HEALTH EDUCATION THAMES VALLEY - SPECIALTY TRAINING PROGRAMME IN CHEMICAL PATHOLOGY WITH METABOLIC MEDICINE
About Health Education England 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 Specialtytrainees.
Health Education England 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 England 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 Chemical Pathology with Metabolic Medicine Training Programme
The Chemical Pathology with Metabolic Medicinetraining programme is a 5.5year programme, starting at ST3. During this time, the trainee's work will be monitored for satisfactory progress and subject to annual reviews in the form of ARCPs. Progression on the programme will be dependent upon these reviews.
The posts on this rotation have been approved for Specialist Training by the Joint Royal Colleges Postgraduate Training Board. 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 England Thames Valley so trainees may find themselves employed by any of the following Trusts and placed in any of the following hospitals:
Trust / Hospitals and LocationsOxford University Hospitals NHS Foundation Trust / John Radcliffe Hospital, Churchill Hospital, Nuffield Orthopaedic Centre, Horton General Hospital
Cambridge University Hospitals / Addenbrooke’s Hospital
Rotation Information
The programme is based in the Oxford University Hospitals Trust, and will include clinical duties in any of the four hospitals in this Trust (the John Radcliffe Hospital, the Churchill Hospital, the Nuffield Orthopaedic Centre, and the Horton General Hospital in Banbury. In general, trainees will be based in the Department of Clinical Biochemistry in the John Radcliffe Hospital.
Rotations may at times change in response to clinical need from the Trusts. Expected rotation arrangements for this programme are:
- Most of the laboratory activities will take place in the John Radcliffe Hospital, but it may be necessary to visit or work from the other laboratories (Churchill and Horton).
- Lipid and diabetes clinics are held in the Churchill Hospital.
- Metabolic bone clinics are held in the Nuffield Orthopaedic Centre (osteoporosis), Churchill Hospital (calcium disorders) and John Radcliffe Hospital (X-linked hypophosphataemic rickets).
- Nutrition ward rounds and clinics are held in the John Radcliffe Hospital.
- Inherited metabolic disorders (IMD) clinics are held in the Churchill Hospital. Much of the specialised training in IMD occurs in Cambridge, through a special arrangement with Cambridge University Trust.
- Other special interest clinics, e.g., renal stone and investigation of renal tubular disorders, are held in the Renal Unit, Churchill Hospital, or the Nuffield Department of Medicine outpatients in the John Radcliffe Hospital.
Trust Information
The Department provides an analytical and consultative service to clinicians in general practice, hospitals and specialist units within Oxfordshire, and specialist services over a wider area. The catchment population is approximately 800,000. The throughput (patients per bed per year) of the hospitals in Oxfordshire is amongst the highest in the country. Because teaching and general hospitals are combined a very wide range of medical problems is covered. The group has many specialist departments, many of world-wide reputation.
The main group of teaching hospitals is based in Oxford. These hospitals are: the John Radcliffe (JR, 643 beds), the Churchill Hospital (383 beds), the Nuffield Orthopaedic Centre (NOC, 196 beds), the Littlemore Hospital (371 beds), the Warneford Hospital (104 beds). The JR, Churchill and NOC are part of the Oxford University Hospitals Trust, and the Littlemore and Warneford Hospitals are part of the Oxfordshire Health NHS Trust. Horton General Hospital in Banbury is part of the Oxford University Hospitals Trust and is a District General Hospital with 220 beds.
The JR is the main acute hospital in Oxford, and has general medicine and surgery, maternity, paediatrics (in the Children’s Hospital), and specialties such as ophthalmology, neurology and neurosurgery (in the West Wing), whilst the Churchill Hospital has many specialist units such as oncology, clinical haematology, chest medicine, haemophilia, dermatology, and endocrinology and diabetes. The Littlemore and Warneford Hospitals form the main centres of the psychiatric service. There are also eleven major country towns with Community Hospitals. Many of the Regional Specialties are provided within the Oxford hospitals.
Clinical Biochemistry
The Clinical Biochemistry Department has laboratories on three sites (JR, Churchill, Horton Hospital), receives approximately 800,000 requests per year and performs approximately 7.5 million tests per year. It offers a regional service for endocrinology, for antenatal screening for neural tube defects and Down syndrome, and for extended neonatal screening. The clinical lead is Dr Brian Shine. The Training Programme Director is Dr Nishan Guha.
The laboratory at the John Radcliffe Hospital provides routine and emergency services together with the postgraduate teaching and research laboratories of the Department. The Consultant Chemical Pathologists are based here. The laboratory at the Churchill Hospital combines Haematology and Biochemistry and operates from 8:30 to 18:00 on weekdays. The laboratory at the Horton Hospital provides routine and emergency services.
