Job description for Specialist Training
Respiratory Medicine, Oxford Region.
The Specialist Training Programme for Respiratory Medicine is a five year post
providing training in general and respiratory medicine leading to accreditation and a
CCT in both specialities. Training is centred on eight hospitals in the Oxford deanery.
The hospitals involved are
 Churchill (Oxford. The Oxford Centre for Respiratory Medicine; Regional Unit)
 John Radcliffe (Oxford. Respiratory and GIM)
 Heatherwood and Wexham Park Hospitals (Ascot and Slough. Respiratory and GIM)
 Horton (Banbury. Respiratory and GIM)
 Milton Keynes (Respiratory and GIM)
 Royal Berkshire Hospital (Reading. Respiratory and GIM)
 Stoke Mandeville (Respiratory and GIM)
 Wycombe (Respiratory and GIM)
There are currently 18 Specialist Registrars in the Oxford Region. Training in respiratory
and general internal medicine in Oxford region is based on broad practical experience
with appropriate training. In addition there are regular regional meetings and audit,
research, journal clubs and grand round teaching, within each centre. Specialist grade
teaching is held weekly in Oxford. Study leave to attend national and international
meetings is encouraged. Within the region there is special expertise and training in:
Respiratory physiology
Epidemiology
Sleep disorders
Lung immunology and interstitial lung disease
Pleural disease
Thoracoscopy
Clinical trials
Lung infection
Lung cancer, respiratory oncology and interventional bronchoscopy
COPD
Cystic fibrosis
The rotations also include modular training in line with the curriculum for respiratory
medicine developed by the Royal College of Physicians. There are opportunities for
research and a number of trainees have progressed to complete higher degrees.
Chairman and Programme Director Of The Specialist Training Committee
Dr Chris Davies
Consultant Physician
Department of Respiratory Medicine
Royal Berkshire Hospital
Reading
RG1 5AN
Tel: 0118 322 8293
Regional Representative and Royal College Of Physicians Representative
Dr Chris G Wathen
Wycombe Hospital
Queen Alexandra Road
High Wycombe
Bucks HP11 2TT
Tel: 01494 425006
Lead Academic
Dr Robert Davies
Consultant Physician
Oxford Centre for Respiratory Diseases
Churchill Hospital
Oxford
OX3 7LT
Tel: 01865 225 230
The Consultants involved are:Oxford Hospitals
Professor John STRADLING
Dr Robert DAVIES
Dr Lesley BENNETT
Dr Malcolm BENSON
Dr Maxine HARDINGE
Dr Mark SLADE
Dr Ling Pei HO
Dr Y C Gary LEE
Horton General Hospital
Dr Rolf SMITH
Heatherwood and Wexham Park
Hospitals
Dr Michael SMITH
Dr Lorraine HART
Dr John WIGGINS
Dr Richard RUSSELL
Milton Keynes
Dr Stewart FISHER
Royal Berkshire Hospital
Dr Chris DAVIES
Dr Andrew ZUREK
Dr Anne MCGOWN
Dr Grace ROBINSON
Stoke Mandeville and Wycombe
Hospitals
Dr Chris WATHEN
Dr David TAYLOR
Dr Anjani PRASAD
Dr Mitra SHAHIDI
Dr Charlotte CAMPBELL
PERSON SPECIFICATIONS FOR ENTRY INTO THE PROGRAMME
More information is available on the MMC website (www.mmc.nhs.uk)
Section A: Oxford Centre for Respiratory Medicine,
Churchill Hospital Site, Oxford Radcliffe Hospital
The Oxford Centre for Respiratory Medicine (OCRM) is the base for the specialist respiratory
medicine in the Oxford Specialist Registrar Training Rotation. OCRM is a Regional Specialist
Respiratory Unit and is part of the Oxford Radcliffe Hospital Trust and academically part of the
Nuffield Dept of Medicine, Oxford University. There are four clinical trainees at the OCRM at any
one time. In order to preserve clarity, these four posts are described as if they were separate for
the purposes of this document. However, the posts are actually combined in practice, such that
a trainee will experience elements of each post during a twelve month period serving on the
Unit. This process is pursued flexibly to the mutual advantage of the trainee and the unit.
Infrastructure
The Oxford Centre for Respiratory Medicine has the following infrastructure.
1. 20 in-patient beds situated on Geoffrey Harris ward at the Churchill Hospital,
2. A dedicated out-patient unit consisting of a suite of 7 rooms including consultation and
treatment rooms.
3. A bronchoscopy/thoracoscopy unit running two bronchoscopy lists and one interventional
pleural list per week. The unit is equipped with modern video bronchoscopes,
thoracoscopes, the necessary facilities for biopsy cytology, trans-bronchial biopsy, transbronchial needle aspiration, airway stenting, electrocautery, cryotherapy, thoracoscopic
pleural biopsy, talc pleurodesis, autofluorescence thoracoscopy, indwelling pleural
catheter management etc. Screening facilities are available through the modern imaging
fluoroscope in the Regional Radiology Unit.
4. A respiratory sleep unit including 4 dedicated sleep laboratories equipped to RCP
recommended standards.
5. A respiratory high dependency unit with facilities for non-invasive ventilation.
6. A lung function laboratory equipped to British Thoracic Society recommended standards.
This has the facilities for dynamic ling volumes, gas transfer estimation, oesophageal and
trans-diaphragmatic pressure monitoring, body plethysmography, pharyngeal acoustic
reflectance and exercise training.
7. A clinical research unit with facilities for ambulatory and beat to beat non-invasive blood
pressure measurement, ambulatory 24 hour ECG monitoring, autonomic tone
assessment including heart rate variability, and baroreflex testing, the objective
quantification of excessive sleepiness respiratory pattern monitoring etc.
8. An MRC Clinical Trials Unit linked respiratory clinical trials unit running both single centre
and multi-centre clinical trials.
9. A pulmonary rehabilitation unit allied to the lung function laboratory and including
exercise testing/training equipment.
10. The regional thoracic imaging service which includes on site helical CT scanning, MR
scanning, radionuclide imaging including lung ventilation/perfusion, isotope bone
scanning and inhaled DTPA measurement and ultrasound imaging. This service provides
a full portfolio of image guided biopsy of the lung, mediastinum and pleura. The regional
PET/CT service is provided via a mobile scanner two days per week, pending the
completion of dedicated facilities in the new regional cancer centre, opening 2008.
11. Thoracic surgery is provided at Harefield Hospital and is supported by the regional
cardiothoracic surgical unit based on the adjacent John Radcliffe site.
12. The regional medical and clinical oncology units are on the Churchill Hospital site, and
from 2008 will be located in the state-of-the-art regional cancer centre.
13. There are close links with the regional infectious diseases/HIV service that has its inpatient service supplied through John Warin ward and to which the respiratory trainees
have on call commitments.
Staff
The Oxford Centre for Respiratory Medicine is staffed as follows
Senior Medical Staff
Dr. Malcolm Benson, Senior Physician with extensive in-patient and out patient general
respiratory practice. Sub speciality interest: Cystic Fibrosis and Medical Ethics.
Professor John Stradling, Professor of Respiratory Medicine. Director of the Respiratory Sleep
Unit and a general respiratory practice. Sub-specialty interest in sleep medicine
Dr. Robert Davies, Reader and Consultant Physician. Director of the Pleural Disease Unit and
lead for research. Lead clinician for pleural diseases plus a general respiratory and sleep
medicine practice.
Dr. Mark Slade. Consultant Physician. Lead clinician for Lung Cancer, with a special interest in
interventional bronchoscopy and a broad practice in general and respiratory medicine.
Dr. Lesley Bennett. Clinical Director, Director of the Adult Cystic Fibrosis Centre and a broad
practice in general and respiratory medicine.
Dr Maxine Hardinge. Consultant physician with particular interests in COPD and respiratory
sleep and lead for pulmonary rehabilitation.
Dr. Y C Gary Lee. Consultant Physician and Senior Lecturer. Wellcome Advanced Fellow and
Consultant. Dr. Lee has a laboratory and clinical research interest in basic pleural disease
science and contributes to the clinical pleural service plus a general respiratory practice.
