HEALTH EDUCATION THAMES VALLEY - SPECIALTY
TRAINING PROGRAMME IN GASTROENTEROLOGY
About Health Education Thames Valley
We are the Local Education and Training Board (LETB) for Thames Valley covering
Berkshire, Buckinghamshire and Oxfordshire. Our vision is to ensure the delivery of
effective workforce planning and excellent education and training to develop a highly
capable, flexible and motivated workforce that delivers improvements in health for
the population of Thames Valley. Thames Valley LETB is responsible for the training
of around 2000 Foundation and Specialty trainees.
Health Education Thames Valley is a relatively small organisation 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
Health Education Thames Valley as a whole. This may mean that you may be
allocated to any geographic location within the deanery depending on training
needs.
The Gastroenterology Training Programme
The gastroenterology training programme is a 5 year programme, starting at with
competitive entry at ST3 level. 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
JRCPTB. The posts attract National Training Numbers and provide training towards
a Certificate of Completion of Training (CCT).
The Postgraduate Dean has confirmed that this post has the necessary educational
and staffing approvals.
The programme is based in several different Trusts throughout Health Education
Thames Valley so trainees may find themselves employed by any of the following
Trusts and placed in any of the following hospitals:
Trust
Oxford University Hospitals NHS
Trust
Hospitals and Locations
John Radcliffe Hospital, Oxford
http://www.ouh.nhs.uk/
The Horton Hospital, Banbury
http://www.ouh.nhs.uk/
Royal Berkshire NHS Foundation
Trust
Royal Berkshire Hospital, Reading
http://www.royalberkshire.nhs.uk/
Buckinghamshire Healthcare NHS
Trust
Wycombe Hospital, High Wycombe & Stoke
Mandeville Hospital, Aylesbury
http://www.buckshealthcare.nhs.uk/
Milton Keynes Hospital NHS
Foundation Trust
Milton Keynes General Hospital
http://www.mkgeneral.nhs.uk/
Rotation Information
Rotations may at times change in response to clinical need from the Trusts.
Expected rotation arrangements for this programme are:
There are 12 posts within the Health Education Thames Valley programme in
Gastroenterology/General Internal Medicine.
2 posts
-
Gastroenterology and G(I)M
Supervisors:
3 posts
-
Gastroenterology and G(I)M
Supervisors:
3 posts
-
Gastroenterology and Hepatology
Supervisors:
Milton Keynes Hosp.
Dr S Lanzon-Miller
Dr G MacFaul
Royal Berks Hosp Reading
Dr M Myszor
Dr A DeSilva
Dr J C L Booth
Dr J Simmons
Dr C Green (P/T)
Dr Alex Evans
John Radcliffe, Oxford
Dr A Bailey
Dr J Collier
Dr SPL Travis
Dr S Keshav
Dr B Braden
Dr AA Bailey
Dr J East
2 posts
-
Gastroenterology and G(I)M
Supervisors:
2 posts
Hospital
-
Gastroenterology and G(I)M
Supervisors:
Horton Hospital, Banbury
Dr A Ellis
Dr J Marshall
Dr B Braden (1 day)
Dr A Bailey (1 day)
Wycombe/Stoke
Mandeville
Dr D Gorard
Dr E Johns
Dr S Cullen (P/T)
Dr R Sekhar
The rotation is built up on an individual basis taking into account the trainee’s
interests, training requirements and prior experience. These requirements will be
balanced by the availability of local posts and the needs of others in the Training
Programme. A rotation will usually consist of a year 1 placement in either Banbury or
Milton Keynes. Subsequently trainees may move to either Reading or High
Wycombe. A year of training in Oxford tends to occur in years 3 or 4. Over a 5 year
period most trainees will spend 12 months at each of the training centres. Year 6
placements may be at any centre in the region.
Most trainees undertake a formative period of research culminating in the award of
an MD or DPhil. Where appropriate, trainees have undertaken an MSc. See:
http://www.expmedndm.ox.ac.uk/home and
http://www.expmedndm.ox.ac.uk/gastroenterology-unit for clinical and basic science
research projects undertaken by trainees.
The output from the training programme is good and recent appointments as
consultants have been to centres including Southampton, Gloucester, Exeter, St
Marks, and Manchester.
The full outline scheme is shown on the enclosed rotations. Research is actively
encouraged during the tenure of the post. Trainees are encouraged to undertake
clinical research whilst working in the 5 centres and to undertake a formal period of
research either in Oxford or other major centre of research.