The JR laboratory is currently divided into four analytical sections, each under the day-to-day control of a head of section; two other heads of section are responsible for training and information management.
Analytical equipment includes an Inpeco track system with 4 Abbott C16,000 and 2 i2000 analysers, an AutoDelfia immunoassay system at the JR, 2 C8,000 and 1 i1000 analysers at the Churchill, and 2 combined C8,000/i2,000 analysers at the Horton Hospital. Other equipment includes a Konelab 30, 2 Waters HPLC systems, and three Tandem Mass Spectrometry systems. Analytical techniques currently available include electrophoresis, spectrophotometry, ELISA, thin layer chromatography, HPLC, and mass spectrometry.
The laboratory at the JR is open 24 hours a day. A duty biochemist (medical graduate or clinical scientist) is in the department from 08:30 to 21:00 during the working week and 08:30 to 13:00 on Saturday. The laboratory at the Horton Hospital is open 24 hours a day. The Churchill laboratory is open from 08:30 to 18:00 on weekdays.
The laboratory data handling is fully computerised. The main laboratory information management system (LIMS) system is an in-house development written in Caché and maintained locally. The core automated laboratory is controlled through middleware provided by Abbott. Other computing facilities include many networked computers used for analyser control, and personal computers for data analysis, word processing, statistics and graphics.
Scientific meetings within the department include a clinical meeting (for medical staff and clinical scientists), a general educational meeting (for all staff) and an analytical and quality assurance review (all weekly). Many departments of the hospitals run scientific, clinical and multidisciplinary meetings, which our staff may attend. There is a weekly Grand Round during term time.
Formal clinicopathological conferences are held to review hepatology, endocrinology, paediatric neurology, paediatric endocrinology, and general paediatrics. The medical staff in Clinical Biochemistry are responsible for preparing cases for these conferences in addition to the staff rounds that all clinical departments hold.
NHS staffing consists of two whole time equivalent Consultant Chemical Pathologists, 3 Specialty Trainees, 1 Foundation Year 2 doctor, one Consultant Scientist, one Principal Biochemist, one Principal BMS, four Chief BMSs, seven senior BMSs, 27 BMSs, Junior BMSs, and administration, clerical and secretarial staff. The laboratory also works in a network with laboratories in Milton Keynes, Aylesbury, High Wycombe and Swindon, and Consultant Chemical Pathologists from those laboratories attend meetings in the OUH department.
The department provides a programme for the training of biomedical scientists and clinical scientists. The department is heavily involved with teaching medical students at the University of Oxford Clinical Medical School.
Point of care testing
The laboratory has an extensive point of care testing portfolio, managed jointly with clinical departments and Clinical Measurement. These include more than 150 networked glucose meters, Abbott iStats, and blood gas analysers (Radiometer).
Clinical services
Members of the department are involved with many clinical services, including the following.
•Antenatal and Newborn Screening
•Paediatrics, particularly paediatric neurology
•Metabolic bone disease clinical services, including osteoporosis, hypophosphataemic rickets
•Diabetes
•Lipids
•Nutrition and Bariatric Surgery services
•Adult endocrinology
•Mitochondrial Genetics
•Inherited Metabolic Disease
•Neuroendocrine clinics
•Paediatric endocrinology
•Oncology
•Thyroid cancer
•Point of care testing
Recent R & D interests include:
Point of Care Testing and data networking.
Biochemical assessment of liver viability during experimental liver transplantation.
Improved methods for evaluating early deterioration of renal function in patients with diabetes mellitus
Biochemical aspects of chronic wound healing with particular focus on oxidative stress in chronic venous ulceration
Comparison of plasma and urine metanephrine levels in patients with suspected phaeochromocytoma
Comparison of plasma and urine 5-HIAA levels in patients with suspected and known carcinoid tumours
Biochemical markers of Growth Hormone misuse in elite athletes
University Department: Nuffield Division of Clinical Laboratory Sciences.
Research:
The Nuffield Division of Clinical Laboratory Sciences is part of the Radcliffe Department of Medicine within the Medical Sciences Division of the University of Oxford. It brings together all of the clinical laboratory based disciplines within the Oxford Medical School (Microbiology, Genetics, Cellular Pathology, Haematology and Clinical Biochemistry). The Nuffield Departments date from Lord Nuffield's original benefaction to the Oxford Medical School in 1938. The Head of Department is Professor Alison Banham.
