HEALTHEDUCATIONTHAMESVALLEY - SPECIALTY TRAINING PROGRAMME IN RHEUMATOLOGY

AboutHealthEducationThamesValley

We are the Local Education and Training Board (LETB) for ThamesValley 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 ThamesValley. Thames Valley LETB is responsible for the training of around 2000 Foundation and Specialty trainees.

HealthEducationThamesValley 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 HealthEducationThamesValley as a whole. This may mean that you may be allocated to any geographic location within the deanery depending on training needs.

The Rheumatology/GIM Training Programme

The training programme is a 5year dual rheumatology/GIM programme, starting at ST3 level.In exceptional circumstances a single accredited rheumatology training programme may be possible. During this time, the trainee's work will be monitored for satisfactory progress by their Educational Supervisor and subject to annual reviews in the form of ARCPs. Progression on the programme will be dependent upon these reviews and upon satisfactory acquisition of competences and Clinical Supervisor reports.

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

The Postgraduate Dean has confirmed that these post have the necessary educational and staffing approvals.

The programme is based in several different Trusts throughout HealthEducationThamesValley 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 University Hospitals NHS Trust / Nuffield Orthopaedic Centre, Oxford

Frimley Health NHS Foundation Trust / WexhamParkHospital, Slough

Royal Berkshire NHS Foundation Trust / RoyalBerkshireHospital, Reading

Buckinghamshire Healthcare NHS Trust / Stoke Mandeville, Aylesbury

Great Western Hospitals NHS Foundation Trust / GreatWesternHospital, Swindon

Gloucester Hospitals
NHS Trust / CheltenhamGeneralHospital, Cheltenham

The Area

The Oxford Deanery Rheumatology programmecovers the counties of Oxfordshire, Berkshire, Buckinghamshire, Northamptonshire and Wiltshire. This part of the country is particularly pleasant to live in and has excellent cultural facilities and recreational sports, as well as good schools both in the private and state sectors. There are good road and rail links with all parts of the country and there is easy access to London and HeathrowAirport.

A wide variety of housing is available to rent and buy within the Region both in towns and in surrounding villages.

The hospitals involved in the training programme are the Nuffield Orthopaedic Centre in Oxford, RoyalBerkshireHospitals in Reading, WexhamParkHospital in Slough, StokeMandevilleHospital in Aylesbury and GreatWesternHospital, Swindon. A new post in Cheltenham is to commence August 2015 (details to follow)

The Principles of the Training Scheme

The principles of the rotations agreed by the Oxford Regional Rheumatology Speciality Training Committee are as follows:

1. A5 year dual Rheumatology/GIM accreditation programme.

2. The exact order of rotation is at the Deanery’s discretion. The relevant rotation will often need adjustment at the time of new appointments.

3. The principles of training are set out on the JRCPTB website (

Continuing Formal Appraisal of the specialist GradeRegistrar

Formal appraisal of the trainees is conducted annually by the Specialty Training Committee at the ARCP and a representative from the Specialist Advisory Committee in Rheumatology to ensure that:

  1. The trainees’ development and knowledge gained is satisfactory. If the development of a trainee is not satisfactory, the problem should be identified early and action taken to correct this.
  1. An attachment which is not providing appropriate training and educational opportunities is identified, adjusted and improved.

A formal meeting will occur at the beginning and also at the end of each attachment with the trainee, at least one of the trainers and an “outside” assessor one not currently working with the trainee. The purpose of this meeting is to ensure that the post is providing all of the requirements for the trainee to cover the curriculum, set goals for the trainee and to assess progress. Should problems arise either with the training programme or the trainee then action to solve the problem, in terms of discussion, counselling or modification of goals, will be taken with the involvement of the outside assessor.

Duties of the post

The precise details of each post will vary with each hospital (see later). However, the following duties are relevant to all Hospitals in the rotations.

