NHS Lothian
Women’s Services
Royal Infirmary of Edinburgh
Clinical Fellow in Obstetrics and Gyanecology (ST6 or above equivalent or CCT
holder)
Fixed term one year
1. Outline of the post
Available from 01 August 2015. This is a fixed term post for one year. An extension
for a second year may be possible. The post holder will join a forward looking and
vibrant department and play an active role in inpatient obstetrics as well as having
the opportunity to develop their special interests in fetomaternal medicine,
gynaecology, sexual health or medical education. The job plan will include night and
weekend day shift work covering obstetrics and emergency gynaecology. The
existing consultants have either traditional on call or resident emergency cover in
their job plans and it is envisaged that the majority of consultants will move to having
a mixture of on call and resident shifts in their job plans in order to provide 168 hour
per week resident consultant cover.
The prinicipal base for the posts is the Royal Infirmary of Edinburgh. There may be
clinics in surrounding health centres.
Adjacent to the RIE building are the University of Edinburgh Chancellor’s Building,
providing outstanding facilities for undergraduate and postgraduate education and
the Queen’s Medical Research Institute. This includes the MRC Centre for
Reproductive Health (see www.crh.ed.ac.uk), which houses the Tommy’s Centre for
Maternal and Fetal Health.. In addition, there is a range of teaching and seminar
accommodation embedded within the clinical space at SCRH.
The posts will include time devoted to special interests. There is the opportunity
within the department to develop or maintain special interests in the following areas
Maternal medicine
Urogynaecology
Gynae-oncology
Reproductive medicine
Medical education
Emergency gynaecology
Outpatient gynaecology
2. NHS Lothian
NHS Lothian is an integrated NHS Board in Scotland providing primary, community,
mental health and hospital services. Mr Tim Davison is Chief Executive and Dr David
Farquharson is the Medical Director.
The NHS Board determines strategy, allocates resources and provides governance
across the health system. Services are delivered by Lothian University Hospitals
Division, the Royal Edinburgh hospital and associated mental health services, four
community health (and social care) partnerships (CH(C)Ps) in City of Edinburgh,
West Lothian, East Lothian and Midlothian, and a Public Health Directorate.
NHS Lothian serves a population of 850,000.
University Hospitals
The University Hospitals Division provides a full range of secondary and tertiary
clinical services to the populations of Edinburgh, Midlothian, East Lothian and West
Lothian. The Division is one of the major research and teaching centres in the United
Kingdom.
Hospitals included in the Division are:
The Royal Infirmary of Edinburgh
The Western General Hospital
The Royal Hospital for Sick Children, Edinburgh
St Johns Hospital
Royal Victoria Hospital
Liberton Hospital
The Princess Alexandra Eye Pavilion.
The Royal Infirmary (RIE) is a major teaching hospital on a green field site in the
South East of the city of Edinburgh built in 2003. It comprises 25 wards, 869 beds,
and 24 operating theatres, and is equipped with modern theatre and critical care
equipment and monitoring. Within the main building is a dedicated, multidisciplinary,
five-theatre day surgery complex. The hospital provides for most specialities and is
the centre for:
General surgery
Vascular surgery
Hepatobiliary and transplant medicine and surgery
Cardiac and thoracic surgery
Elective and trauma orthopaedic surgery
Neonatology
Obstetrics & Gynaecology
Cardiology
Renal medicine
Sleep medicine
Accident and Emergency.
There is a Combined Assessment Unit which takes unselected GP or direct
emergency referrals, and from A&E. CAU includes the Department of Liaison
Psychiatry and the Scottish Poisons Bureau and Treatment Centre. There are full
supporting Laboratory and Diagnostic Radiology Services (including CT, MR,
Ultrasound and PET scanning). There is a full range of lecture theatres, a library and
AV facilities.
The Western General Hospital (WGH) has 600 beds and five operating theatres
and is equipped with modern theatre and critical care equipment and monitoring. The
Anne Ferguson Building was completed in 2001. The hospital provides for most
specialties and is the centre for:
Neurology, neurosurgery and neuropathology
The UK CJD unit
Colorectal surgery
Urology and Scottish Lithotriptor Centre
Breast surgery
Gastroenterology
Rheumatology
Infectious diseases
Haematology and oncology
Medical oncology
Radiation oncology
Dermatology (Inpatient)
There is an Acute Receiving Unit, which accepts GP referrals and 999 ambulance
medical cases on a zoned basis within the city, and a nurse led Minor Injuries Unit.
