NHS EDUCATION FOR SCOTLAND – WEST REGION
SPECIALIST/SPECIALTY REGISTRAR IN STROKE MEDICINE
Job Description
1.
INTRODUCTION
The Specialist/Specialty Registrar post forms part of the West of Scotland Training
Programme in Stroke Medicine. The post has training approval from the SSAC in Stroke
Medicine and will conform to the guidelines laid out in the SSAC documents.
The post of Specialist/Specialty Registrar in Stroke Medicine provides 12 months of training in
Stroke Medicine. Additional time may be made available to achieve necessary competency
when parent specialty training does not meet minimum criteria for stroke training eligibility. A
particular strength of the West of Scotland programme is the extensive exposure to acute
thrombolysis for stroke.
During the training programme, the trainee’s education and progress is supervised by the
Regional Specialty Training Committee in Stroke Medicine and by the designated Regional
Educational Supervisor. The Committee is chaired by the Programme Director. Individual
trainees are required to sign a training programme agreement, and performance assessment
is carried out on a regular basis throughout training. Summative assessment is conducted
after one year and is based on in-house training assessment criteria laid down by the SSAC.
Study leave conforms to terms and conditions of service for the Specialist/Specialty Registrar
grade. Trainees will be expected to achieve the competencies as set out by the SSAC for
Stroke Medicine. Provided that the training and experience of the trainee is compatible with
the regulations leading to a CCT in a relevant/eligible medical specialty the successful
completion of the training and achievement of the competencies required may lead to the
aware of a CCT with Stroke Sub-specialty recognition.
A brief outline of the services provided within Stroke Medicine are contained in the appendix.
2.
ENTRY REQUIREMENTS
The Trainee will be appointed by a Committee comprising representatives of the
Postgraduate Dean, Speciality Training Committee, teaching hospitals, University of Glasgow.
Applicants must currently be in a Type 1 training post, hold a National/Visiting Training
Number in CPT, Geriatric Medicine, Rehabilitation Medicine, Cardiology, Neurology or G(I)M
and should by the time of taking up the post usually have completed 3 years of training
towards Certificate of Completion of Training. Applicants who are in or have transferred to the
ST programme should be at an equivalent stage in their training, but also are eligible to
undertake specialist stroke training after award of their CCT. Applicants from outwith the West
of Scotland should have the agreement of their Postgraduate Dean to retain their original
training number and to return to their original deanery at the end of the year of training.
Applicants must have an MB ChB, or recognised equivalent and MRCP or equivalent
qualification.
On successful completion of the programme applicants will return to their base specialty and
the relevant SAC will be informed that they have had special training in Stroke Medicine. The
base specialty will retain responsibility of the award of CCT.
3.
DUTIES OF THE POST
Training
The trainee must make full use of the training opportunities provided in each
placement.
Clinical
Under the supervision of the Stroke Consultants, the Specialist/Specialty Registrar
will be expected to participate in duties in Stroke Medicine and other relevant clinical
attachments appropriate to his/her previous experience.
Administration
The Trainee will be expected, when appropriate, to participate in the day to day
running of the department in administrative activities such as organisation of on-call
rotas, organisation of undergraduate training, patient reports and letters. The Trainee
will have the opportunity to develop management skills as required by the College.
Communication
This will include:
Communication with patients and relatives.
Discussion with Consultants regarding clinical problems.
Communication with General Practitioners – this will include telephone discussion of
problems and writing of letters about cases seen in the Department.
Liaison with specialists in other hospitals and with other agencies such as district
nurses, ambulance service, police etc.
4.
EDUCATION
Continuing Education
The trainee will be expected to participate in educational activities on a local and
national basis.
Trainees are expected to further their education through attendance at meetings and
courses held both locally and nationally. Management development is encouraged
and the Trainee will be expected to attend appropriate courses.
Teaching
The Trainee will be expected to take part in departmental teaching of junior staff,
undergraduates, nursing staff etc.
5.
RESEARCH AND AUDIT
Research
There is a strong tradition of research in the West of Scotland. Facilities and support
for research activities are available through the University Divisions of Medicine &
Clinical Neurosciences and within hospital departments. The trainee will be
encouraged to participate in clinical research and time will be allocated consistent
with current Terms & Conditions.
Audit
Audit is an essential component of Stroke Medicine practice and the Trainee will be
required to participate in local and national audit activities.
6.