The specialist registrar will attend

  1. At least two supervised outpatient clinics in general Rheumatology case mix per week with other clinics, as required.
  1. At least one ward round per week.
  1. He or she will have the experience of continuing care of Rheumatology patients on an In and Outpatient basis.
  1. The trainee will record knowledge, experience and skills acquired during the post in the training record.
  1. The trainee will be involved in the training and supervision of Senior House Officers and of Paramedical Staff and participate in audit and contribute to hospital teaching meetings.
  1. He or she will become involved in the management and administration of the department.
Educational Contract

Wherever possible trainees will be assisted to undertake research and publication. Progress in these areas will be assessed and discussed at the annual appraisals. The training programme benefits from a part time Masters Course in Musculoskeletal Science, based at the University of Oxford, which all trainees are encouraged to take up.

Trust Information

THE OXFORD UNIVERSITY HOSPITALS NHS TRUST

THE NUFFIELD ORTHOPAEDIC CENTRE, OXFORD

The successful candidate will work directly with the Consultant Rheumatologists

(Professor N Arden, Dr K Bailey, Professor P Bowness, Dr J David, Dr K Javaid, Professor R Luqmani, Dr C Swales, Professor P Taylor, Professor BP Wordsworth, Dr Julia Newton) and as part of the training for clinical and administrative responsibilities.

The rheumatology unit at the NOC has a world-class reputation for research and teaching and trainees will have an opportunity to develop expertise and research experience in a variety of subspecialities including vasculitis, inherited disorders

spondyloarthritis, immunology, osteoporosis and rare metabolic boone diseases, and sports and exercise medicine. The rheumatology unit is part of a BIU with the NDORMS.

The trainee will be involved in the teaching of undergraduates when they attend the hospital for orthopaedic/rheumatological clerking, will be involved in the teaching of other staff, not only those attached to the hospital but attending courses held for professions supplementary to medicine, and be involved in postgraduate teaching and in clinical conferences.

Rheumatology Unit

This comprises a section of Ward D for inpatients (usually around 8) and the Day Care Unit. The major features of the unit’s work are the application of detailed team assessment of patient’s difficulties and the very close integration of medical and surgical care of patients with rheumatic diseases. The pre and post-operative assessment and care is undertaken in the medical unit with regular ward rounds, clinical conferences and combined out-patient clinics being held with the orthopaedic surgeons.

Unit activities include regular case conferences, X-ray, Imaging, Pathological and audit sessions as well as frequent combined meetings with Regional Colleagues.

Out-patient clinics including general rheumatology, vasculitis, sports and exercise medicine and paediatric rheumatology are held at the Nuffield Orthopaedic Centre, Oxford. Outreach clinics are held in Banbury, Bicester, Witney and Chipping Norton.

Teaching Facilities

Within the Nuffield Department of Medicine and Orthopaedic Surgery at the JRH II Hospital and the Nuffield Orthopaedic Centre, the following teaching facilities are available and would provide the candidates with unrivalled contact with the problems which are closely related to his/her own specialty and for learning the inter-relationships of the specialties:

Medical Staff Conferences

Lectures in Basic Science of the Musculo-Skeletal System

X-ray demonstrations including CT, MRI and Ultrasonography

Clinical Pathological Conferences

Combined Clinics with Immunologists and others interested in Connective Tissue Diseases

Research

Any research will be carried out within the Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS). Several of the consultants regularly act as academic supervisors for trainees. Professor Wordsworth has a focus on genetics of rheumatic diseases and on patients with heritable complex connective tissue diseases and leads the musculoskeletal theme on rare diseases for the National Institute for Health Research with Dr Javaid. Professor Luqmani is the theme leader for vasculitis research at the NDORMS, focusing on the epidemiology, mechanisms, treatment and long term outcome of systemic vasculitis. Professor Taylor is the Norman Collisson Chair of musculoskeletal sciences at Oxford and directs the new clinical trials unit within NDORMS. He has experience of over 15 years in biologic therapy testing with particular expertise in early proof of concept trials and experimental medicine studies using targeted therapy as a probe of pathogenesis to investigate in vivo biology of the therapeutic target. Professor Bowness has a strong laboratory research programme investigating the immunology of inflammatory arthritis, particularly the spondyloarthropathies. Professors Taylor, Luqmani and Bowness have recently been funded by Arthritis Research UK to set up an experimental arthritis treatment centre, with a focus on using imaging techniques to demonstrate effectiveness of novel agents in early phase clinical trials in inflammatory arthritis.