There are full supporting Laboratory and Diagnostic Radiology Services (including
CT, MR, Ultrasound and NM). There is a full range of lecture theatres, a library and
AV facilities.
St John’s Hospital is located in the centre of Livingston, a new town about 30
minutes drive west from Edinburgh. The hospital provides for most common
specialties, has a paediatric ward and is the centre for:
General medicine with cardiology, diabetes & endocrinology, gastroenterology,
respiratory medicine and care of the elderly
Obstetrics & Gynaecology
Paediatrics and community child health
Plastic surgery
Oral and maxillofacial surgery
ENT
Critical Care (ITU, HDU and CCU)
Accident and Emergency
General surgery
Orthopaedics
Mental Health including ICCU and ICPU
Recent developments at SJH include a new endoscopy suite, an Intensive
Psychiatric Care Unit, a digital mammography unit, an oncology (cancer care) day
centre, a satellite renal dialysis unit and a £2.75m reprovision of A&E. There are full
supporting Laboratory and Diagnostic Radiology Services (including CT, Ultrasound
and NM).
The hospital has been accredited full teaching hospital status by the University of
Edinburgh. There is a full range of lecture theatres, a library and AV facilities.
The Royal Hospital for Sick Children (RHSC) is a 141 bedded hospital providing
general and specialist services for children. The hospital is situated in a residential
area close to the centre of Edinburgh and is approximately three miles from the site
of the New Royal Infirmary and the co-located University of Edinburgh Medical
School and three miles from the Western General Hospital. The RHSC is the main
paediatric teaching hospital for the South-East of Scotland providing general and
specialised services on a local, regional and national basis. It acts as the local
paediatric referral centre for the children of Edinburgh and surrounding areas, and as
a tertiary referral centre for intensive care patients; gastroenterology, hepatology &
nutrition; respiratory medicine; cardiology; nephrology; neurology; oncology;
haematology; neonatal surgery; plastic surgery; orthopaedic surgery; urological
surgery and general surgery.
Hospital accommodation encompasses five theatres, a critical care unit comprising
an eight bedded Paediatric Intensive Care Unit, a six bedded High Dependency Unit
and a three bedded Neonatal Intensive Care Unit. There is an excellent library facility
and a modern lecture theatre with a full range of audio-visual equipment.
All services are supported by comprehensive radiology, neurophysiology, laboratory
and therapy services. The local radiology department provides on site Magnetic
Resonance Imaging, CT Scanning, nuclear scanning and ultrasound. On site
laboratories provide biochemistry, haematology, pathology and neuropathology
services.
The children’s hospital will be re-located to the Royal Infirmary site in 2017.
Community Healthcare Partnerships
The four established Lothian Community Health (and Social Care) Partnerships
serve the population of Edinburgh, Midlothian, East Lothian and West Lothian.
Hospitals in the CH(C) Ps include:
The Astley Ainslie Hospital in Edinburgh
The Midlothian Community Hospital
Herdmanflat Hospital, Roodlands and Edenhall Hospitals in East Lothian.
The four CHPs are coterminous with Edinburgh, Midlothian, East Lothian and West
Lothian Councils bringing together those responsible for planning, managing and
providing community-based health services for the population of Edinburgh and the
Lothians.
There are 7,500 members of staff. In addition, there are approximately 1,000
independent contractors in General Medical and Dental Practice, as well as
pharmacists and opticians. A population of 850,000 people is served across health
board area. The range of services care of the elderly, medical rehabilitation,
community mental health, substance misuse and learning disability, district nursing
and health visiting, family planning, well woman, comprehensive dental care and
those provided by Allied Health Professions, such as physiotherapy, pharmacies and
optometrists. Specialist services provided include brain injury rehabilitation, bioengineering and prosthetics, drugs and alcohol misuse and harm reduction,
AIDS/HIV and Children and Family Psychiatric Services.
