NHS Lothian Women’s Services Royal Infirmary of Edinburgh Academic Clinical Fellow in Obstetrics and Gynaecology (ST6 or above equivalent) Fixed term one year Less than full time 0.75 WTE 1. Outline of the post Available from 01 June 2015. This is a fixed term post for one year with the possibility of extension for a second year. They post holder will contribute to a research project where the aim of the project is to determine the relationship between sunlight exposure, NO release and pregnancy outcomes. The post is less than full time to provide adequate free time for self-funded work on the research project. The post holder will join a forward looking and vibrant department and play an active role in inpatient obstetrics. The job plan will include fixed night and weekend day shift work covering obstetrics and emergency gynaecology. The existing consultants have either traditional on call or resident emergency cover in their job plans and it is envisaged that the majority of consultants will move to having a mixture of on call and resident shifts in their job plans in order to provide 168 hour per week resident consultant cover. The prinicipal base for the posts is the Royal Infirmary of Edinburgh. There may be clinics in surrounding health centres. Adjacent to the RIE building are the University of Edinburgh Chancellor’s Building, providing outstanding facilities for undergraduate and postgraduate education and the Queen’s Medical Research Institute. This includes the MRC Centre for Reproductive Health (see www.crh.ed.ac.uk), which houses the Tommy’s Centre for Maternal and Fetal Health. In addition, there is a range of teaching and seminar accommodation embedded within the clinical space at SCRH. 2. NHS Lothian NHS Lothian is an integrated NHS Board in Scotland providing primary, community, mental health and hospital services. Mr Tim Davison is Chief Executive and Dr David Farquharson is the Medical Director. The NHS Board determines strategy, allocates resources and provides governance across the health system. Services are delivered by Lothian University Hospitals Division, the Royal Edinburgh hospital and associated mental health services, four community health (and social care) partnerships (CH(C)Ps) in City of Edinburgh, West Lothian, East Lothian and Midlothian, and a Public Health Directorate. NHS Lothian serves a population of 850,000. University Hospitals The University Hospitals Division provides a full range of secondary and tertiary clinical services to the populations of Edinburgh, Midlothian, East Lothian and West Lothian. The Division is one of the major research and teaching centres in the United Kingdom. Hospitals included in the Division are: The Royal Infirmary of Edinburgh The Western General Hospital The Royal Hospital for Sick Children, Edinburgh St Johns Hospital Royal Victoria Hospital Liberton Hospital The Princess Alexandra Eye Pavilion. The Royal Infirmary (RIE) is a major teaching hospital on a green field site in the South East of the city of Edinburgh built in 2003. It comprises 25 wards, 869 beds, and 24 operating theatres, and is equipped with modern theatre and critical care equipment and monitoring. Within the main building is a dedicated, multidisciplinary, five-theatre day surgery complex. The hospital provides for most specialities and is the centre for: General surgery Vascular surgery Hepatobiliary and transplant medicine and surgery Cardiac and thoracic surgery Elective and trauma orthopaedic surgery Neonatology Obstetrics & Gynaecology Cardiology Renal medicine Sleep medicine Accident and Emergency. There is a Combined Assessment Unit which takes unselected GP or direct emergency referrals, and from A&E. CAU includes the Department of Liaison Psychiatry and the Scottish Poisons Bureau and Treatment Centre. There are full supporting Laboratory and Diagnostic Radiology Services (including CT, MR, Ultrasound and PET scanning). There is a full range of lecture theatres, a library and AV facilities. The Western General Hospital (WGH) has 600 beds and five operating theatres and is equipped with modern theatre and critical care equipment and monitoring. The Anne Ferguson Building was completed in 2001. The hospital provides for most specialties and is the centre for: Neurology, neurosurgery and neuropathology The UK CJD unit Colorectal surgery Urology and Scottish Lithotriptor Centre Breast surgery Gastroenterology Rheumatology Infectious diseases Haematology and oncology Medical oncology Radiation oncology Dermatology (Inpatient) There is an Acute Receiving Unit, which accepts GP referrals and 999 ambulance medical cases on a zoned basis within the city, and a nurse led Minor Injuries Unit. There are full supporting Laboratory and Diagnostic Radiology Services (including CT, MR, Ultrasound and NM). There is a full range of lecture theatres, a library and AV facilities. St John’s Hospital is located in the