OXFORD DEANERY:Academic Clinical Fellow in Emergency Medicine (CT1, CT2 Or CT3 Entry)

OXFORD DEANERY:Academic Clinical Fellow in Emergency Medicine (CT1, CT2 or CT3 entry)

Academic Clinical Fellowship (ACF) posts have been awarded by the NIHR to University/NHS Trust/Deanery partnerships nationally through competition. Oxford has been very successful attracting 79 ACF and 30 Clinical Lecturer posts previously. These posts form part of the NIHR Integrated Training Pathway, further details of which can be found on the NIHR TCC website All ACF posts attract an NTN-A. The ACF in Emergency Medicine has been established jointly with the National Blood Service Centre in Oxford where the research component of the post will be supervised.

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About Oxford Deanery

The Oxford Deanery covers the counties of Oxfordshire, Berkshire and Buckinghamshire, with Banburyand Milton Keynes in the North, to Readingand Slough in Berkshire and High Wycombe and Aylesbury in the West.

The Oxford Deanery is part of the South Central Strategic Health Authority which serves a large population and covers the regions mentioned above as well as the Wessex Deanery areas of Hampshire and the Isle of Wight. The Oxford Deanery is responsible for the training of some 1500 trainees.

The Oxford Deanery is a relatively small deanery 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 Oxford Deanery as a whole. This may mean that you may be allocated to any geographic location within the Oxford Deanery depending on training needs.

ACF in Emergency MedicineTraining Programme

The posts on this rotation have been approved for Specialist Training by the College of Emergency Medicine. The posts attract National Training Numbers and provide training towards a Certificate of Completion of Training (CCT).

The ACF post may be awarded to doctors starting at CT1, CT2 or CT3 level. Successful applicants musthave the essential competences to enter training at an equivalent level to Acute Care common Stem (ACCS) CT1, CT2 or CT3. Details of these essential competences and qualifications are detailed in the MMC person specification for ACCSwhich is available from

The ACF would be expected to intercalate the majority of their 9 months academic time in blocks either before or after their ACCS CT3 year. Details of the rotation will be tailored to the educational needs of the ACF within the constraints of the Oxford Deanery ACCS rotation.

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 programme is designed to support academic clinical training alongside clinical core training in Emergency Medicine. It is anticipated that completion of this three year programme will allow doctors to complete the competences required for Core Training in Acute Care Common Stem and necessary for the Emergency Medicine Higher Specialty Training programme at ST4 level. At the end of the ACF post as long as all the required clinical competences are met the trainee will take up a place within the clinical training programme without the need for competitive entry.

The Postgraduate Dean has confirmed that this post has the necessary educational and staffing approvals and the post will attract an NTN (a).

The programme is based in several different Trusts throughout the Oxford Deanery so trainees may find themselves employed by any of the following Trusts and placed in any of the following hospitals:

Trust / Hospitals and Locations
Oxford Radcliffe Hospitals NHS Trust / JohnRadcliffeHospital, Oxford
HortonHospital, Banbury

Buckinghamshire Healthcare NHS Trust / WycombeGeneralHospital, Wycombe
Stoke MandevilleHospital, Aylesbury

The RoyalBerkshireHospital NHS Foundation Trust / RoyalBerkshireHospital, Reading

Milton KeynesHospital NHS Foundation Trust / Milton KeynesGeneralHospital, Milton Keynes

Heatherwood and WexhamParkHospital NHS Foundation Trust / WexhamParkHospital, Slough

Expected rotation arrangements for this programme are:

• Acute Care Common Stem training aims to provide trainees with a broad base of training in Acute Medicine, Anaesthesia, Emergency Medicine and Intensive Care Medicine.

• Depending on prior experience, trainees will be attached to each of the four specialties; spending one year in Acute Medicine and Emergency Medicine and one other year in Anaesthesia and Intensive Care Medicine.

