JOB DESCIPTION FOR SUBSPECIALTY POST
IN GYNAECOLOGICAL ONCOLOGY TRAINING
AT THE UNIVERSITY HOSPITAL OF WALES, CARDIFF
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Introduction to the post
The sub-specialist training within Gynaecological Oncology has been a successful programme for a number of years. An opportunity exists for a trainee in Gynaecological Oncology based in the University Hospital of Wales (UHW), Cardiff and Velindre. This is a formal training programme for two to three years (dependent on research exemption), which will lead to accreditation by the Royal College of Obstetricians and Gynaecologists. It should be stressed that the third year is not a formal research year but an additional year requested by the RCOG to compensate for on-call commitments during the training programme. Or it can be utilized to complete research projects. We would therefore prefer candidates to be research exempt.
Registration of Gynaecological Cancer in Wales (1992-2001))
Area of Residence / Standardised Registration Ratio (Average annual registrations)Cervical Cancer / Uterine Cancer / Ovarian Cancer * / TOTAL
Clwyd / 113 (58) / 97 (39) / 114 (56) / 153
Gwynedd / 104 (32) / 104 (29) / 107 (32.8) / 94
N Wales TOTAL / 90 / 68 / 89 / 247
E Dyfed / 119 (36) / 115 (32) / 110 (33) / 101
Pembrokeshire / 115 (18) / 113 (12) / 104 (12.8) / 43
W Glam / 105 (16) / 99 (13) / 97 (13.6) / 43
W Wales TOTAL / 70 / 57 / 59 / 187
Powys / 125 (32) / 98 (34) / 92 (45.2) / 111
Mid Wales TOTAL / 32 / 34 / 45.2 / 111
S Glam / 64 (49) / 82 (40) / 99 (43.8) / 133
Mid Glam / 106 (70) / 111 (58) / 87 (53.4) / 181
Gwent / 84 (46)) / 93 (45) / 98 (50.4) / 141
S Wales TOTAL / 165 / 143 / 147 / 455
* Registrations for ovarian cancer (ICD9) include rare malignant ovarian germ cell and stromal tumours and uterine adnexal tumours, e.g. fallopian tube cancers which constitute no more than 10% of registrations in this group, 90% are epithelial cancers.
Pattern throughout Wales
The standardised registration rate for uterine cancer does not vary greatly (range 82 - 115). The highest rates are in East Dyfed and Pembrokeshire, whilst the lowest rates are in what was previously South Glamorgan. There is greater variation for cervical cancer registration, the SRR for cervical cancer is highest in Powys at 125 and lowest in South Glamorgan at 64. The rates for ovarian cancer are similar throughout Wales, the highest rate being in Clwyd at 114 and the lowest in Mid Glamorgan at 87 (now included with South Glamorgan in Bro Taf Health Authority).
Welsh Regional service for Gynaecological Oncology, Cardiff.
Canolfan Oncoleg Gynecolegol Rhanbarthol Cymraeg.
Gynaecological Oncology is multidisciplinary, including various surgical skills and support structures, medical oncology and radiotherapy, and the other intellectual disciplines of audit, epidemiology, pathology, cytology, etc. In Cardiff, over ten years of development of a sub-regional service to serve the valleys of South Wales and West Wales, an inclusive pattern of care has developed, with a central base at Cardiff.
There are three sites of activity in Cardiff: all are closely integrated in a “virtual centre”.
· The major surgical disciplines are centred at the University Hospital of Wales, Cardiff and also The Royal Gwent Hospital, Newport.
· Clinical and Medical Oncology disciplines are centred at Velindre Hospital NHS Trust, Cardiff.
· Cytology and colposcopy is centrally organised through the Cervical Cytology Service at The University Hospital of Wales, Cardiff.
Colposcopy Services
CLINICAL CERVICAL CYTOLOGY
STATISTICS FOR COLPOSCOPY & TREATMENT
The statistics are compiled from the University Hospital of Llandough and now the UHW. Treatment figures include both diathermy loop biopsy and laser. Colposcopy figures also include patient who have attended to discuss results etc., and may not have necessarily undergone colposcopy examination.
LOCATION / NEW REFERRALS / FOLLOW UPS / TREATMENTS / HOSP TOTALUNIVERSITY HOSPITAL OF
LLANDOUGH / 1121 / 1675 / 380 / 2796
Cardiff and Vale University Health Board
Gynaecological oncology in Cardiff and Vale UHB serves the Cardiff community and also serves as a tertiary referral centre for patients from most of South Wales. The University Hospital of Wales is part of Cardiff and Vale UHB and is currently the recognised surgical centre, and undertakes the majority of radical gynaecological surgery (although some is undertaken at the RGH). The general surgical and urological services at sited at UHW and plastic surgery services are located at Morriston Hospital Swansea.