LOCATION OF DUTIES
The programme will be based in the Stroke Services of the Western
Infirmary/Gartnavel general Hospital, Glasgow Royal Infirmary and South Glasgow
Hospitals. Rotation amongst up to 3 of the services is expected - within these,
concurrent training on two sites where these form part of a single service is
envisaged to provide an appropriate balance of the components of stroke training
(acute, prevention and rehabilitation) whilst maintaining continuity. Trainees to date
have spent 8 months of the twelve in units with a high throughput of acute stroke
thrombolysis cases, with an on call commitment in the remaining time, and training in
this aspect is a particular strength of the Glasgow stroke programme. Attachments of
suitable duration can be made to units for Neurology, Cardiology, Coronary and
Intensive Care. The training programme will however be individually tailored to
complement previous experience. The hospitals involved in the training programme
are as follows:
Southern General Hospital (including Institute of Neurological Sciences) & Victoria
Infirmary, Glasgow
Western Infirmary & Gartnavel General Hospital, Glasgow
Royal Infirmary & Lightburn Hospital, Glasgow
Stobhill General Hospital, Glasgow
Secondments to other units or departments as appropriate for training.
7.
ASSESSMENT
The Trainee will be continuously assessed by the trainers in their place of work with
formal interviews each 6 months and annual review by West of Scotland Specialty
Training Committee and by the SSAC in Stroke Medicine.
If, in the opinion of the Training and Assessment Committee, the Trainee fails to show
adequate commitment or progress, career guidance will be arranged, and
exceptionally, in the absence of satisfactory progress, the committee may
recommend that the contract be terminated.
Trainees are required to keep a logbook following the requirements laid down by the
SSAC for Stroke Medicine. These are currently under review.
8.
GENERAL INFORMATION
Hours and Salary
The salary scale currently applicable is appended under general information. The
standard hours of duty will remain 40 hours per week and in addition a supplement
will be paid for any out of hours duties.
Please note that the hospitals are continually monitoring rotas therefore, the current
banding will be subject to change and an offer of Employment may not reflect the
current banding. Please also note that at the time of this post going to advert there is
no guarantee that banding will be available.
Further Information
For further information on the training programme please contact:
Professor Kennedy R Lees
Department of Medicine & Therapeutics
Western Infirmary
44 Church Street
Glasgow, G11 6NT Tel: 0141 211 2176 or 2780, Email: k.r.lees@clinmed.gla.ac.uk
APPENDIX
WEST GLASGOW STROKE SERVICE
Western Infirmary & Gartavel General Hospital
The acute stroke unit at the Western Infirmary has 14 dedicated stroke beds plus one
thrombolysis/research bed. It can also expand into adjacent general medical beds. The unit
is staffed by a team of experienced stroke nurses with consultant medical cover from 6 stroke
physicians in weekly rotation. There is junior and middle grade medical staff support on
secondment from the general medical teams. There is a daily consultant-led ward round (7
days) and 24/7 consultant cover. The unit offers an acute thrombolysis service 24/7 for its
own catchment population of 225,000 and for any patients referred from adjacent north
Glasgow areas or hospitals, following the local referral policy. Imaging facilities include an
internal carotid Doppler and TCD service (training available) plus CT, MRI and MRA via the
general radiology department, with research imaging facilities available through the NHS R&D
department. Cardiological investigation is provided by the nearby specialist department.
Consultant stroke physicians run 5 cerebrovascular clinics over 3-4 days across which 12-20
new and 16-24 return patients are seen. There is also a consultant stroke psychologist. The
stroke trainee assesses new patients within the ward at a further weekly clinic. A daily stroke
clinic service is in planning stages. There are dedicated hypertension, lipid, epilepsy,
headache, general medical and cardiovascular risk clinics within the same department; and
non-invasive cardiology, coronary care, carotid stenting, vascular and cardiac surgery
services and general intensive care facilities on site to which access can be provided. Cardiac
surgery and invasive cardiology for the city have recently been relocated to a nearby site, the
Golden Jubilee hospital, and the Western Infirmary provides stroke support to these patients.
There is an active stroke research programme including coordination of acute treatment
(thrombolysis, neuroprotection), secondary prevention and mechanistic trials, with developing
interest in rehabilitation research; and outcome assessment, data analysis/trial design and
stroke training leadership. Resources include a database of acute presentation details and
outcome for over 10,000 patients as well as digitally stored brain scans on over 5,000
patients.
Approximately 24 stroke rehabilitation beds are staffed by a consultant geriatrician/stroke
specialist, based in Gartnavel General hospital. There is excellent liaison between the two
units, with a joint interdisciplinary review meeting of all acute cases joined by radiologist,
neurologist, geriatrician and liaison staff; a multidisciplinary stroke meeting on both sites led
by a stroke liaison charge nurse (Western Infirmary) or consultant geriatrician (Gartnavel
hospital); and by a coordinated approach to follow-up with all discharges attending a single
clinic for final review. Regular staff training is linked to the Western MDT meetings. The SpR
takes a lead role in providing medical input to the MDT meetings.
Training based in the Western/Gartnavel service involves concurrent exposure to acute,
prevention and rehabilitation aspects, with 10-20% of the week based in Gartnavel and 8090% in the Western Infirmary, and with on call commitments for acute stroke at the Western
Infirmary.
