HEALTH EDUCATION THAMES VALLEY SPECIALTY TRAINING PROGRAMME IN EMERGENCY MEDICINE
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 some 1500 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 Emergency Medicine Training Programme
The Emergency Medicine training programme is a 3 year programme, starting at ST4. 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 College of Emergency Medicine.
The Postgraduate Dean has confirmed that all posts have the necessary educational and staffing approvals.
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 LocationsOxford University Hospitals NHS Trust / John Radcliffe, Oxford
http://www.ouh.nhs.uk/
Milton Keynes Hospital NHS Foundation Trust / Milton Keynes General Hospital
http://www.mkgeneral.nhs.uk/
Buckinghamshire Healthcare NHS Trust / Stoke Mandeville, Aylesbury
http://www.buckshealthcare.nhs.uk/
Wycombe Hospital, High Wycombe
http://www.buckshealthcare.nhs.uk/
Royal Berkshire NHS Foundation Trust / Royal Berkshire Hospital, Reading
http://www.royalberkshire.nhs.uk/
Heatherwood and Wexham Park Hospitals NHS Foundation Trust / Wexham Park Hospital, Slough
http://www.heatherwoodandwexham.nhs.uk/location/wexham-park-hospital-slough
Individual Trust Information
Oxford University Hospitals NHSTrust
General information
The Oxford University Hospitals NHSTrust is one of the largestacute teaching trusts in the UK. We have a national and international reputation for the excellence ofour services andour role in teaching and research.
At the end of the financial year 2008/9 the Trust employed a total of 10,283 people (equivalent to 8,052 full-time employees), makingus one of the largest employers in Oxfordshire, with a turnover of £614 million.
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.
We have around 1,500 inpatient beds acrossourthree sites. In 2009/10 there were:
123,592 attendances at the emergency departments, 87,275 admissions for emergency assessment and treatment, 614,056 outpatient appointments, 19,688 admissions for treatment as inpatients, 62,062 admissions for treatment as day cases (108,308 if renal dialysis is included) and 8,077 babies delivered.
The Trust is split across four large sites:
John Radcliffe Hospital, Churchill Hospital, Nuffield Orthopaedic Centre and Horton General Hospital (Banbury)
As a teaching Trust, we have a vital role to play in the education and training of doctors, nurses and other healthcare professionals. We do this in close partnership with the Oxford University and Oxford Brookes University. 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 Emergency Departments
There are 2 Emergency Departments, one at the John Radcliffe, and one at the Horton Hospital. The Emergency Medicine HST trainees all work at the John Radcliffe site. The John Radcliffe is anticipated to become a Level 1 trauma centre in April 2011. There is a full range of tertiary services at the John Radcliffe site.
The Emergency departments have 9 Consultants, 12 middle grades and 10 junior grade doctors at the John Radcliffe, and 7 middle grades and 7 junior grade doctors at the Horton. Further information can be found at: http://www.ouh.nhs.uk/
Local teaching
In addition to a 1-2 day induction, the teaching at the ORH for the EDs is as follows.
The local training at the John Radcliffe ED occurs on the second Wednesday of each month, and lasts for a whole day; trauma meeting in the morning and clinical governance in the afternoon. The teaching programme is currently concentrating on critical appraisal skills, OSCE preparation and management teaching.
First tier teaching at the John Radcliffe occurs once a month for a whole day.
The first tier teaching at the Horton occurs on Friday mornings between 9am and 12. It comprises teaching with Paediatrics in the ED, followed by sessions delivered by Dr George (consultant), and ending with Radiology teaching. The weekly middle grade teaching is on Thursday afternoons.
The Royal Berkshire NHS Foundation Trust
General information
The Royal Berkshire NHS trust is a foundation hospital and provides a wide range of services for a population of about 600,000 people living in the west of Berkshire, purchased mainly by the PCTs of West Berkshire. The area extends as far as Hungerford in the west to Henley on Thames and Braknell in the east, parts of Hampshire to the south and parts of Oxfordshire to the north.
