HEALTH EDUCATION THAMES VALLEY:
SPECIALTY TRAINING PROGRAMME IN RESPIRATORY MEDICINE
Welcome to the Respiratory Training programme! I hope that this document gives you an insight into what our programme has to offer you. We wish to encourage any trainee interested in excellence in respiratory medicine. For the majority of trainees this includes higher research; and robust general medical training as a dual specialty.
We pride ourselves on being a close knit, smaller programme giving you individual time within a full regional programme involving our Tertiary centre- Oxford University Hospitals, and our district general hospitals. You keep the same Educational supervisor for your training period of 5 years to allow support and mentorship.
Best wishes
Dr. Charlotte Campbell
Training Programme Director.
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 around 2000 Foundation and Specialty 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 RESPIRATORY MEDICINE Training Programme
The Respiratory Medicine training programme is a 5 year programme, starting at St3. During this time, the trainee's work will be monitored for satisfactory progress by an allocated Educational supervisor, 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 JRCPTB. The posts attract National Training Numbers and provide training towards a Certificate of Completion of Training (CCT).
The Postgraduate Dean has confirmed that this post has the necessary educational and staffing approvals.
The programme is based in several different Trusts throughout the Thames Valley; 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
http://www.ouh.nhs.uk/ / Churchill Hospital, Oxford
John Radcliffe, Oxford
Horton Hospital, Banbury
Milton Keynes NHS Foundation Trust
http://www.mkgeneral.nhs.uk/ / Milton Keynes General Hospital
Royal Berkshire NHS Foundation Trust
http://www.royalberkshire.nhs.uk/ / Royal Berkshire Hospital, Reading
Frimley Health NHS Trust: Heatherwood and Wexham Park Hospitals
http://www.heatherwoodandwexham.nhs.uk/ / Wexham Park Hospital, Slough
King Edward VII Hospital, Windsor
Buckinghamshire Healthcare NHS Trust
http://www.buckshealthcare.nhs.uk/ / Wycombe General Hospital
Stoke Mandeville Hospital
Rotation Information
Training in respiratory and general internal medicine in Oxford region is based on broad practical experience with appropriate training to cover the respiratory and GIM curriculums. Consultants in the centres are approachable, and give on the job teaching and feedback in inpatient and outpatient settings.
In addition there are regular regional meetings and audit, research, journal clubs and grand round teaching, within each centre.
Specialist grade regional teaching is held monthly in Oxford, and has scored highly in the GMC survey of trainees. There is an excellent pass rate of the SCE exam. Trainees are themselves involved in the training and feedback is encouraged.
Study leave to attend national and international meetings is encouraged.
Trainees will usually spend the first 1-2 years of programme within one of the District General Hospitals gaining experience in both GIM and general respiratory disorders. Within the final 3 years each trainee will work in the Churchill Hospital for at least 12 months and within the John Radcliffe ICU for 3 months. Where possible the rotation is agreed at the beginning of the placement, but can be subject to changes depending on the requirements of other trainees. Rotations may at times change in response to clinical need from the Trusts.
Many trainees live in Oxford and commute to the various DGHs. Some trainees live in hospital accommodation.
Within the region there is special expertise and training in:
· Respiratory physiology
· Asthma and difficult airways
· Sleep disorders
· Lung immunology and interstitial lung disease
· Pleural disease and Thoracoscopy
· Clinical trials
· Epidemiology
· Lung infection and TB
· Cystic fibrosis and bronchiectasis
· Lung cancer, respiratory oncology and interventional bronchoscopy
· COPD
The rotations at the tertiary centre of Oxford include modular training of specialist areas e.g. CF, in line with the curriculum for respiratory medicine developed by the Royal College of Physicians.
There are established links to centres for transplant and pulmonary hypertension experience.
Research:
There are manifold opportunities for research which is actively encouraged in our region, and most trainees have progressed to complete higher degrees by taking take out of programme experience in research (OOPR). OOP time is allowed commencing February or August start dates and with a minimum of 6 months notice.
Academic clinical lecturer posts in respiratory medicine occur periodically which allow those pursing research careers the opportunity to combine clinical and research training for the last period of their training. This is usually by spending 3-6 month periods alternating lab based work with clinical placements.
