WEST OF SCOTLAND DEANERY
SUB-SPECIALIST TRAINEE IN UROGYNAECOLOGY
JOB DESCRIPTION
TRAINING CENTRE
Southern General Hospital
1345 Govan Road, Glasgow G51 4TF
NHS Greater Glasgow & Clyde
Training programme Director: Dr Karen Guerrero
Lead Clinician in Obs / Gyn:Dr. Stewart Pringle
MEDICAL STAFF CONTRIBUTING TO SUBSPECIALTY TRAINING
Urogynaecology
- Dr Karen Guerrero Consultant Urogynaecologist
Weekly sessions in sub-specialty: 7
- Dr Stein Bjornsson Consultant Obstetrician & Gynaecologist
Weekly sessions in sub-specialty: 3
- Dr Stewart Pringle Consultant Obstetrician & Gynaecologist
Weekly sessions in sub-specialty: 3
- Dr Bob Hawthorn Consultant Obstetrician & Gynaecologist
Weekly sessions in sub-specialty: 2
Coloproctology
- Mr David Wright Consultant Colorectal Surgery
- Mr Graham Sunderland Consultant Colorectal Surgery
Urology
- Ms Voula Granitsiotis Consultant Urologist
Radiology
- Dr Rachel Connor Consultant Radiologist
THE TRAINING CENTRE
NHS Greater Glasgow & Clyde is Scotland’s largest health board. There are 3 large Obstetric & Gynaecology units within the trust. The Sub-Specialty Training post in Urogynaecology is based in the South of the City, at the Southern General Hospital (SGH). This is a large teaching hospital which serves as a regional (and National) centre for many medical specialties, as well as Urogynaecology e.g. neurology, spinal injuries. It is currently undergoing redevelopment. The maternity unit has a recently openeddelivery suite and the new children’s and general hospital are being built on-site.
Department of Obstetrics & Gynaecology South Glasgow
Number Consultants: 17.5
Number Trainees: FY2 – 7
ST (GP) – 8
ST (O&G) – 19
Sub-Spec Trainees – 2 (Feto-maternal medicine / Urogynaecology)
Deliveries / yr: 6000
Gynaecology workload: New Outpatients: 8600
Emergency Admissions: 2932
Elective Procedures: 3600
In-patient gynaecological surgery and Gynaecology emergencies are based at the SGH. Day-surgery occurs at the New Victoria Hospital (NVH) which is a purpose built Ambulatory care unit with 23-hour beds. Out-patient Clinics are held at the SGH, NVH and Western Infirmary.
We have an Ante-natal day Unit at the SGH, and a separate 24 hour Obstetric Triage / admission unit. Gynaecology services at the SGH include our own in-house Ultrasound department, an Early Pregnancy Assessment Unit and a Gynaecology Emergency Unit.
The Ian Donald department of Foetal Medicine at the SGH serves as the tertiary referral unit for the West of Scotland.
Department of Urogynaecology
Urogynaecology, as a sub-specialty, has run within the hospital for over a decade. We are currently located in a special wing on the ground floor of the Obstetrics & Gynaecology block. This is made up of an office, 3 generic clinical rooms, 2 rooms for pelvic floor physiotherapists plus further offices for continence advisors with space for clinical examination and a dedicated investigation room for urodynamics and voiding studies.
The Unit functions as the major secondary care service for Pelvic Floor Dysfunction within the health board.
Health Professional working within the Department:
- Medical Consultants: 6
- Continence Advisors: 3
- Physiotherapists: 6.6 WTE, 2.1 dedicated solely to out-patient Urogynaecology services
- Nursing Support Staff: 1
The full range of all specialist investigations and treatments are available including a very well developed conservative management programme. There are no other units within the locality competing for this work and the Health Board has a long history of supporting urinary incontinence as a health gain initiative. The Unit also provides training for staff within the Board.
Glasgow is also relatively rich in community continence services. There are numerous GP surgeries / community clinics offering Specialist Physiotherapy Pelvic Floor Services and Continence Advisors. We hold monthly MDT meetings with community teams and are involved in community patient pathways.
