SOUTH EAST SCOTLAND
SPECIALIST REGISTRAR IN ADVANCED STROKE MEDICINE (2 POSTS)
(1 YEAR)
1. Background information
This post offers the opportunity to live, work and train in the outstanding city of
Edinburgh and its rural environs.
This job description details information regarding the structure of training offered
within this post and provides a description of the hospitals where training occurs.
Further information regarding the training scheme in general can be obtained from
the Subspecialty Advisor and course director, Dr Simon Hart, Consultant Stroke
Physician at the Royal Infirnary of Edinburgh, 0131 537 2939, mobile 07500 126604
or Prof Martin Dennis 07979 708008.
The post
This post has been established to offer Subspecialty Training in Advanced Stroke
Medicine and to prepare the post holder for a lead role in Stroke Services. This may
contribute to JRCPTB approved Training that may be counted towards CCST
Accreditation in Stroke Medicine.
The post is available to trainees from several different Parent Specialties including:
Geriatric Medicine, Acute Medicine, Neurology, Rehabilitation Medicine or Clinical
Pharmacology & Therapeutics.
It has been designed to enable the post holder who, will be nearing the completion of
their training in a relevant specialty, to complete a comprehensive training in Stroke
medicine from whichever background they have come. The subspecialty of Stroke
Medicine has been officially recognised by the JRCPTB, PMETB and the GMC.
The post itself and the units through which it rotates have gained approval for training
from the Royal College of Physicians and the JRCPTB. The training programme has
been approved by PMETB.
The post is available from the 1st April 2015 but some alteration to the start date can
be negotiated by successful applicants.
Entry requirements
Full or Limited registration with the General Medical Council is required. Candidates
must have achieved MRCP (UK or Ireland) and have satisfied the requirements for
General Professional Training in General Internal Medicine.
The successful
applicant will ideally be within a year or so of completing a specialist training in
General & Geriatric medicine or Neurology or Rehabilitation medicine or Acute
Medicine or Clinical Pharmacology & Therapeutics. Candidates who are graduates
of non-UK medical schools and who have undergone postgraduate medical training
outside the United Kingdom will also be considered for the post. Details of non-UK
training will be reviewed at the shortlisting and interview stage.
Interview and shortlisting will be undertaken by a panel comprising representatives of
the Postgraduate Deanery in Medicine, University of Edinburgh, National Panel of
Specialists and the NHS units through which the post rotates.
Structure of training and assessment
On appointment one of the trainee's and Stroke Medicine Supervisors will review the
trainee’s previous experience, knowledge and skills and together agree a training
scheme which will ensure that the trainee completes all aspects of the curriculum
which has been developed by the British Association of Stroke Physicians and
approved by the PMETB (available through their websites). The minimum duration of
training will be one year although some postholders, depending on their prior
experience, may require longer to complete the curriculum. Professor Martin Dennis
and/or Dr Simon Hart will act as mentors for this period of training unless the
postholder wishes to identify an alternative person.
The trainee is required to maintain an up-to-date, written formal record (“log-book”) of
their training experience, which will require written endorsement by individual
consultant trainers.
A Specialist Year Assessment of the trainee will be undertaken, comprising an
interview, oral presentation by the trainee and review of the written record of training.
This will be undertaken by the Programme Director/Specialty Advisor (Dr Simon
Hart) and/or Professor Martin Dennis and a representative of the SAC.
Unsatisfactory progress at any stage in training may result in an additional period of
training. In extreme circumstances, and in the absence of satisfactory progress, the
Training Committee may recommend withdrawal of the training privileges and
termination of the contract of employment.
Options in training
Any request to change from full-time to part-time training, or vice versa, at any point
in the training programme, will be considered by the Training Committee.
Training Opportunities Offered
The training will be based mainly at the Royal Infirmary of Edinburgh (RIE) but
training may involve rotation to other services within Edinburgh (both stroke specific
and others) including the Western General Hospital (WGH). Individual training needs
will determine the precise location of training for each trainee.
Edinburgh is in a unique position to provide a really comprehensive training in all
aspects of stroke medicine owing to its teams of stroke specialists from a wide range
of disciplines. Patients with acute stroke are admitted to a 32-bedded Acute Stroke
Unit at the RIE often via a Medical Admission Unit, or to a 16-bedded Integrated
Stroke Unit (acute and rehabilitation) at the WGH. Those at RIE that require
prolonged rehabilitation may be transferred to one of three stroke rehabilitation units.
Patients who do not require admission are assessed rapidly at a “One Stop” Minor
Stroke and TIA Clinic, which will be part of the post-holders training.
The WGH hosts the regional neurosciences unit with 14 consultant neurologists and
six consultant neurosurgeons.
The neuroradiology department has seven
consultants and access to CT scanners, two MRI scanners (with facilities for MRA
and MR spectroscopy), state of the art Duplex and transcranial Doppler imaging and
digital subtraction angiography. There are daily neuroradiology meetings where all
imaging is reviewed and a weekly stroke radiology meeting.