Dual training:
Trainees in our region have applied and commenced dual training in Intensive Care medicine (previously triple training with GIM).
Working less than full time:
Trainees for personal reasons, may choose to work less than full time. After an application to HETV, we arrange the training if possible in a job share with another LTFT trainee in respiratory medicine.
Management:
There are management training opportunities in each of the Trusts.
The respiratory training committee (STC) is attended by a trainee rep voted by the trainees. The rep also chairs a respiratory trainee committee that meets to discuss issues and allows the rep to feedback to the STC and HETV. The rep also sits on a All specialities trainee committee at HETV to feedback to the deanery.
Trainees in our region have successfully applied for national management schemes such as the NICE scholar programme.
Teaching:
Some trainees have taken out of programme time for teaching. In addition participation in the Physicians as Educators scheme has been done by several.
TRUST INFORMATION
Oxford Centre for Respiratory Medicine, Churchill Hospital
The Oxford Centre for Respiratory Medicine (OCRM) is the base for the specialist respiratory medicine in the Oxford Specialist Registrar Training Rotation. OCRM is a Regional Specialist Respiratory Unit and is part of the Oxford Radcliffe Hospital Trust and academically part of the Nuffield Dept of Medicine, Oxford University. There are four clinical trainees at the OCRM at any one time, and they rotate through subspecialism and ward work on a modular basis.
This process is pursued flexibly to the mutual advantage of the trainee and the unit.
The registrars take par tin on call duties covering the Churchill hospital site.
Infrastructure
The Oxford Centre for Respiratory Medicine has the following infrastructure.
1. 20 in-patient beds situated on Geoffrey Harris ward at the Churchill Hospital,
2. A dedicated out-patient unit consisting of a suite of 7 rooms including consultation and treatment rooms.
3. A respiratory treatment centre for the assessment of acutely ill patients, setting up of NIV/CPAP, administration of various treatments (e.g. omalizumab), ABGs/CBGs, etc.
4. An interventional bronchoscopy/thoracoscopy service runs two bronchoscopy lists and one interventional pleural list per week, and delivers general anaesthetic interventions in collaboration with thoracic surgery. The unit is equipped with modern video bronchoscopes, thoracoscopes, the necessary facilities for biopsy cytology, trans-bronchial biopsy, trans-bronchial needle aspiration, airway stenting, electrocautery, cryotherapy, pleural ultrasound, thoracoscopic pleural biopsy, talc pleurodesis, autofluorescence thoracoscopy, indwelling pleural catheter management etc. Fluoroscopy screening facilities are available through the modern imaging fluoroscope in the Regional Radiology Unit.
5. A respiratory sleep unit including 6 dedicated sleep laboratories equipped to RCP recommended standards, as well as domiciliary systems.
6. A respiratory high dependency unit with facilities for non-invasive ventilation.
7. A lung function laboratory equipped to British Thoracic Society recommended standards. This has the facilities for dynamic ling volumes, gas transfer estimation, oesophageal and trans-diaphragmatic pressure monitoring, body plethysmography, pharyngeal acoustic reflectance and exercise training.
8. A clinical research unit with facilities for ambulatory and beat to beat non-invasive blood pressure measurement, ambulatory 24 hour ECG monitoring, autonomic tone assessment including heart rate variability, and baroreflex testing, the objective quantification of excessive sleepiness, respiratory pattern monitoring, etc.
9. A UKCRC registered Respiratory Clinical Trials Unit running both single centre and multi-centre clinical trials.
10. A pulmonary rehabilitation unit allied to the lung function laboratory and including exercise testing/training equipment.
11. The regional thoracic imaging service which includes on site helical CT and PET/CT scanning, MR scanning, radionuclide imaging including lung ventilation/perfusion, isotope bone scanning and inhaled DTPA measurement and ultrasound imaging. This service provides a full portfolio of image guided biopsy of the lung, mediastinum and pleura.
12. Thoracic surgery is provided by the regional cardiothoracic surgical unit based on the adjacent John Radcliffe site, where the service is supplied by one dedicated thoracic surgeon and two cardiothoracic surgeons.
13. The regional medical and clinical oncology units are on the Churchill Hospital site in a new, state-of-the-art regional cancer centre.