SOUTH GLASGOW STROKE SERVICE
Southern General Hospital & Victoria Infirmary
An integrated acute and rehabilitation service is provided by 4 DME Consultants and 3
Neurologists for all suspected stroke admissions referred by general practitioners or A&E
departments of the Victoria and Southern General Hospital. They are admitted to one of 4
high dependency beds in ward 67 in the Institute of Neurological Sciences or to the acute
stroke beds in ward 56 in the Langlands Building, which is adjacent to the INS. The acute
Unit provides a thrombolysis service for South Glasgow. Those likely to recover rapidly
normally remain in Ward 56 and are discharged from there, utilising support of a rapid
discharge rehabilitation team (Stroke DART). Those requiring more prolonged rehabilitation
and who are in the geographical area of the South remain in Ward 56, those from the Victoria
catchment area are moved to the Stroke Rehabilitation Unit of the Mansionhouse Unit,
Victoria Infirmary. Post-discharge rehabilitation is also available via a Day Hospital based on
each site, and Specialist Stroke Liaison Nurse are available to both sites.
The Stroke Consultants are available on a daily basis to assess referrals of suspected strokes
admitted to other beds in both Victoria Infirmary and Southern General Hospital.
Each week, 2 fast-track one-stop clinics for suspected TIAs are available on the Victoria site
with a weekly follow-up cerebrovascular clinic. There is a further weekly fast-track one-stop
TIA clinic at SGH based in the Institute of Neurological Sciences, and a follow-up
cerebrovascular clinic in the Day Hospital.
In addition this post offers opportunities for wider training. The INS is the regional
Neurosciences centre for the West of Scotland, a catchment population of approximately 2.5
million. It has departments of Neurology, Neurosurgery, Neuroradiology, Neuropathology,
Clinical Neurophsyiology, and Neuroanaesthesia. Regional referrals with stroke and related
cerebrovascular pathologies are routinely admitted through the INS, most under the
supervision of three consultants with cerebrovascular interests. There is also a regional
Neurovascular clinic, and an acute interventional Neuroradiology service including intraarterial thrombolysis in appropriate cases. There are regional or national referral clinics for
intracranial vascular malformations, CADASIL, and other rare cerebrovascular diseases.
Comprehensive neuroimaging facilities include spiral CT, MRI (1.5T and 3T), SPECT, TCD,
and angiography.
The Division of Clinical Neurosciences is based at the INS, and includes clinical and
laboratory research facilities.
The Glasgow Young Physical Disability Rehabilitation Unit is based at the Southern General
Hospital with in-patient beds and spasticity clinics and the regional wheelchair service,
Wesmarc are also based at the Southern General Hospital.
NORTH GLASGOW STROKE SERVICE
Royal Infirmary & Stobhill Hospital
The stroke service in GRI and Stobhill serves the North and East side of the city providing a
comprehensive service operating under a single team of consultants. The service comprises
two acute (comprehensive) stroke units, rehabilitation stroke unit, stroke clinics, supported
discharge service and day hospital. The acute stroke units at Glasgow Royal Infirmary have
19 female beds and 19 male beds and aim to accept all patients with probable new stroke.
Patients are often admitted via the Acute Medical Admissions Unit with selected direct
admission in the near future. The Unit emphasises comprehensive stroke unit care; a
combination of good acute medical care, early mobilisation and multi-disciplinary team
working. Imaging facilities include CT scanning, MRI (including DWI) scanning, MRA and
carotid Doppler ultrasound. There are 5 consultants who operate in rotation. Middle grade
staffing is provided through the geriatric medicine rotation (at SpR and SHO level). There is a
consultant-led ward round four times per week with middle grade ward rounds on the
remaining days. A multi-disciplinary meeting takes place every week day morning with a
formal (consultant-led) meeting once per week. There is a weekly CT Scan meeting and
regular departmental in-service activities.
There are 5 stroke clinics per week between GRI and Stobhill at which 5-15 new patients and
10-20 returns are seen. The clinic includes input from clinical psychology staff (with whom
attachments can be arranged). There are also weekly nurse-led clinics for risk factor
management.
The acute stroke unit is supported by a 30-bed rehabilitation unit at Stobhill Hospital which is
run by two of the consultant staff and specialises in multi-disciplinary rehabilitation. There are
2 consultant-led ward rounds each week each with a multidisciplinary team meeting. The
Rehabilitation Unit has specialist input from physiotherapy, occupational therapy and speech
and language therapy along with dietician input as required. Patients are discharged from the
unit with rehabilitation follow-up either at the Day Hospital or by the stroke Supported
Discharge Team.
The stroke supported discharge service is for patients who require support and ongoing
rehabilitation at home. It is provided by the multidisciplinary IRIS team with medical liaison on
a weekly basis.
Trainees will have the opportunity to participate at various stages in the stroke care pathway
plus a range of multidisciplinary research and audit activities hosted in the department.
During attachment to the Royal Infirmary and Stobhill Hospital, on call for training purposes
takes place at the Western Infirmary, allowing continuity for patients transferred between
these two services.