OXFORD DEANERY SPECIALTY TRAINING PROGRAMME IN

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OXFORD DEANERY SPECIALTY TRAINING PROGRAMME IN
INTENSIVE CARE MEDICINE
About Oxford Deanery
The Oxford Deanery covers the counties of Oxfordshire, Berkshire and Buckinghamshire,
with Banbury and Milton Keynes in the North, to Reading and Slough in Berkshire and
High Wycombe and Aylesbury in the West.
The Oxford Deanery is part of NHS South of England which comprises South Central,
South West and South East Coast Strategic Health Authorities. The Oxford Deanery is
responsible for the training of some 1500 trainees.
The Oxford Deanery is a relatively small deanery with a defined geographical area which
serves as a single unit of application. In the majority of cases successful candidates will be
asked to preference their choice of location for either one or two years. Some programmes
will require successful candidates to indicate a location and specialty. Future placements
will usually be based on individual training and educational needs. Please note that
applications are to the Oxford Deanery as a whole. This may mean that you may be
allocated to any geographic location within the Oxford Deanery depending on
training needs. Currently hospitals involved in the ICM programme are The Oxford
hospitals group and the Royal Berkshire Hospital in Reading.
The Intensive Care Medicine Training Programme
The Intensive Care Medicine training programme is a five year programme, starting at
ST3. During this time, the trainee's work will be monitored for satisfactory progress and
subject to annual reviews in the form of ARCPs. Progression on the programme will be
dependent upon these reviews.
The posts on this rotation have been approved for Specialist Training by the Faculty for
Intensive Care Medicine. The posts attract National Training Numbers and provide training
towards a Certificate of Completion of Training. The Postgraduate Dean has confirmed
that this post has the necessary educational and staffing approvals.
The programme is based currently at the Oxford University Hospitals Trust and the Royal
Berkshire hospital Trust. The other Trusts in the deanery are listed below and with time the
programme may expand to these other hospitals. Trainees may find themselves employed
by any of the following Trusts and placed in any of the following hospitals. Specialist
training such as ECMO or liver may occur at other hospitals if this is deemed necessary.
Trust
Oxford University
Hospitals Trust
Hospitals and Locations
Adult Intensive Care Unit, John Radcliffe Hospital,
Oxford http://www.ouh.nhs.uk/
Adult Intensive Care Unit, Churchill Hospital, Oxford
http://www.ouh.nhs.uk/
Neurosciences Critical Care Unit, Oxford Radcliffe
Hospitals, Oxford http://www.ouh.nhs.uk/
Cardiothoracic Critical Care Unit, Oxford Radcliffe
Hospitals, Oxford http://www.ouh.nhs.uk/
Paediatric Critical Care Unit, Oxford Radcliffe Hospitals,
Oxford http://www.sort.nhs.uk/home.aspx
Milton Keynes Hospital
Trust
Heatherwood and
Wexham Park Hospitals
Trust
Milton Keynes Hospital, Milton Keynes
Royal Berkshire Hospital
Trust
Royal Berkshire Hospital, Reading
Buckingham Hospitals
Trust
Wycombe General Hospital, High Wycombe
http://www.mkgeneral.nhs.uk/
Wexham Park Hospital, Slough
http://www.heatherwoodandwexham.nhs.uk/location/wexhampark-hospital-slough
http://www.royalberkshire.nhs.uk/
http://www.buckshealthcare.nhs.uk/
Stoke Mandeville Hospital
http://www.buckshealthcare.nhs.uk/
Rotation Information
The expected rotation arrangements for this programme are:
ST3
12 months in the two Adult Intensive Care Units in the teaching hospital (Oxford University
Hospitals Trust). It is during this time that we would expect you to complete your Stage 1
competencies. In Oxford all trainees will be FICE trained in this year, a unique opportunity
to develop early echo skills.
ST4
12 months in acute medicine/anaesthesia training as required. It is likely that this will be in
one of the district general hospitals in view of the case mix and clinical support experience
available.
ST5
Four months each in regional specialist ICUs (Neurosciences, Cardio-thoracic and
Paediatric ICU at the John Radcliffe Hospital. The PICU may involve time at Southampton
PICU too).