Dr Ling-Pei Ho, MRC-DH Clinician Scientist and Honorary Consultant. Dr Ho has a research
and clinical interest in sarcoidosis and diffuse lung disease.
Dr. Ann Thompson. Director of the Paediatric Cystic Fibrosis Centre. Dr. Thompson is based in
the John Radcliffe Hospital and works closely with Dr. Bennett and Dr. Benson in liaison over
cystic fibrosis care (including combined adolescent clinics etc.)
Dr. Fergus Gleeson. Consultant Radiologist. Director of the Regional Thoracic Imaging Service.
Dr Rachel Benamore, Consultant Radiologist
Specialist Registrars and Senior House Officers
OCRM has two Clinical Lecturers (specialist registrar grade).
OCRM has four full time clinical registrars on the Churchill site (see timetables below) which
comprise the posts included in the current training scheme.
They are currently four full time research fellows studying laboratory or clinical doctoral projects.
Three full time Senior House Officers.
Respiratory Sleep Disorders
One respiratory sleep clinic sister/co-coordinator. One clinical sister. Two specialist nurses, one
health care assistant and one technical engineer.
Pleural Disease
One dedicated specialist nurse (and a close liaison with the lung cancer specialist nurse service)
Cystic Fibrosis
Two cystic fibrosis specialist nurses, two specialist cystic fibrosis senior physiotherapists, one
dietician and one clinical psychologist.
Pulmonary Rehabilitation
One senior occupational therapist, one senior physiotherapist, two occupational therapy
assistants.
Bronchoscopy
Two part time nurses and one part time health care assistant.
Lung cancer
Two lung cancer nurse specialists
Clinical Research Unit/Respiratory Trials Unit/Lung function laboratory
One clinical trials administrator, four research nurses, two lung function technicians
Other Senior Nurses
One ward sister, one lecturer practioner, two respiratory specialist nurses with a specific role in
early COPD discharge policy.
Workload
General Respiratory Medicine
The Oxford Centre for Respiratory Medicine provides a service to the population of Oxford and
surroundings (approx. 550,000). The unit managed about 1400 in-patients last year. Two of the
beds are in a dedicated high dependency unit specialising in post intensive care recovery and
non-invasive ventilatory support and NIV is also given via other unit beds. The medical and
specialist respiratory nurse staff provide a consultation service to the other Oxford Hospitals.
The unit runs 23 out-patient clinic sessions per week and handles about 8000 out-patient events
every year. The out-patient new patient to old patient ratio is 1:3. This service provides the
opportunity for a rounded training in specialist respiratory medicine.
Bronchoscopy and Thoracoscopy
The unit performs 6-8 bronchoscopies per week and 6 local anaesthetic thoracoscopy each
month, . Bronchoscopic procedures include standard bronchial lavage, brushing and biopsy for
malignancy and infection, interventional bronchoscopic procedures including electrocautery,
argon plasma coagulation, cryotherapy and tracheobronchial stenting. The Unit is a tertiary
referral centre for pleural diseases and provides an active regional thoracoscopy service,
physician-operated pleural ultrasound and ambulatory indwelling catheter service.
Thoracoscopic intervention includes pleural biopsy, adhesiolysis and talc pleurodesis. Special
patient groups are seen including the immunocompromised (both HIV and therapeutic
immunosupression) and patients with substantial respiratory impairment. Procedure outcomes
(biopsy positivity rate and complications etc) and numbers of procedures are documented.
Trainees are given records of their procedures etc. The unit is acknowledged as a centre of
excellence for training in bronchoscopy and thoracoscopy.
Respiratory Sleep Medicine
The unit sees 1200 new referrals with possible sleep and breathing disorders each year. It has
4000 patients on long term nasal CPAP for sleep apnoea (with 8 more being added each week)
and 90 on nasal ventilation for nocturnal hypoventilation. It performs 1250 sleep studies per year
and patients are seen in 4 clinics a week on two days when there are also dedicated technical
‘equipment clinics’. This service supplies the facilities for respiratory sleep training to the
standards required to run a regional respiratory sleep unit. If trainee numbers are expanded in ,
if the future, sleep module is an opportunity for a dedicated attachment in respiratory sleep
medicine undertaken while in Oxford.
Cystic Fibrosis
The cystic fibrosis (CF) centre is run by three consultants (two in the adult service and one in the
paediatric service). The adult centre is an expanding unit which currently has 65 patients,
increasing to an estimated 80-100 patient over the next five years. The specialist clinics are
multi-disciplinary with input from two consultants, a specialist registrar, CF specialist nurse,
specialist CF physiotherapists, dietician and clinical psychologist. As well as providing the full
range of essential services outlined in the CF Trust Management Guidelines, including annual
reviews and a home care service, our centre provides a wide range of treatment and services
not readily available at local CF clinics e.g. insertion and management of totally implantable
venous access devices, expertise in nasal ventilation and bronchial artery embolisation. In
addition we have liaison within Oxford with specialists with an interest in CF-related gastrointestinal disease, CF-related endocrine conditions and fertility problems. If trainee numbers are
expanded in the future, there is an opportunity for a dedicated attachment in cystic fibrosis.
Bronchiectasis
This service is run by one consultant and specialist nurses based on the treatment centre to coordinate out-patient intra-venous antibiotic treatment. The specialist clinics are multi-disciplinary
with input from one consultant, a specialist registrar, specialist nurse and senior
physiotherapists. The cohort of patients are managed by providing a comprehensive annual
review service including education regarding self-management of condition, with additional
telephone contact support at the time of clinical need.
COPD and Pulmonary Rehabilitation
The department has dedicated COPD clinics with input from specialist nursing team, runs an
early discharge scheme for COPD and is part of a countywide COPD nursing strategy. There is
non-invasive ventilation for acute COPD and experience with long term home ventilation. Liaison
with thoracic surgical centres exists for transplantation and lung volume reduction surgery. The
pulmonary rehabilitation programme was established in 1996 and runs throughout the year. The
programme content complies with the recommendations of the British Thoracic Society
Standards of Care and Committee.
Lung Cancer
The Oxford Centre for Respiratory Medicine is part of the Oxford Regional Lung Cancer Service.
Patients are seen and then discussed in a multi-disciplinary meeting including physicians,
surgeons, medical and clinical oncologists, specialist lung cancer nurses and two thoracic
radiologists. Patient care is co-ordinated through the physician assessment, medical oncology,
radiotherapy, interventional palliation and palliative care services all on the Churchill Hospital
site. Last year these services handled over 300 patients with lung cancer. This range of services
provides the facilities for a complete training in lung cancer management. If trainee numbers are
expanded in the future, there is an opportunity for a dedicated attachment in thoracic oncology
and palliative care.
Respiratory Research
The Oxford Centre for Respiratory Medicine performs "bench to bedside" research, including
genetic and cellular inflammation and lung immunology in disease areas including lung and
pleural infection, pleural malignancy, and diffuse lung disease; translational animal models in
pleural inflammation; and single and multi-centre clinical trials and cohort studies in pleural
disease and respiratory sleep disorders. Research active staff include 1 Professor, 1 Reader, 2
Senior Lecturers, 2 Lecturers, 4 Clinical Research Fellows, and supporting research staff. Major
research themes include;
Respiratory sleep disorders: Prof JR Stradling. Clinical trials (particularly focused on the
vascular complications of sleep apnoea), cohort epidiemiology, new treatment methods, and
interventional physiological studies.
Pleural diseases: Dr RJO Davies. Clinical trials, cohort and interventional physiological
studies in malignant and infective pleural disease.
Sarcoidosis and diffuse lung disease: Dr L-P Ho. A research group based at the MRC
Human Immunology Unit, Weatherall Institute of Molecular Medicine working on immune
regulation in T cell mediated diseases, and the clinical aetio-pathology of sarcoidosis.
Inflammation and fibrosis and lung disease: Dr YCG Lee. Work on cellular and
translational research into inflammation and fibrosis - particularly in the pleural space.
