MTI 2015 Candidate Preferences CANDIDATE FULL NAME: ………………………………………………………………………………………………………… East of England East of England East Midlands East Midlands East Midlands London London London KSS KSS KSS Northern North West Broomfield Hospital 1 & Royal Brompton Hospital Broomfield Hospital 1 Watford General Hospital Rotational posts between Lincoln County Hospital & Nottingham City Hospital Nottingham Children’s Hospital Leicester Royal Infirmary 1 Royal London Hospital, Whitechapel & Newham University Hospital Queens Hospital, Romford Whipps Cross University Hospital 1 Darent Valley Hospital Frimley Park Hospital Medway Maritime Hospital Royal Victoria Infirmary, Newcastle Stepping Hill 3 2 1 2 1 1 Post content Duration (Years) General paeds with cardiology 2 years General paeds with academic interest General paeds/neonatology General Paeds & NICU 2 years General paeds & paediatric oncology NICU & Neonatal transport One post has an option to spend 6 months in Paediatric Cardiac Intensive Care Neonatology 2 years General paeds & neonatology General paeds & Level 2 neonatology 2 years 2 Years 2 Years (1 year at ST1-3, 1 year at ST4+ level) 2 years 2 years 1 year to be extended to 2 subject to performance 2 years 1 General paeds & neonatology General paeds & neonatology Neonatology 2 Neonatology 2 years 1 General paeds, 2 years 2 2 years 2 years Ranking East of England Placement Location(s) Places available Deanery Hospital, Stockport North West Ormskirk Hospital 1 Peninsula Royal Devon & Exeter Hospital Cheltenham General Hospital Musgrove Park Hospital Great Western Hospital Wexham Park Hospital Children’s hospital for Wales Children’s hospital for Wales 1 Glan Clwyd & Wrexham Maelor Hospitals Alexandra Hospital Redditch & Worcestershire Royal Hospital, Worcester 3 Severn Severn Severn Thames Valley Wales Wales Wales West Midlands 1 1 1 2 1 2 2 community & level 2 neonatology General paeds & Level 2 neonatology General paeds & neonatology General paeds & neonatology General paeds & neonatology General paeds & neonatology General paeds & Level 2 neonatology Paediatric haematology oncology Options include: General paediatrics, paediatric emergency medicine, cardiology, respiratory, neurology, gastroenterology, nephrology, community paediatrics, palliative care, paediatric endocrinology General paediatrics & neonates General paeds & Level 2 neonatology 1-2 years 2 years 2 years 2 years 2 years 2 years 2 years 2 years 2 years 2 years Please preference posts by ranking them 1 to XX (with 1 being your most preferred post and XX being your least preferred) or state N/A if you would not consider a post. Please only preference posts which you would be willing to work in if you were offered them. Please be aware that posts may be subject to change following a final sign off of all posts. Please be aware that indicating a preferred post or specialty does not guarantee placement in that post or specialty. All appointments are subject to an assessment of the candidate’s full application and interview. Please submit a copy of this form with your application to [email protected] before 09:00am (BST) on Monday 16th March 2014.