Within the rotations and centres to which a Trainee will be attached, all sub-specialty
parts of the curriculum are covered. These include: specialist management of
inflammatory bowel disease, intestinal failure and nutrition, experience in specialised
hepatobiliary and pancreatic disorders, general hepatology, interventional
endoscopic techniques, capsule endoscopy, endoscopic ultrasound, oesophageal
pH testing, oesophageal and anorectal manometry, liaison psychiatry, and paediatric
gastroenterology. Oxford is also one of two centres in the UK for intestinal
transplantation.
The only aspect of gastroenterology not formally covered in a local centre is liver
transplantation. Trainees wishing to obtain such experience will normally undertake a
2 year training programme in Hepatology within their 5 yr rotation, 1 year of which
would be in Oxford with a 3 month secondment at a major transplant centre. These
posts are competitive and decided by separate interview and are advertised on a
national basis.
Trust Information –
WYCOMBE / STOKE MANDEVILLE HOSPITAL
Dr David Gorard (Training Lead), Dr Sue Cullen, Dr Emily Johns, Dr R Sekhar
Buckinghamshire Healthcare NHS Trust encompasses Wycombe Hospital, Amersham
Hospital and Stoke Mandeville Hospital. It serves residents in Buckinghamshire, Thame
(Oxfordshire), Tring (Hertfordshire) and Leighton Buzzard (Bedfordshire) with a
combined population of 550,000. Following the reconfiguration of acute services,
Wycombe Hospital performs predominantly elective work, while acute emergency
services are mainly provided at Stoke Mandeville Hospital.
The 2 registrars in gastroenterology are each based at the more elective Wycombe
Hospital site for 4 months, and based at the more acute Stoke Mandeville Hospital site
for 8 months.
Gastroenterology at Wycombe
Currently most elective Gastroenterology training is organised at Wycombe Hospital:
although from 2014 some elective outpatient sessions take place at the Stoke
Mandeville site in Aylesbury on a rotational basis. The department of Gastroenterology
at Wycombe consists of three Consultants; Dr Sue Cullen, Dr David Gorard, Dr Emily
Johns. They are supported by an Associate Specialist (Dr Christine Helmer).
During the 4 months at Wycombe Hospital, the gastroenterology trainee will attend 3
outpatient clinics each week, and 3 or 4 endoscopy lists each week. There is a
dedicated viral hepatitis clinic which runs weekly, in addition to general gastroenterology
clinics and endoscopy lists.
Gastroenterology at Stoke Mandeville Hospital
During the 8 months at Stoke Mandeville Hospital, the gastroenterology registrars have
a pivotal role in managing a team of junior doctors and are involved in the day-to-day
care of acute gastroenterology, hepatology and general medicine inpatients. The
consultants (Dr Cullen, Dr Gorard, Dr Johns, Dr Sekhar) are also rostered as duty
gastroenterologist at Stoke Mandeville Hospital for a week at a time. On a daily basis,
patients with acute gastroenterology/hepatology problems are triaged to the
gastroenterology inpatient team. Dr Cullen leads a Nutrition Team and undertakes a
once weekly nutrition ward round at Stoke Mandeville Hospital. Depending on the
registrar’s experience, he/she will attend at least one endoscopy session at Stoke
Mandeville Hospital each week and gain experience in endoscoping upper GI bleed
patients. Although based at Stoke Mandeville Hospital, during the 8 month period, the
registrar will spend Wednesdays at Wycombe Hospital (+/- Amersham hospital) to
attend one clinic and one endoscopy session.
Endoscopy Training
The Endoscopy Suite at Wycombe Hospital has two procedure rooms equipped with Fuji
endoscopes. The Endoscopy Suite at Stoke Mandeville Hospital has two procedure
rooms equipped with Olympus endoscopes. Most of the lists are run by the
Gastroenterology Department with a handful run by Consultant Surgeons. Training
opportunities vary widely from the ability to teach basis diagnostic endoscopy and
flexible sigmoidoscopy, through to colonoscopy for those in their third year. For those in
more senior years advanced colonic polypectomy techniques, PEG insertions and
oesophageal stenting are available. A wide range of haemostatic techniques including
injection, banding, clipping and heater probe therapy are available. Depending on a
trainee’s experience, appropriate lists are allocated and adjusted to allow for optimal
training and experience. There is one ERCP list at Wycombe and one at Stoke
Mandeville Hospital each week – although these are available for training those who
wish, such training is supplemental to more formal training elsewhere.
Teaching and Training
Specialist Registrars in Gastroenterology are released on Thursday afternoons each
week to attend central training in Oxford. Trainees are also released to attend general
medical training one day a month. Within the hospital there is a weekly grand round.
The gastroenterology journal club runs approximately fortnightly at Wycombe Hospital.