Professor Arden directs the Musculoskeletal Epidemiology Unit with Dr Javaid, Professor Cooper, Dr Judge and Prieto-Alhambra focusing on the epidemiology of osteoarthritis, osteoporosis and sports injury. The unit has a strong track record of training and successful supervision of clinical fellows with national and international collaborations, publications in high impact general and specialist journals as well as successful grant applications. We have recently been awarded the ARUK Sports Injury and Osteoarthritis Centre of Excellence and an NIHR HS&DR grant to determine effective models of secondary fracture prevention in addition to being part of the ARUK Epidemiology UK-Rime network.

Should the interests of the trainee lie outside this range of experience suitable advice and supervision will be arranged in the university departments.

Candidates are advised to visit the hospital and should contact:

Dr J David, Professor P Wordsworth, Professor P Bowness , Professor R Luqmani

Nuffield Orthopaedic Centre

Headington

Oxford

OX3 7LD

Telephone : (01865) 227527

General Condition of Service

There is an on call rota for rheumatology.

On call cover for Rheumatological referrals for all oxford specialist centres and regional GPs. General medicine cover of Nuffield Orthopaedic Centre. Rheumatology opinions for Oxford University Hospitals.

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THE ROYAL BERKSHIRE NHS FOUNDATION TRUST

The Royal Berkshire Hospital, one of the largest District General Hospitals in the UK, has a high reputation as a medical training centre and has been popular with rheumatology trainees in the Oxford Deanery for the wide variety and intensity of experience that it offers in both Rheumatology and in General Internal Medicine. The Rheumatology Department at the Royal Berkshire NHSFT provides rheumatology services to patients from the districts of Reading, Wokingham, Newbury, Henley-on-Thames, Wallingford and Wantage - a population over 550,000.

Staff

  • Consultants

Dr Antony Bradlow – Rheumatology

Dr Jeremy McNally – Rheumatology & General Internal Medicine

Dr Antoni Chan - Rheumatology & General Internal Medicine

Dr Gordon MacDonald– Rheumatology & General Internal Medicine

Dr Joanne Kitchen - Rheumatology & General Internal Medicine

Medicine

Three Specialist Registrars:

Oxford Rotation (Rheumatology & GIM)

  • Two Senior House Officers (1 CMT + 1 GPVTS
  • Two House Physicians
  • One Hospital Practitioner
  • Seven Nurse Specialists (DAWN, Biologics, Osteoporosis)

Rheumatologists and General Physicians.

Rheumatology in Reading spans the entire spectrum of musculoskeletal disease from soft tissue problems to complicated connective tissue disease. A full orthopaedic service is available.

There are combined Orthopaedic Hand, Dermatology, and Vasculitis clinics (the latter with a renal physician with an interest in vasculitis) and a weekly Combined Radiology meeting with s specialist muscolskeletal radiologists.

Early arthritis and Biologics services are provided by the Rheumatology Department. The Department has its own physiotherapists and occupational therapists as well as regular sessions in clinical psychology. The Department runs metabolic bone clinics and has access to DEXA scanning.

The Specialist Trainees’ particular duties are on the enclosed weekly programme. The STs will work with all five consultants. Their inpatient duties include cover of a combined GIM/ rheumatology ward and of those outlying patients for which the Rheumatology Department has responsibility. Under the supervision of the consultants the trainees provide a daily consultation service to the Clinical Decision Unit (CDU) and see all rheumatology in-patient referrals in the Trust.

The G(I)M / Rheumatology ward (currently Lodden ward) has several hundred admissions annually and has access to an on-site hydrotherapy pool. A dedicated IMID Unit attached to this ward deals with the many day cases admitted for treatments such as pulse intravenous Cyclophosphamide therapy and intravenous biologic treatment.

In addition to the combination of rheumatology and general medicine in the same department, the Department’s strengths are its comprehensive teaching programme and the high level of supervision of Medical Staff in Training by the Consultants..