centre of Livingston, a new town about 30 minutes drive west from Edinburgh. The hospital provides for most common specialties, has a paediatric ward and is the centre for: General medicine with cardiology, diabetes & endocrinology, gastroenterology, respiratory medicine and care of the elderly Obstetrics & Gynaecology Paediatrics and community child health Plastic surgery Oral and maxillofacial surgery ENT Critical Care (ITU, HDU and CCU) Accident and Emergency General surgery Orthopaedics Mental Health including ICCU and ICPU Recent developments at SJH include a new endoscopy suite, an Intensive Psychiatric Care Unit, a digital mammography unit, an oncology (cancer care) day centre, a satellite renal dialysis unit and a £2.75m reprovision of A&E. There are full supporting Laboratory and Diagnostic Radiology Services (including CT, Ultrasound and NM). The hospital has been accredited full teaching hospital status by the University of Edinburgh. There is a full range of lecture theatres, a library and AV facilities. The Royal Hospital for Sick Children (RHSC) is a 141 bedded hospital providing general and specialist services for children. The hospital is situated in a residential area close to the centre of Edinburgh and is approximately three miles from the site of the New Royal Infirmary and the co-located University of Edinburgh Medical School and three miles from the Western General Hospital. The RHSC is the main paediatric teaching hospital for the South-East of Scotland providing general and specialised services on a local, regional and national basis. It acts as the local paediatric referral centre for the children of Edinburgh and surrounding areas, and as a tertiary referral centre for intensive care patients; gastroenterology, hepatology & nutrition; respiratory medicine; cardiology; nephrology; neurology; oncology; haematology; neonatal surgery; plastic surgery; orthopaedic surgery; urological surgery and general surgery. Hospital accommodation encompasses five theatres, a critical care unit comprising an eight bedded Paediatric Intensive Care Unit, a six bedded High Dependency Unit and a three bedded Neonatal Intensive Care Unit. There is an excellent library facility and a modern lecture theatre with a full range of audio-visual equipment. All services are supported by comprehensive radiology, neurophysiology, laboratory and therapy services. The local radiology department provides on site Magnetic Resonance Imaging, CT Scanning, nuclear scanning and ultrasound. On site laboratories provide biochemistry, haematology, pathology and neuropathology services. The children’s hospital will be re-located to the Royal Infirmary site in 2017. Community Healthcare Partnerships The four established Lothian Community Health (and Social Care) Partnerships serve the population of Edinburgh, Midlothian, East Lothian and West Lothian. Hospitals in the CH(C) Ps include: The Astley Ainslie Hospital in Edinburgh The Midlothian Community Hospital Herdmanflat Hospital, Roodlands and Edenhall Hospitals in East Lothian. The four CHPs are coterminous with Edinburgh, Midlothian, East Lothian and West Lothian Councils bringing together those responsible for planning, managing and providing community-based health services for the population of Edinburgh and the Lothians. There are 7,500 members of staff. In addition, there are approximately 1,000 independent contractors in General Medical and Dental Practice, as well as pharmacists and opticians. A population of 850,000 people is served across health board area. The range of services care of the elderly, medical rehabilitation, community mental health, substance misuse and learning disability, district nursing and health visiting, family planning, well woman, comprehensive dental care and those provided by Allied Health Professions, such as physiotherapy, pharmacies and optometrists. Specialist services provided include brain injury rehabilitation, bioengineering and prosthetics, drugs and alcohol misuse and harm reduction, AIDS/HIV and Children and Family Psychiatric Services. Royal Edinburgh hospital and Associated Services The Royal Edinburgh and Associated Services provides a range of Mental Health services to the population of Lothian and other Boards within Scotland. The Royal Edinburgh Hospital is located on the south side of the City of Edinburgh. It comprises some 20 wards, 420 beds, day hospitals and outpatient facilities. The hospital provides the following range of specialities:Acute Mental Health Rehabilitation Psychiatric Emergency Team Outpatients Assessment Psychiatry of Old Age Forensic Medium Security Unit Inpatient facilities for under 18s Psychotherapy Service Psychology Services Services for Eating Disorders Day Hospitals – Psychiatry of Old Age There are an additional 46 bed and one day hospitals for Psychiatry of Old Age in the north of the city at the Royal Victoria Hospital. The hospital