There is a weekly upper GI cancer MDT meeting and a weekly lower GI cancer MDT
meeting, involving review of X-rays and histology. There is a once monthly joint
gastroenterology and surgical clinic meeting where X-rays and histology are discussed.
At Stoke Mandeville there is a weekly Wednesday morning general medical teaching
session and there are opportunities for the Registrar to teach junior doctors and medical
students on secondment from Oxford.
Research
Wycombe has been a productive department in terms of gastroenterology research and
audit. Time is allowed for Registrars to develop and supervise projects and most
Registrars have successfully completed papers or abstract submissions whilst being at
the hospital.
Examples of timetables
4 months at Wycombe Hospital:
Mon
Tues
Wed
Thurs
Fri
8.15 Upper GI MDT
DG clinic (AH)
DG clinic
SC clinic (AH) or Endoscopy
Endoscopy
Lunchtime: Journal
Club & GI meeting/
lower GI MDT
Endoscopy
admin
Endoscopy or EJ clinic
On calls at WH as per WH stroke/cardiology rota
Oxford
Endoscopy
8 months at Stoke Mandeville Hospital:
Mon
Ward Work
Ward Work
Tues
Wed
Ward Work
or
endoscopy
SC clinic (AH) or Endoscopy
Ward Work
WH: Endoscopy or EJ clinic
Thurs
8.15 Upper & lower
GI MDT
Fri
Ward work
Ward work
Oxford
Ward work or
Endoscopy
On calls at SMH, as per SMH acute medical registrar rota.
General Internal Medicine at Stoke Mandeville and Wycombe Hospitals
Acute services at Wycombe Hospital consist of dedicated Cardiology Services (fully
functional angiography Unit) and Acute Stroke services. There are no gastroenterology
or general medical inpatient services at Wycombe Hospital. The gastroenterology
registrar when based at Wycombe will participate in an out-of-hours on call rota for
cardiac/stroke patients at Wycombe as part of GIM training.
Acute medicine is centred at Stoke Mandeville Hospital which receives unselected
medical take, apart from cardiac and stroke patients who are admitted to Wycombe
Hospital. The gastroenterology registrars will participate in an on call rota for unselected
medical patients at Stoke Mandeville as part of GIM training.
Experience will include:
Acute general medicine.
including CCU experience and ward follow up clinic.
Gastroenterology
a) Management of gastroenterology inpatients
b) Gastroenterology outpatients to include general gastroenterology, inflammatory
bowel disease and hepatology clinics.
c) Experience of emergency gastroenterology (in particular upper gastrointestinal
bleeding) and including emergency endoscopy under consultant supervision.
d) Therapeutic upper gastrointestinal endoscopy including variceal injections/
variceal banding, oesophageal dilatations, insertion of oesophageal stents,
insertion of feeding gastrostomy tubes.
e) Colonoscopy including training in colonoscopic polypectomy.
f) ERCP training where appropriate
g) Experience in parenteral nutrition
ROYAL BERKSHIRE HOSPITAL
Dr Margaret Mysor, Dr Jonathan Booth, Dr Jon Simmons (Training Lead), Dr
Des deSilva, Dr Caroline Green, Dr Nish Chandra, Dr Alex Evans
The Royal Berkshire NHS Foundation Trust (650 beds) is the District General
Hospital serving West Berkshire, an area extending from Hungerford in the west to
Henley-on-Thames in the east, and including Wokingham and parts of Hampshire to
the south and parts of Oxfordshire to the north. The resident population served by
the Trust is around 550,000. The hospital provides all those services normally
associated with a very large District General Hospital. Only cardio-thoracic surgery,
complex hepato-biliary and transplant surgery, neurological surgery, plastic and
major neonatal surgery are referred outside the district to specialist centres in Oxford
or London.
Gastroenterology , Endoscopy and General Internal Medicine
There are five speciality based 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.
All acute medical patients are currently admitted via the Acute Medical Unit (AMU),
which is based near the X-ray and A+E Departments. Within the AMU there is a
Higher Monitoring Area (Medical HDU) of four beds providing care of the critically ill
including non-invasive ventilation, CVP monitoring and step down from ITU. The
HMU is supported by the ITU outreach team. The gastroenterology ward consultant
and registrar provide daily input into AMU to see new admissions with
gastroenterological problems
The Gastroenterology unit is currently based on 28-bedded Sidmouth Ward and in
the Endoscopy and Outpatients’ Departments. Outpatient clinics and endoscopy lists
are also carried out at West Berkshire community hospital in Newbury.