We serve as the Tertiary referral unit for the West of Scotland and beyond. This comprises patients requiring investigation, assessment as well as further surgical management. The workload figures, and case complexity, are sufficient to ensure excellent access to a large number of clinical cases for a sub specialist trainee.
The extensive range of surgical procedures offered include:
- Incontinence Procedures
- Tapes – Retropubic, Obturator, Single-Incision
- Autologous Slings
- Colposuspension (Open/Laparoscopic)
- Bladder Neck injections
- Intravesical BOTOX
- Prolapse Surgery
- Vaginal Hysterectomy
- Fascial Cystocoele / Rectocoele repairs
- Vaginal Mesh repairs
- Vaginal vault fixation procedures
- Sacrocolpopexies (Open/Laparoscopic)
A summary of the current annual workload is expressed in table form below. (2011 data)
Secondary / TertiaryUrogynaecology referrals / + 850 /yr / 480 /yr
Urodynamic workload / 450 /yr / 250 /yr
Urogynaecology procedures / Number procedures / year
Minimal Invasive Procedures e.g.
- Tapes
- Bulking Agents
- BOTOX
50 /yr
60 /yr
Retropubic Procedures
e.g. colposuspension / slings / 25 /yr
Prolapse Surgery
- Vaginal hysterectomy
- Traditional repairs
- Mesh repairs
- Sacrospinous Ligament fixation
- Sacrocolpopexies (open/lap)
350 /yr
110 /yr
70 /yr
30 /yr
Urology
We work very closely with a urologists who sub-specialises in reconstructive / female Urology. They offer further continence surgery, such as augmentation cystoplasty, urinary diversion etc.
Video and ambulatory urodynamics are available within the unit. Both will form a regular session in the trainee’s timetable.
Our Urologists provided the service for the regional Spinal Injuries Unit and now offer the Sacroneuromodulation service for Scotland.
The combined Urogynaecology – Urology service functions as a regional centre for fistula repair
Coloproctology
We work with 2 Coloproctologists working in this sub specialist surgical field. We run fortnightly Multidisciplinary Clinics / meetings and have joint lists.
They support our dedicated Obstetric Anal Sphincter Injury service.
The trust has a rectal physiology unit with facilities including anal manometry, endo-anal ultrasound and electromyography.
Radiology
The trust offers excellent radiology opportunities, including a new MRI suite at the NVH allowing dynamic imaging.
There is ample opportunity to learn endo-anal USS and perform this in clinics.
We hold monthly Pelvic Floor MDT meetings together with our Radiology, Urology and Coloproctology colleagues.
Medicine for the Elderly
We have long-standing links with the department of Medicine for the Elderly at the SGH. An excellent service is offered which includes Rehab / Stroke and Parkinson Clinics.
Our department trains the Medicine for the Elderly trainees from the West of Scotland deanery undergoing their continence modules.
Research
The Department of Obstetrics and Gynaecology has an active Urogynaecology research programme. Current projects include collaboration in Multi-centre trials as well as centrally organised research projects into both continence and prolapse surgery.
The department is well supported by the hospital’s Research & Development unit. We work closely with Clinical Research Units across the country on several projects. We also have links with the University of Glasgow academic department of O & G.
SUB-SPECIALTY TRAINING PROGRAMME
Aims
This post is designed to allow an interested post-MRCOG doctor to become a Subspecialist in Urogynaecology. The exact timetable / programme duration will depend upon the requirements of the successful applicant, but he/ she will need to spend a minimum of two, and possibly three years in the post depending upon requirements for the completion of structured training and then CCST, together with Subspecialty Accreditation.
Clinical Role
The Subspecialty Trainee would be expected to join in providing a secondary and tertiary service for women attending the unit with disorders of the lower urinary tract and pelvic floor. The trainee will undertake the relevant administrative tasks as clinic/ ward discharge letters.
Multi-disciplinary team working
The successful candidate will be expected to work within the MDT. He/She will take responsibility of the monthly Urogynaecology team meeting and will be encouraged to attend the department risk management team monthly meeting. They will also co-ordinate / lead the MDT Pelvic Floor meetings.