• The CT3 year will be spent in Emergency Medicine and Paediatric Emergency Medicine

• Trainees will be expected to rotate within the Deanery. Rotations depend on

vacancies available and the training needs of the individual.

Anaesthetics/ITU Rotations usually begin the programme in an Anaesthetics/ITU post in either Reading; WexhamPark; Milton Keynes for a period of 12 months.

Emergency Medicine Rotations usually begin the programme in an Emergency Medicine post for 6 months in either Reading; WexhamPark; Buckinghamshire (Wycombe/Stoke Mandeville) Trust.

Acute Medicine Rotations usually begin the programme in an Acute Medicine post for 6 months in either Reading; Horton (Banbury); Milton Keynes

Please note: rotations may have to change in response to clinical need within a Trust.

Research Training

A key goal of the Academic Clinical Fellowship (ACF) programme is to provide the applicant with appropriate research experience and training, to enable the successful application for an externally funded Clinical Training Fellowship, usually of 3-year duration and leading to a higher research degree or equivalent further postgraduate experience. If at the end of the ACF post, if funding applications are not successful and clinical competencies are met, a place will be available on the clinical training programme.

Research

There are excellent research facilities in Transfusion Medicine in Oxford. There are 3 research groups (see below) based in NHS Blood & Transplant and which are part of the Nuffield Department of Laboratory and Clinical Sciences ( It is anticipated that the ACF in Emergency Medicine will work with Professor Murphy and Dr Stanworth on some aspect of the transfusion management of patients with major haemorrhage (see below).

The ACF will have 9-12 months of laboratory or clinical research within Transfusion Medicine leading to an application for a Clinical Training Fellowship leading to a DPhil/PhD. The ACF will spend their research time with the academic group they have chosen to work with. Initially the key aim is for the head of the research group and the ACF to jointly develop a PhD project that draws on the strengths of the ACF and the host group. Practically, the ACF will do a focused project, much like a BSc student. A secondary aim is for the ACF to become involved in projects that lead to publication. In the latter part of research time, the major aim is to write the Clinical Training Fellowship application. Prior to this, the supervisor and ACF will be aware of the timelines for applications.

PRINCIPAL INVESTIGATORS IN TRANSFUSION MEDICINE

Professor Murphy & Dr Stanworth: clinical research (systematic reviews, clinical trials) to develop safe and effective transfusion practice.

The primary objective of the group is to strengthen the evidence base for the effective and safe practice of transfusion medicine. The need to achieve this objective was highlighted in successive ‘Better Blood Transfusion’ Health Service Circulars and from 2000 a supporting infrastructure for clinical research has been established to meet this objective, including a Systematic Reviews Initiative (SRI) supported by the UK Cochrane Centre, a Clinical Studies Unit (supported by the MRC Clinical Trials Unit), and linkage to the National Comparative Audit of Blood Transfusion programme (supported by the Royal College of Physicians Clinical Evaluation and Effectiveness Unit). The group has support from the Oxford Haemophilia Centre for novel laboratory studies of haemostasis.

A key area of the group’s research is the investigation of the use of blood transfusions in critically ill patients for example in trauma, critical care, and cardiac by-pass surgery. A number of clinical studies and trials in patients who are bleeding or at risk of major bleeding will be completed or started in the next 3 years:-

• A multicentre randomised controlled trial of restrictive v. liberal red cell transfusions in acute upper gastro-intestinal bleeding will start in 2012.
• A UK wide study of outcomes in trauma patients receiving multiple transfusions is ongoing.
• A multicentre international randomised controlled trial to study whether patients receiving "fresh" blood up under 7 days storage age do better compared to those given standard aged blood is just beginning.
• Two new study proposals will investigate products designed to improve blood clotting and which might reduce FFP usage. These are an evaluation of fibrinogen concentrate in bleeding trauma patients, and a study to investigate whether a commercially available clotting factor concentrate can safely reduce bleeding in patients undergoing cardiac by-pass surgery.
• Further trials of anti-fibrinolytics in patients with acute haemorrhage are being planned.