ST6
12 months ICM with special skill training. The likely available options would be
echocardiography training or simulation / medical education training. Please see below for
further details. It is during this Stage 2 training that the final FFICM must be taken.
Teaching will be adapted to ensure high exam success rates. With the previous ICM DICM
pass rates were > 95%.
ST7
12 months advanced ICM training in the Adult Intensive Care Units (Oxford University
Hospitals Trust), with up to 6 months in another General Adult ICU in the region. This will
compete Stage 3 training and ensure you are able to function as a consultant Intensivist.
Rotations may at times change in response to clinical need from the Trusts and training
requirements.
Training Centre Information
Adult Intensive Care Unit (AICU) and Churchill Intensive Care Unit (CICU)
These two general Intensive Care Units admit over 1000 patients per year. The majority of
patients are level 3. Approximately 20% of admissions are elective surgical patients and
the remainder critically ill emergency patients with a wide range of medical and surgical
pathologies. Oxford is the tertiary referral centre for major trauma, spinal, interventional
cardiology, oesophageal, vascular, major maxillo-facial surgery, interventional radiology,
haematological malignancy and transplantation (including bowel and pancreas). This is
reflected in the pathology of patients on the AICU/CICU. The Standardised Mortality Ratio
is significantly below the national average.
A full range of invasive monitoring and all major forms of organ support are employed. The
majority of patients require multi-organ support and invasive monitoring. Trainees can
expect to gain experience of oesophageal Doppler monitoring, thrombo-elastography,
renal replacement techniques, echocardiography, bronchoscopy, ultrasound, invasive and
non-invasive ventilation as well as more basic procedures such as line placement and
resuscitation.
The units are medically staffed in multiple groups: three groups of trainees (from both an
anaesthetic and non-anaesthetic background) and the consultant tier. The presence of
trainees from a variety of backgrounds provides a fantastic training environment and so
represents a rare opportunity given the UK system of early specialisation. It is particularly
useful for those trainees doing professional exams and helps our high success rate in the
FRCA final/DICM and EDIC.
The twelve consultants cover each unit separately on a split week system. The consultants
come from a background in anaesthesia, medicine, military services and research. There
is local expertise in clinical trials research, bench research, sepsis and genomics,
ventilation, difficult airways, teacher training, simulation, international transfer, primary
trauma in developing countries, resuscitation, follow up, ultrasound and echocardiography.
The unit has an active teaching programme. This includes protected teaching, weekly unit
meetings, daily microbiology rounds and various yearly meetings. The senior trainees
have an active exam orientated program in addition to one half-day per month of protected
teaching. This contributes to the high success rate in the Diploma.
There is a very strong trainee drive for training in the Oxford region. There are monthly
OXDAT meetings www.oxdat.co.uk which is a forum to advance ideas and ensure high
standards of training in all hospitals within the rotation.
The Neurosciences Intensive Care Unit
The Oxford Neuroscience Unit is one of the busiest regional neurosurgical units in the
country with an international reputation for the quality of its services. It is involved in many
aspects of pioneering work including functional neurosurgery and radiological
interventional techniques. The busy unit will provide trainees with unrivalled exposure to all
aspects of neurosurgical work. The Oxford Neurosciences Unit moved to a new purposebuilt modern facility in the West Wing of the John Radcliffe Hospital in January 2007.
The Neurosciences Intensive Care Unit provides level 2 and level 3 specialist critical care
to both neurosurgical and neurological patients from the region. The Unit currently
contains 11 level 3 critical care beds, with planned expansion over the next few years to a
17 bed unit. Training is provided in the management of the full range of neurosurgical and
neurological pathologies, with particular emphasis on the management of traumatic brain
injury and subarachnoid haemorrhage.
Cardiothoracic Critical Care Unit
The John Radcliffe Hospital is a tertiary referral centre for cardiac and thoracic disease.
The Cardiothoracic Critical Care (CTCC) is an 11 bedded unit supporting an annual
caseload of approximately 950 adult cardiac cases of which 65% represent patients
undergoing coronary bypass grafting, 20% valve repair or replacement and 15% combined
or complex procedures. About 100-200 thoracic cases are performed each year. There is
local expertise and training in trans-oesophageal echocardiography. In addition there is
close work with the interventional cardiac laboratory where a 24 hour PCI is run.
