JOB DESCRIPTION
INTEGRATED ACADEMIC TRAINING PROGRAMME
ACADEMIC CLINICAL FELLOWSHIP
IN
HAEMATOLOGY ST3 LEVEL
October 2015
LOCAL TRAINING PROGRAMME
The major objective of the current ACF rotation based at Addenbrooke’s Hospital is to foster future academic and NHS leaders in haematology and transfusion medicine. This academic post was secured as part of the UKCRC/MMC Integrated Academic Training: Academic Clinical Fellowship Programme and is a protected academic training post in a first class training rotation situated in a world class research environment. The Trainee will be exposed to a top ranking academic and clinical department in Addenbrookes Hopsital, while usually rotating for around 8 months to a DGH in Norwich, or Ipswich or West Suffolk or King’s Lynn or Peterborough to ensure a broad exposure to general haematology (see below).
This academic trainee will rotate through training slots in Addenbrookes which are currently: general laboratory, lymphoma, coagulation, transfusion, paediatrics and the 2 ward slots (general and stem cell transplantation). There will also be an attachment at a district general hospital. This will provide laboratory and clinical haematology training leading to Part 1 FRCPath. The 25% academic time required in an NTN(A) in the first 3 years will consist of two 4-month academic slots, complemented by a transfusion course and 6 weeks annual study leave, as well as weekly educational meetings, coagulation, morphology and case based teaching, and regular research group presentations. The two 4-month academic slots will offer general orientation in the research interests of the department and the wider opportunities available in Cambridge and attachments to 1 or more research groups, depending on the trainees’ interests.
Mentoring for the academic trainees will be provided throughout by the academic lead for haematology trainees, Dr Brian Huntly and the head of department, Professor Tony Green. At appointment, trainees will be made aware of the research themes of the department. During regular reviews with the academic mentors, a favoured area of research will be identified, along with a preferred Principal Investigator either in Cambridge or in another centre. The PI will then lead on developing a project and a fellowship application for funding to pursue a PhD. As the academic training plan follows the current format of the haematology training rotation, any academic SpR wishing to switch to a non-academic slot would be considered for the next available vacancy.
The chairperson of the local training committee will be responsible for ensuring that the Local Training Programme reflects the National Curriculum for Haematology and that each trainee has an Individual Training Programme. In addition to an academic mentor, Dr Huntly, an Educational Supervisor, who will be a consultant haematologist, will be appointed within each trust to ensure that facilities and opportunities are made available to the trainee and to conduct formative assessment.
The assessment of all haematology trainees comprises supervisors' reports at the end of each attachment and continuous assessment of nationally determined competencies, including workplace based assessments, monitored through the training record on e-portfolio (through the JRCPTB in the Royal College of Physicians). This is reviewed at the yearly formative assessments (ARCP) conducted under the auspices of the postgraduate dean. Summative assessment will be made by examination for FRCPath. Assessment of progress towards an academic training fellowship will be undertaken by the mentor in discussion with heads of the relevant research laboratories after each attachment
Regional Training Committee
The haematology training programme within the Eastern Deanery is coordinated by a training committee which meets at least twice a year. The current composition of the regional training committee is as follows:
Dr Jenny Craig (Chair of regional training committee)
Dr Martin Besser (training programme director, TPD)
Prof Tony Green (Regional Speciality Advisor and University Representative)
Dr Michael Dronfield (Associate Dean)
Dr Brian Huntly (academic representative)
Dr Gillian Turner (Norwich)
Dr Dora Foukaneli (Transfusion representative)
Dr D Ademokum (Ipswich)
Dr Mamatha Karanth (West Suffolk)
Dr K Rege (Peterborough)
Dr Emma Mitchell (SpR/ LAT representative)
ADDENBROOKE’S HOSPITAL, Cambridge University Hospitals NHS Foundation Trust
A Brief Description of Addenbrookes Hospital
Addenbrooke's was granted Trust status from 1 April 1993. It offers a full range of acute, maternity and mental health services, which are provided from two main hospital sites - Addenbrooke's Hospital and Fulbourn Hospital. Community psychiatry and midwifery services form part of the service ensuring continuity for those patients who are more appropriately cared for in their own communities.
Addenbrooke's Hospital (approx. 1100 beds) lies on the southern boundary of Cambridge city occupying a 66 acre site which is shared by the University Of Cambridge School Of Clinical Medicine, the Medical Research Council, the Regional Blood Transfusion Centre and the Parke Davis Research Institute. Close links with the University have given the hospital an international reputation for converting research and development into practical health care. The hospital has a long history of training first class doctors and offers excellent opportunities for training in biomedical computing, molecular biology, medical statistics, health service management as well as higher specialist training.
