NHS EDUCATION FOR SCOTLAND WEST OF SCOTLAND REGION SPECIALIST REGISTRAR IN BREAST DISEASE (ONCOPLASTIC FELLOWSHIP) Ref: WOS 010312 JOB DESCRIPTION 1. INTRODUCTION This Specialist Registrar post in Breast Disease forms part of the Surgical Training Programme in General Surgery. The successful candidate will be appointed from October 2012 until July 2013 only, no extensions will be available. It has training approval from the Postgraduate Dean and Joint Committee in Surgical Training. The trainee’s education and progress is supervised by the Surgical Training Committee and by designated supervisors in each hospitals involved in the programme. The Surgical Training Committee comprises the Regional Education Adviser, Trust Representatives, University and Junior Staff Representatives. Individual trainees are required to sign a training programme agreement, and performance assessment is carried out on a regular basis throughout training. Summative assessment is conducted annually and is based on in-house training assessment criteria laid down by the JCST. Study Leave conforms with terms and conditions of service for the Specialist Registrar grade. The aims of the post is to provide training in the subspecialty of Breast Surgery with emphasis on Oncoplastic training. The post is ideally suited to a higher surgical trainee in year 5 or 6 who is committed to a career in the management of breast disease. 2. ENTRY REQUIREMENTS The Trainee will be appointed by a Committee comprising representatives of the Postgraduate Dean, Specialty Training Committee, teaching hospitals, district hospitals, University of Glasgow and National Panel of Specialists. Applicants should already be on a Surgical Training Programme. All trainees will require to have completed basic surgical training and to hold the diplomas of MRCS/FRCS/AFRCS or equivalent. The post is designed for trainees who hold a National Training Number Applicants will be expected to provide evidence of their competence to communicate in English. 3. DUTIES OF THE POST Training The Trainee must make full use of the training opportunities provided in each placement. Clinical The Trainee will be expected to participate fully in the clinical work of the department, including the pre- and post-operative care of patients. He/she will be expected to extend and improve their surgical skills and be involved in on-call rotas for the majority of clinical attachments. Supervision by Consultant Staff will always be available. Emergency surgery will be undertaken as part of this post by participation in the emergency surgical rota at the hospital in which the trainee is based. Administration The Trainee will be expected, when appropriate, to participate in the day to day running of the department in administrative activities such as organisation of on-call rotas, organisation of undergraduate training, patient reports and letters. The Trainee will have the opportunity to develop management skills as required by the JCST. Communication This will include: Discussion with relevant Consultants regarding clinical problems. Communication with General Practitioners – this will include telephone discussion of problems and writing of letters about cases seen in the Department. Liaison with Specialists in other hospitals/agencies such as district nurses, ambulance, police, etc. 4. EDUCATION Continuing Education The Trainee will be expected to participate in educational activities on a local and national basis. All hospitals enjoy well stocked departmental libraries and in addition comprehensive education facilities. Education leading to the intercollegiate FRCS is available through in-house tutorials and locally arranged postgraduate courses. Trainees are expected to further their education through attendance at meetings and courses held both locally and nationally. Management development is encouraged and the Trainee will be expected to attend appropriate courses. Teaching At the appropriate stage of training, the Trainee will be expected to take part in departmental teaching for junior staff, undergraduates, nursing staff, etc 5. RESEARCH AND AUDIT Research There is a strong tradition of research in the West of Scotland. Facilities and support for research activities are available through the University academic department and within hospital departments. The trainee will be encouraged to participate in clinical research and time will be allocated consistent with current Terms & Conditions. Audit Audit is an essential component of Surgical practice and the Trainee will be required to participate in local and national audit activities. 6. LOCATION OF DUTIES The hospitals involved in the training programme are as follows: Canniesburn Plastic Surgical Unit, Royal Infirmary, Glasgow Western Infirmary Breast Unit, Glasgow 7. ASSESSMENT The Trainee will be continuously assessed by the trainers in their place of work with formal interviews every 6 months and annual review by the Surgical Sub-Committee of the West of Scotland Postgraduate Medical Education Board. If, in the opinion of the Surgical Training Committee, the Trainee fails to show adequate commitment or progress, career guidance will be arranged, and exceptionally, in the absence of satisfactory progress, the committee may recommend that the contract be terminated. Trainees are required to keep a portfolio and logbook following the requirements laid down by the JCST 8 GENERAL INFORMATION Hours and Salary The hours of duty will be the standard working week of 40 hours for which a standard salary (as detailed in paragraph 8b, Appendix 1 of the Terms and Conditions of Service, appended under general information) will be paid. From December 1st 2000, a new system for calculating Junior Doctor's out of hours pay was introduced, the 'Banded Intensity Contract'. The standard hours of duty will remain 40 hours per week and in addition a supplement will be paid. The banding for the hospitals on the rotation will be confirmed on appointment. Please note that a monitoring exercise is currently being undertaken, therefore, the current Banding may be subject to change. An offer of Employment may not reflect the current Banding. Further Information For further information the training programme, please contact: Mr C R Wilson, Training Programme Director and Consultant Breast Surgeon, Western Infirmary, Glasgow, Telephone: 0141 211 6248 Ms J C Doughty, Consultant Breast Surgeon, Western Infirmary, Glasgow