Approximately 2000 new patients and 3500 follow-up patients are seen annually in
the Department’s outpatient clinics. In addition to general gastroenterology, we have
specialist inflammatory bowel disease, intestinal failure and viral hepatitis clinics.
Endoscopy: The trust runs a modern purpose built 4 room endoscopy unit with xray
facilities in one of the rooms. The unit perform in excess of 6000 procedures a year
and offers the full range of endoscopic modalities including diagnostic and
therapeutic upper and lower GI endoscopy, push enteroscopy, endoscopic
ultrasound and ERCP. The unit is managed by gastroenterology but work is shared
with the surgical specialities with pooling of lists. The unit has JAG accreditation and
is a screening centre for the National Bowel Cancer Screening programme. In
addition to hospital based medical staff the unit is staffed by 2 GP assistants and 2
nurse endoscopists. There is also a GI physiology lab, managed by the surgical
directorate, providing pH monitoring and manometry for oesophageal diseases.
Reduced points training lists are provided and active participation with JETS is
strongly encouraged.
The trust provides a regional service for wireless capsule endoscopy.
A specialist PEG nurse provides a comprehensive enteral feeding access service to
the hospital and community. There is a multidisciplinary hospital nutrition team
providing support for enteral and parenterally fed patients.
Meetings within the Gastroenterology Department: The Department holds
fortnightly X ray and pathology meetings, and a fortnightly seminar / journal club for
which the junior members of the gastroenterology medical team prepare papers in
rotation. There is a well-attended weekly medical grand round meeting.
Links with Surgery: We continue to enjoy a close working relationship with both the
upper GI and colorectal surgeons, with joint management of difficult hepatobiliary
and inflammatory bowel disease patients and those with acute GI bleeding. The
department contributes to weekly upper and lower GI cancer MDT meetings and a
monthly pancreatico-biliary MDT with Oxford.
Existing Gastroenterology Staff Establishment:
7
Consultant Gastroenterologist / Physicians
3
Specialist Registrars in gastroenterology (Oxford Regional Rotation)
1
Associate Specialist
1
F2
4
Clinical Nurse Specialists (PEG/wireless endoscopy, IBD, hepatitis, bowel
screening)
1ST1 2 FY1
Examples of weekly timetables when not on call for General medicine
Ward week
Monday
Tuesday
Wednesday
Thursday
Friday
Consultant WR
X-Ray meeting
Consultant WR Nutrition WR
Consultant WR
Ward work
Clinic or
Endoscopy
Endoscopy
Grand Round
Oxford
Teaching
Wednesday
Thursday
Gastro Meeting
UGI MDT
Non-ward week
Monday
Tuesday
Friday
IBD clinic
Gastro clinic
Endoscopy
LGI MDT
endoscopy
Nutrition WR
IBD clinic
Grand Round
Oxford
Teaching
Hepatitis clinic
Training will include
1. Acute General Medicine
To include rotad weeks running the Acute Medical Unit with supervision of the
junior team and Consultant post take ward rounds, general medical inpatient care
and ward rounds,.
2. Gastroenterology
a) Management of gastroenterology inpatients
b) Gastroenterology outpatients to include general gastroenterology, inflammatory
bowel disease and hepatology clinics.
c) Experience of emergency gastroenterology (in particular upper gastrointestinal
bleeding) and including emergency endoscopy under consultant supervision.
d) Therapeutic upper gastrointestinal endoscopy to include variceal banding,
oesophageal dilatations, insertion of oesophageal stents, insertion of feeding
gastrostomy tubes.
e) Colonoscopy - training under supervision including polypectomy.
f) ERCP as appropriate
g) Experience in parenteral nutrition
MILTON KEYNES
Drs. Lanzon-Miller, Madhotra and MacFaul (TPD and training Lead)
MKFT is a district general hospital and a foundation trust, serving a catchment area
of 270,000 population. There are 3 gastroenterologists: Dr Sandro Lanzon-Miller, Dr
Ravi Madhotra, and Dr George MacFaul.
Dr Sandro Lanzon-Miller is a senior general gastroenterologist. He did his GI training
at London and area of research was on acid-peptic disease. He has special interest
in inflammatory bowel disease. He is the Lead clinician for Upper GI cancer for the
trust.
Dr Ravi Madhotra is the Lead clinician for gastroenterology and endoscopy. He is
Director of Bowel Cancer Screening programme for Buckinghamshire.
Dr George MacFaul is a gastroenterologist trained in the Oxford deanery. He has
special interest in nutrition, hepatology and general gastroenterology, is a keen
endoscopist and an accredited bowel cancer screener and colonoscopy trainer,
currently leading Endoscopy training. He also leads the Nutrition team in the
hospital. He is the Gastroenterology Training programme Director for the Oxford
Deanery.