The expected benefits from these studies will apply to both patients and NHS. Many patients continue to receive transfusions of platelets, red cells or plasma, in the absence of good evidence that they are being used effectively. But blood transfusions are costly, scarce and associated with risks to patients. Given concerns about the safe and secure supply of blood for the future, it is also important that new studies are planned which test whether alternatives to blood transfusions can safely be used in patients which reduce the need for blood transfusions. In many of the group’s clinical studies, an economic cost evaluation, because is included it is important to know whether the study or the methods used to improve the quality of care, actually represent good value for money.

Professor Roberts: prion disease, mechanisms of anaemia in chronic disease, isolation and use of Tregs in BMT.

The current projects in immuno-haematology have been built on our expertise in the study of host-pathogen interactions in malaria by functional and genetic approaches.

Professor Watt: haemopoietic stem cell biology.

The Stem Cell Research Laboratory has a series of projects aimed at understanding the biology of stem cell development and the homing of stem cells to tissues and are translating this research into the clinic.

Pluripotent stem cells may differentiate into blood, endothelial, muscle and mesenchymal cells etc. The use of stem cells may therefore lead to novel cell therapies for a wide variety of diseases including haematological malignancy, cancer and cardiovascular disease.

More details about the activities and publications of these 3 research groups on the Nuffield Department of Clinical and Laboratory Sciences website:

Trust Information

Buckinghamshire Healthcare NHS Trust provides a wide range of high quality acute and community services from three acute hospital sites in Amersham, Stoke Mandeville and Wycombe, five community hospitals at Thame, Marlow, Buckingham, Chalfonts and Gerrards Cross and Waterside, and a number of community sites across the county. Specialist services include our regional dermatology, allergy and skin cancer centre, burns care and plastics sub-regional centre, cardiac services and the National Spinal Injuries Centre.
More than 6,000 staff serve residents across Buckinghamshire, Thame (Oxfordshire), Tring (Hertfordshire) and Leighton Buzzard (Bedfordshire) - a combined population of 500,000. It serves a much larger population, 1.5m for burns and plastic services and 14m for spinal injuries.

Stoke Mandeville Hospital is an acute hospital located on the edge of the market town of Aylesbury. It provides a range of hospital services including 24 hour accident and emergency, maternity, cancer care and a range of outpatient services. The hospital is the base foreye carefor the area.The regional burns and plastics unit provides specialist services to patients from Buckinghamshire, and as far away as Reading and Northampton. Stoke MandevilleHospital is also home to the world renowned national spinal injuries centre.

WycombeHospital is situated in the centre of the historic town of High Wycombe, and offers a full range of planned surgical services, as well as 24 hour emergency medical care (including minor injuries) and specialist medical care, including stroke and heart conditions. There is also a midwifery-led maternity unit. The hospital also offers specialist cancer and urological services.

(All Information taken from Buckinghamshire Healthcare NHS Trust website

Oxford Radcliffe Hospitals NHS Trustis one of the largest NHS teaching trusts in the UK and provides a wide range of clinical services and medical education, training and research.

The Trust provides high quality general hospital services for the local population in Oxfordshire and neighbouring counties, and more specialist services for patients from a wide geographic area. The Trust is also involved in a wide variety of research programmes, in collaboration with the University of Oxford and many other research bodies. The Trust has around 1,500 inpatient beds across three large sites:

The JohnRadcliffeHospital (JR) was opened in the 1970s and is Oxfordshire's main Emergency Medicine site. The JR will be formally designated as a Major Trauma Centre in April 2012, and is already a tertiary hub for acute stroke, myocardial infarction, neurosurgery, cardiothoracic surgery vascular surgery and interventional radiology. Itis situated in Headington, about three miles east ofOxford city centre. It is the largest of the Trust's hospitals,covering around 66 acres. It houses the Children's Hospital and West Wing| and the John Radcliffe Women's Centre|. It also provides acute medical and surgical and paediatric services, |intensive care. It also houses many departments of OxfordUniversityMedicalSchool, is home to the George Pickering Education Centre| and base for most medical students who are trained throughout the Trust. The Emergency Department at the John Radcliffe was judged best designed hospital building in the country in the Department of Health’s national Annual Building Better Healthcare Awards 2004. In October 2009 the new Oxford Heart Centre| opened at the JohnRadcliffeHospital to meet the growing needs of heart patients in Oxfordshire and across the region.