Royal Edinburgh hospital and Associated Services
The Royal Edinburgh and Associated Services provides a range of Mental Health
services to the population of Lothian and other Boards within Scotland. The Royal
Edinburgh Hospital is located on the south side of the City of Edinburgh. It comprises
some 20 wards, 420 beds, day hospitals and outpatient facilities. The hospital
provides the following range of specialities:Acute Mental Health
Rehabilitation
Psychiatric Emergency Team
Outpatients
Assessment Psychiatry of Old Age
Forensic Medium Security Unit
Inpatient facilities for under 18s
Psychotherapy Service
Psychology Services
Services for Eating Disorders
Day Hospitals – Psychiatry of Old Age
There are an additional 46 bed and one day hospitals for Psychiatry of Old Age in the
north of the city at the Royal Victoria Hospital.
The hospital is currently housed in a mix of accommodation ranging from 19th
century to present. There is a major project now in place to take forward a
reprovisioning programme in line with the strategic vision with the “Delivery for
Mental Health” Scottish Executive 2006.
Department of Public Health Medicine
The aim of the department is to improve the health of the people of Lothian in
collaboration with many other partners. Using a range of knowledge, experience and
networking capability, the distinctive contributions are:
the promotion of specific measures to monitor and improve health;
the collation and interpretation of health related information.
The following objectives have been agreed as the basis for the Department’s work
plans:
To monitor the health status and health needs of people in Lothian;

To promote improvements in the health of Lothian people directly, and by
providing information and advice to the public on health matters;

To assist Lothian NHS Board to fulfil its statutory obligations

To contribute to strategic changes within the NHS in Lothian by providing
information on clinical effectiveness;

To facilitate improvements in health and health care services directly, and
through ‘managed clinical networks’ and wider alliances;

To contribute on a 24 hour basis to the control and prevention of
communicable diseases and environmental hazards;

To maintain commitments to teaching, training, professional development,
audit and research.

To enable efficient management of the Department: there are at present four
groups in the Directorate. These are; Healthy Communities, Healthcare;
Health Protection and Health Information.
3. University of Edinburgh
The University of Edinburgh was established in 1582 and is one of the largest in the
United Kingdom located on a number of prominent sites in Scotland’s capital city. It is
Scotland’s premier research university, graded within the top six multi-faculty British
Universities in the last national research assessment exercise (90 percent of its
academic staff were in units rated 4, 5 or 5*). It has 3,000 academic staff, over
16,000 undergraduate and over 4,000 postgraduate students and an annual
expenditure of over £261M for teaching and research. The University is organised
into three Colleges: Humanities and Social Science, Medicine and Veterinary
Medicine, Science and Engineering.
A new MRC / University of Edinburgh Centre for Reproductive Health opened in April
2011. There are close links between the centre and the Simpson Centre for
Reproductive Health, with seven of the current clinical staff having dual
appointments, and with further opportunities for collaboration.
4. NHS Library and Postgraduate Facilities
There are excellent facilities on all sites.
5. Departmental Information
The Simpson Centre for Reproductive Health (SCRH) currently has a delivery rate of
approximately 7000 deliveries per annum, with a commensurate gynaecological
workload. On the ground floor of the building are an integrated out-patient facility,
emergency triage and assessment areas, an obstetric day assessment unit, a
Pregnancy Support Centre and obstetric and gynaecological ultrasound scanning
and pre-natal diagnostic services. A midwifery-led birthing centre opened adjacent to
SCRH in October 2011. 1294 women gave birth here in 2013. Also on the ground
floor is the Edinburgh Fertility and Reproductive Endocrine Centre, providing an
integrated level 3 fertility service. On the first floor are the labour suite, obstetric inpatient accommodation, integrated obstetrics and gynaecological theatre suite, and
the neonatal intensive care unit. The second floor houses the gynaecological inpatient accommodation, further obstetric in-patient accommodation, as well as office
accommodation for medical, administrative and support staff, and the University
department offices. There is also a dedicated Day Surgery Unit which is shared with
other specialties. The newly opened Chalmers Sexual Health Centre has close links
with the SCRH and the University of Edinburgh Department of Obstetrics &
Gynaecology and offers experience and training in all aspects of community sexual &
reproductive health.