The Rosie Maternity Hospital (94 beds and 19 special care cots) is also located on the Addenbrooke's site and includes the Regional Neonatal Intensive Care Unit.
Fulbourn Hospital (366 beds) is situated on the outskirts of Cambridge, approximately 3 miles from the Addenbrooke's site. It provides the main in-patient base for general and specialised psychiatric services supplemented by out-patient and community services.
Addenbrooke's Hospital employs over 7,000 staff and offers both a district general hospital service to a more local constituency and is a specialist referral centre for a wider catchment population. Some special services, such as bowel/liver transplantation, draw patients supra-regionally or internationally.
Lady Mary Archer was appointed as the Trust's second chairman on 1st November 2002 and will chair the board consisting of six executive and seven non-executive directors. They are responsible for the strategic management of the Trust. The six executive directors also sit on the Addenbrooke's executive board which coordinates operational policies and practice where general practitioners' views are represented).
University of Cambridge Clinical School
The University of Cambridge has granted medical degrees since 1540. The Clinical School of the University, which was formally established in 1975, admitted its first clinical students the following year and at present admits about 130 students each year. The Clinical School has its base at Addenbrooke's Hospital where purpose built accommodation for the school, comprising lecture theatres, seminar rooms, medical library (which includes 900 serials) and postgraduate medical centre, was opened in 1980. In addition to receiving clinical instruction at Addenbrooke's Hospital and other hospitals in and around Cambridge, clinical students undertake part of their training in hospitals further afield in the East Anglian and neighbouring regions; they also spend short periods attached to general practices throughout East Anglia. The teaching programme is co-ordinated by the clinical dean. Cambridge is arguably the premier biomedical research centre in Europe. Over recent years four new research institutes have been built on the Addenbrookes site, which also houses the new MRC laboratory of Molecular Biology. The major Clinical School departments were all top-rated in the recent research selectivity exercise.
The Department of Haematology, Addenbrookes Hospital
The haematology department at Addenbrookes offers the full range of clinical and laboratory haematology. It acts as a tertiary referral centre for complex cases and serves as routine service for local patients.
The Clinical Service
In-patients are housed in 1) a 16 bed dedicated haematology ward (C10) with hepa filtration consisting of 11 single, one triple, and one double room and 2) ward D6 (shared with neurosciences) with 11 haematology beds and 3) Ward C9 a teenage and young adult facility with 11 beds. Nearby there is a haematology day unit (ward E10)which includes the regional apheresis service. The wards are well equipped and have a full complement of qualified nursing staff, ward clerk and a phlebotomy service. The nursing staff are full time haematology nurses qualified to administer chemotherapeutic agents and antibiotics as well as perform stem cell harvesting and apheresis. The in patient and day unit medical care is primarily provided by 2 pre-registration house officers(FY1), 2 senior house officer (ST1/2), clinical fellows and 2 specialist registrars. The ward is occupied predominantly by patients suffering from leukaemia, lymphoma, myeloma and similar disorders, although patients with non-malignant disorders such as TTP, sickle cell disease, haemophilia, etc, are also treated as inpatients on the haematology wards.
The clinical department includes the regional bone marrow and stem cell transplantation programme. The estimated referral population base is around 3-4 million. Norfolk and Norwich and Ipswich hospital perform autografting according to common protocols and policies. Stem cell processing and storage is performed on the Addenbrooke's site in the stem cell laboratory. There are shared care meetings 2 times a year with all participants and an annual regional transplant meeting which reviews the transplant programme and has an educational component.
The department is the designated regional Comprehensive Care Centre for haemophilia and has a large referral practice for thrombophilia and immunohaematological disorders. Anticoagulant care is delivered through a centrally coordinated combined hospital and community based service and primarily delivered by dedicated clinical nurse specialists.
Addenbrooke’s is the regional referral centre for paediatric haematology (Dr M Gattens, Dr H Oram) and paediatric oncology (Dr D Williams, Dr J Nicolson, Dr A Burke).
Outpatient clinics include general haematology disorders (Dr Baglin, Dr Perry, Dr Besser), haemophilia (Dr Baglin/Dr Perry) Women’s haematology clinic (Dr Perry), specialist clinics for MPD/CML (Prof Green, Dr Huntly, Dr Godfrey), MDS and marrow failure syndromes (Prof Warren, Dr Foukaneli) lymphoma (Dr Follows, Dr Uttenthal, Dr Hodson), CLL (Dr Follows, Dr Ringshausen), transplantation (Dr Craig, Dr Crawley Dr Krishnamurthy, Dr Uttenthal), myeloma and acute leukaemia (Dr Craig, Dr Crawley, Dr Vassiliou, Dr Chapman).