All other major medical specialties are also represented including cardiological
services with a state of the art echocardiography service.
The hospital has an excellent medical library with on-line access to Medline and a
large range of journals and books relevant to cerebrovascular disease.
The trainee will be able to gain closely supervised experience in the following areas:
Diagnosis and assessment – the trainee will, with supervision from one or more of
the senior members of the department, assess in detail large numbers of patients
admitted to the hospital with a possible stroke (more than 700/year). He/she will be
expected to present the cases, with their diagnostic formulation, at the weekly
meeting of the stroke physicians and neuroradiologists. The patients' investigations
are reviewed and interesting management points discussed.
He/she will be a member of the Acute Stroke Team which is available at all times to
assess patients in the Emergency Department or our Acute Receiving Unit/ Medical
Assessment Unit who may benefit from treatment with thrombolysis or other acute
treatments. Professor Dennis, Dr Keir, Dr Hart and Prof Sandercock provide senior
cover for the team during the day and are supplemented by several other consultant
neurologists out of hours. Therefore this will provide the trainee with supervised
experience in hyper-acute diagnosis, assessment, thrombolysis and randomisation in
acute stroke trials which are increasingly important parts of stroke medicine. A
telemedicine service to support thrombolysis is currently being installed.
In addition, he/she will assess at least five new patients presenting to the 3x weekly
neurovascular clinics. These clinics attract patients with transient ischaemic attacks,
minor strokes and a wide range of conditions, which may mimic them. They offer
same day CT and Duplex scanning. The trainee will discuss the diagnosis and
management of each patient with Professor Dennis & Sandercock who are able to
review his/her findings if necessary. Patients are currently being seen within 3 days
of referral.
Acute General Treatment –The trainee can be involved in the day to day
management of admitted stroke patients throughout his training. This training will
take place in the context of a service where there is systematic recording of post
stroke complications and studies of their aetiology and the effectiveness of
treatments. For example, he/she will be involved in the CLOTS trial (which is
evaluating compression stockings for DVT prophylaxis). He/she will be encouraged
to develop his own approach to dealing with the difficult ethical issues surrounding
the management of patients with severe strokes.
Acute Specific Treatment - We are involved in the evaluation of several multicenter
randomised controlled trials of treatments. The trainee will be working closely with a
research team, which is systematically reviewing evidence for the effectiveness of
thrombolysis and evaluation of treatments after intra-cerebral haemorrhage. Trainees
will gain experience in selecting patients for acute interventional radiology and
decompressive surgery.
Neurovascular imaging - We have access to state of the art imaging equipment in
the Scottish Brain Imaging Centre. Professor Joanna Wardlaw, not only runs a
superb clinical service but co-ordinates many research projects evaluating the role of
imaging in patients with cerebrovascular disease. The trainee may attend the daily
neuroradiology meetings and the weekly stroke register meetings where the
radiological findings are demonstrated. He/she will gain experience in CT and MR
interpretation and might learn to perform transcranial Doppler sonography and
Carotid Duplex. He/she will therefore be exposed to modern imaging techniques but
in an environment where their usefulness is being rigorously assessed.
Rehabilitation –The trainee may work as part of one of our multidisciplinary stroke
teams and will be provided with supervised training in all aspects of multidisciplinary
work including:

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Chairing team meetings
Goal setting
Discharge planning
He/she will have the opportunity to work closely alongside the various members of
the team, e.g. physiotherapy, OT and speech and language therapy, to gain insight
into their roles.
Secondary Prevention –The trainee will, under supervision, be expected to initiate
plans for preventing further vascular events in both inpatients and outpatients. This
will include the assessment of patients who might benefit from carotid surgery and
anticoagulation. He/she will be trained in how to counsel patients with respect to
these treatments.
Audit - Much of our research has been devoted to developing appropriate methods
and tools to monitor the quality and effectiveness of stroke services. The trainee will
be involved in Lothian Stroke care Audit System – this comprises a register of
patients with collection of data on process and outcomes of care. We have a Stroke
Audit Co-ordinator in the WGH and the RIE.
Service Organisation – the trainee will be working within a service, which has
evolved over many years. It has at different times incorporated a roving stroke team,
a stroke family support worker, and a medical assessment unit and both onsite and
offsite stroke rehabilitation units. The Managed Clinical Network in Lothian comprises
two acute stroke units, three stroke rehabilitation units and one combined stroke unit.
Thus within Lothian the trainee will have an opportunity to explore different ways of
delivering stroke services. He/she may attend management meetings including the
Lothian Stroke Network and the Managed Clinical Network, which will provide
experience in how services can be co-ordinated across a region. They will be
encouraged to visit other units, which offer different types of service.
Senior Staff who will be involved in training and supervision
Professor Martin Dennis – Professor of stroke medicine and Lead Clinician for the
Lothian Stroke Managed Clinical Network. He is Principal Investigator for the CLOTS
trials, Ex President of the British Association of Stroke Physicians and has been the
Postgraduate Tutor at the Western General Hospital. He Chairs the national
Advisory Committee on Stroke.
