OXFORD DEANERY: Academic Clinical Fellow in Rheumatology (ST3)

Academic Clinical Fellowship (ACF) posts have been awarded by the NIHR to University/NHS Trust/Deanery partnerships nationally through competition. Oxford has been very successful attracting 79 ACF and 30 Clinical Lecturer posts previously. These posts form part of the NIHR Integrated Training Pathway, further details of which can be found on the NIHR TCC website http://www.nihrtcc.nhs.uk/intetacatrain/ All ACF posts attract an NTN-A.

About Oxford Deanery

The Oxford Deanery covers the counties of Oxfordshire, Berkshire and Buckinghamshire with Banbury and Milton Keynes in the North; Reading and Slough in Berkshire; and High Wycombe and Aylesbury in the West. The Rheumatology specialist registrar programme also includes Swindon in Wiltshire to the south.

The Oxford Deanery is part of the South Central Strategic Health Authority which serves a large population and covers the regions mentioned above as well as the Wessex Deanery areas of Hampshire and the Isle of Wight. The Oxford Deanery is responsible for the training of some 1500 trainees.

The Oxford Deanery is a relatively small deanery with a defined geographical area which serves as a single unit of application. 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 Oxford Deanery as a whole. This may mean that you may be allocated to any geographic location within the Oxford Deanery depending on training needs.

The Rheumatology Training Programme

The Rheumatology training programme is a four (single accreditation) or five (dual accreditation with general internal medicine) year programme, starting at ST3 level. The ACF post will take up three years of the training programme at the end of which there will be a return to full-time clinical training in unless funding for a research degree is obtained. During the programme, 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 as assessed by workplace – based assessments 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 this post has 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 Locations
Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust / Nuffield Orthopaedic Centre, Oxford
http://www.noc.nhs.uk/
Heatherwood and Wexham Park Hospitals NHS Foundation Trust / Wexham Park Hospital, Slough
http://www.heatherwoodandwexham.nhs.uk/location/wexham-park-hospital-slough
Royal Berkshire NHS Foundation Trust / Royal Berkshire Hospital, Reading
http://www.royalberkshire.nhs.uk/
Buckinghamshire Healthcare NHS Trust / Stoke Mandeville, Aylesbury
http://www.buckshealthcare.nhs.uk/
Great Western Hospitals NHS Foundation Trust / Great Western Hospital, Swindon
http://www.swindon-marlborough.nhs.uk/
Buckinghamshire Healthcare NHS Trust / Amersham Hospital
http://www.buckshealthcare.nhs.uk/
Wycombe General Hospital, High Wycombe
http://www.buckshealthcare.nhs.uk/
The Area

The Oxford Deanery Rheumatology programme covers 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 Heathrow Airport.

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, Royal Berkshire Hospitals in Reading, Wexham Park Hospital in Slough, Stoke Mandeville Hospital in Aylesbury and Great Western Hospital, Swindon.

The Principles of the Training Scheme

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

  1. One rotation will be Dual Accreditation GIM/Rheumatology (5 years) and the other Single Accreditation Rheumatology (4 years).
  1. GIM accreditation by JCHMT requires 36 months of GIM – 12 of which are “heavy” (as at Reading and at Stoke) and 24 “light” (defined as 2 takes per month).
  1. Trainees will not be able to switch from one rotation to the other after appointment. The rotations will be advertised as separate rotations. Trainees will have to decide which rotation they wish to take before interview.
  1. The current SAC rules for single accreditation are: 36 months of Rheumatology “heavy” and one year “optional”. In the case of these rotations, the “optional” 12 months is GIM. Single accreditees who want to do research will do it as OOPE (out of programme experience).
  1. The exact order of rotation is at the Deanery’s discretion. However, the academic trainee appointed will start in Oxford – the relevant rotation will thus often need adjustment at the time of new appointments. If multiple appointments are made at the same time, it may not be possible for some trainees to start in Oxford. These trainees are likely to be required to rotate through Oxford later in the rotation.
  1. The academic clinical fellow will need to work flexibly during his/her time in post to ensure that sufficient time is available to complete the competing demands of academic activity as well as clinical training. This will require good negotiation skills and time management to ensure that the trainee has sufficient time dedicated to academic activities throughout the rotation.
  1. The academic clinical fellow will devote 9 months to full time research, to allow completion of a specific project outlined below. Subsequently, it is expected that they will be given dedicated time to develop further research ideas to apply for funding for higher academic positions, with the support of their academic supervisors.

Single Accreditation in Rheumatology
(48 months) / Dual Accreditation in GIM/Rheumatology
(60 months)
NOC – 12 months including 9 months of full time research / NOC– 12 months including 9 months of full time research
Stoke Mandeville – 12 months / Stoke Mandeville – 12 months
Swindon – 12 months / Wexham Park– 12 months
Wexham Park– 12 months / Swindon – 12 months
Reading – 12 months

Continuing Formal Appraisal of the specialist Grade Registrar

Formal appraisal of the trainees is conducted annually by the Specialty Training Committee 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.