.
Surgical activity-oncology operations (South East Wales Gynaecological Cancer Network)
YEAR / CERVICALCANCER (RHND/TRACHEL) / ENDOMETRIAL
CANCER
(TAH/BSO/LN) / SUSPECTED/OVARIAN CANCER
(LAPAROTOMY/DEBULKING)
2003 / 29 / 53 / 157
2004 / 11 / 17 / 59
2005 / 28 / 53 / 144
2006 / 53 / 74 / 184
2007 / 40 / 99 / 174
2012/13 / 45 / 180 / 200
YEAR / VULVAL
CANCER
(RVND/WLE) / EXENTERATION/
ILEOCONDUIT/
BOWEL PROCEDURE ETC / OTHER * / TOTAL
2003 / 37 / 12 / 275
2004 / 28 / 15 / 589
2005 / 56 / 22 / 622
2006 / 51 / 15 / 293 / 616
2007 / 49 / 12 / 263 / 580
2012/13 / 44 / 20 / 180 / 669
Velindre Hospital NHS Trust
Oncology and radiotherapy services are available at Velindre. The major outpatient activity is undertaken through this hospital, at the combined clinics for Gynaecology. Major peripheral clinics are in Newport, East Glamorgan and Bridgend District General Hospitals. The Oncology group have developed and encouraged referral at a primary and tertiary level, and we are hoping for further improvement in organisation following the report of the Cancer Services Expert Group for Wales (CSEG). There is active support from academic colleagues, who have encouraged this application, and a good opportunity exists for support in academic research and clinical trials.
Personnel
Gynaecologists
Currently the surgical activity and colposcopy management is undertaken by four sub-specialist Gynaecological Oncologists; R.E.J. Howells, K. Lim, Amanda Tristram and Aarti Sharma. Practically all patients are referred at a tertiary level, and are assessed at either Velindre or UHW outpatients, but are also assessed in peripheral clinics at the Royal Gwent Hospital. There is a good level of junior staff support, experienced nursing staff in post, with three nurse practitioners with a specialist interest in Gynaecological oncology.
Clinical Oncologists
There are two NHS clinical oncologists Dr Emma Hudson (currently on maternity leave) and Dr Louise Hanna and one medical oncologist, Dr Rachel Jones, all with a special interest in gynaecological oncology based at Velindre Hospital, undertaking combined and peripheral outpatient clinics in Gynaecological Oncology.
Pathologists
University Hospital Wales acts as a referral centre for South Wales pathologists. There is also close liaison with the pathologists and cytologists with an active combined audit of tumour material. Dr A Boyd and Dr G Rowlands are actively involved in teaching, training and research in this field and attend the weekly MDM. Consultant pathology input is also available for the RGH
Cytology
Mr Howells is currently the lead colposcopist for Cardiff and Vale UHB, with colposcopy services currently being provided at University Hospital of Wales, in close approximation to gynaecological oncology. This is an active colposcopy department, undertaking basic and further colposcopy training, and actively promoting screening and training in primary care. The department runs an annual BSCCP-accredited basic colposcopy course. All colposcopists are registered members of BSCCP. There are close links with the HPV Research Group at Cardiff University.
Radiologists
There are facilities for ultrasound, CT, MRI and PET scan investigations, with a primary team of two radiologists Dr.R. Bleehan and Dr Anghared Eynon based at UHW. Facilities are also available for intervention radiology procedures at the UHW, Heath Hospital. In addition, there are also consultant radiologists at Velindre and the RGH available to provide expert radiological management.
Palliative Care
Cardiff has a particular strength in training in this area with Dr A Byrne and Dr Melanie Jefferson and close cooperation with a local hospice.
Genetics
The regional genetics department, based at UHW, provides an excellent potential opportunity for research and there are currently two consultants with a particular interest in this area of work.
Colorectal
We currently use the services of three consultant colorectal surgeons who are based at The University Hospital of Wales, Cardiff. We undertake a number of joint cases especially when primary large bowel anastomosis is undertaken as part of debulking surgery. One surgeon special interest is Pseudomyxoma surgery.
Urology
Two Urologists have a particular interest in exenterative surgery and one in bladder reconstruction, and there is good liaison between disciplines.
HepatoBiliary
We undertake upper abdominal surgery (debulking surgery) in conjunction with colleagues in HPB surgery – who we have developed a good relationship with.
Research Activity
There is every opportunity to undertake research in Cardiff. Cardiff has a good record of research in this with a defined gynaecological research group.
Clinical Research
National MRC phase III clinical trials, together with phase II studies, are currently being supported in Cardiff, with a full time research nurse to support recruitment into portfolio trials and also to the Wales Cancer Bank.