Dr Sarah Keir - Consultant geriatrician with an interest in stroke.
Integrated Stroke Unit in the WGH jointly with Professor Dennis.
She runs the
Professor Peter Sandercock – Professor of Medical Neurology and Head of the
Stroke Research Group. He is Principal Investigator for the Cochrane Collaboration
Stroke Review Group and the IST3 trial.
Professor Joanna Wardlaw –Professor of Neuroradiology and Director of the Scottish
Brain Imaging Centre.
Dr Gillian Mead – Senior Lecturer in Geriatric medicine at the Royal Infirmary who
manages acute stroke patients on their unit and co-ordinates their rehabilitation.
Dr Simon Hart – Consultant Stroke Physician at Royal Infirmary and Western
General Hospitals and Specialty Advisor for Stroke Medicine.
Dr Ian Todd – Consultant in Rehabilitation medicine who runs the rehabilitation unit
for the young stroke patients at the Astley Ainslie Hospital
Study Leave
All SpR’s have an entitlement to study leave. Up to two weeks of funded study leave
per year for approved Stroke-related study leave is potentially available. Trainees
will be expected to take study leave to attend the UK stroke forum, and the annual
stroke audit meeting or equivalent.
Research Opportunities
The Neurosciences Trials Unit employs around 40 people on various research
projects relating to stroke. We have two experienced biostatisticians and very
experienced trials co-ordinators. The department has a computer network connected
to the University of Edinburgh and the Internet. In addition the stroke review group of
the Cochrane Collaboration is based in the department which will provide the trainee
with unequalled access to the literature assessing the efficacy of interventions for
stroke. This is a unique resource. An interest in research will be expected and
encouraged but previous research experience would be an asset but is not essential
for appointment to this post.
Teaching responsibilities
All units in the rotation function as teaching hospitals. As such the trainee will be
expected to adopt an enthusiastic and positive approach to the teaching of medical
undergraduates and junior medical staff. The consultant staff who all have a long
record in training will support the trainee in their preparation for seminars and
lectures. They will have access to the Universities courses on teaching methods.
Experience in teaching: Trainees will be involved in bedside and clinic teaching, in
delivering seminars to medical students. We have appointed a Staff Stroke Training
Co-ordinator who is running basic, intermediate and advanced courses in stroke
aimed at all healthcare professional involved in patients care. The trainees will be
expected to participate in these programmes.
On call
The Stroke trainees will regularly be members of the Acute Stroke Team (Stroke
consultant and Reg). They would be responsible for the acute assessment and
treatment of patients with hyper-acute stroke. They would supervise FY1 & 2 in
assessment of new stroke admissions to the Unit. In addition they would see
patients referred by GPs and other specialties in ARU or on the non stroke wards.
These duties would be in addition to those out of hours duties which they might have
if they joined the GIM, Neurology or Geriatric on call rotas, whichever was agreed
most appropriate for their training. It is likely that the postholder will be part of the
Hospital at Night team rota, with appropriate associated on call additional salary.
Service Commitments , terms and conditions.
The post is covered by the Terms and Conditions of Service for Hospital Medical and
Dental Staff. The appropriate sections of the Whitley Council also apply. A standard
working week of 40 hours, standard salary and terms and conditions of service will
apply.
Precise details of service commitment including on-call will vary from unit to unit on
the rotation.
Exposure prone invasive procedures
The holder of this post will be required to undertake on a regular basis exposure
prone invasive procedures. As this could potentially place patients at risk,
candidates must show evidence of immune status to hepatitis B or agree to undergo
the necessary procedures to establish immune status. In this regard the offer of
appointment is subject to confirmation by the Occupational Health Service that the
candidate is Hepatitis B immune.
General Medical Council
All medical staff must be registered with the GMC. The appropriate certificate must
be provided at interview, and it, or proof of renewal, may also be requested at other
occasions.
Further Information and Arrangements to visit please contact:
Dr S Hart
Consultant Stroke Physician
Bramwell Dott Building
Western General Hospital
Crewe Road
Edinburgh EH4 2XU
Shart1@staffmail.ed.ac.uk
Tel: 07500 126604
Or Prof M Dennis
Tel: 07979 708008
PERSON SPECIFICATION
SPECIALIST REGISTRAR IN STROKE MEDICINE
REQUIREMENT
Qualifications and
training
ESSENTIAL
GMC registration
DESIRABLE
ALS training
MRCP (UK) or equivalent
Experience and
knowledge
An NTN in a relevant specialty
(geriatrics, neurology,
rehabilitation or clinical
pharmacology)
Academic
achievements
Enthusiasm for involvement in MD or PhD with original
research
research leading to
presentation or publication
Able
to
demonstrate
a
commitment
to
stroke
medicine and a wish to lead a
stroke service
A positive approach to stroke
patients
Enthusiasm, communication,
organisation and leadership
skills.
Ability to work in a team
Motivation
Personal attributes
Within a year of attaining
CCST