The Gastroenterology firm consists of 2 SpRs (Oxford rotation), 2 Staff Grade
doctors, 2 FY2/ST1 and 2 FY1 doctors,
Clinical There are a variety of training opportunities in gastroenterology and general internal
medicine, available for specialist registrars at Milton Keynes. Each ST/SpR has 2 or
more endoscopy training sessions available for supervised training. For senior
trainees ERCP training is available. The trainees have access to therapeutic
endoscopy including oesophageal stent insertion, variceal banding and PEG/PEJ
insertion. A brand new state-of-the-art 4-room endoscopy unit opened in April 2009
(Olympus scopes) with Scopeguide in 2 rooms. MKHFT is a designated Screening
centre for Buckinghamshire bowel cancer screening programme. An induction pack
is available for all trainees when they join the department, with a Nurse lead for
training who co-ordinates the training lists as per the needs of the trainee. There is
arrangement for regular feedback between trainees and trainers, and a monthly
endoscopy users group meeting which the trainee is encouraged to attend.
There are 2 supervised clinics per week in general gastroenterology and IBD, mixed
for new and follow up patients. The trainees are required to attend colorectal, UGI,
hepatobiliary and IBD MDTs on Thursday between 12-1.30pm, before attending
Gastro SpR teaching at Oxford.
The trainees get good experience in general medicine while on-call for unselected
admissions, with predominantly gastro in-patients on the dedicated gastrointestinal
ward. There are plentiful opportunities to gain experience in seeing inpatient referrals
under supervision. There is a multi-disciplinary nutrition meeting weekly, led by Dr
MacFaul and the Nutrition ANP. There is a weekly general medicine grand round on
Wednesdays and Journal club on Fridays.
1. General medicine at MKHFT
Acute general medicine to include inpatient ward rounds, acute general medical
take, post take ward rounds, some general medical follow-up and including CCU
Unit experience. There is a busy MAU with 5 acute physicians and an excellent
Ambulatory Care Unit.
2. Gastroenterology
Management of gastroenterology in-patients including 2 general
medical/gastroenterology ward rounds per week.
b) Gastroenterology outpatients: 2 gastroenterology outpatient clinics will be held
weekly.
a)
c) Endoscopy - Upper Gastrointestinal Endoscopy under supervision, it will also
include therapeutic procedures like Sclerotherapy, variceal banding,
oesophageal stent insertion and PEG
d) Rigid and Flexible Sigmoidoscopy
e) Colonoscopy and polypectomy training
f) Training in therapeutic ERCP for senior GI trainees
g) Experience in delivering a nutrition service.
MILTON KEYNES HOSPITAL
Post 1 (Dr Lanzon-Miller)
Monday
Tuesday
Wednesday
Thursday
Friday
Consultant
WR
Ward round
OPD
(IBD)
Consultant
Ward Round
Registrar
Ward
Round
Postgraduate
Teaching
CME/audit
Endoscopy
Training
MDT
Colorectal/UGI
Meeting
Endoscopy
Training
Oxford
Study Half Day
OPD Gastro
Wednesday
Thursday
Friday
SpR WR
CME
OPD Gastro
Post 2 (Dr MacFaul)
Monday
Tuesday
SpR WR
Consultant
round
ward
Postgraduate
Teaching
Endoscopy
Training
Gastro OPD
Endoscopy
Training
MDT
Colorectal/UGI/
IBD Meeting
Oxford
Study Half Day
Horton Hospital - Oxford University Hospitals NHS Trust
Dr Antony Ellis (Training Lead), Dr Jonathan Marshall.
Ward work
The Horton hospital is situated in Banbury and serves a population of approximately
160,000. Since 1998 it has been part of the John Radcliffe Hospitals NHS Trust. The
hospital currently provides services in acute medicine, acute surgery, trauma and
orthopaedics, obstetrics, gynaecology, and paediatrics. There are many visiting
consultants from Oxford who deliver sub-specialty services including rheumatology,
neurology, ophthalmology, ENT to name a few.
The Department of Medicine has 106 beds in a dedicated medical block with in
addition a 10 bedded medical assessment unit. The average number of admissions
is 20 with takes of up to 40 on occasion. There are 8 medical consultants who cover
the acute medical take on a 1:8 rota. They are supported by 6 SpRs and 2 trust
grade registrars. There is additional on-call support utilising research fellows from
Oxford. The F1 programme involves doctors rotating within the JRII trust. The ST1
and ST2 grades are all in training programmes.