The diagnostic haematology laboratory is situated in the main clinical laboratory and is and is fully accredited (CPA). It is responsible for providing a routine and emergency service to this trust and general practitioners, serving a population of 250,000 plus referral work. Specialist areas include 1) the Haemato-Oncology Diagnostic service consisting of molecular diagnosis, immunophenotyping, cytogenetics and cell biology sections, facilities including 4-channel FACS, Taqman PCR, digital image analysis, automated metaphase image capture and multicolour FISH. 2) the stem cell laboratory 3) specialist coagulation and thrombophilia services. The transfusion laboratory is fully integrated within haematology.
The diagnostic haematology laboratory processed over 900,000 tests annually (diagnostic lab 640,000; blood transfusion 100,000; blood product issuing 45,000; haemostasis 150,000) of which 30% were GP requests. Major equipment: Beckman Coulter LH1500 system, 4 Trinity Biotech MDA 180s, 2 Ortho Autovue Innovas and 1 Beckman Coulter Exel flowcytometer.
The department participates in all appropriate quality assurance schemes including UKNEQAS Blood Group Serology, Coagulation, Microbiology (parasites) and Leucocyte Immunophenotyping. The haematology laboratory has a budget of £1-8m / year.
Departmental policy is decided at a monthly consultant’s meeting chaired by Professor Green. Haematology falls within 2 divisions in the trust, the clinical directors for these being Dr C Crawley (haematology in cancer), Dr T Baglin (haemostasis and thrombosis) and Dr M Scott (haematology laboratory in the Investigative Sciences division) Workload activity contracts with PCTs and other hospitals are under regular review and managed by the Health Agreements department of the Trust. Clinical governance is supervised by a dedicated committee. Guidelines for full implementation of clinical governance at a local level have been drawn up in accordance with the department of health guidelines. Management arrangements are consistent with the recommendations of the Strategic Review of Pathology Services paragraphs 4.22 and 4.26.
The Academic Department of Haematology
Academic Haematology
There are exceptionally strong links between the Addenbrooke’s Department of Haematology and the University of Cambridge Department of Haematology, with Professor Tony Green acting as chairman of the former and head of the latter.
The University department contains 7 Professors (AR Green, AJ Warren, R Read, JP Allain, W Ouwehand, B Göttgens, M Mueschen and J Huntingdon), 3 Readers (H Lee, L Williamson and B Huntly) and 1 Senior Lecturer (C Ghaevert), one senior clinical fellow (Dr Ringshausen) and two intermediate Fellows (Dr M Chapman and Dr Hodson), has an annual research spend of £3-4M, and in the last 5 years has had numerous publications in high-ranking journals (including Nature, Nature Genetics, Science, EMBO J, PNAS, Lancet, NEJM and Blood).The major research interests of the department are:
Stem cell and leukaemia biology
This focuses on the transcriptional regulation of haematopoietic stem cells and pathogenesis of myeloid leukaemias that arise from such stem cells. Research groups are situated in the Cambridge Institute for Medical Research (CIMR) and MRC laboratory of Molecular Biology. Major thrusts include the pathogenesis of bone marrow failure syndromes (Professor Warren), the transcriptional regulation of haematopoietic stem cells (Prof Göttgens,), the biology of normal and leukaemia stem cells (Dr Huntly, University Reader, Dr E Laurenti, Wellcome Henry Dale Fellow and Dr D Kent, LRF Bennett fellow), the molecular pathogenesis of myeloproliferative disorders (Professor Green) the biology of Myeloma (Dr Chapman) and the biology of lymphoma (Dr Hodson).
Thrombosis/haemostasis and structural medicine
This focuses on structural approaches to a number of clinically important molecules with research groups based in the CIMR. Prof Huntingdon is studying the mechanisms that control the behaviour of coagulation proteins and other serpins. The group of Professor Read (Wellcome Trust Principal Fellow) works on extending the power and scope of methods used in protein crystallography and has particular interest in the mechanism of action of bacterial toxins.
Transfusion medicine
Research groups are based in the NHS Blood and Transplant building. This houses a GMP facility, stem cell processing and stem cell research laboratories together with groups working on platelet immuno-biology and functional genomics (Prof Ouwehand), the use of antibody engineering to generate novel and clinically useful monoclonal antibodies (ProfOuwehand) and the study of megakaryocyte biology (ProfOuwehand and C Ghaevert). There is also a Clinical Studies Unit in conjunction with the MRC Clinical Trials Unit.