Emergency Department
The department is the main ED in West Berkshire, serving a population of 600,000 and sees approximately 80,000 new patients a year about 25% of these being under 16 years old. It is a consultant led service with consultants providing leadership and patient care on the ‘shop floor’ into the evenings 7 days a week.
On the RBH site there is also a dedicated ophthalmic casualty department, which is open daily, there is also an out of hours GP cooperative with which we have excellent relations. Within the region there is a WIC in Reading town centre and MIU in Newbury and Henley.
The department has excellent links with inpatient hospital teams with two of the recent consultant appointments being joint posts with the Intensive Care Unit. We work collaboratively with other inpatient teams as demonstrated by our award of a HSJ patient safety award for work on neutropenic sepsis and falling door to balloon times for PCI. We are keen to promote further collaborative working and will shortly be providing extended hours stroke thrombolysis led jointly by the neurology and emergency medicine consultant teams.
The Emergency Department is a purpose built unit opened in 2002 comprising four resuscitation bays (3 adult and 1 paediatric) equipped to provide state of the art care to critically ill and injured patients. There are 12 majors’ assessment bays, a 3 bedded rapid assessment area and a dedicated minor area – with treatment bays and a plaster room.
The new paediatric emergency department opened in 2010 has a dedicated waiting room, 4 major assessment bays, minor injury assessment cubicles and 2 treatment rooms.
In addition there are 4 observation beds for ED patients on the adjacent Clinical Decision Unit, a decontamination unit within the ED, and two dedicated X-ray rooms.
The main radiology department with CT, US and MRI scanning facilities is directly opposite the department.
The department has a computerised registration, tracking and clinical audit system as well as a computerised radiology PACS system. We are currently developing and implementing a purpose designed Electronic Patient Record system, which will integrate many of these functions and provide seamless record keeping throughout the trust. Phase one is due to be implemented in the spring of 2011.
These other services mean that we see a higher than average acuity of patient in the ED and the vast majority of patients have genuine emergency medicine problems. Our admission rate is approximately 20%. Over the last year we have introduced a new Emergency Nurse Practitioner service. There is a consultant led ED review clinic held every weekday morning.
Staffing of the Emergency Department
Consultants in Emergency Medicine Dr Andrew Blyth (Clinical Director)
Mr Shanti Soysa (retiring)
Miss Maria Dudek
Mr Sreenath Reddy
Dr Liza Keating (ICU / EM)
Dr David Mossop (EM / ICU)
Associate Specialists Dr P Jeyakumar
Dr B Sharma
Dr S Myint
Mr J Nagaraj
ST3 – ST6 Five – Oxford rotation
Speciality Doctors Dr A Donohoe
Dr T Perry
Dr B Gerov
Dr V Dimitrov
Dr R Weldon (part time)
Dr A Sandercott (part time)
Junior doctors 1 ACCS ST1
5 GP VTS ST1
4 F2
Emergency Nurse Practitioners 7 WTE
Matrons Brenda Morton
Georgina Brown
Teaching, Research and Audit
The department has an active and well-received educational programme.
We recently received a grade A from the Deanery Approval Committee for 2010 for the Royal Berkshire Hospital NHS Trust for both Emergency Medicine and our ACCS programme. For junior doctors a weekly programme based on the new CEM ACCS curriculum has been developed which makes good use of the simulation centre. There is a monthly middle grade educational after-noon, we regularly host regional training days for ST3 and ST4 – 6 EM trainees which receive excellent feedback. The trust regularly holds regular life support courses (including ATLS, ALS and APLS).
The trust has an excellent reputation for education, as measured by its PMETB report and regular responses from trainees and medical students. It has a recently upgraded medical library and an active clinical librarian service, a clinical skills unit and a state of the art simulation centre opened in 2009.
Wexham Park Hospital
The population & district
East Berkshire has a population of 380,000 and covers the Boroughs of Slough, Windsor & Maidenhead, and Bracknell, but together with an overlap zone in South Buckinghamshire, the true catchment area of the Trust is nearer to 430,000, of whom 90 000 are children. This is a large and diverse population and includes affluent areas such as Ascot, Windsor, Gerrards Cross and Maidenhead, but also the larger urban area of Slough. The towns of Bracknell, Maidenhead, Slough and Windsor house two-thirds of the total population, the remainder living in rural areas or small towns. Much of the District lies within the designated Green Belt areas.