is currently housed in a mix of accommodation ranging from 19th century to present. There is a major project now in place to take forward a reprovisioning programme in line with the strategic vision with the “Delivery for Mental Health” Scottish Executive 2006. Department of Public Health Medicine The aim of the department is to improve the health of the people of Lothian in collaboration with many other partners. Using a range of knowledge, experience and networking capability, the distinctive contributions are: the promotion of specific measures to monitor and improve health; the collation and interpretation of health related information. The following objectives have been agreed as the basis for the Department’s work plans: To monitor the health status and health needs of people in Lothian; To promote improvements in the health of Lothian people directly, and by providing information and advice to the public on health matters; To assist Lothian NHS Board to fulfil its statutory obligations To contribute to strategic changes within the NHS in Lothian by providing information on clinical effectiveness; To facilitate improvements in health and health care services directly, and through ‘managed clinical networks’ and wider alliances; To contribute on a 24 hour basis to the control and prevention of communicable diseases and environmental hazards; To maintain commitments to teaching, training, professional development, audit and research. To enable efficient management of the Department: there are at present four groups in the Directorate. These are; Healthy Communities, Healthcare; Health Protection and Health Information. 3. University of Edinburgh The University of Edinburgh was established in 1582 and is one of the largest in the United Kingdom located on a number of prominent sites in Scotland’s capital city. It is Scotland’s premier research university, graded within the top six multi-faculty British Universities in the last national research assessment exercise (90 percent of its academic staff were in units rated 4, 5 or 5*). It has 3,000 academic staff, over 16,000 undergraduate and over 4,000 postgraduate students and an annual expenditure of over £261M for teaching and research. The University is organised into three Colleges: Humanities and Social Science, Medicine and Veterinary Medicine, Science and Engineering. A new MRC / University of Edinburgh Centre for Reproductive Health opened in April 2011. There are close links between the centre and the Simpson Centre for Reproductive Health, with seven of the current clinical staff having dual appointments, and with further opportunities for collaboration. 4. NHS Library and Postgraduate Facilities There are excellent facilities on all sites. 5. Departmental Information The Obstetrical and Gynaecological service of the Royal Infirmary of Edinburgh (RIE) at Little France is located in the Simpson Centre for Reproductive Health (SCRH) at the north end of the hospital campus. This state-of-the-art facility incorporates the Simpson Memorial Maternity Pavilion and Gynaecological Department from the old Royal Infirmary site, as well as the Regional Neonatal Intensive Care Unit (39 cots). The Simpson Centre for Reproductive Health (SCRH) currently has a delivery rate of approximately 7000 deliveries per annum, with a commensurate gynaecological workload. A midwifery-led birthing centre opened adjacent to SCRH in October 2011. 1294 women gave birth here in 2013.On the ground floor of the building are an integrated out-patient facility, emergency triage and assessment areas, an obstetric day assessment unit, a Pregnancy Support Centre and obstetric and gynaecological ultrasound scanning and pre-natal diagnostic services. Also on the ground floor is the Edinburgh Fertility and Reproductive Endocrine Centre, providing an integrated level 3 fertility service. On the first floor are the labour suite, obstetric in-patient accommodation, integrated obstetrics and gynaecological theatre suite, and the neonatal intensive care unit. The second floor houses the gynaecological in-patient accommodation, further obstetric in-patient accommodation, as well as office accommodation for medical, administrative and support staff, and the University department offices. There is also a dedicated Day Surgery Unit which is shared with other specialties. The newly opened Chalmers Sexual Health Centre has close links with the SCRH and the University of Edinburgh Department of Obstetrics & Gynaecology and offers experience and training in all aspects of community sexual & reproductive health. The SCRH has been recognised for sub-specialty training in Reproductive Medicine, Gynaecological Oncology and Maternal Fetal Medicine. A full range of Advanced Training Skills Modules are available for Year 6 & 7 trainees in the ST training programme. High-risk antenatal clinics are held at the Royal Infirmary and Western General