The Paediatric Intensive Care Unit
The tertiary Paediatric Intensive care Unit serves the Oxfordshire population and supports
a wide range of both surgical and medical paediatric specialties in all the Oxford hospitals.
Elective surgical specialties include general and urological surgery, orthopaedics,
craniofacial, plastics, neurosurgery, ENT, dental and ophthalmology whilst the medical
specialities include oncology, radiology (including MRI), radiotherapy, gastroenterology
and cardiology. There were 350 admission last year and the unit has been merged with
Southampton to form the SORT service and critical services for South Central.
www.sort.nhs.uk Southampton admit about 1000 cases per year and manage the regional
transport service. The biggest part of PICU is probably the stabilisation of the sick child in
a DGH who then get’s retrieved. There is scope to obtain training in retrieval of these
children.
The Royal Berkshire Hospital Intensive Care Unit
This ICU has 11 beds and there is an 8 bedded HDU opening in April 2013. Currently
there are 750 admissions per year but this will increased to 1200 with the surgical HDU.
The 8 consultants work a weekly rota incorporating a second consultant for extra
supervision and teaching. There are 2 advanced/senior ICM trainees doing a traditional
oncall rota and 8 trainees on a 1 in 8 full shift rota. There is a weekly journal club and
radiology sessions which are particularly well evaluated. The unit has a progressive
approach to educational supervision. The unit is fully computerised with the Philips clinical
information system.
In addition to standard pathologies, patients are treated after major urological, vascular
and oesophageal surgery and spinal trauma. Level two paediatric patients are also
supported.
Trainees can expect exposure to a variety of advanced monitoring and therapeutic
procedures. Examples include percutaneous tracheostomy (100 per year), ultrasound,
ODM, echocardiography, bronchoscopy, PICCO and intracranial pressure monitoring
(inserted by the ICU staff). Audit and research are encouraged and supported by a
powerful clinical information system, research nurses and a data manager. The research
team are the leading recruiters to many national trials.
Reading also has expertise beyond the traditional boundaries of Intensive Care. The
follow-up clinic is the second oldest in the UK and there is a 24/7 outreach service which
sees 8000 patients per year. A centrally funded bereavement expert co-ordinates relative
follow-up, organ donation and staff pastoral care.
Buckinghamshire Intensive Care Units
These 2 expanding ICUs have 16-20 beds with input from 15 consultants. In addition to
the usual DGH specialties, the unit is the regional centre for acute spinal injury and major
burns. This provides exposure to these highly specialised areas of the Intensive Care
syllabus including free flap reconstructive surgery, weaning and rehabilitation of acute
spinal injury and burns patients. In addition to routine procedures, percutaneous
tracheostomy and Doppler flow monitoring are performed on the ICU.
Wexham Park Intensive Care Unit
This unit has recently been rebuilt into a state of the art general ICU with 12 level 2 and
level 3 beds. Nine consultants contribute to dedicated 24 hour cover and lead three ward
rounds per day. The midday round is actively supported by specialist pathology /
microbiology, pharmacy, clinical biochemistry and respective surgical specialties. There is
a very busy outreach service which provides trainees an insight into flagging up potential
ICU admissions and their management in the wards. An ICU follow up clinic is well
established. Research & audit is greatly encouraged and actively taken up by most
trainees. A weekly formal teaching programme is conducted within the department and all
trainees have a protected half day for this activity.
Practical procedures training is provided in routine ICU procedures such as lines,
haemofiltration etc. Specialist procedures include percutaneous tracheostomy (about
50/yr), intra-cranial pressure transducer placement & monitoring, oesophageal Doppler
and PiCCO cardiac output monitoring.
Milton Keynes Intensive Care Unit
This unit runs flexibly up to a maximum of nine level 2/3 patients. There is dedicated
daytime consultant sessional commitment.
Specialist procedures performed routinely on the unit include percutaneous tracheostomy
(about 50/yr), oesophageal Doppler cardiac output monitoring, Bi-Spectral Index
monitoring and fibre-optic guided airway training.