The Department of Gastroenterology consists of 2 Consultant Gastroenterologists,
Dr Antony Ellis and Dr Jonathan Marshall based in Banbury. There are 2 further
Consultant Gastroenterologists, Dr Barbara Braden and Dr Adam Bailey who are
based in Oxford and work in Banbury for 1 day each. The Consultants are supported
by 2 SpRs in gastroenterology, 2 ST1/ST2’s and 1F1.
Both Dr Ellis and Dr Marshall have undertaken the ‘Train the Trainers’ course and
have an interest in postgraduate medical education.
The endoscopy suite has recently been modernised and consists of 2 rooms
equipped with Olympus Lucera stacks. For upper GI endoscopy we have lucera
scopes with a twin channel therapeutic gastroscope for emergency upper GI
bleeding. We have NBI capability for Barrett's surveillance. Haemostatic techniques
taught include adrenaline injection, heater probe, variceal banding, cyanoacrylate
injection, clipping and argon plasma coagulation (APC). We have the Olympus
scope guide system which is used to facilitate colonoscopy training.
The department is accredited for the bowel cancer screening programme (BCSP)
ERCP services are now delivered in Oxford and Dr Ellis undertakes a list on this site.
Trainees identified as appropriate for ERCP training may utilise this list. Dr Marshall
undertakes a weekly dedicated colonoscopy training list in Oxford which is open to
all StR’s within the Trust
At present there are 6 out-patient clinics for training purposes which are supervised
by consultants. These do not take place if a consultant is absent. To facilitate the
rapid evaluation of patients these clinics remain coded as general gastroenterology
but contain a mix of luminal and solid organ pathology. General medicine accounts
for less than 5% of all follow ups seen in clinic.
There are 31 in-patient beds run by Gastroenterology of which between 12 and 15
are filled by ‘specialty patients’.
In addition to the above there is a weekly journal club, X-Ray meeting, and 1 hour
case presentation session. SpRs are encouraged to attend the upper GI and HPB
MDTs with Dr Ellis on a Monday morning. There is weekly teaching in Oxford which
is timetabled to allow for regular attendance. This includes a lecture, pathology –
including Banbury histology, and interesting cases. The StR’s are released on a
monthly basis to attend the general medicine teaching.
The unique affiliation with the JRII allows for a seamless transition for patients
requiring tertiary intervention with rapid repatriation to their local community when
investigation/treatment is complete. StR’s are able to monitor progress of patients
both with visits to the wards in Oxford on training days and remotely via the
integrated computer system.
Feedback from previous StR’s has been positive with particular reference to
endoscopy training and personal support.
During this post experience will be gained in
1. General Medicine
a) Acute general medicine to include general medical take and post take ward
round.
b) Management of acute general medicine inpatients.
c) General Medical Outpatients to include general medical referrals and ward follow
up clinic.
d) Coronary care / HDU experience.
2.
Gastroenterology
a) Management of gastroenterology in-patients including 2 general gastroenterology
ward rounds per week.
b) Gastroenterology outpatients. One clinic in general gastroenterology / IBD and
one general gastroenterology / hepatology.
c) Training in upper gastrointestinal endoscopy under supervision 2 sessions per
week under consultant direction.
d) Focused training in colonoscopy
e) Rigid and flexible sigmoidoscopy.
f) Work with Dr Marshall for nutrition round and participate in PEG service
g) ERCP. Senior SpR’s can arrange training with Dr Ellis
Examples of timetables at HGH
Monday
Tuesday
Wednesday
Thursday
Friday
Ward Round
(Dr A Ellis)
UGI / pancreatico biliary MDT
Endoscopy
Research /
audit
Clinic
Gastroenterology
/ IBD
(Dr A Ellis)
Endoscopy
(Dr Braden)
Medical cases
Grand round
Oxford
Ward round
Journal Club
OPD
Ward
Ward round
Gastroenterology /
Hepatology
Monday
round
reg
(Dr A Ellis)
Tuesday
Study Half Day
Wednesday
(Dr A Ellis)
Thursday
Friday
Reg round /
Admin
Admin
Ward Round
(Dr J
Marshall)
Teaching
Medical cases
Endoscopy
(Dr J Marshall /
Dr J Harrison)
Oxford
training half
day
Grand
Round
Clinic
(Dr J
Marshall)
X-Ray Meeting
Endoscopy
(Dr J Marshall
Admin
Journal Club
Clinic
(Dr J Marshall)
Ward Round
(Dr Marshall)
John Radcliffe Hospital – Oxford University Hospitals NHS Trust
The John Radcliffe Hospital serves a local population of 620,000, with an allied clinical
gastroenterology service at the Horton Hospital, Banbury (Dr Tony Ellis, Dr Jonathan
Marshall), which is an independent component of the regional rotation. The Unit sees
2000 inpatients, 3250 new patient referrals, 14500 follow-ups and 12500 endoscopic
procedures/year, of which 15% are tertiary referrals with inflammatory bowel disease, liver
disease or intestinal failure.