The Trust
The Trust is an Acute Hospital Trust and achieved Foundation status in 2007. It has 750 beds and provides in-patient services on two sites: Heatherwood in Ascot and Wexham Park, north of Slough - essentially, one hospital on two sites. In addition, the Trust provides outpatient and diagnostic facilities at St Mark’s Hospital (Maidenhead), King Edward VII Hospital (Windsor) and Upton Hospital (Slough). This post will work exclusively at Wexham Park Hospital.
The hospitals
Wexham Park Hospital, Slough, has 520 beds with a full range of services including general medicine and its sub-specialities, paediatrics, general surgery, vascular surgery, urology, orthopaedics, obstetrics and gynaecology, otolaryngology, oral surgery, and also a sub-regional plastic surgery unit with an extensive catchment area. There is an active programme of building and development. The Emergency Department underwent a major rebuild and enlargement, with a self-contained children’s area, in 2003, and is due to have further capital development in the next 2-3 years, to include an integrated Clinical Decision Unit and improved children’s facilities.. There are well developed intensive care and cardiac investigation and treatment units, with developing links with the ED. There is also an excellent new rehabilitation department, a centralised laboratory, and diagnostic imaging including a new spiral CT scanner and MRI. A new theatre complex opened in 2004 and a surgical assessment unit.
There is a large purpose built post-graduate centre with skills lab, which runs regular ATLS, ALS, and APLS courses. The extensive library has an intranet connection to the wards for accessing guidelines, Medline etc.
Heatherwood Hospital, The minor injuries unit, which comes under the auspices of the main ED, is staffed by Nurse Practitioners who care for 20,000 attendances per year. The hospital in Ascot, has 230 beds including general medicine and its sub-specialities, elective orthopaedics, urology, otolaryngology, oral and general surgery, elective and emergency gynaecology and a midwifery-led low risk maternity unit plus a children’s centre. A superb diagnostic imaging unit opened in August 1998.
The Emergency Department
The staff in the Emergency Department deliver care to in excess of 90 000 new patients a year, with an additional 4000 returns. Approximately 25% of patients are children and the overall admission rate is 21%. There are excellent facilities comprising a five bedded resuscitation unit plus a well-resourced trauma bay equipped with overhead X-ray gantry. There is an 8 bedded majors unit and a 6 bayed minors area plus dedicated ENT / Eyes and Gynaecology examination cubicles. Children are cared for in a separate unit, which is open for between 12-14 hours a day and contains a waiting area (often supervised by Play Specialist), triage room, teenage room, treatment room and three bays. Each area of the department has a bay, which has additional resources to meet the needs of children attending when the Paediatric unit is not open. A four bedded observation facility is within the department and patients are admitted there under the care of the Emergency Physicians for periods of up to 12 hours.
At Heatherwood Hospital there is a Minor Injuries Unit, which sees approximately 24,000 – attendances a year. One consultant undertakes review clinic at Heatherwood on a weekly basis. There is also a Walk In Centre at Upton Hospital, Slough and discussions are underway regarding provision of primary care practitioners at Wexham Park site. The new MIU at St Marks opened in September 2008.
The current establishment includes 6 Consultants, 1 Associate specialist, 2.5 Staff Grades, 2 Senior Clinical fellows and 9 ST3 - 6 / SpRs, (who are part of the Oxford Regional Training Programme). The junior tier consists of 5VTS, 4 FY2, 1 ACCS and 4 junior clinical fellows. The nursing establishment is overseen by a modern matron supported by a team of senior nurses and a Practice Development Nurse. Much of the care of patients presenting with minor injuries is delivered by Emergency Nurse Practitioners, who contribute to the training of junior doctors and nursing colleagues. The Paediatric area is run by a band 7 RSCN, and there is a commitment to having either a fully trained paediatric nurse, or one with agreed competencies, on every shift.