Training information
The Oxford region has a strong tradition of training excellent which was reflected in the
2011 GMC training survey ranking of the program as the highest in the country for overall
satisfaction. All joint CCT trainees have secured consultant post in ICM at the end of their
training and the DICM pass rate is over 95%. The training environment is continually
monitored using the PHEEM questionnaire and all training centres offer active teaching
programs and host regional meetings.
The programme offers an outstanding range of training opportunities. In addition to
attachments to standard specialist units the region has a tradition of offering extra short
attachments to related specialities. Popular attachments have included microbiology,
radiology and hepato-biliary ICM and there is currently a fully funded travel bursary to
Hong Kong awarded yearly to an Intensive Care trainee in the region.
The ST6 year represents a particularly interesting opportunity for the ICM trainee to
develop expertise in an area related to Intensive Care. At this early stage of curriculum
development the intention is to adapt 2 existing and successful ICM posts in the region
that currently offer Echocardiography and Simulation training.
The echocardiography training post combines ICM-specific trans-thoracic
echocardiography with further advanced ICM experience. The post provides
comprehensive training from both ICM and cardiology trainers, taking the novice up to
British Society of Echocardiography standard. The successful program has run for several
years and a report was published recently (JICS 11:1 2010). The fellowship represents an
opportunity to develop a sought-after clinical skill with applications in any ICU.
The medical education post offers a subsidiary interest in Simulation training. The training
rota includes protected time for work with OxStar, the state of the art “Simulation Centre”
based at the John Radcliffe Hospital. The successful candidate develops expertise in
simulation, leads simulation training on the Intensive Care units, undertakes a higher level
formal teaching qualification and can take up research opportunities as offered by the
OxStar centre. The post has the potential to provide a thorough grounding for a trainee
with an interest in teaching and training.
Duties of Post
The appointee will be responsible for the day-to-day running of the unit, including the
management of individual patients, management of bed availability, and supervision of
junior staff. Further responsibilities are rotated between trainees:
Significant self directed study is expected.
An appointee will be responsible for organising and running the regular teaching sessions.
This will include arranging speakers, and ensuring the programme is advertised in a timely
fashion.
The appointee will be expected to undertake some work with a view to producing
published results. As an alternative to a research/review project the appointee may wish
to consider undertaking an audit, retrospective or prospective, of patients on the Intensive
Care Unit. It is expected that the audit will be of a sufficient standard to be published or
presented at national meetings.
There is an expectation the appointee will assist with any contract research undertaken on
the Intensive Care Units.
It is expected the appointee will attend at least one national meeting on Intensive Care
during their appointment. This will be funded in the usual way from the study leave budget.
The appointee will assist in teaching of the more junior trainees and medical students on
attachment to the Intensive Care Unit.
The appointee will be expected to attend, as an observer, some of the management
meetings of the Critical Care Centre and Intensive Care Unit and take an active role in the
practical running and development of the unit. This may include managing the junior and
senior trainee rota.
The appointee will be expected to complete Competency Based Assessment
documentation as outlined by the GMC/FICM.
There is a full shift resident commitment with internal leave cover.
The progress of the appointee will be continually monitored by the Consultant staff. This
will include regular appraisal. The appointee will also receive regular assessment covering
skill, knowledge and attitudes and any other relevant areas.
The appointee will work towards sitting a higher exam(s) in Intensive Care in the course of
training.
Main Conditions of Service
Appointments to this programme are subject to the Terms and Conditions of Service (TCS)
for Hospital Medical and Dental Staff (England and Wales). In addition appointments are
subject to:
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
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Applicants having the right to work and be a doctor or dentist in training in the UK
Registration with the General Medical Council
Pre-employment checks carried out by the Trust HR department in line with the
NHS employment check standards, including CRB checks and occupational health
clearance.