The SCRH has been recognised for sub-specialty training in Reproductive Medicine,
Gynaecological Oncology and Maternal Fetal Medicine. A full range of Advanced
Training Skills Modules are available for Year 6 & 7 trainees in the ST training
programme.
High-risk antenatal clinics are held at the Royal Infirmary and Western General
Hospital sites, with a significant amount of antenatal care being delivered in the
community. Out-patient clinics in general gynaecology, infertility, urogynaecology,
gynaecological endocrinology, colposcopy and vulval disorders are held at the Royal
Infirmary site. In addition, many Consultants have clinics in other locations, including
the Western General Hospital, Edenhall and Roodlands Hospitals and Leith
Community Treatment Centre. Gynaecology lists are performed at the Western
General and Roodlands Hospitals, in addition to the RIE site.
There is an established group of trained Educational Supervisors who take active
responsibility for education and training for all junior doctors at SCRH, supported by
the RIE’s Postgraduate Medical Education Department. The Department has been
consistently ranked amongst the highest in the region for overall satisfaction with
training in Obstetrics and Gynaecology training in the GMC trainee survey.
There is large general gynaecological workload with approximately 500
hysterectomies (abdominal and vaginal) and 5,000 day cases being performed per
annum. 3,000 new gynaecological outpatients are seen per year. Sub-specialty
interests include Infertility, urogynaecology, gynaecological oncology and menstrual
dysfunction. Within The Simpson Centre for Reproductive Health, there is a
dedicated centre, The Edinburgh Fertility and Reproductive Endocrinology Centre
(EFREC) for patients with endocrine and infertility problems.
The Obstetric and Gynaecological Services at St. John’s comprises fifty obstetric
beds, including a day bed unit, and twenty gynaecology beds (twelve in-patient and
eight day beds). In 20131 the department handled approximately 2,674 deliveries.
There is an out-reach antenatal service covering West Lothian and part of the west of
Edinburgh. Special interests of the department include urogynaecology, menstrual
dysfunction and fetomaternal medicine. There are strong links between the two
Maternity Units.
Medical Staffing at the Royal Infirmary of Edinburgh
Feto-maternal Medicine Unit
Dr C Alexander
Dr A Campbell
Dr E Cooper
Dr S Cowan
Dr F Denison (University of Edinburgh)
Dr E Doubal
Dr K Dundas
Dr K Edgar
Dr F Fankam
Dr D Gatongi
Dr Louisa Hermis
Dr R Hughes (Clinical Director for Obstetrics and Neonatology, NHS Lothian)
Dr C Love
Dr N Mary
Dr H Mustafa
Professor J Norman (University of Edinburgh)
Dr N Palaniappan
Dr B Smyth
Dr S Stock
Gynaecology / Oncology / Urology Unit
Dr C Busby-Earle
Dr P Dewart
Dr S Fegan
Dr S Jack
Dr C Martin
Dr S Nicholson (Clinical Director for Gynaecology NHS Lothian)
Dr S Milne (Associate Specialist)
Reproductive Medicine Unit
Professor R Anderson (University of Edinburgh)
Dr B Brady
Professor H Critchley (University of Edinburgh)
Dr W Duncan (University of Edinburgh)
Dr A Horne (University of Edinburgh)
Dr C Tay (Gynaecologist and ACU Consultant)
Dr J Thong (Gynaecologist and ACU Consultant)
Dr C West
Medical staffing at St. John’s Hospital, Howden
Dr A Armstrong*
Dr T Cooper
Dr S Court
Dr S Coutts
Dr S Kallat
Dr A MacLeod
Dr P Mills
Dr S Rane
Dr K Rose *
Dr J Wilkens
Those consultants marked * work at both RIE and St John’s Hospital.
14 ST3+ Speciality Trainees including sub-specialty trainees
4 ST2 Specialty Trainees,
16 ST1 Specialty Trainees, Foundation Year 2 trainees, GPST2 trainees
The department provides at least 91 hours per week consultant presence on Labour
Ward and has established a number of resident consultant posts, in addition to a
separate consultant gynaecologist rota. There are a minimum of two doctors working
at ST3 or above level on duty out-of-hours at all time, in addition to two doctors
working at ST1 level or equivalent with additional doctors for some shifts. The Clinical
Fellow will work at a level equivalent to that of the ST6+ and participate in the out of
hours rota as above.