Specialist Registrars usually become involved in research projects during their clinical
attachments and where appropriate, facilities are available for consolidated research periods
leading to a higher degree.
HIV/Infectious Diseases
The Specialist Registrars have on call duties on the regional infectious diseases unit that also
manages the majority of the HIV infections in Oxford. This unit provides the opportunity of
clinical exposure to the full range on infectious diseases. If trainee numbers are expanded in the
future, there is an opportunity for a dedicated attachment in both the clinical and laboratory
aspects of HIV medicine and respiratory microbiology.
Thoracic Imaging
The regional thoracic imaging unit is based at the Churchill Hospital site. It is run by a specialist
thoracic radiologists and includes ‘AMBER’ plain radiographs, ultrasound, fluoroscopy, helical
CT scanning, state-of-art MR and PET/CT scanning, and radionucleide imaging including lung
DTPA clearance. If trainee numbers are expanded in the future, there is an opportunity for a
dedicated attachment in thoracic imaging.
Weekly Specialist Registrar timetable
The Registrars are on call from home 1 in 5 with prospective cover. Admissions are direct from
General Practise as transfers from A&E/General Medicine at the John Radcliffe Hospital.
Respiratory medicine referrals arising from the Churchill/John Radcliffe/Radcliffe Infirmary are
taken by the Registrars and handled with appropriate senior support. Referrals are also seen for
acute medical emergencies arising in any Churchill Hospital in-patient. While on call, the post
includes responsibilities for the in-patient infectious diseases patients on the adjacent John
Warin Ward. The weekly timetables below describe the working week of the two registrars
working in the ward setting at any one time.
Firm A
Monday
Tuesday
Wednesday
Thursday
Friday
8.15am
Meeting with
ward coordinator.
Ward review of
new and HDU
patients
Meeting with
ward coordinator.
Ward review of
new and HDU
patients
Meeting with
ward coordinator.
Organise
notes for MDT
Meeting with
ward coordinator.
Ward review of
new and HDU
patients
Meeting with
ward coordinator.
Ward review of
new and HDU
patients
9am
Clinic MS
2pm
Cons. ward round
5-5.30pm
Ward to liaise
with SHOs
SpR ward
round or
bronchoscopy
list
SpR ward round if
not in morning
Ward to liaise
with SHOs
8.30 MDT,
10.30 Ward
review of new
and HDU
patients
12:30 lunch mtg
Consultant WR
(MS, GL) or
Ward work
Clinic GL
Ward to liaise
with SHOs
Cons. ward round
(MH) or ward work
Ward to liaise
with SHOs
SpR ward round
SpR teaching
Ward to liaise
with SHOs
Modular Registrar*
8.15 am
2-5.30 pm
Monday
Tuesday
? Bronchoscopy list
Wednesday
MDT, 12:30 lunch mtg
Thursday
Clinic LB 1st and 3rd and 5th
Clinic MH 2nd and 4th
Friday
Clinic JRS
SpR teaching
*
[Modular timetable not included – NB modular SpR will cover ward work (but not clinics) for ward
SpR on A/L, S/L or nights]
Modules available: Sleep and ventilation (JRS/MH), pleural (RJOD), lung cancer(MS), CF
(LSB), ID and microbiology(Dr Bridget Atkins). Please make arrangements with the relevant
Consutlants asap once you have decided what you want to do.
Firm B
Monday
Tuesday
Wednesday
Thursday
Friday
8.15am
Meeting with
ward coordinator.
Ward review
of new and
HDU patients
Meeting with
ward coordinator.
Ward review
of new and
HDU patients
Meeting with
ward coordinator.
Organise
notes for MDT
Meeting with
ward coordinator.
Ward review
of new and
HDU patients
Meeting with
ward coordinator.
Ward review
of new and
HDU patients
9am
Cons. ward
round
2pm
5-5.30pm
Ward to liaise
with SHOs
Clinic LSB (need
to arrange cover
for bronchoscopy
list)
SpR ward round
Ward to liaise
with SHOs
8.30 MDT,
10.30 Ward
review of new
and HDU
patients
12:30 lunch mtg
Cons. ward
round
Ward work
Ward to liaise
with SHOs
Clinic MS
Ward to liaise
with SHOs
SpR ward round
SpR teaching
Ward to liaise
with SHOs
John Radcliffe Registrar
8.15 am
Monday 8.15am MAU to liaise with night
take
9am Post-take radiology round
Referrals
Tuesday
Clinic RJOD
Wednesday
Thursday
8.30am MDT
10.30am referrals
12:30 lunch meeting
? bronchoscopy list
2 -5.30 pm
Clinic JRS
Referrals
Clinic MKB
Referrals
Section B - Horton Hospital
i
Duties of the post
Main duties and responsibilities
The main duties of the SpR is to oversee the work of the SHOs on the ward, take part in the General
Medical on-call Rota (full shift), to assist in one Cardiology or care of the elderly and General Medical
Clinic per week and two Chest and General Medical Clinic per week. When on call and when in Outpatients, he/her is under consultant supervision. Opportunities are also available for the trainee to
contribute to the Lung Function Clinic, Bronchoscopies, general management of ITU patients and the
Pulmonary Rehabilitation Programme.
Daily commitment and description of working pattern
year 1
Monday
Tuesday
Wednesday
Thursday
Friday
a.m.
Ward Round
(incorporating
admissions from
weekend take)
Lung Function
Clinic.
Or general clinic
General and
Cardiology Clinic
Chest Clinic
p.m.
Journal Club
Ward work
Ward work
Ward work and
Bronchoscopies
X-Ray
conference
Departmental
Clinical
Meeting
General and
Chest Clinic
Structured
Specialist
Registrar’s
teaching.
The SpR is on-call 1 in 4 on a full shift basis (third on) and has a half day the following day.
During weekends the on call is until 11pm. Weekends on call comprise Friday until 11pm,
Saturday 8am-5pm, Sunday 9am-5pm.
Teaching
The SpR assists in teaching the SHOs at the bedside and in practical procedures. He is also
responsible for organisation of a programme of more specific subject-orientated teaching for SHOs and
House Officers which takes place on Wednesday lunch time.
Administration/Management (secretarial assistance/office space)
The SpR assists on a particular firm when the Consultant is away (although covered by the paired
Consultant). He is responsible for organising the above-mentioned Wednesday lunch time teaching
programme. There is adequate secretarial assistance for the routine work, e.g., clinic letters, etc. The
SpR has his own desk in the Department of Medicine office suite.
ii
Training and research
Training scheme
There is a learning opportunity for at least an hour of every week day including Journal Club, XRay Conference, Didactic Teaching, Departmental Meeting and Hospital Grand Round.
The most important formal training event is the Friday afternoon session for all the SpRs in the
Region with a Consultant present. This takes the format of one or two topics for extensive discussion
followed by a blind case prepared by the Consultant.
Research
It is not anticipated that research will be a major component of the SpRs responsibilities during the
first year of the attachment but time (e.g. half day a week) could be made available if necessary.
Facilities for study leave
Usual entitlement to study leave is available. Post-Graduate medical education courses available.
The SpR is encouraged to attend all local Post-Graduate courses and the BTS Specialist Respiratory
courses.
Team chart
Name
Dr S R Smith
Consultant Physician
Dr I R Arnold
Consultant Physician
Dr Sathiavageeswaran Consultant Physician
Dr A Ellis
Consultant Physician
Dr J Marshall
Consultant Physician
Dr N Stewart
Consultant Physician
Dr W Atoyebi
Consultant Haematologist
Section B - Wycombe Hospital
Profile of the Trust
1.
Introduction
The Secretary of State approved the merger of South Buckinghamshire BHS Trust and Stoke
Mandeville Hospital NHS Trust to establish Buckinghamshire Hospitals NHS Trust with effect
from 1 October 2002. The Trust became operational on 1 April 2003.
The two trusts have developed a range of clinical networks that now serve the new Trust’s
population. However, there is still much work to be done of the development of clinical networks
across the three hospitals and with neighbouring trusts, particularly Milton Keynes, Heather
wood and Wexham Park, Oxford Radcliffe Hospitals and the Nuffield Orthopaedic Centre.