Basic Research
There is an active HPV Research Team at Cardiff University, with Dr Amanda Tristram (Gynaecological Oncology), Dr Ned Powell and Dr Sam Hibbitts (HPV scientists) and Dr. Steven Mann (Immunology) with activity directed towards immunotherapy for cervix cancer, and a number of vulval and ovarian protocols. There are close links between the academic and clinical teams.
Training Experience.
Oncology has developed as a subspecialty practice in Cardiff over the previous thirteen years, with all seven trainees having completed training and appointed to sub-specialist posts within the UK. We have also trained a number of overseas doctors who are currently practising oncology in major overseas centres. A number of our junior staff have also taken up appointments with a particular interest in oncology, acting as a referral points within cancer units.
The colposcopy department has always provided appropriate training for developing colposcopists in accordance with BSCCP guidelines. In postgraduate terms we have in place in Cardiff’s formal postgraduate training sessions, with access and use of The Welsh Institute for Minimal Access training laboratory.
Whilst we provide a possible trainee timetable, we would plan for any trainee to undertake, with their training committee, a plan of training appropriate to the trainee’s skills and development needs.
Teaching Programme
There are teaching facilities in both Velindre and UHW.
Opportunities exist to attend and participate in the postgraduate and academic programmes at both hospitals.
Teaching rounds are Wednesday morning at UHW. Audiovisual conferencing for the MDM is currently running.
Teaching clinics are the combined clinic at Velindre and the Wednesday all-day clinic at UHW
All others - see introduction.
MEDICAL STAFF CONTRIBUTING TO SUBSPECIALTY TRAINING IN GYNAECOLOGICAL ONCOLOGY
Name / Qualifications / Speciality/Discipline / Subspecialty sessionsAdam Boyd / FRCPath / Pathology
R Bleeham / FRCRad / Radiology
A Byrne / Palliative Care
Prof A Fiander / MD, FRCOG / Professor Obs & Gynae
Professor Ilora Findlay / Professor Palliative Care
L. Hanna / FRCR / Clinical Oncology / 4
E Hudson / FRCR / Clinical Oncology / 4
R Jones / MRCP / Medical Oncology / 4
Rob Howells / MD, FRCS (Ed), FRCOG / Gynae Oncology / 7
Professor H Kynaston / MD, FRCS / Professor Urology
Ken Lim / MD, MRCOG / Gynae Oncology / 6
Amanda Tristram / MD, MRCOG / Gynae Oncology / 4
Aarti Sharma / PhD, MRCOG / Gynae Oncology / 6
Director of training programme: R.E.J. Howells
Description of Subspecialty Training Unit
The organisation of the service for referral and management of gynaecological oncology patients is described earlier. Over 70% of the clinical workload is from outside Cardiff, and we consider there is a good working relationship with most hospitals in South and West Wales. There is close collaboration with gynaecologists in the University Hospital and with related disciplines of pathology, radiology and palliative medicine, and we have established good communication with primary care physicians. We are looking towards establishing protocols with the Regional Genetics Department. Statistical advice is available and there is close contact with colleagues in Breast Test Wales.
GO4 - training programme
Principal Institution
Cardiff and Vale UHB /Velindre NHS Trust.
Programme Director
REJH.
Proposed Programme:
We would be looking to provide all the facilities as described in GO 1-Syllabus. There is no obstruction to any trainee for the development of excellent oncology training. Integration into the current postgraduate training would be encouraged, with the director having a wide experience of under- and postgraduate teaching.
We aim to provide a skeleton training programme, incorporating relevant experience for the trainee and add on particular experience in areas we regard as strengths, namely in
· urological reconstructive surgery
· Colorectal surgery
· cytology and pathology training
· pain and palliative care.
We are also particularly well placed for clinical research, with excellent multidisciplinary liaison.
The time tables for two-year and three-year trainees are detailed below.
TWO YEAR PROGRAMME
Year 1 - First 6 months: Initial Surgery and Colposcopy
a.m. / p.m.MONDAY / Surgery / Surgery
TUESDAY / Surgery / Surgery/research/teaching*
WEDNESDAY / MDM/Surgical Oncology OPD / Surgical Oncology OPD
THURSDAY / Surgery / Surgery
FRIDAY / Surgery/Colposcopy / Administration/audit/research
Year 1 - Second 6 months: Clinical & Medical Oncology/Palliative Care/Elective
a.m. / p.m.MONDAY / Oncology Clinic / Ward round
TUESDAY / Radiotherapy marking up clinic / Chemotherapy clinic
WEDNESDAY / MDM/clinic / Chemotherapy clinic
THURSDAY / Radiotherapy theatre (Selectron) / Combined clinic
FRIDAY / Research/Colposcopy / Administration
This will also include a period of time in Palliative care and the Elective period.
In Year 2, the intention is to provide modules of care undertaken with the Urologists and the Colorectal Surgical Team.