Organisation The Service is consultant led. There are two 'sides': a Luminal side (Dr
Travis and Dr Keshav) and Hepatobiliary side (Dr Collier and Dr Cobbold), with combined
outpatient clinics and shared Consultant care on each side. A 200 page Gut Doctors’
Guide (2012) is available on line to every trainee, explaining local protocols and practice.
Consultants
John Radcliffe
Dr Jane Collier MD FRCP
Dr Ollie Brain
Dr Satish Keshav DPhil FRCP
Dr Simon Travis DPhil FRCP
Dr Barbara Braden MD PhD
Dr Adam Bailey FRACP
Dr James East MD MRCP
Dr Jeremy Cobbold
Dr Beth Bird - Lieberman
Honorary Consultants
Dr E Barnes DPhil FRCP
Special Interest
Hepatology
Endoscopy/IBD
IBD
IBD, intestinal failure
Endoscopy/EUS
Upper GI
Endoscopy
Hepatology
Endoscopy /upper GI
Hepatic viral immunology
Dr A Simmons PhD FRCP
Mucosal T-cell immunology
Trainees rotate through posts and clinics
There are 3 rotation StR’s and 1 Hepatology* StR (3 months Cambridge and 9 month
oxford post- nationally appointed). Each week there are 3 general gastroenterology and
specialist clinics in liver disease, hepatitis C, inflammatory bowel disease and coeliac
disease, as well as regular nutrition, adolescent IBD, HIV and haemophilia clinics. There
are also 12 joint liver transplant clinics/year.There is a 19 bed specialist gastroenterology
ward and 6 bed day unit (for ERCP, paracentesis, anti-TNF therapy, venesection). There
are 5 endoscopy rooms. There are over 40 endoscopy lists/week, including all diagnostic
and interventional procedures, EUS (2) and ERCP (3). Great emphasis is placed on
multidisciplinary care, with close cooperation between colorectal and upper
gastrointestinal surgeons, gastrointestinal
Specialist
Senior Clinical
histopathology and radiology. There is a
Registrars
Fellows
specialist IBD multidisciplinary team meeting
Luminal
4 posts, each with 6
each week. Intestinal transplantation started
endoscopy and 4
Hepatology*
in Oxford in 2009. The hepatobiliary radiology
academic
Hepatobiliary
sessions/week
meeting is attended by the hepatobiliary
Nutrition
surgeons acting as a benign MDT.
Allied professions
Other trainees
F1 (1)
ST 1 (1)
ST 2 (1)
ACF (1)
CNS; hepatology (2.5),
IBD (2), nutrition (3)
Dietitians (4)
Research (2)
GI Pharmacy (1)
Teaching and Training Education of junior
medical staff is carried out through two
gastroenterology teaching sessions each
week, together with Consultant-lead regional
Specialist Registrar teaching each week.
There is a weekly joint postgraduate teaching session held between physicians and
surgeons, a journal club, separate luminal and hepatobiliary histopathology and X-ray
sessions each week. The Gastroenterology Unit undertakes training of first and third year
clinical Oxford medical students, as well as medical students from overseas. These
activities specifically include tutorials, teaching ward rounds and seminar sessions as well
as less formal ward and outpatient based teaching.
Research The Oxford Gastroenterology Unit is acknowledged as one of the premier units
for gastroenterological research in Europe and attracts research fellows from all over the
world. It is lead by Fiona Powrie, Sidney Truelove Professor of Gastroenterology, a
mucosal immunologist. She has established the Translational Gastroenterology Unit,
situated in the John Radcliffe Hospital, with laboratories adjacent to the clinical service
offices and the Gastroenterology ward. The Unit builds on excellent clinical programmes
in inflammatory bowel disease and hepatology as well as cutting edge basic science
programmes in mucosal immunology. The new state of the art laboratories bring together
scientists, clinician scientists and gastroenterologists with the objective of translating
fundamental research in mucosal immunology into enhanced treatments for inflammatory
bowel disease, liver disease and cancer. Oxford has an international reputation in the
aetiopathogenesis and therapeutics of inflammatory bowel disease, viral hepatitis and
primary sclerosing cholangitis. There is a 3 bed Clinical Trials’ Facility within the new
Endoscopy Unit.