This work may form the foundation of a possible service configuration in the new Trust, subject
to public consultation. Strong links have already been established with the Buckinghamshire
Scrutiny Committee and the Community Health Councils.
2.
Population Served
The Trust serves residents in Buckinghamshire, Thame (Oxfordshire), Tring (Hertfordshire) and
Leighton Buzzard(Bedfordshire), a combined population if almost 500,00. It serves a much
larger population for Burns and Plastics services (1.5m) and Spinal Injuries (14m).
Three Primary Care Trusts are responsible for commissioning healthcare for this population
(except for Bedfordshire and Hertfordshire patients): Vale of Aylesbury PCT; Chiltern and South
Bucks PCT; and Wycombe PCT.
3.
Trust resources and services
There are three hospitals in the Trust – Amersham Hospital, Stoke Mandeville Hospital, and
Wycombe Hospital. It has 1044 beds, 4,700 staff and an annual budget of £172m.
Between them the hospitals provide a comprehensive range of acute hospital services. Both
Wycombe and Stoke Mandeville Hospitals have A&E services, critical care support, general
surgery and general medicine. Wycombe is the base for Urology and Vascular Surgery and for
the cardiac catheterisation service. Stoke Mandeville is the base for Ophthalmology, Burns and
Plastics and Spinal Injury services. The latter two services are participating in region/multiregional reviews.
Wycombe and Amersham Hospitals were significantly upgraded as a result of a recent £40m
PFI scheme. Stoke Mandeville’s PFI scheme includes medical wards, elderly care wards,
paediatrics, day care and space for the Burns’ unit. The current value is £42. Building was
completed at the end of 2005.
The Trust hosts the Buckinghamshire Shared Services – an organisation providing finance, HR,
IT and procurement services for the majority of NHS organisations in Buckinghamshire.
There are day nursery services available on all three hospital sites.
The Trust’s headquarters are based at Amersham Hospital.
Main duties and responsibilities
The registrars (3), with SHOs, will supervise the house physicians on the Respiratory Unit and
give them support as necessary. S/he will respond to requests for opinions from other services
in consultation with Dr Wathen , Dr Taylor , Dr Prasaad or 2 newly appointed consultants and do
two or three out-patient sessions per week under the supervision of the consultants. The
registrar will also take part in the weekly bronchoscopy list in order to receive training in
bronchoscopy. When on call the registrar is available for general medical emergencies with the
on-call team and has no other duties. (This will include approx 1:10 night shifts,some at Stoke
Mandeville Hospital)..One of the registrars does outpatient clinics at Stoke Mandeville Hospital
Daily commitment and description of working pattern
year 2
a.m.
p.m.
Monday
Tuesday
Wednesday
Thursday
Friday
Out-patients
(respiratory/
General WH or
SMH)
Option/
administration
Ward work
Ward round
Out-patients
(respiratory or
allergy at AH)
MDT,Ward
round
Bronchoscopy
list
Out-patients
(respiratory/
General,WH)
Option/
administration
Structured
specialist
registrar training
or Harefield
Consultant
Meeting
On call commitment is 1:10 with cover for colleagues
Teaching
SpRs are expected to contribute to the day to day teaching of the remaining juniors.
Administration/Management (secretarial assistance/office space)
It is the responsibility of the SpRs to organise the on call rota and ensure cover for holidays by the other
staff. There is adequate secretarial assistance for all routine work (e.g. clinic letters, etc.) and also for any
research related activity by arrangement. The SpRs share an adequate rest area.There are many
computer terminals in clinics and on the Respiratory Unit. Radiology is digital.
Training and research
Monday
Wednesday
Thursday
Friday
 Diabetic teaching session
 Medical teaching
 Postgraduate lecture
1.00-2.00
1.00-2.00
1.00-2.00









1.00-2.00
2.00-3.00
2.00-3.00
12.30-1.15
8.30 -9.30
1.15-2.15
2.15-4.00
2.00-5.00
3.00-5.00
Clinico-pathology meeting
Every 1st - Chest histologyl
Every 3rd - journal club
Radiology tutorial
Every week – Lung MDT
General journal club
Medical teaching
Lung Cancer Clinic
Every 4th - thoracic meeting,
Harefield Hospital
 Oxford teaching session

2.30-5.00 (respiratory)
The most important formal training event is the Friday afternoon session for all the SpRs in the region with
a consultant present. This takes the format of one or two topics for extensive discussion followed by a
blind case prepared by the consultant. There is a new Postgraduate Centre and Library.
Research
There is opportunity to carry out clinically based research while in the post. Dr Wathen has a particular
interest in asthma and diffuse lung disease.
Facilities for study leave
Doctors may apply to the clinical tutor for study leave of up to 15 days in each six months, giving at least
one months notice. No other registrar can be away at the same time, so early application is essential.
Postgraduate medical education courses available
The hospital is within easy reach of London and Oxford, where many training sessions and courses are
available at the Royal College of Physicians and the Royal Society of Medicine, etc.
Team chart
There are 12 consultant physicians who practice general medicine and who also have a specialist interest.
Hospital Practitioners:
Dr R Stevens, interest in Rheumatology
Dr Ian Gallen, interest in Diabetes
Dr David Gorard, interest in Gastroenterology
Dr P Clifford, interest in Cardiology
Dr Alistair McIntyre, interest in Gastroenterology
and Hepatology
Dr S Manchandra, interest in Care of the Elderly
Dr Laurence Sandler, interest in Endocrinology and
Diabetes, Clinical Director
Dr Chris Wathen, interest in Respiratory medicine
Dr H Hillawi, interest in Care of the Elderly
Dr S Firoozan Interest in Cardiology
Dr D Taylor, Interest in Respiratory Medicine
Dr D Walshe, Interest in care of the Elderly
Dr Graham Lang, Gastroenterology
Dr Andy Sapsford, Gastroenterology
Clinical assistants:
Dr Pattie Beresford, Gastroenterology and
Oncology
Dr David Harley, Neurology
Junior Staff at Wycombe
10 Registrars
10 SHOs
8 House Officers
Other consultants in the clinical directorate:
Dr Sue Kelly - Haematology
Dr Robin Aitchinson - Haematology
Dr Jonathan Pattinson - Haematology
Dr Graz Luzzi - Genitourinary medicine
Dr Matthew Jackson - Neurology
These consultants admit to medical wards and are
associated with one of the medical teams for junior
support for in-patients.
Dr Bernadette Lavery - Clinical Oncology
(based in Oxford, 4 sessions a week in the
Wycombe district)
Other Staff
R K Sherman, General Manager, General Medical
Group
Jo Hockley, Assistant General Manager, General
Medicine
Mrs Joan Kearsey, Nurse Manager
14 Secretaries
5 Ward clerks
Phlebotomist
Physiological Technicians
Bed Manager (24 hours responsible for finding
emergency beds)
Other allied District Physicians
Dr Andrew Kirk, Rehabilitation and Rheumatology
Associate Specialists:
Dr Ghilly Davies, Gastroenterology
Dr Marguerite Black, Respiratory Medicine
Speciality services provided by the unit (plus any future changes)
The Medical Unit is a general medical unit of 100 beds with a CCU and access to ITU. In
addition to general medicine the thoracic medicine department offers a24 bedded Respiratiry
Unit, OP clinics, bronchoscopy, pulmonary function laboratory, overnight sleep studies and
radiology including isotope, CT and MRI scanning. There is a very active TB service. Thoracic
surgery facilities are based at Harefield Hospital. There is close liaison between the clinic and
GPs in relation to asthma therapy and management of COPD including long-term oxygen
therapy.
There are weekly cancer MDTs at Wycombe and Stoke Mandeville.