Telephone: 0141 211 6248 Mr J H Anderson, Chair of the Surgical Training Committee and Consultant Surgeon, Glasgow Royal Infirmary, Glasgow Telephone: 0141 221 4793 Miss E Mithoff, Consultant Plastic Surgeon, Canniesburn Unit, Glasgow Royal Infirmary, Telephone: 0141 211 5798 Mr I MacKay, Consultant Plastic Surgeon, Canniesburn Unit, Glasgow Royal Infirmary Telephone: 0141 211 5798 Mr B Chew, Consultant Plastic Surgeon, Glasgow Royal Infirmary Telephone: 0141 211 4000 Mr V Sivarajan, Consultant Plastic Surgeon, Glasgow Royal Infirmary Telephone: 0141 211 4000. Mr A Malyan, Consultant Plastic Surgeon, Glasgow Royal Infirmary Telephone: 0141 211 4000. APPENDIX OUTLINE OF PROPOSED PROGRAMME SPECIALIST REGISTRAR IN BREAST SURGERY Western Infirmary Breast Unit Canniesburn Plastic Surgical Unit INTRODUCTION Glasgow has a National and International reputation for the management of all aspects of Breast disease and in recent years has developed a fully integrated model for the provision of and training in Oncoplastic Breast techniques. This model of Oncoplastic Breast Surgery relies on the close working relationship between the Plastic Surgeons and Breast Surgeons in Glasgow. This has resulted in excellent training opportunities for our local trainees who spend at least 6 months dedicated Breast Plastic Surgical Training in the Canniesburn Unit. .The establishment of an interface group of the two SACs to process this approach has highlighted the combination of general and plastic training in breast surgery. We are, therefore, able to offer the full range of specialist training in breast surgery as outlined by the curriculum devised by the SAC in general surgery in a new combined unit of surgeons who have nationally recognised expertise. This could provide appropriate experience in the management of breast disease for both general and plastic surgery trainees. The unit has an international reputation for its clinical and basic research and this is reflected by the prominent role that many of the units play in the organisation of breast cancer and other cancer services in Scotland and the rest of the UK STAFFING Western Infirmary Ms. J.C. Doughty Mr C R Wilson 4 Nurse Specialists Canniesburn Unit, Glasgow Royal Infirmary Mr I MacKay Miss. E. Mithoff Mr. A. Ray Mr. J. Scott Mr A. Malyon Ms M. Strick Multidisciplinary Team Close working relationships with other specialists within a multidisciplinary team are a key part of modern breast cancer management. This is long established in our practice, we are fortunate to collaborate with a number of outstanding clinicians, many of whom are recognised nationally. Pathology Dr. E. Mallon Dr. M. Seawright Dr. D. Kipgen Radiology Dr. H. Dobson Dr. C.Cordiner Dr. N. Moss Dr. J. Litherland Dr H. Griffiths Oncology Dr. P. Canney Dr. G. Fraser Dr. J. Fraser Dr M Rizwanallah UNIT CLINICAL PROGRAME Multidisciplinary One stop Assessment Clinics Breast Screening Assessment Clinics Genetic Evaluation and High risk Clinics Breast Cancer Planning and Results Clinics Follow up Clinics Breast Reconstruction and Oncoplastic Assessment Clinics Symptomatic Breast MDT Breast Screening MDT Symptomatic Breast Theatre Sessions ( Combined with Endocrine Cases ) Impalpable Screen Detected Theatre Sessions Oncoplastic / Immediate / Delayed Reconstuctive Theatre Sessions Clinical Workload Western Infirmary Approximately 4000 symptomatic new breast patients per year are assessed in two on-stop diagnostic clinics and in excess of 400 breast cancers are treated which includes 150 screen-detected cancers. A further 50 patients with breast cancer are treated non-surgically with primary medical therapy. Forty per cent of patients have conservation surgery and 30 pr cent of those undergoing mastectomy have immediate reconstruction in conjunction with the plastic surgery team. In excess of 150 localisation procedures are performed for impalpable lesions. We have been at the forefront in the UK of developing new surgical techniques such as sentinel lymph node biopsy. Canniesburn Plastic Surgical Unit There are more than 500 new referrals per year for reconstructive surgery and approximately 200 immediate and 200 delayed reconstructions are performed annually. This allows ample opportunity for training in all aspects of ‘oncoplastic surgery.’. Training Opportunities The workload, range of activity, level of specialisation and supervision allows for provision of specialist training. Appropriate supervision is always available from the consultants involved in the management of breast disease. Training is available in palpable and unpalpable breast disease and also breast reconstruction Research Research is fundamental to clinical training and remains the requirement for the Intercollegiate FRCS examination. Out unit has developed an international reputation in both clinical and basic research. All trainees are encouraged to take an active part in this, and in recent years have all presented work at national and international meetings. Clinical Research Clinical trials are a central part of the development of our specialty and the unit is strongly committed to them. Members of the team are on the supervisory committees for several other national and international trials. Patients from our practice are actively recruited into the trials and a trainee is expected to be part of this process. Numerous other clinical projects are carried out in the unit for which we have a high rate of success in converting these for presentation at clinical meetings and for publication. Basic Research We have a strong framework of basic breast cancer work within the academic department and our research is recognised internationally. There are strong collaborative links with the Department of Pathology and the Beatson Institute. It is not unusual for clinical trainees to do laboratory work during the clinical training, as they are encouraged to take an interest in it and to make an intellectual contribution. Proposed Timetable This appointment should have particular emphasis on the techniques and assessment for Oncoplastic Surgery which will be gained by working within the model of care between the Western Infirmary and the Canniesburn Unit. This would provisionally involve spending time between the Western Infirmary and Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, but during that time there can be flexibility depending on the educational and training requirements of the trainee. .