6. Details of the Post
Supervising consultants Dr Rhona Hughes, Dr Simon Nicholson
Main Role
To obtain training to develop clinical skills in an area of special interest, while
maintaining a clinical commitment in general Obstetrics and Gynaecology, working
closely with the consultants and clinical team. The post holder will be accountable to
the Clinical Directors. The successful candidate will have the opportunity to gain
invaluable experience and training whilst working in a busy tertiary referral centre as
part of a dynamic team of enthusiastic people.
The post is not recognised for training however each doctor will have an Educational
Supervisor who will support the clinical components of the post by assisting in
meeting the individual’s training and career goals, including regular appraisal and
support to complete appropriate work-place based assessments.
Special interest training in Maternal Medicine, Urogynaecology Gynae oncology
Reproductive Medicine, Medical Education is available and for suitable candidates. It
is hoped that an ATSM will be completed.
Leadership and management (including risk management) training and experience
can be offered as part of this post. The department has a robust risk management
process and actively encourages and involves all staff to participate in this. Training
can be tailored to the needs of the individual. Patient safety activity centres around
the work of the Scottish Patient Safety Programme in Obstetrics and Gynaecology
and effective leadership is a skill crucial to the success of this and many other
aspects of modern medical careers. NHS Lothian recognises the need for effective
medical leaders and supports activity to engender a positive culture for staff and
women.
Clinical Duties
The Clinical Fellow will work on the ST6/7 rota, and as such will take on the
responsibilities associated with this role. The Clinical Fellow will be supervised by a
consultant and will need to respect the roles of others within a multidisciplinary team,
and communicate with them appropriately.
The weekly timetable will consist of two days dedicated to advanced clinical skills
and three days contributing to the general clinical workload of the Department. The
clinical duties will vary from week to week to accommodate the needs of the
Department but will aim to complement special interest component of the post.
Clinical duties may include sessions in antenatal clinic, labour ward, gynaecology
outpatients, gynaecology theatre and the emergency gynaecology, with duties in the
followiing areas
Antenatal clinic –
Under the supervision of a consultant obstetrician Attend the antenatal clinics which may include one of the more specialised maternal
medicine clinics
Counsel women adequately about the investigations offered during pregnancy,
interpret the results, communicate the significance of abnormal results to the patient
and arrange further management if needed.
Detect and manage commonly occurring disorders in pregnancy, recognising his/her
limitations
Recognise the roles of the multidisciplinary team
Develop good communication with patients and staff
Delivery Unit
The Clinical Fellow will work under the supervision of the consultant
obstetrician responsible for Labour Ward. They will work
Supervise FY2/GPST2/ST1-5s working on the Delivery Suite.
Be aware of the needs of women in labour, and respect their physical and
psychological comfort
Be responsible for the monitoring of fetal wellbeing in labour
Assess and manage progress in labour
Perform instrumental and operative deliveries, or supervise the ST1-5 to do this if
appropriate
Manage third stage complications
Be able to manage maternal collapse
Have input into the management of high risk pregnancies in conjunction with the
consultant obstetrician
Take an active role in managing patients through Triage and/or the Antenatal Day
Assessment Unit
Gynaecology Outpatients
Whilst some gynaecology clinics cover a wide range of problems other clinics are
more specialised in nature. The Clinical Fellow should
Be able to take a gynaecological history and perform an appropriate examination with
respect for the woman’s dignity and autonomy
Instigate the initial investigation and management of common gynaecological
problems such as disorders of menstruation, infertility, incontinence, menopausal
symptoms, psychosexual problems and genital tract infections.
Understand the principles of cervical screening, the management of pre invasive and
invasive disease and post treatment follow up
Gynaecological Emegencies
Provide support and advice to the ST1-5/GPST2/FY2s working in the Emergency
Gynaecology Unit
Be able to carry out emergency gynaecology procedures normally expected at ST6
level, with consultant support and supervision as appropriate.
Gynaecology Theatre
Liaise with theatre and anaesthetic staff when arranging the theatre cases
Observe, assist or undertake procedures in theatre with an appropriate level of
supervision.