Ther is an allergy service at Amersham Hospital
Section B - Stoke Mandeville Hospital (linked
with Wycombe Hospital)
Stoke Mandeville Hospital (SMH) is a busy District General Hospital and also has a
National Spinal Injuries Centre and Regional Burns Unit on site. Both Spinal Injury
patients and patients with burns may have significant respiratory problems. There is a
well established Chest Team and Multi Disciplinary Lung Cancer Team. The Chest
Team has close links with the ITU and on site palliative care service and this post offers
an opportunity to obtain experience and training in Intensive Care and Palliative Care.
The department is working very closely with the Respiratory Unit at Wycombe Hospital
(now part of the same trust) to provide a modern comprehensive integrated chest
service.
Post
Specialist Registrar Training Resident on-call
Specialty
General Medicine/Chest Medicine
On-call
1 in 10 with prospective cover
Staff
Chest Department
Consultant:
Dr A Prasaad
Dr Chris Wathen
(1 Clinic per week at SMH, based Wycombe Hospital)
Junior Staff:
Specialist Training Registrar
1 Specialist Training Registrar
(General Medicine/Care for the Elderly)
2 Senior House Officers
1 House Officer
Out-patients Nurse
Marika Templeton
(& Smoking Cessation Nurse)
Respiratory Technicians:
Lung Cancer Nurse:
Chest:
Consultant Oncology:
Radiology:
Palliative Care:
Duties of Post
Sue Dunning
Maureen Wyatt
Dr A. Prasaad (lead)
New consultant
Consultant Dr Nick Bates
Dr Tom Meagher
Dr Phil Savage
Dr Vipin Uthappa
(Interventional Radiologist)
Consultant Dr Helen Pegrum
Hospital MacMillan Nurse - Amelia Sayce
1. Assistance with the care, investigation and treatment of in-patients admitted to
Wycombe Respiratory Unit under the care of the chest team.
2. Supervision of House Officers
3. Management of chest and general medical patients in Chest Out-Patients.
4. Communication with General Practitioners by ward discharge summary and
out-patient correspondence.
5. Participation in the organization and execution of case presentation, audit and
other postgraduate education for the Department of Medicine.
Timetable (Provisional)
Monday
Tuesday
Wednesday
Thursday
Friday
AM
Out-patient Clinic
PM
Registrar Ward Round ’ linic
2nd Monday each month
(Teaching)
Study
Consultant Ward Round (or
ITU training if required)
8.00- X-ray Meeting
9.00- Postgraduate
meeting
10.00- Lung cancer patients
review
Bronchoscopy /
Percutaneous biopsy
Consultant Ward Round
Out-Patient Clinic
9.00 - MDT Lung Cancer
Training in Oxford
meeting
10.00-Out-patient Clinic or
Palliative Care
training
if required
Section B - Royal Berkshire Hospital
HOSPITAL AND SERVICES
1. The Royal Berkshire Hospital is now a Foundation Trust and provides a wide range of
services for the people living in the west of Berkshire, purchased mainly by the PCTs of
West Berkshire. Our area extends as far as Hungerford in the west to Henley on
Thames and Bracknell in the east, part of Hampshire to the south and parts of
Oxfordshire to the north. The population is expanding and stands at approximately
500,000. The Trust has just completed a programme of consolidation of the two
Hospitals in Reading on to the Royal Berkshire Hospital site. The Department of
Respiratory Medicine moved its offices and out-patient services over to the Royal
Berkshire site from Battle Hospital in 2003
Facilities are those associated with a very large District Hospital and Include;





Medicine: General Medicine, Gastroenterology, Renal Medicine, Diabetes &
Endocrinology, Cardiology, Elderly Care, GU Medicine, Dermatology,
Respiratory Medicine, Rheumatology, Clinical Haematology (level2), Neurology,
Rehabilitation and Stroke Unit.
Surgery: Trauma & Orthopaedics, General Surgery, Urology, ENT, Maxillo-facial Surgery
and Ophthalmology.
Obstetrics: Gynaecology and Paediatrics, including SCBU and NICU
Clinical Support Services: Pathology, Radiotherapy, CT Scanning, MRI, Nuclear Medicine,
Radio-isotopes, Accident & Emergency, Intensive Care Unit at the Royal
Berkshire Site, High Dependency Unit, and Day Bed Unit.
Oncology
GENERAL MEDICINE AT THE ROYAL BERKSHIRE HOSPITAL
1. There are five medical firms within the Trust. Each team has a home base ward, and looks
after any patients admitted to their ward. Where possible, patients are triaged to the ward
most relevant to their specialty problem. These are nominally:





Respiratory
Rheumatology
Renal
Gastroenterology
Endocrinology
Cardiology no longer take part in the GIM rota and in return provide a Cardiology on call service
and full CCU cover.
2. All acute medical patients are currently admitted via the Clinical Decision Unit, which is
based near to X-ray and A+E. As part of the significant consolidation work, the CDU opened
at the Royal Berkshire site in March 2004, as an admissions centre for all medical patients
requiring hospital assessment apart from direct admissions to CCU for patients with
suspected acute coronary syndromes.
3. The CDU consists of 16 trolleys and is located in the heart of the hospital close to all
investigation facilities, the A&E department and also contains the Emergency Surgical Unit
and Venous Thrombosis Clinic managing patients with DVT and PE treated at home. There
is a hospital central line team who provide facilities for out-patient treatment of infections
such as cellulitis.
4. Within the CDU there is a Higher Monitoring Area (Medical HDU) of four beds providing
experience in care of the critically ill including non-invasive ventilation, CVP monitoring and
step down from ITU. The HMU is supported by an ITU outreach team.
5. The unit is staffed daily by a team comprising highly dedicated nurses and:
Consultant Physician of the Day
Consultant Geriatrician of the Day
Consultant Cardiologst of the Day
Specialist Registrar
3 –5 SHO’s on various rotas
F1
POD
GOD
COD
6. Patients requiring admission are triaged to either a 3 day ward under the receiving team for
that day, a specialty bed, a general medical bed or to the Elderly Care services who may
accept patients after GOD review. Since the introduction of this acute care process there has
been a reduction in the number of admissions by ~20%. In addition the majority of patients
receive care from the appropriate specialist team – this has been very valuable for patients
with respiratory disorders.
THE DEPARTMENT OF RESPIRATORY MEDICINE
The Respiratory Department is based in South Block, Royal Berkshire Hospital.
The present staff consists of four consultants:




Dr. Chris Davies
Dr. Andrew Zurek
Dr. Anne McGown
Dr. Grace Robinson




Two Specialist Registrars (Full-time) on the Oxford SpR Scheme
One Senior House Officer/ST1-2 (GIM rotation)
One Senior House Officer/ST1-2 (Critical Care rotation)
One F1
Consultant in GIM and Respiratory Medicine (Full time)
Consultant in GIM and Respiratory Medicine (Full time)
Consultant in GIM and Respiratory Medicine (Part time 8PA)
Consultant in Respiratory Medicine (Full time)
There are 4-5 secretaries working within the department
Other staff within the department includes:







Three Specialist Respiratory Nurses, who provide the Acute Respiratory Assessment
Service (ARAS) for COPD and asthma patients.
One Specialist Respiratory Nurse in TB
Two Clinic Nurses
Two part-time Lung Function Laboratory technicians.
One Sleep Nurse
Part-time Respiratory Physiotherapist
Designated Psychologist for respiratory patients.
RESPIRATORY FACILITIES
-
The Department is situated in a new self-contained area within South Block and consists
of a separate waiting area and reception, areas for clinic nurses and administrative staff
and 7 clinic rooms. Pulmonary function laboratory and the Sleep Unit are also situated
within the department, and there is a treatment area used for some day case procedures.
-
The in-patient beds are situated in Castle Ward, within the new Battle block. Day cases
can also be seen on this ward. The ward has expertise in the management of most
common respiratory disorders and also provides facilities for use of non-invasive
ventilation for acute and chronic conditions. Castle ward is currently staffed and opened
as 28 beds, although this number can vary depending on overall hospital bed status.