Hospital sites, with a significant amount of antenatal care being delivered in the community. Out-patient clinics in general gynaecology, infertility, urogynaecology, gynaecological endocrinology, colposcopy and vulval disorders are held at the Royal Infirmary site. In addition, many Consultants have clinics in other locations, including the Western General Hospital, Edenhall and Roodlands Hospitals and Leith Community Treatment Centre. Gynaecology lists are performed at the Western General and Roodlands Hospitals, in addition to the RIE site. There is an established group of trained Educational Supervisors who take active responsibility for education and training for all junior doctors at SCRH, supported by the RIE’s Postgraduate Medical Education Department. The Department has been consistently ranked amongst the highest in the region for overall satisfaction with training in Obstetrics and Gynaecology training in the GMC trainee survey. There is large general gynaecological workload with approximately 500 hysterectomies (abdominal and vaginal) and 5,000 day cases being performed per annum. 3,000 new gynaecological outpatients are seen per year. Sub-specialty interests include Infertility, urogynaecology, gynaecological oncology and menstrual dysfunction. Within The Simpson Centre for Reproductive Health, there is a dedicated centre, The Edinburgh Fertility and Reproductive Endocrinology Centre (EFREC) for patients with endocrine and infertility problems. The Obstetric and Gynaecological Services at St. John’s comprises fifty obstetric beds, including a day bed unit, and twenty gynaecology beds (twelve in-patient and eight day beds). In 20131 the department handled approximately 2,674 deliveries. There is an out-reach antenatal service covering West Lothian and part of the west of Edinburgh. Special interests of the department include urogynaecology, menstrual dysfunction and fetomaternal medicine. There are strong links between the two Maternity Units. Medical Staffing at the Royal Infirmary of Edinburgh Feto-maternal Medicine Unit Dr C Alexander Dr A Campbell Dr E Cooper Dr S Cowan Dr F Denison (University of Edinburgh) Dr E Doubal Dr K Dundas Dr K Edgar Dr F Fankam Dr D Gatongi Dr Louise Hermis Dr R Hughes (Clinical Director for Obstetrics and Neonatology, NHS Lothian) Dr C Love Dr N Mary Dr H Mustafa Professor J Norman (University of Edinburgh) Dr N Palaniappan Dr B Smyth Dr S Stock (University of Edinburgh) Gynaecology / Oncology / Urology Unit Dr C Busby-Earle Dr P Dewart Dr S Fegan Dr S Jack Dr C Martin Dr S Nicholson (Clinical Director for Gynaecology NHS Lothian) Dr S Milne (Associate Specialist) Reproductive Medicine Unit Professor R Anderson (University of Edinburgh) Dr B Brady Professor H Critchley (University of Edinburgh) Dr W Duncan (University of Edinburgh) Dr A Horne (University of Edinburgh) Dr C Tay (Gynaecologist and ACU Consultant) Dr J Thong (Gynaecologist and ACU Consultant) Dr C West Medical Staffing at St. John’s Hospital, Howden Dr A Armstrong* Dr T Cooper Dr S Court Dr S Coutts Dr S Kallat Dr A MacLeod Dr P Mills Dr S Rane Dr K Rose * Dr J Wilkens Those consultants marked * work at both RIE and St John’s Hospital. 14 ST3+ Speciality Trainees including sub-specialty trainees 4 ST2 Specialty Trainees, 16 ST1 Specialty Trainees, Foundation Year 2 trainees, GPST2 trainees The department provides at least 91 hours per week consultant presence on Labour Ward and has established a number of resident consultant posts, in addition to a separate consultant gynaecologist rota. There are a minimum of two doctors working at ST3 or above level on duty out-of-hours at all time, in addition to two doctors working at ST1 level or equivalent with additional doctors for some shifts. The Clinical Fellow will work at a level equivalent to that of the ST6+ and participate in the out of hours rota as above. 6. Details of the Post Main Role The research project is funded by the Edinburgh Tommy’s Centre, which has a major focus on maternal obesity and the pregnancy “stressors” of maternal depression/stress, inflammation and hypoxia. These pregnancy stressors are largely responsible for the clinical conditions of gestational diabetes, preterm birth and stillbirth, all of which have devastating effects on pregnant women and their babies. The research aspects of this post will be based in the MRC Centre for Reproductive Health (www.crh.ed.ac.uk) under the supervision of Dr Sarah Stock (Senior Clinical Lecturer Maternal and Fetal Medicine MRC CRH) and Dr Richard Weller (Senior Clinical Lecturer Dermatology MRC CIR) The aim of the project is to determine the relationship between sunlight exposure, NO release and pregnancy outcomes. It will involve an epidemiological study linking meteorological data to pregnancy outcome data, and mechanistic preclinical and clinical studies examining the vascular responses to UV exposure. The successful candidate