As well as the teaching of Undergraduate and Clinical Medical Student courses, the Department has an active research programme, holding more than £2.2m per annum (£11m in total) of research grants from Research Councils and charities. It was rated 5 in the most recent HEFCE research assessment.
Currently there are active research teams in areas including the resistance of tumours to chemotherapy, the genetic basis of mental retardation, gene therapy for cystic fibrosis, microbial genetics, genetics of skull and limb malformations, the biology of stem cells, myelodysplasia and myeloid leukaemia, tumour angiogenesis, immunodiagnostics and malaria.
Research groups
ATR-X Syndrome Research Group (Prof. Richard J Gibbons)
Blood (malaria) Group (Prof. D. Roberts)
Clinical Genetics Group (Prof. Andrew O.M. Wilkie)
CRUK Tumour Pathology Group (Prof. Kevin C. Gatter, Dr. Francesco Pezzella)
Echo Core Lab & Cardiac Surgical Physiology Group (Dr Xu Yu Jin)
Gene Medicine Research Group (Associate Prof. Deborah R. Gill, Associate Prof. Stephen Hyde)
Molecular Haematology Unit (Dr. Jackie Boultwood)
Haemato-oncology Group (Prof. Alison H Banham, Dr Demin Li)
Malaria Pathology (Dr Gareth Turner)
Oxford BRC Haemato-Molecular Diagnostic Laboratory (Associate Prof. Anna Schuh)
Oxford Clinical Research in Transfusion Medicine (Prof. Mike Murphy, Dr Demin Li
Stem Cell research Group (Prof. Suzanne Watt)
Transcriptional control of normal myeloid cells and myeloid leukaemia (Prof. Paresh Vyas)
Ultrastructural Morphology Group (Prof. David J.P. Ferguson)
Research opportunities exist within other research groups, including that run by Professor R.V. Thakker in the Nuffield Department of Medicine. This group carries out research into the molecular basis of endocrine and metabolic conditions, such as parathyroid disorders affecting calcium metabolism.
There are also links with the Institute of Molecular Medicine, Oxford Centre for Diabetes, Endocrinology and Metabolism, and the Botnar Research Centre, Oxford University Institute of Musculoskeletal Sciences. There is, therefore, an active programme of seminars and research visitors.
For further details about ongoing research:
Duties of Post
a)Laboratory Responsibilities:
Duties as appropriate to the grade of the post under the direction of the consultants responsible including:
Supervision of the clinical biochemistry service. Duty Chemical Pathologist approximately 3-4 sessions per week, including evenings until 2100h.
Supervision of and participation in biochemical analysis of specimens and interpretation of results for the Oxford and Banbury Hospitals and surrounding general practitioners. Provision of services in endocrinology, paediatric investigations and less common determinations for other hospital laboratories in the region.
Attendance at the weekly Departmental Clinical Meetings.
Attendance by agreement at the Departmental Quality Assurance Meeting.
Other commitments, by arrangement tailored to an individual’s training requirements, to make up the 40 core hours
Training in analytical sections. Routine analytical work.
Secondment possibilities include: District General Hospitals (including Horton General Hospital); Postgraduate Teaching Hospitals, if possible, for training in specialist aspects of Chemical Pathology particularly Paediatric Chemical Pathology and possibly Toxicology; Department of Immunology in Oxford.
Attendance at relevant Scientific and Medical meetings inside and outside the Hospital including the possibility of structured courses, such as day release MSc courses where relevant, as can be arranged to fit in with training and service needs.
Writing of reports and letters as appropriate.
On-call shift
The Laboratory is open 24 hours a day. A shift system of Biomedical Scientists carries out the major part of the on-call analytical work. There is a duty rota of Chemical Pathologists or Clinical Scientists on site from 0830h to 2100h, Monday to Friday and 0830h to 1300h on Saturday. Outside these times and on Bank Holidays, a rota of medical staff provides a non-resident on call service. This may require coming into the hospital to carry out consultative and analytical work. Consultant cover is provided at all times.
b)Clinical Responsibilities
Attendance at Diabetes, Endocrinology (general, specialised), Lipids, Osteoporosis, Nutrition, Inherited Metabolic Disease or other appropriate outpatient clinics in accordance with training and service needs; recommended minimum one session per week and maximum two per week.
c)Teaching Responsibilities
Lectures to clinical, pre-clinical and science students.
Training of Biomedical Scientists.
Teaching – biomedical scientists, scientific and medical colleagues and medical students from the University of Oxford Medical School.
d)Participation in clinical audit
You will be expected to participate in the audit programme of the Department.