14. There are close links with the regional infectious diseases/HIV service that has its in-patient service supplied through John Warin ward and to which the respiratory trainees have on call commitments, and share tuberculosis care with this team.
Staff
The Oxford Centre for Respiratory Medicine is staffed as follows:
Senior Medical Staff
Dr. Steve Chapman Consultant and Senior Lecturer, Adult Cystic Fibrosis Centre and a broad practice in general and respiratory medicine.
Dr. William Flight, Consultant in CF and Bronchiectasis
Dr Henry Bettinson, Joint ITU/Respiratory Consultant with interest in TB and ILD
Dr Alistair Moore Consultant Lung Cancer and Interventional bronchoscopy
Dr. Anny Sykes, Consultant in Lung cancer
Dr. Naj Rahman, Oxford Respiratory Trials Unit and Pleural disease service Unit and Unit academic lead. Lead clinician for pleural diseases plus a general respiratory and sleep medicine practice.
Dr Maxine Hardinge. Consultant physician with particular interests in COPD and respiratory sleep and lead for pulmonary rehabilitation. Dr Hardinge is the Strategic Health Authority lead for COPD
Dr. Annabel Nickol: Consultant in Respiratory Sleep Unit and lung function.
Dr Ling-Pei Ho, Senior Lecturer and Consultant. Dr Ho has a research and clinical interest in sarcoidosis and diffuse lung disease.
Dr Rachel Hoyles. Lead clinician for the interstitial lung disease service, and has a broad respiratory and general medical practice.
Prof I Pavord: Difficult airways disease
Dr. Mona Bafadhel: Difficult airways disease.
Dr. Fergus Gleeson. Consultant Radiologist. Director of the Regional Thoracic Imaging Service.
Dr Rachel Benamore, Consultant Thoracic Radiologist
Specialist Registrars and Senior House Officers
OCRM has three Academic Clinical Lecturers (specialist registrar grade).
OCRM has four full time clinical registrars on the Churchill site (see timetables below) which comprise the posts included in the current training scheme.
They are currently five full time research fellows studying laboratory or clinical doctoral projects.
Three full time Senior House Officers.
Respiratory Sleep Disorders
One respiratory sleep clinic sister/co-coordinator. One clinical sister. Four specialist nurses, four health care assistant and one technical engineer.
Pleural Disease
One specialist nurse working with the lung cancer specialist nurse service.
Cystic Fibrosis
Four cystic fibrosis specialist nurses, three specialist cystic fibrosis senior physiotherapists, one dietician and one clinical psychologist.
Pulmonary Rehabilitation
One senior occupational therapist, one senior physiotherapist, two occupational therapy assistants.
Bronchoscopy
Two part time nurses and one part time health care assistant.
Lung cancer
Two lung cancer nurse specialists
Clinical Research Unit/Respiratory Trials Unit/Lung function laboratory
One operations director, one senior and two trial managers, data manager pending appointment, lead for trial QA, trial monitor, nine research nurses, statistician and database programmer support and two lung function technicians
Other Senior Nurses
One ward sister, one lecturer practitioner, two respiratory specialist nurses with a specific role in early COPD discharge policy.
Workload
General Respiratory Medicine
The Oxford Centre for Respiratory Medicine provides a service to the population of Oxford and surroundings (approx. 550,000). The unit managed about 1400 in-patients last year. Two of the beds are in a dedicated high dependency unit specialising in post intensive care recovery and non-invasive ventilatory support and NIV is also given via other unit beds. The medical and specialist respiratory nurse staff provide a consultation service to the other Oxford Hospitals. The unit runs 23 out-patient clinic sessions per week and handles about 8000 out-patient events every year. The out-patient new patient to old patient ratio is 1:3. This service provides the opportunity for a rounded training in specialist respiratory medicine.
Bronchoscopy and Thoracoscopy; pleural interventional service.
The thoracic interventional service is expanding and currently performs 6-8 local anaesthetic, and 2/3 fluoroscopic/general anaesthetic bronchoscopies, 6 local anaesthetic thoracoscopies each month, and a large number of more minor pleural procedures. Bronchoscopic procedures include standard bronchial lavage, brushing and biopsy for malignancy and infection, interventional bronchoscopic procedures including electrocautery, argon plasma coagulation, cryotherapy and tracheobronchial stenting under general and local anaesthesia.