Horton General Hospital in Banbury serves the growing population in the north of Oxfordshire and surrounding areas. It has over 220 inpatient beds and over 20 day-case beds, and is an acute general hospital providing a wide range of services.

The majority of these services have inpatient beds and outpatient clinics, with the outpatient department running clinics with visiting consultants from Oxford in dermatology, neurology, physical medicine, rheumatology, ophthalmology, radiotherapy, oral surgery and paediatric cardiology.

Acute general medicine also includes a short-stay admissions ward, a medical assessment unit, a day hospital as part of specialised elderly care rehabilitation services and a cardiology service.

Other clinical services include physiotherapy, occupational therapy, dietetics, radiology and pathology. The radiology service includes a managed mobile MRI and a breast cancer screening unit. Currently, there are also four main operating theatres and a large day-case unit.

The hospital employs 1,200 people, making it one of Banbury's biggest employers.The local community takes great pride in the hospital and provides exceptional levels of volunteer support through the League of Friends, the Authorised Volunteer Service, Pets as Therapy Volunteers and Horton GeneralHospital Radio.

(All Information taken from Oxford Radcliffe Hospitals NHS Trust website

Royal Berkshire NHS Foundation Trustis one of the largest general hospital trusts in the country, providing acute medical and surgical services to Reading, Wokingham and West Berkshire and specialist services to a wider population across Berkshire and its borders.

The trust has over 4,800 staff, 607 acute, 44 paediatrics and 57 maternity post natal beds and 204 day beds and spaces.

Royal Berkshire Hospital is based on a single site near the centre of Reading. The hospital is the main base for the Trust and provides a wide range of services. Full information on the Wards and Services available at the RoyalBerkshireHospital can be found by visiting the Trust website

Heatherwood and Wexham Park Hospitals NHS Foundation Trustbecame a Foundation Trust in 2007. The Trust employs over 3,700 permanent staff delivering quality healthcare 24 hours a day 365 days a year. Heatherwood and Wexham Park Hospitals NHS Foundation Trust provides hospital services to a large and diverse population of over 400,000 which includes Ascot, Bracknell, Maidenhead, Slough, south Buckinghamshire and Windsor. Heatherwood has been a hospital since the 1920s and WexhamParkHospital since 1968.

The Trust also manages outpatient services at:

• King Edward VII Hospital in Windsor
• St. Mark's Hospital in Maidenhead
• Fitzwilliam House in Bracknell
• Chalfonts Outpatients in Chalfont St Peter

Wexham Park Hospital has 521 beds with a full range of services including general medicine and its sub-specialties, paediatrics, general surgery, vascular surgery, urology, orthopaedics, obstetrics and gynaecology, otolaryngology, oral surgery and a sub-regional plastic surgery unit.

The hospital contains a range of facilities, including:

• A large Accident and Emergency department
• A new theatre complex with 9 general theatres and one obstetric theatre
• A 12 bed combined Critical Intensive Therapy/High Dependency Unit
• A 16 bed Day Surgery Unit and a 16 bed Short Stay Unit
• An 8 bed Coronary Care Unit accompanied by a 6 bed Post Coronary Care Unit, which acts as a step down unit
• An Angiography Suite
• An excellent new rehabilitation department
• A centralised laboratory
• Diagnostic imaging including a new spiral CT scanner and MRI Scanner Suite
• A new state of the art Central Sterile Services Department (CSSD)

(All Information taken from Heatherwood and Wexham Park Hospitals NHS Foundation Trust website