></ul>
  11. 11. What I did in stroke <ul><li>2 weeks during COTE training </li></ul><ul><li>Then 6 months attachment in year 4 - 5.5 months acute/prevention </li></ul><ul><li>- 0.5 rehab </li></ul><ul><li>Then stroke training year in year 6 - negotiations with deanery tricky! - 50/50 stroke rehab vs acute stroke and prevention!! </li></ul>
  12. 12. What I found different? <ul><li>I know all about MDT working </li></ul><ul><li>I know all about rehab </li></ul><ul><li>“ develop the ability to work effectively within a multi-disciplinary stroke service” General _________________ Rehab physician consultant </li></ul>
  13. 13. Acute stroke/prevention <ul><li>TIA clinics </li></ul><ul><li>Neurology </li></ul><ul><li>Clinical pharmacology </li></ul><ul><li>Thrombolysis </li></ul><ul><li>Neurosurgery </li></ul><ul><li>Vascular surgery/interventional radiology </li></ul><ul><li>Neuroradiology </li></ul><ul><li>Orthoptics </li></ul><ul><li>Clinical research trials, conferences </li></ul><ul><li>Stroke research evaluation </li></ul>
  14. 14. Stroke rehab <ul><li>Patient pathways (foot in both camps; community rehab options) </li></ul><ul><li>Orthotics </li></ul><ul><li>Seating incl wheelchairs </li></ul><ul><li>Spasticity </li></ul><ul><li>“ learning the therapists’ language” </li></ul><ul><li>Depression/anxiety/behavioural (head injured patients)/neuropsychology </li></ul><ul><li>Post-stroke sexuality </li></ul><ul><li>Driving assessments </li></ul><ul><li>Discharge planning (staged discharges, home visits) </li></ul>
  15. 15. Other <ul><li>Stroke community services/carers /social work & welfare issues </li></ul><ul><li>Teaching opportunities </li></ul><ul><li>Stroke management opportunities - Fraserburgh - Elgin - Orkney - stroke MCN </li></ul><ul><li>Came to Glasgow to meet Margaret Roberts for assessment </li></ul>
  16. 16. When to do a subspecialty year during your geriatric training? <ul><li>SSAC recommends at least 1 year of specialty training first </li></ul><ul><li>Full or part-time by negotiation </li></ul><ul><li>Consider: </li></ul><ul><ul><li>Degree of autonomy you’re comfortable with </li></ul></ul><ul><ul><li>Future career plans </li></ul></ul><ul><ul><li>Timing of consultant posts </li></ul></ul><ul><ul><li>Type of consultant post (DGH, tertiary centre) </li></ul></ul>
  17. 17. Curriculum paperwork <ul><li> </li></ul><ul><li>Length of training – “complicated” </li></ul><ul><li>SSAC just about to present the new curriculum to PMETB </li></ul><ul><li>The curriculum is undergoing revision and will be available end of year “Content no different but emphasises Geriatric Medicine contribution to training and need to spend training in comprehensive unit for one year” </li></ul>
  18. 18. Numbers of training posts <ul><li>West - 3 </li></ul><ul><li>Lothian - 2 </li></ul><ul><li>Dundee - 1 </li></ul><ul><li>Aberdeen – 1 </li></ul><ul><li>England – 30+ </li></ul><ul><li>Training places in Scotland not likely to change, expansion this year in England </li></ul><ul><li>“ Keen to get some takers” </li></ul>
  19. 19. <ul><li>? </li></ul>