-
There are currently 13 out-patient clinics at RBH and 2 at Newbury District Hospital
(West Berkshire) per week. Three of these clinics (run concurrently) are designated for
lung cancer patients. Lung cancer is managed in conjunction with West Berkshire Cancer
Care Unit at the Royal Berkshire Hospital. There are two dedicated thoracic oncologists,
two Lung Cancer Nurses, Palliative Care Physicians, and two hospices within the area.
We have one visiting thoracic Surgeon, from Guy’s Hospital in London who visits
fortnightly and does a clinic at RBH. There is a multidisciplinary team meeting (MDT)
every week which is co-ordinated by dedicated MDT co-ordinators. There is an active
Cancer Network.
-
Tuberculosis Service –There are 2 open contact clinics per week and a BCG Service is
provided for West Berkshire. A neonatal service is provided for high risk families and a
community clinic has been set up in an urban GP practice. There is now a designated
Tuberculosis Nurse. There are about 50 – 70 cases of TB each year in Reading, many
co-infected with HIV.
-
A diagnostic bronchoscopy service – 2 lists/week, with facilities for TBNA.
-
Lung Function Laboratory run by two technicians
-
Sleep Laboratory currently with one nurse and a research nurse funded by the MRC as
part of a multicentre project with Oxford. The laboratory now uses out-patient Embletta
study systems as well as a Visi-Lab system available for in-patients, and several
oximeters for home screening. There are facilities for nCPAP, and also NIV for both
acute and chronic ventilatory failure.
-
Nurse led clinics and open referral service for patients with airway diseases including
COPD and asthma.
-
Rehabilitation courses for COPD.
-
Long term oxygen therapy LTOT service including dedicated input from on CNS in line
with the new national oxygen contract
-
Flight assessment service
-
Nebuliser loan service
-
X-Ray services include spiral CT and MRI. PET scan available at Churchill Hospital. The
hospital utilises PACS and there are no hard X-ray films in use (since 2002).
-
Respiratory referrals from all other specialities are covered including bronchoscopies at
the Royal Berkshire Hospital in the Intensive Care Unit, on the wards or in the Oncology
Department.
-
Occasional shared care of cystic fibrosis patients with the Royal Brompton or the
Churchill Hospital, Oxford.
Teaching
Multidisciplinary cancer/surgical meeting is held every two weeks
Grand Round
X-Ray meeting
Departmental Meeting
Medical Audit every month
Thursday 12.10pm – 1.10pm
Monday 1pm – 1.45pm weekly
Wednesday RBH 8.30am – 9.30am
Section B - John Radcliffe (general medicine)
i
Duties of the post
Main duties and responsibilities
Resident medical officer for acute takes on Firm C
The SpR will usually be attached to the respiratory Physicians working on the general medical wards i.e
Drs Slade, Hardings and Bennett. However, for two months of the year there are no respiratory physicians
doing general medicine and the SpR would have the opportunity to work with other consultant members of
Firm C.
Firm C Consultants:
Respiratory Physicians: Dr Mark Slade, Dr Lesley Bennett, Dr Maxine Harding
Firm Lead: Dr Dr Jon Salmon (ITU)
Other Consultants and their sub-specialty interests:
Dr Jon Salmon (ITU)
Professor Nick White(Tropical Medicine)
Dr Nick Day (Tropical Medicine)
Daily commitment and description of working pattern
Monday
Tuesday
Wednesday
Thursday
Friday
a.m.
Ward round
ward round
8.30
consultant
ward round
Consultant
ward round
p.m.
1.30 consultant
ward round
2.00 outpatients clinic
8.30 – Firm B/C
meeting
9.30 – radiology
meeting
11am - student
presentations
Out patients
1pm Grand
round
Ward round +
student
teaching
Also on take 1:6 (12 hour take) with post take ward round (8.30am after night takes and 4.30pm after day
takes).
Teaching
Supervising SHO and HO activities. Weekly student teaching
Administration/Management (secretarial assistance/office space)
Secretarial support for clinic letters and organising student teaching. Shared responsibility for
discharge summaries with SHOs.
ii
Training and research
Training:
1. General medical SpR teaching. A formal teaching programme exists on alternating
Wednesday and Monday afternoons monthly. A wide range of topics of relevance are
covered.
2. Opportunity to attend Respiratory SpR teaching held weekly in term times at the Oxford
Centre for Respiratory Diseases (takes permitting)
3. Firm B/C meeting-opportunity to listen to Consultant presentations; present Consultant
‘blind cases’, or to deliver own presentation.
4. Grand Round weekly
Research
No formal research although it should be possible to continue any research started in previous years.
Facilities for study leave
The usual entitlement to study leave is available.
Section B - East Berkshire
RESPIRATORY AND GENERAL MEDICINE SERVICES IN EAST BERKSHIRE;
SUMMARY OF SERVICES AND TRAINING OPPORTUNITIES
3 posts, usually rotate after 6 months between Wexham Park Hospital & Heatherwood
Hospital.
1. 2 SpRs based at Wexham Park Hospital
Senior Medical Staff: Dr John Wiggins & Dr Richard Russell
On-call: 1 in 10 (full shift) 2B
Consultant Ward Based System – Wexham Park Hospital
Consultant
Ward 17 (26 beds) +
medical outliers on ward
9E
Speciality
GIM + Respiratory Medicine
Junior Staff
2 Respiratory SpRs
2 ST2
1 F1
Dr J Wiggins
Dr R Russell
SpR Job Plan
a.m.
Monday
Tuesday
Wednesday
Thursday
Friday
Consultant ward
round
GIM/chest clinic
WPH
SpR led round (or
clinic KE7) *
Consultant
ward round
Main chest
clinic KE
Lunchtime
meeting
Referrals/
outliers etc.
Lung Cancer
MDT KE
Lung Cancer
Clinic* Clincal
MDT
Research/private
study
Bronchoscopy
Structured
specialist
registrars
teaching in
Oxford
The sessions* on Tues pm and Weds am can be adapted flexibly according to a trainees needs.
p.m.
2. 1 SpR based at Heatherwood Hospital
Senior Medical Staff: Dr Mike Smith & Dr Lorraine Hart
On-Call: 1 in 10 (full shift) 2B
Consultant Ward Based System - Heatherwood Hospital
Consultant
Ward 8
20 beds
Dr M Smith
Dr L Hart
Speciality
GIM + Respiratory Medicine
Junior Staff
1 Respiratory SpR
1 GIM SpR
1 ST2
1.5 F1
SpR Job Plan
a.m.
Monday
Tuesday
Wednesday
Thursday
Friday
Main chest clinic
KE
Joint Consultant
ward round
Bronchoscopy
Consultant
ward round
(Dr Hart)
Academic
meeting
Consultant
ward round
(Dr Smith)
p.m.
SpR ward round
Lung Cancer
MDT KE
Lung Cancer
Clinic (optional)
Clincal MDT
Research/private
study
Chest/GIM
clinic HW
Structured
specialist
registrars
teaching in
Oxford
THE POPULATION & DISTRICT OF EAST BERKSHIRE
East Berkshire has a population of 380,000 and covers the Boroughs of Slough,
Windsor & Maidenhead, and Bracknell, but together with an overlap zone in South
Buckinghamshire the true catchment area of the Trust is nearer to 430,000. This is a
large and diverse population and includes affluent areas such as Ascot, Windsor and
Maidenhead, and also the larger urban area of Slough. The towns of Bracknell,
Maidenhead, Slough and Windsor house two-thirds of the total population, the
remainder living in rural areas or small towns. Much of the District lies within the
designated Green Belt areas.
THE TRUST
The Trust is an Acute Hospital Trust which has more than 800 beds and provides inpatient services on two sites: Heatherwood in Ascot and Wexham Park, north of Slough
- essentially, one hospital on two sites. In addition, the Trust provides outpatient and
diagnostic facilities at St Mark’s Hospital (Maidenhead), King Edward VII Hospital
(Windsor) and Upton Hospital (Slough).
WEXHAM PARK HOSPITAL
Wexham Park Hospital, Slough, has 578 beds with a full range of services including
general medicine and its sub-specialities, paediatrics, general surgery, vascular surgery,
urology, orthopaedics, obstetrics and gynaecology, otolaryngology, oral surgery and a
sub-regional plastic surgery unit which has an extensive catchment area. There is a
large Accident and Emergency department, and a new 12 bedded combined ITU / HDU.