will be expected to contribute to all aspects of the research and have the necessary skills in data linkage and biostatistical analysis and ideally experience of sheep models of pregnancy. They will also be required to maintain a clinical commitment in general obstetrics and gynaecology and have the opportunity to gain invaluable experience and training whilst working in a busy tertiary referral centre as part of a dynamic team of enthusiastic people. The research performed may contribute towards a higher degree at the University of Edinburgh or another institution. Applicants registered for a higher degree either in Edinburgh or elsewhere will be required to pay the relevant postgraduate tuition fee to the University of Edinburgh. The post is not recognised for training however each doctor will have an Educational Supervisor who will support the clinical components of the post by assisting in meeting the individual’s training and career goals, including regular appraisal and support to complete appropriate work-place based assessments and an Academic Supervisor who will support any research component of the post. Clinical Duties The Clinical Fellow will work on the ST6/7 rota, and as such will take on the responsibilities associated with this role. The Clinical Fellow will be supervised by a consultant and will need to respect the roles of others within a multidisciplinary team, and communicate with them appropriately. The weekly timetable will consist of one day a week contributing to the general clinical workload of the Department. In addition, the Clinical Fellow will contribute to the out of hours rota (1 in 7 evening and 1 in 7 night shift). The clinical duties will vary from week to week to accommodate the needs of the Department but will aim to complement the special interest component of the post. While fixed research/clinical days will be preferred some flexibility will be required to support the clinical Out Of Hours work of the Department. Clinical duties may include sessions in antenatal clinic, labour ward, gynaecology outpatients, gynaecology theatre and the emergency gynaecology, with duties in the followiing areas. Antenatal clinic Under the supervision of a consultant obstetrician Attend the antenatal clinics which may include one of the more specialised maternal medicine clinics Counsel women adequately about the investigations offered during pregnancy, interpret the results, communicate the significance of abnormal results to the patient and arrange further management if needed. Detect and manage commonly occurring disorders in pregnancy, recognising his/her limitations Recognise the roles of the multidisciplinary team Develop good communication with patients and staff Delivery Unit The Clinical Fellow will work under the supervision of the consultant obstetrician responsible for Labour Ward. They will work Supervise FY2/GPST2/ST1-5s working on the Delivery Suite. Be aware of the needs of women in labour, and respect their physical and psychological comfort Be responsible for the monitoring of fetal wellbeing in labour Assess and manage progress in labour Perform instrumental and operative deliveries, or supervise the ST1-5 to do this if appropriate Manage third stage complications Be able to manage maternal collapse Have input into the management of high risk pregnancies in conjunction with the consultant obstetrician Take an active role in managing patients through Triage and/or the Antenatal Day Assessment Unit Gynaecology Outpatients Whilst some gynaecology clinics cover a wide range of problems other clinics are more specialised in nature. The Clinical Fellow should Be able to take a gynaecological history and perform an appropriate examination with respect for the woman’s dignity and autonomy Instigate the initial investigation and management of common gynaecological problems such as disorders of menstruation, infertility, incontinence, menopausal symptoms, psychosexual problems and genital tract infections. Understand the principles of cervical screening, the management of pre invasive and invasive disease and post treatment follow up Gynaecological Emegencies Provide support and advice to the ST1-5/GPST2/FY2s working in the Emergency Gynaecology Unit Be able to carry out emergency gynaecology procedures normally expected at ST6 level, with consultant support and supervision as appropriate. Gynaecology Theatre Liaise with theatre and anaesthetic staff when arranging the theatre cases Observe, assist or undertake procedures in theatre with an appropriate level of supervision. Out of hours, the Clinical Fellow will be resident in the hospital and work with a ST3-5 resident in the hospital, with two2 ST1or equivalent resident as first on call. The consultant obstetrician is resident in the evening and then resident or on call from home. The consultant gynaecologist is on call from home. The rota has been devised to enhance