2.  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.

In addition to this appraisal, the trainee will be formally reviewed by the academic training committee for NDORMS (chaired by Mr Jonathan Rees) on an annual basis, in order to ensure that their academic needs are being met.

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.

We propose that the trainee starts the post in full time research for 9 months in Oxford (details are shown below), following which he/she will rejoin the standard rotation (i.e. completing 3 months more in Oxford prior to moving to another trust in the rotation).

The specialist registrar will attend

a.  At least two supervised outpatient clinics in general Rheumatology case mix per week with other clinics, as required.

b.  At least one ward round per week.

c.  He or she will have the experience of continuing care of Rheumatology patients on an In and Outpatient basis.

d.  The trainee will record knowledge, experience and skills acquired during the post in the training record.

e.  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.

f.  He or she will become involved in the management and administration of the department.

g.  The trainee will work as part of a research team relevant to their project as well as working in the relevant clinical team

h.  The trainee will be expected to negotiate with and be supported by their clinical supervisors to ensure that their academic role is clearly defined and the time protected within each part of the rotation, especially when they have completed their period in full time research.

i.  The trainee will be expected to attend courses relevant to the academic project, as provided within the region, or in special circumstances, outside the region – all such courses will be funded by the fellowship programme

j.  The trainee will be expected to travel to other relevant centres as required as part of the academic project, with guidance from the academic supervisor. Funding will be available from the academic fellowship and other means to support the travel.

Research

Professors Raashid Luqmani, Peter Taylor and Paul Bowness will be the Academic Supervisors for the ACF. 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 and Professor Cooper 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. We have recently been awarded the ARUK Sports Injury and Osteoarthritis Centre of Excellence and an NIHR SDO grant to determine effective models of secondary fracture prevention.

If the successful applicant chooses to focus on ultrasound research and application to management of musculoskeletal disease, training can be offered in ultrasonographic assessment of inflammatory peripheral arthritis or in giant cell arteritis and this can be linked to a specific research project in which the candidate will acquire the skill of2 and3 dimensional quantification of inflammation in either synovitis or vasculitis. In addition, the ACF will help to develop methods to standardise ultrasound use across the region, with a view to ensuring robust methodology for future clinical trials in early arthritis or large vessel vasculitis. The expectation is that the ACF will become skilled in research methodology and clinical management based on ultrasound assessment of either inflammatory arthritis or large vessel vasculitis.

If the fellow wishes to choose a project related to the spondyloarthropathies, they could primarily look at imaging (Prof Peter Taylor) or primarily undertake a translational immunology project (Bowness or Bowness/Taylor), obtaining an introduction to immunological laboratory techniques including flow cytometry. Enzyme linked immunoassay and cell culture of peripheral blood or synovial samples.

If the successful candidate chooses a project within the Musculoskeletal Epidemiology Unit there is an extensive portfolio of innovative studies to choose from within osteoarthritis and osteoporosis including epidemiology, biomarkers, imaging, genetics and tailoring therapy. The ACF will be working in a multidisciplinary team of clinicians, epidemiologists, statisticians, post doctoral and doctoral students and gain an extensive grounding in research methods as specific literature base.

Therefore, several well defined projects in a variety of themes are available to the successful candidate, who will be expected to focus on one and develop and implement it with the relevant theme leader. We expect the fellow to generate publications and pilot data that will be used as the basis of an application for a clinical research fellowship to support a higher degree and training of a future clinical academic.

Modules in statistics are available through the university and some travelling will be required, to other centres as well as to meetings to present findings, for which there is funding available.

Timetable in Oxford (year 1)

Months 1-9 / Full time research
AM / Lunchtime / PM
Monday / Research / X-ray meeting/admin meeting / Research
Tuesday / Research / Research
Wednesday / Research / Research
Thursday / Oxford regional meeting.. (1st Thursday) or
research / Research
Friday / Research / Research
Months 10-12 / Standard Spr training programme
AM / Lunchtime / PM
Monday / Academic meeting/Ward round / X ray meeting/admin meeting / Out patient clinic (RL or JD)
Tuesday / Research / Out patient clinic (RL/MS)
Wednesday / Banbury clinic (PB/NA) / General rheumatology clinic (RL/JD)
Thursday / Oxford regional meeting. (1st Thursday) or
Ward round/biologics clinic / Ward work/admin
Friday / Ward work/admin / General rheumatology clinic
(JD/NA/PB)

In years 2 and 3 there will be some short periods of time allocated for research and these are described under each rotation. The ACF will be supported in developing a proposal to submit for funding to enable a period of out of programme research for a higher degree at the end of year 3. The ACF will rejoin the clinical specialty training programme at the completion of the post if funding is not successfully secured.