Research and Development

The department is actively involved in clinical research. We have a number of ongoing Comprehensive Local Research Network (CLRN) research studies (as part of the ThamesValley network) and commercially sponsored biologic clinical trials. Trainees are encouraged to participate actively in the R&D activities of the Department. The University of Reading has several Health Research Fellowships which are designated for funding of collaborative clinical research sessions. Specialist Trainees are encouraged to consider undertaking a collaborative research project under this scheme. Those interested are advised to obtain a copy of the University of Reading Health Research Group prospectus from the Rheumatology consultants before interview. The Royal Berkshire NHSFT is also starting a Research Funding scheme to pump prime research projects from 2010. STs will be encouraged to apply for this through open competition.

For further information please contact:

Dr Jeremy McNally0118 322 6559

BUCKINGHAMSHIRE HEALTHCARE NHS TRUST

The Hospitals

Rheumatology at Buckinghamshire Healthcare is based at Stoke Mandeville (SMH) and Amersham Hospitals (AGH), with clinics also being held at WycombeHospital. This post is based at StokeMandevilleHospital with 2 Specialist trainees. The post provides a broad experience in rheumatology and the opportunity to train in general medicine. Trainees are also encouraged to attend specialist clinics and participate in research activities and clinical audit.

Structure of Department of Rheumatology

The department currently has 4 consultants: Dr Sally Edmonds, Dr Richard Stevens Dr Malgosia Magliano, Dr Chetan Narshi and Dr Jas Chana. Dr Edmonds has a particular interest in paediatric rheumatology and runs one paediatric clinic per month. Dr Magliano leads an osteoporosis service and development of early arthritis pathway. The department is developing a MSK ultrasound service to support Early Arthritis Clinics. The department has 3 specialist nurses (2.4 WTE) who run nurse led clinics, a rheumatology helpline and a busy day unit (Stoke Mandeville) where infusions of biologic, cytotoxic and other intra-venous agents are given. The department has two specialist registrars, one FY1 trainee and a GP VTS trainee.There is also a specialist ankylosing spondylitis clinic run by a senior physiotherapist and a combined hand clinic with plastic surgeons. The department provides a consulting service for the hospital in patients with a weekly consultant lead ward round. The department has one full time research nurse and an active research portfolio. There is also an excellent support from rheumatology OT and podiatry available across three hospital sites, with access to physiotherapy and hydrotherapy as well as clinical psychology. The radiology department provides a specialist MSK service with weekly X-ray meetings. DXA scan service is available in AmershamHospital. The Unit has excellent secretarial support.

The Specialist Registrars posts

There are two posts based at SMH: Rheumatology (SpR1) and Rheumatology/GIM (SpR2). Specialist trainees run general rheumatology clinics as well as early arthritis, flare and biologics lists under consultant supervision. They support Rheumatology Day Unit activities and assess inpatient referrals. Specialist trainees supervise the work of FY1 and GPVTS trainees and work closely with our specialist nurses.

Timetable

AM / Lunch / PM
Monday / SpR Admin/WR / SpR Admin/WR
Tuesday / New Patient clinics including Early Arthritis clinic / Follow-up Clinics
Paediatric Clinic
(1stTuesday)
Wednesday / 8.15-9.00 MDT Xray meeting
9-10am Hospital Grand Round
10am Flare clinic / SpR Admin/WR
Thursday / Regional Meetings (NOC, Oxford 1stThursday)
Combined Hand Clinic
(2ndThursday)
Osteoporosis Clinic
(3rdThursday) / CPC meeting / Consultant Ward Round (times may vary)
Rheumatology Educational Meeting 4-5pm
Monthly Management/ Governance meetings 2-5pm
Friday / SpR2 - Biologics clinics SMH
SpR1 Clinic at AGH with Dr Nashi / SpR Admin/WR

Education and Training

Educational activities include:

  • MDT X-ray meeting with MSK radiologists and orthopaedic – weekly
  • Hospital Medical Grand Round – weekly
  • Rheumatology Departmental meetings – weekly
  • Hospital Academic Half Day and Audit meetings - monthly
  • Oxford Rheumatology Regional meetings every 1st Thursday of the month
  • ILD meeting with the respiratory team – monthly
  • Combined rheumatology/orthopaedic educational meetings every 6 months
  • Combined educational meetings with WexhamParkHospital every 4 months

Rheumatology department has up to date library of excellent rheumatology textbooks and a subscription to the online anatomy software. There is an excellent support from the PGC library and audit department. Trainees are encouraged to get involved in clinical research and undertake regular audit.