the special interest component of the post and out-of-hours duties include evenings and night shifts but no weekend day work. Pattern of work The working pattern conforms to a ‘Full shift’ system. For the majority of the time the Clinical Fellow will work from 08.30 to 16.30 on weekdays. Evening shifts are from 16.30 to 21:00, and night shifts are 20:30 until 09.00. Night shifts are worked in a pastern of four nights then three nights once every seven weeks with appropriate compensatory rest. Althought not a formal training post, the terms and conditions for medical trainees in NHS Scotland will apply. Applicants should ensure they understand the those aspects of the Terms and Conditions that apply to LTFT posts. This is an Exposure Prone post and evidence of the relevant immunities will be required before starting work. 7. Research and Development The Royal Infirmary of Edinburgh is the site of the University’s newly established Queens Medical research Institute of which MRC Centre for Reproductive Health is a key component. This is largest aggregation of Reproductive Scientists and Clinicians in Europe and offers unique opportunities for research collaboration in all areas of obstetrics and gynaecology. The MRC Centre for Reproductive Health includes the Tommy's Centre for Maternal and Fetal Health, which has a research focus on maternal obesity and preterm birth. The Tommy's Centre currently has around £10 million of pregnancy related research funding, and there are excellent opportunities for collaboration with interested clinicians. Currently the most prominent areas of clinical research include fertility control (conception and contraception), gynaecological endocrinology, mental dysfunction, gonad and gamete biology, feto-maternal disorders, placental function and the biological control of parturition. 8. Teaching The Department of Obstetrics and Gynaecology is recognised for sub-speciality training in feto-maternal medicine, reproductive medicine and gynaecological oncology. There are also sub-speciality training opportunities in sexual and reproductive health at the Family Planning Clinic in Dean Terrace, Edinburgh. Advanced training skill modules are available for trainees in years ST6/7. The post holders may be asked to contribute to the organisation, delivery and quality control of undergraduate and postgraduate medical education and training at the Royal Infirmary and St. John’s. 9. Contact Details Further information is available from Dr Corinne Love, Obstetric Lead RIE, corinne.love@luht.scot.nhs.uk Dr Sarah Stock MRC Centre for Reproductive Health (sarah.stock@ed.ac.uk) Dr Rhona Hughes, Clinical Director of Obstetrics, NHS Lothian, rhona.hughes@luht.scot.nhs.uk 11. Person Specification Requirements Essential Qualifications and Training Registered with the GMC. Desirable License to practice Four years experience in middle grade registrar posts or equivalent including experience of working on ST6/7 or equivalent tier of obstetric rota. MRCOG Part 2 or equivalent. Relevant Experience Completion of BLS ALSO/ATLS or equivalent Satisfactory assessment of clinical ability. Completion of RCOG log book competencies up to intermediate level or equivalent. Training in ultrasound with evidence of ability to perform fetal biometry and assess fetal wellbeing scans. Ability Ability to manage patients with acute gynaecological conditions. Research Completion of information governance course and knowledge of UK data protection legislation Original research/audit leading to publication and/or presentations Demonstratable understanding of concepts of health care epidemiology Experience in biostatistical analysis Completion of course in analysis of linked health data Experience of preclinical and laboratory research Experience in managing large datasets Teaching and Audit Evidence of participation in clinical audit Evidence of formal and informal teaching and training of junior doctors, medical students and other clinical staff. Previous experience of designing teaching programmes. Qualification in teaching Experience of designing and effecting audit Motivation Evidence of learning and continuous professional development. programmes Dedicated to a career in Obstetrics & Gynaecology Interest in reproductive health and wellbeing at individual and population level Demonstrates interest and background knowledge in the specific area of research project Personal Attributes Evidence of patient focused care. Good team player, good communication skills, experience of working in multidisciplinary teams. Commitment to improving quality of care with consultant delivered care in and out of hours. Understanding of and commitment to the work of the Scottish Patient Safety Programme and the maternal work stream within this (Maternal Collaborative Quality Improvement Programme {McQIC}). Interest in reproductive health and wellbeing at individual and population level