The gastroenterology Specialist Registrars rotate in 3-4 month blocks round subspecialty
areas (luminal, hepatology, hepatobiliary, nutrition). The general medical commitment is
limited to night cover in rotation with all the specialist registrars (32) at the John Radcliffe.
a) Management of Gastroenterology inpatients including 2 gastroenterology ward
rounds per week. The specialist GI ward has 21 beds for secondary and tertiary
referrals needing inpatient treatment.
b) Gastroenterology outpatients. A general weekly gastroenterology clinic and
weekly hepatology or inflammatory bowel disease clinic.
c) Advanced endoscopy/colonoscopy/ERCP training. The opportunity to learn
endoscopic ultrasound techniques.
d) Opportunity to learn upper and lower GI motility techniques, including
oesophageal manometry, oesophageal pH testing and rectal manometry.
e) Nutrition training, including management of complex intestinal failure and intestinal
transplantation
Examples of timetable
(i) Hepatology
Monday
Tuesday
Hepatitis Clinic
Gastro Clinic
Wednesday
MDT HPB
cancer
Endoscopy
(training list)
Thursday
Friday
Endoscopy
List
Journal Club
OPD
Hepatology
Student and
SHO teaching
Grand Round
Consultant Liver
Ward Round
Radiology
Meeting
ERCP
(training list)
Oxford Study
Half Day
Ward work
Liver Histology
(ii) Luminal
Monday
Tuesday
Wednesday
Thursday
Friday
Journal Club
Emergency
Endoscopy list
Colonoscopy/
Endoscopy
Ward Round
(Dr Travis or Dr
Keshav)
GI X Ray
Meeting
OPD
General Gastro
(Dr Travis/ Dr
Keshav)
Intestinal failure
ward round
(Dr Travis)
Student and
SHO teaching
IBD MDT
meeting
Oxford Study
Half Day
IBD Clinic
(Dr Travis/ Dr
Keshav)
Teaching and Research
There is a fixed half-day teaching session in Oxford each week. Teaching
includes formal lectures, histology review sessions, clinical cases and talks from
guest speakers. The lectures are designed to cover the curriculum over a 3 year
cycle. All trainers within the rotation are committed to training StR’s in
Gastroenterology. Teaching is arranged both locally at the base hospitals and
centrally in Oxford on a weekly basis. General Medicine is taught locally with monthly
formal teaching arranged by the deanery
Research is encouraged at every level, with almost three quarters of all
trainees doing a PhD or MD. The Translational Gastroenterology Unit in Oxford is
co-located with the clinical service, integrating basic science and clinical practice.
Each year trainees will be expected to develop a project in conjunction with their
Education Supervisors. It is expected that this work will lead to presentation to a
learned Society at Regional, National or International level and to publication. All
trainees would be expected to present a project at least once during the year and
those that have not presented to a learned Society will present to the members of
the Specialty Training Committee
Duties of Post –
MAIN DUTIES AND RESPONSIBILITIES
These vary slightly and according to the exact part of the rotation the trainee
is attached to, but all posts include 6 fixed sessions consisting of 2 out-patients, 2
endoscopy and 2 ward round sessions. All posts in Banbury, High Wycombe, Milton
Keynes and Reading include General Medicine and a commitment to acute General
Medical Take with experience on CCU and/or ICU. StRs based in Oxford have no inpatient or out-patient general medicine exposure but may participate in the medical
on-call rota.
Daily Commitment
This varies between posts but is outlined in the timetables given with each
rotation which is enclosed with this job description.
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:
 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 52hours 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/your-workforce/need-to-know/european-working-timedirective
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/your-workforce/pay-and-reward/pay/pay-andconditions-circulars/medical-and-dental-pay-and-conditions-circulars 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/your-workforce/pay-and-reward/pay/pay-andconditions-circulars/medical-and-dental-pay-and-conditions-circulars
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 205206 of the TCS. The TCS may be viewed at
http://www.nhsemployers.org/your-workforce/pay-and-reward/nhs-terms-andconditions/junior-doctors-dentists-gp-registrars/junior-doctors-terms-and-conditionsof-service-and-associated-documents
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/MedicalandDentalContracts/JuniorD
octorsDentistsGPReg/Pages/DoctorsInTrainingJuniorDoctorsTermsAndConditions150908.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 preemployment checks. The employer will confirm their local arrangements, which are
expected to be in line with national guidance at
http://www.nhsemployers.org/your-workforce/recruit/employment-checks/nhsemployment-check-standards
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 LETB’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://specialtytraining.hee.nhs.uk/.
Please ensure that you inform Health Education Thames Valley of any changes to
your contact details.
January 2015