Out of hours, the Clinical Fellow will be resident in the hospital and work with a ST3-5
resident in the hospital, with two2 ST1or equivalent resident as first on call. The
consultant obstetrician is resident in the evening and then resident or on call from
home. The consultant gynaecologist is on call from home.
The rota has been devised to enhance the special interest component of the post
and out-of-hours duties include evenings and night shifts but no weekend day work.
Pattern of work
The working pattern conforms to a ‘Full shift’ system. For the majority of the time the
Clinical Fellow will work from 08.30 to 16.30 on weekdays.
Evening shifts are from 16.30 to 21:00, and night shifts are 20:30 until 09.00. Night
shifts are worked in a pastern of four nights then three nights once every seven
weeks with appropriate compensatory rest.
Although not a formal training post, the terms and conditions for medical trainees in
NHS Scotland will apply.
This is an Exposure Prone post and evidence of the relevant immunities will be
required before starting work.
7. Research and Development
The Royal Infirmary of Edinburgh is the site of the University’s newly established
Queens Medical research Institute of which MRC Centre for Reproductive Health is a
key component. This is largest aggregation of Reproductive Scientists and Clinicians
in Europe and offers unique opportunities for research collaboration in all areas of
obstetrics and gynaecology. The MRC Centre for Reproductive Health includes the
Tommy's Centre for Maternal and Fetal Health, which has a research focus on
maternal obesity and preterm birth. The Tommy's Centre currently has around £10
million of pregnancy related research funding, and there are excellent opportunities
for collaboration with interested clinicians.
Currently the most prominent areas of clinical research include fertility control
(conception and contraception), gynaecological endocrinology, mental dysfunction,
gonad and gamete biology, feto-maternal disorders, placental function and the
biological control of parturition.
8. Teaching
The Department of Obstetrics and Gynaecology is recognised for sub-speciality
training in feto-maternal medicine, reproductive medicine and gynaecological
oncology. There are also sub-speciality training opportunities in sexual and
reproductive health at the Family Planning Clinic in Dean Terrace, Edinburgh.
Advanced training skill modules are available for trainees in years ST6/7.
The post holders may be asked to contribute to the organisation, delivery and quality
control of undergraduate and postgraduate medical education and training at the
Royal Infirmary and St. John’s.
9. Contact Details
Further information is available from
Dr Corinne Love, Obstetric Lead RIE, corinne.love@luht.scot.nhs.uk
Dr Rhona Hughes, Clinical Director of Obstetrics, NHS Lothian,
rhona.hughes@luht.scot.nhs.uk
10. Person Specification
Requirements
Essential
Desirable
Qualifications
and Training
Registered with the GMC.
CCT
License to practice
Additional postgraduate
qualifications e.g.
MD/PhD.
Four years experience in middle
grade registrar posts or equivalent.
MRCOG Part 2 or equivalent.
Relevant
Experience
Completion of BLS
Satisfactory assessment of clinical
ability.
Completion of RCOG log book
competencies up to intermediate
level or equivalent.
Ability
Ability to manage patients with
acute gynaecological conditions.
Research
Teaching and
Audit
Evidence of participation in clinical
audit.
Evidence of formal and informal
teaching and training of junior
doctors, medical students and other
clinical staff.
Evidence of learning and continuous
professional development.
Motivations
Dedicated to a career in Obstetrics
& Gynaecology
Evidence of ability and interest in
the special interest part of the post
Personal
Attributes
Evidence of patient focused care.
Ability to work well in a multidisciplinary team i.e. good team
player and good communication
skills.
Commitment to improving quality of
care with consultant delivered care
RCOG Advanced Skills
Training Module in
Advanced Antenatal
Practice, Advanced
Labour Practice, Labour
Ward Lead or
Maternal Medicine
ALSO/ATLS or equivalent
Experience of research
desirable.
Publications
Previous experience of
designing teaching
programmes.
Qualification in teaching
Experience of designing
and effecting audit
programmes
in and out of hours.
Understanding of and commitment
to the work of the Scottish Patient
Safety Programme and the maternal
work stream within this (Maternal
Collaborative Quality Improvement
Programme {McQIC}).