The employing Trust’s offer of employment is expected to be on the following nationally
agreed terms:
Hours – The working hours for junior doctors in training are now 48-hours (or 52-hours if
working on a derogated rota) averaged over 26 weeks (six months). Doctors in training
also have an individual right to opt-out if they choose to do so, but they cannot opt-out of
rest break or leave requirements. However, the contracts for doctors in training make clear
that overall hours must not exceed 56 hours in a week (New Deal Contract
requirements) across all their employments and any locum work they do.
http://www.nhsemployers.org/PlanningYourWorkforce/MedicalWorkforce/EWTD/Pag
es/EWTD.aspx
Pay – you should be paid monthly at the rates set out in the national terms and conditions
of service for hospital medical and dental staff and doctors in public health medicine and
the community health service (England and Wales), “the TCS”, as amended from time to
time. The payscales are reviewed annually. Current rates of pay may be viewed at
http://www.nhsemployers.org/PayAndContracts/Pay%20circulars/Pages/PayCircularsMedi
calandDental.aspx Part time posts will be paid pro-rata
Pay supplement –depending upon the working pattern and hours of duty you are
contracted to undertake by the employer you should be paid a monthly additional pay
supplement at the rates set out in paragraph 22 of the TCS. The current payscales may
be viewed at
http://www.nhsemployers.org/PayAndContracts/Pay%20circulars/Pages/PayCircularsMedi
calandDental.aspx . The pay supplement is not reckonable for NHS pension purposes.
The pay supplement will be determined by the employer and should be made clear in their
offer of employment and subject to monitoring.
Pension – you will be entitled to join or continue as a member of the NHS Pension
Scheme, subject to its terms and rules, which may be amended from time to time. If you
leave the programme for out of programme experience you may have a gap in your
pension contributions. More information can be found at
http://www.nhsbsa.nhs.uk/pensions
Annual Leave – your entitlement to annual leave will be five or six weeks per annum
depending on your previous service/incremental point, as set out in paragraphs 205-206 of
the TCS. The TCS may be viewed at
http://www.nhsemployers.org/PAYANDCONTRACTS/JUNIORDOCTORSDENTISTSGPR
EG/Pages/DoctorsInTraining-JuniorDoctorsTermsAndConditions150908.aspx
Sick pay – entitlements are outlined in paragraph 225 of the TCS.
Notice –you will be required to give your employer and entitled to receive from them notice
in accordance with paragraphs 195-196 of the TCS.
Study Leave –the employer is expected to offer study leave in accordance with
paragraphs 250-254 of the TCS. Local policy and procedure will be explained at induction.
Travel Expenses – the employer is expected to offer travel expenses in accordance with
paragraphs 277-308 of the TCS for journeys incurred in performing your duties. Local
policy and procedure should be explained at induction.
Subsistence expenses – the employer is expected to offer subsistence expenses in
accordance with paragraph 311 of the TCS. Local policy and procedure should be
explained at induction.
Relocation expenses – the employer will have a local policy for relocation expenses
based on paragraphs 314 – 315 of the TCS and national guidance at
http://www.nhsemployers.org/PAYANDCONTRACTS/JUNIORDOCTORSDENTISTSGPR
EG/Pages/DoctorsInTraining-JuniorDoctorsTermsAndConditions150908.aspx. You are
advised to check eligibility and confirm any entitlement with the employer before incurring
any expenditure.
Pre-employment checks – all NHS employers are required to undertake pre-employment
checks. The employer will confirm their local arrangements, which are expected to be in
line with national guidance at
http://www.nhsemployers.org/RecruitmentAndRetention/Employmentchecks/Pages/Employment-checks.aspx
Professional registration – it will be a requirement of employment that you have
professional registration with the GMC/GDC for the duration of your employment. Though
the post is covered by NHS Indemnity, you are strongly advised to register with the MPS
for professional indemnity.
Health and Safety – all employers have a duty to protect their workers from harm. You
should be advised by the employer of local policies and procedures intended to protect
your health and safety and expected to comply with these.
Disciplinary and grievance procedures – the employer will have local policies and
procedures for dealing with any disciplinary concerns or grievances you may have. They
should advise you how to access these, not later than eight weeks after commencement of
employment.
Educational Supervisor – the employer or a nominated deputy (usually the Director of
Medical Education) will confirm your supervisor on commencement.
General information on the Deanery’s management of Specialty Training programmes,
including issues such as taking time out of programme and dealing with concerns or
complaints, is available at www.oxforddeanery.nhs.uk and in the national ‘Gold guide’ to
Specialty Training at http://www.mmc.nhs.uk Please ensure that you inform Oxford
Deanery of any changes to your contact details.
December 2012