Building of a new theatre complex is currently under way. A medical assessment unit
opened in 1998 and has recently been expanded, and a new 8 bedded Coronary Care
Unit opened in January 2002 followed by a Cardiac Angiography Suite in September
2004. There is also an excellent new rehabilitation department, a centralised CPA
accredited laboratory, diagnostic imaging including spiral CT scanner and a MRI suite.
HEATHERWOOD HOSPITAL
Heatherwood Hospital, Ascot, has 241 beds including general medicine and its subspecialities, paediatrics, elective orthopaedics, urology, otolaryngology, oral and general
surgery, elective and emergency gynaecology. There is a dedicated, purpose-built day
surgery unit and endoscopy suite. A 12-bedded medical assessment unit and a 4bedded medical HDU/CCU support acute general medicine. Other developments
include a minor injuries unit (approx. 20,000 attendances per year) and a children’s
centre. A superb diagnostic imaging unit opened in August 1998. Physiotherapy and
rehabilitation are also on site. CT and MRI will soon be available.
THE MEDICAL UNIT
The Heatherwood and Wexham Park Hospitals Trust is a single Trust spread across two
acute hospital sites. The Medical Unit, like most other Units in the Trust, works as a
single unit across these sites and includes general medicine, acute elderly medicine and
associated specialities such as haematology, neurology, rheumatology, dermatology,
oncology, etc. We have recently established a system of consultant-based wards.
There is a Medical Assessment Unit on each site. At Wexham Park Hospital the Unit
has 36 beds and the majority of medical emergencies are admitted here. At
Heatherwood Hospital the unit has 14 assessment beds and 4 high dependency beds.
RESPIRATORY MEDICINE
Respiratory medical services are focused on the Windsor Chest Clinic. The clinic has
self-contained facilities but has the added advantage of being next door to both a large
Out-patient X-ray Department and an Out-patient Oncology suite.
In-patient care is provided at Heatherwood Hospital for residents of the south of the
district and Wexham Park Hospital in the north. Both hospitals admit emergencies and
provide full training opportunities in general medicine.
PERSONNEL
There are four consultants in general and respiratory medicine and one part time
associate specialist. We have a clinic sister, two full time lung cancer specialist nurses,
a COPD early discharge team, two full time TB specialist nurses, two further specialist
nurses, one full time respiratory physiologist, a part time respiratory dedicated
physiotherapist and full secretarial and administrative support.
SERVICES
There are five dedicated chest outpatient sessions at the Chest Clinic and four mixed
general and chest medical clinics at the DGHs. One of the clinics at the Chest Clinic is a
combined lung cancer clinic involving three chest physicians (Dr Hart, Dr Smith & Dr
Wiggins), an oncologist (Dr Gildersleve) and a thoracic surgeon (Mr Townsend). It is
preceded by a multi-disciplinary lung cancer meeting. The Chest Clinic offers full
respiratory physiology testing, including exercise tests and ear lobe blood gases. We
have a comprehensive TB contact tracing service, Out-patient Pulmonary Rehabilitation,
an early COPD discharge service and a Patient Support Group. There are two
bronchoscopy lists in the hospitals and an acute NIV service.
RESEARCH
The main research interest of the department is in pre-clinical obstructive pulmonary
disease. We have been involved for a number of years with joint projects with the
National Heart and Lung Institute (Professor Barnes). Current research involves studies
of the biochemistry of broncho-alveolar lavage fluid in pre-clinical COPD and genetics of
macrophages in the same patient group.
The Chest Clinic contains a dedicated research lab with bench space, refrigeration,
centrifuges, etc.
TRAINING OPPORTUNITIES
The large population base with its broad ethnic cultural and economic background offers
an extensive range of respiratory diseases in both the outpatient and In-patient setting.
Slough has the third highest notification rate of TB outside Greater London and
extensive experience and training in all aspects of TB is available. Recent development
of a multi-disciplinary lung cancer clinic also offers extensive opportunities training in the
management of this disease. Trainees would be able to work with 4 different consultant
physicians with broad but different interests in respiratory disease. Heatherwood and
Wexham Park offers an excellent modern postgraduate centre, including a skills lab and
there is a programme of postgraduate activities on both DGH sites. An Academic HalfDay takes place each month covering wide ranging topics and includes a regular Audit
session. Attendance at these meetings is compulsory for all junior and senior medical
staff, apart from those on-call. Furthermore, the Respiratory SpRs are expected to
attend the weekly Friday afternoon Respiratory teaching sessions and monthly GIM halfday teaching sessions, both held in Oxford.
Section B - John Radcliffe (ITU)
The Intensive Therapy Unit of the John Radcliffe Hospital is an 9 bedded, general ICU situated on Level 1
of the John Radcliffe Hospital in Oxford. The Unit admitted 628 patients in 1996/7 (2953 patient days) ,
referred from the major medical and surgical services. Ninety percent (90%) of admissions were
emergency or unplanned admissions. The John Radcliffe Hospital ICU has been recognised as suitable
for Intensive Care Training by the Joint Intercollegiate Committee on Intensive Care Training (pending
final site inspection).
The composition of the patient referral base is as follows:General Medicine
General Surgery
Vascular Surgery
Cardiothoracic (non cardio-pulmonary bypass)
3%
Cardio-pulmonary bypass Surgery
Trauma and Orthopaedics
Neurological/Neurosurgical
21%
27%
16%
11%
17%
5%
The average length of stay of an ITU patient is approximately 5.2 days. 60% of the patients are referred
from within the Oxford District, 32% of patients from within the Oxford Region and the remaining 8% are
referred from outside the Oxford Region.
i
Duties of the post
Main duties and responsibilities
Clinical ward rounds are held twice a day at 8.30 a.m. and 4 p.m. seven days a week. The ward round
includes a Consultant, an ITU SpR4 and an SpR3 (Medicine or Anaesthetics). Nursing is represented by
the Senior Staff Nurse or Sister who is in charge of the Unit on each specific day. Ward rounds are also
attended by a Clinical Pharmacist, a Dietician and Medical Students.
Ward rounds are followed by a half hour clinical review conducted by the On-call Consultant 7 days/week.
Daily commitment and description of working pattern
a.m.
p.m.
Mon
Tues
Wed
Thurs
Fri
Sat
Sun
Ward round
(8.30)
ITU ward
work and
patient
care,
procedures.
Patient
transport.
Ward round
(16.00)
Ward round
ITU ward
work and
patient
care,
procedures.
Patient
transport.
Ward round
ITU ward work
and patient
care,
procedures.
Patient
transport.
Ward round
ITU ward work
and patient care,
procedures.
Patient transport.
ICU topic
seminar
Ward
round
ITU ward
work and
patient
care,
procedure
s.
Ward
round
ITU ward
work and
patient
care,
procedure
s.
Case
conference
(14.00)
Ward round
ICU journal
club (14.00)
Ward round
Ward round
Ward
round
ITU ward
work and
patient
care,
procedure
s. Patient
transport.
x-ray
conference
Seminar
Ward
round
Ward
round
Ward
round
Post round teaching 30-45 mins each day
One day off per week (research) as work shared with other registrars
On call 1:4 18:00 to 8:30 next morning.
ii
Training and research
Training scheme
Attachment to the John Radcliffe Hospital General ICU will involve direct patient management under the
supervision of Consultant Staff on a 24 hour basis supplemented by regular didactic teaching sessions. SpR3
in Medicine and Intensive Care will be expected to attend and participate in the weekly Unit meeting with the
Director and the ITU nurses (Tuesday 14.00 hrs), Thursday morning topic seminars (covering major ITU
clinical issues), Friday lunch time ITU Radiology conferences and Friday afternoon guest Topic Seminars.