Allied Specialties
Urology, Colorectal, Radiology, Medicine for the Elderly, Neurology / Spinal Injuries etc... training is expected to be integrated in the training programme. The trainee will be also be released, as felt appropriate by trainers & trainee, according to training needs / opportunities that arise both within the trust as well as elsewhere.
The trainee will however be expected to undergo specific working placements in both the Urology and Colorectal Departments.
Teaching
He/ She would be expected to teach nurses and allied health professionals, as well as undergraduate medical students and postgraduate doctors. The trainee will be responsible for the Urogynaecology component of the departments postgraduate teaching program. They will be expected to teach at the Courses run by the department, such as the Third Degree Tear and Pelvic Anatomy Courses.
Management
The trainee is expected to learn and become involved in clinical care pathways, risk management and service provision.
She/he will learn how to triage GP & Consultant referrals.
Audit
The trainee will be expected to participate in urogynaecology audits and supervise juniors in their audits. In particular they will be responsible for the trust wide Urogynaecology Audit which collects data on all Urogynaecology procedures within the trust. They will also be responsible for maintaining the OASIS database. Both of these are run in conjunction with the trusts Clinical Effectiveness Department.
Courses / Conferences
As well as relevant Urogynaecology training courses, the trainee will be expected to attend courses on Management, Ethical/ medico legal issues, Teaching & Statistics. They will be supported in this.
He/She will be encouraged to attend and actively participate in National & International Urogynaecology meetings.
Research
There is ample opportunity for the sub-specialty trainee in Urogynaecology to develop their research portfolio. The successful candidate will be expected to participate and lead on various projects, and produce first author publications / presentations, regardless of research exemption.
We have close ties with the University of Glasgow. There is the potential of working with them to obtain a higher degree depending on the wishes and eligibility of the successful candidate.
On Call Commitment
ALL of the trainees day-time work will be in Urogynaecology Sub-specialty training programme. There will be minimal general gynaecology (usually co-existing in Urogynaecology patients) and NO day-time Obstetrics.
There remains a requirement for the trainee to take part in the on-call rota in general obstetrics and gynaecology. This is not just a departmental requirement. It is essentialfor training / maintenance of skills in general Obs/Gyn .
The department runs a combined Obstetrics & Gynaecology on-call rota on a tier system. The successful candidate will be expected to contribute to the night time / weekend resident on-call rota together with the other Senior Registrars (Trainees) and Feto-maternal sub-specialty trainee.
Proposed training program for sub-specialist trainee in Urogynaecology
The exact programme will vary depending on the successful candidate. An example of the weekly timetable is found below. This will vary depending on the successful candidate and progression through the programme.
The proposed starting date is August 2012. This can be negotiated if a period of notice is needed, for example, with current employers.
If the trainee is not research exempt they will spend the equivalent of 1-year research integrated into the programme.
The trainee will be supported in completing the theoretical sections of the subspecialty programme. Some of this will be in-house:- e.g.
Dr Doug Small – Medical Physics and Urodynamics
Prof Scott Nelson – Basic sciences
R & D Unit – ‘Good Clinical Practice’
The training programme has the flexibility to allow the trainee to develop their own area of interest if they wish. This may include areas like laparoscopic Urogynaecology, OASIS / coloproctology or the refractory Bladder. The timetable and programme duration can be adjusted accordingly.
Sample Time-Table
Monday * / Research Day / Research DayTuesday / Theatre / Teaching / Administration
Wednesday / Combined urology / colorectal clinics/MDT meeting / Urogynaecology Clinic (Secondary / tertiary referrals)
Thursday / Theatre / Tertiary Clinic/ Theatre
Friday / Theatre / Female Urology / Complex Urodynamics (incl Video / tertiary referrals)
FURTHER INFORMATION
Further advice and information about the sub-specialty training centre and programme can be obtained from both:
Dr Karen Guerrero Tel: 0141 201 2237 email:
Further information regarding University of Glasgow / higher degrees can be made to:
Dr Kevin Hanretty: Consultant Gynaecologist / Senior lecturer
Tel: 0141 232 7953 Email:
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