Ward rounds are conducted primarily to determine care strategies for the next 4 to 6 hours. However, broad
and in-depth discussion of each patient and medical literature is conducted during and after the ward rounds
as part of the educational program. The majority of cognitive skills will be conveyed through didactic lectures
and patient care rounds. Procedural skills must be taught both in didactic sessions and in demonstrations at
the bedside. Distribution of pertinent medical literature and a curriculum summary is encouraged.
All trainees will be encouraged to achieve Advanced (Cardiac) Life Support (ACLS), Advanced Trauma
Life Support (ATLS), and/or Paediatric Advanced Life Support provider status, as appropriate, and
maintain this status throughout their training.
Study leave will be available for trainees to attend meetings both within and outside the Region. Trainees will
be encouraged to become members of the Intensive Care Society and to present results of research at
meetings of that Society. Dr Garrard is the Oxford Region Linkman for the Intensive Care Society and the
Regional Advisor in Intensive Care (appointed by the Intercollegiate Committee on Intensive Care).
CORE CURRICULUM
A. Cardiovascular
1. Recognition and Acute Management of:
a. Shock (all forms)
b. Cardiac arrhythmias
c. Cardiogenic pulmonary oedema
d. Acute cardiomyopathies
e. Hypertensive emergencies
2. Principles of:
a. Vasoactive and inotropic therapy
b. Arterial, central venous, and pulmonary artery catheterization and monitoring
c. Cardiovascular physiology in the critically ill patient
3. Practical procedures and experience in:
a. Arterial puncture and cannulation
b. Insertion of central venous catheters
c. Electrocardiogram interpretation
d. Cardioversion
e. Pulmonary artery catheterization
f. Transcutaneous pacing
g. Pericardiocentesis in acute tamponade
B. Respiratory
1. Airway Management:
a. Maintenance of an open airway in the non-intubated patient
b. Ventilation by bag-mask systems
c. Tracheal intubation
d. Management of pneumothorax
2. Recognition and Acute Management of
a. Acute and chronic respiratory failure
b. Status asthmaticus
c. Smoke inhalation and airway burns
d. Upper airway obstruction, including foreign bodies and infection
e. Near drowning
f. Adult respiratory distress syndrome (non-cardiogenic/ capillary leak pulmonary oedema
3. Use and interpretation of
a. Pulmonary function tests including bedside spirometry
b. Arterial blood gas analysis
4. Principles and Application of
a. Oxygen therapy
b. Mechanical ventilation (invasive and non invasive) including indications, modes, complications, and
weaning
C. Renal
1. Recognition and Acute Management of
a. Fluid and electrolyte disturbances
b. Renal failure c. Acid-base disorders
2. Principles of
a. Drug dosing in renal failure
b. Fluid and electrolyte therapy in the critically ill
patient
c. Dialysis
D. Central Nervous System
1. Recognition and Acute Management of
a. Coma
b. Drug overdose
c. Acute hydrocephalus
d. Brain death evaluation
e. Persistent vegetative state
f. Intracranial vascular accidents
g. Status epilepticus
h. Intracranial infection
i. Intracranial hypertension
j. Spinal cord injury
E. Metabolic and Endocrine
1. Recognition and Acute Management of
a. Hypoadrenal crisis
b. Diabetes insipidus
c. Diabetic ketoacidosis
2. Principles of Alimentation
a. Enteral
b. Parenteral
F. Infectious Diseases
1. Recognition and Acute Management of
a. Sepsis
b. Hospital-acquired and opportunistic infections, including acquired immunodeficiency syndrome
2. Principles of
a. Antibiotic selections and dosage schedules for the critically ill patient
b. Infection risks to healthcare workers
G. Haematologic Disorders
1. Recognition and Acute Management of
a. Defects in haemostasis
b. Haemolytic disorders
c. Haematologic dysplasias and their complications
d. Sickle cell crisis.
e. Thrombotic disorders
2. Principles of
a. Anticoagulation and fibrinolytic therapy
b. Blood component therapy Plasmapheresis for acute disorders, including neurologic and
hematologic diseases
H. Gastrointestinal Disorders
1. Recognition and Acute Management of
a. Gastrointestinal bleeding
b. Hepatic failure
c. Perforation of viscus
2. Principles of prophylaxis against stress ulcer
bleeding
I. Principles of Transplantation
a. Immunosuppression
b. Infections in the immunocompromised patient
c. Organ rejection
d. Organ donation
J. Principles of Sedation, Analgesia, and Neuromuscular Blockade in the Critically ill
K. Monitoring and Biostatistics
1. Prognostic indices such as:
a. Acute Physiology and Chronic Health Evaluation,
b. Therapeutic Intervention Scoring System
c. Paediatric Risk of Mortality
2. Respiratory monitoring
a. pulse oximetry
b. transcutaneous PO2, PCO2,
c. end-tidal CO2
d. impedance plethysmography
L. Ethical and Legal Aspects of Critical Care
a. Do-not-resuscitate orders
b. Principles of informed consent
c. Rights of patients
d. Withholding and withdrawing life support
e. Advance directives
f. Living wills
g. Durable powers of attorney
M. Psychosocial Issues
a. Understanding the effect of life threatening illness on patients and their families
b. Death and dying
N. Transport of the Critically ill Patient
a. Stabilisation
b. Equipment and monitoring
O. Principles of Resuscitation and Postoperative Management of the Patient with Acute Traumatic
Injury
Team chart
1) Dr C. S. Garrard-Intensive Care Physician (Full time Director)
2) Dr. D Young -Intensive Care Anaesthetist (Part Time ICU, Part Time Anaesthetics)
3) Dr O Dyar -Intensive Care Anaesthetist (Part Time ICU, Part Time Anaesthetics)
4) Dr D Wilkinson -Intensive Care Anaesthetist (Part Time ICU, Part Time Anaesthetics)
5) John Salmon -Intensive Care Physician (50% Intensive Care, 50% General Internal Medicine)
Consultant Staff provide 24 hours a days Unit presence or on-call, 7 days a week.
Junior medical staff consists of:
3 SpR3 in Medicine and 4 SpR3 in Anaesthetics. These 7 SpR's work a full shift rota of 56 hrs/week
including annual and study leave. One of the SpR3 in Medicine/ICU also provides on call cover for the
Renal unit, one night per week. Anaesthetic SpR3's rotate on a 6 week basis while Medical SpR3's will
rotate into ICU for 12 weeks. A representative rota is shown in Appendix 1. 3 full time and 1 part time
SpR4 provide a second tier of clinical supervision for SpR3 juniors staff. SpR4 staff work a partial shift
with on-call commensurate with junior doctors hours initiative. One of the SpR 4 grades rotates in from the
Chest Medicine rotation for a period of 6 months each year. This individual is provided with a period of
Anaesthetics training (largely airway and resuscitation skills) at the beginning of the ICU attachment. The
Chest SpR4 acts at the higher level of clinical supervision. The rota is arranged so that when Physicians
are on call either an Anaesthetic SpR3 or SpR4 is also available on the ICU.
Nursing services provided support for 9 ICU beds based on 1 nurse per patient (7 full time equivalents per
bed).
Section B - Milton Keynes General Hospital
Duties of the post
Resident medical officer for GIM acute take one in ten rota.
Following a night on take the SpR normally attends the post-take ward round
SpR on respiratory firm which consists of
Dr. S. Fisher (consultant)
Dr. M. Bhattacharya (locum consultant)
SpR
F2 post 1, F2 post2
F1
The SpR will usually be attached to Dr’s Fisher and Bhattacharya, and will take a
lead role in supervising the junior staff on the firm’s medical ward which at
present is ward 3.
Teaching
Supervising F1 and F2 activities.
Office the SpR has an office and a computer.
SpR/ respiratory medicine, weekly timetable
Monday
am Outpatients (general) Dr. Fisher
Or other GIM outpatient by arrangement
pm Ward Round Dr. Fisher
Tuesday
ward round ward 3
With SHO
12.30 Lung MDT
pm bronchoscopy list
Wednesday
audit/teaching
12.30 grand round
pm ward consults or research
Thursday
Outpatient (Chest/Lung Cancer) Dr. Fisher
pm bronchoscopy list
Friday
am ward round with SHO
Oxford teaching/training