HEALTH EDUCATION THAMES VALLEY - SPECIALTY TRAINING PROGRAMME IN GASTROENTEROLOGY
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 some 1500 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 Gastroenterology Training Programme
The gastroenterology training programme is a 5 year programme, starting at with competitive entry at ST3 level. During this time, the trainee's work will be monitored for satisfactory progress 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 Health Education Thames Valley so 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 / John Radcliffe Hospital, Oxford
http://www.ouh.nhs.uk/
The Horton Hospital, Banbury
http://www.ouh.nhs.uk/
Royal Berkshire NHS Foundation Trust / Royal Berkshire Hospital, Reading
http://www.royalberkshire.nhs.uk/
Buckinghamshire Healthcare NHS Trust / Wycombe Hospital, High Wycombe & Stoke Mandeville Hospital, Aylesbury
http://www.buckshealthcare.nhs.uk/
Milton Keynes Hospital NHS Foundation Trust / Milton Keynes General Hospital
http://www.mkgeneral.nhs.uk/
Rotation Information
Rotations may at times change in response to clinical need from the Trusts. Expected rotation arrangements for this programme are:
There are 12 posts within the Health Education Thames Valley programme in Gastroenterology/General Internal Medicine.
2 posts - Gastroenterology and G(I)M Milton Keynes Hosp.
Supervisors: Dr S Lanzon-Miller
Dr G MacFaul
3 posts - Gastroenterology and G(I)M Royal Berks Hosp Reading
Supervisors: Dr M Myszor
Dr A DeSilva
Dr J C L Booth
Dr J Simmons
Dr C Green (P/T)
Dr Alex Evans
3 posts - Gastroenterology and Hepatology John Radcliffe, Oxford
Supervisors: Dr A Bailey
Dr J Collier
Dr SPL Travis
Dr S Keshav
Dr B Braden
Dr AA Bailey
Dr J East
2 posts - Gastroenterology and G(I)M Horton Hospital, Banbury
Supervisors: Dr A Ellis
Dr J Marshall
Dr B Braden (1 day)
Dr A Bailey (1 day)
2 posts - Gastroenterology and G(I)M Wycombe/Stoke Mandeville Hospital
Supervisors: Dr D Gorard
Dr E Johns
Dr S Cullen (P/T)
Dr R Sekhar
The rotation is built up on an individual basis taking into account the trainee’s interests, training requirements and prior experience. These requirements will be balanced by the availability of local posts and the needs of others in the Training Programme. A rotation will usually consist of a year 1 placement in either Banbury or Milton Keynes. Subsequently trainees may move to either Reading or High Wycombe. A year of training in Oxford tends to occur in years 3 or 4. Over a 5 year period most trainees will spend 12 months at each of the training centres. Year 6 placements may be at any centre in the region.
Most trainees undertake a formative period of research culminating in the award of an MD or DPhil. Where appropriate, trainees have undertaken an MSc. See:
http://www.expmedndm.ox.ac.uk/home and http://www.expmedndm.ox.ac.uk/gastroenterology-unit for clinical and basic science research projects undertaken by trainees.
The output from the training programme is good and recent appointments as consultants have been to centres including Southampton, Gloucester, Exeter, St Marks, and Manchester.
The full outline scheme is shown on the enclosed rotations. Research is actively encouraged during the tenure of the post. Trainees are encouraged to undertake clinical research whilst working in the 5 centres and to undertake a formal period of research either in Oxford or other major centre of research.
Within the rotations and centres to which a Trainee will be attached, all sub-specialty parts of the curriculum are covered. These include: specialist management of inflammatory bowel disease, intestinal failure and nutrition, experience in specialised hepatobiliary and pancreatic disorders, general hepatology, interventional endoscopic techniques, capsule endoscopy, endoscopic ultrasound, oesophageal pH testing, oesophageal and anorectal manometry, liaison psychiatry, and paediatric gastroenterology. Oxford is also one of two centres in the UK for intestinal transplantation.
The only aspect of gastroenterology not formally covered in a local centre is liver transplantation. Trainees wishing to obtain such experience will normally undertake a 2 year training programme in Hepatology within their 5 yr rotation, 1 year of which would be in Oxford with a 3 month secondment at a major transplant centre. These posts are competitive and decided by separate interview and are advertised on a national basis.
Trust Information –
WYCOMBE / STOKE MANDEVILLE HOSPITAL
Dr David Gorard (Training Lead), Dr Sue Cullen, Dr Emily Johns, Dr R Sekhar
Buckinghamshire Healthcare NHS Trust encompasses Wycombe Hospital, Amersham Hospital and Stoke Mandeville Hospital. It serves residents in Buckinghamshire, Thame (Oxfordshire), Tring (Hertfordshire) and Leighton Buzzard (Bedfordshire) with a combined population of 550,000. Following the reconfiguration of acute services, Wycombe Hospital performs predominantly elective work, while acute emergency services are mainly provided at Stoke Mandeville Hospital.
The 2 registrars in gastroenterology are each based at the more elective Wycombe Hospital site for 4 months, and based at the more acute Stoke Mandeville Hospital site for 8 months.
Gastroenterology at Wycombe
Currently most elective Gastroenterology training is organised at Wycombe Hospital: although from 2014 some elective outpatient sessions take place at the Stoke Mandeville site in Aylesbury on a rotational basis. The department of Gastroenterology at Wycombe consists of three Consultants; Dr Sue Cullen, Dr David Gorard, Dr Emily Johns. They are supported by an Associate Specialist (Dr Christine Helmer).
During the 4 months at Wycombe Hospital, the gastroenterology trainee will attend 3 outpatient clinics each week, and 3 or 4 endoscopy lists each week. There is a dedicated viral hepatitis clinic which runs weekly, in addition to general gastroenterology clinics and endoscopy lists.
Gastroenterology at Stoke Mandeville Hospital
During the 8 months at Stoke Mandeville Hospital, the gastroenterology registrars have a pivotal role in managing a team of junior doctors and are involved in the day-to-day care of acute gastroenterology, hepatology and general medicine inpatients. The consultants (Dr Cullen, Dr Gorard, Dr Johns, Dr Sekhar) are also rostered as duty gastroenterologist at Stoke Mandeville Hospital for a week at a time. On a daily basis, patients with acute gastroenterology/hepatology problems are triaged to the gastroenterology inpatient team. Dr Cullen leads a Nutrition Team and undertakes a once weekly nutrition ward round at Stoke Mandeville Hospital. Depending on the registrar’s experience, he/she will attend at least one endoscopy session at Stoke Mandeville Hospital each week and gain experience in endoscoping upper GI bleed patients. Although based at Stoke Mandeville Hospital, during the 8 month period, the registrar will spend Wednesdays at Wycombe Hospital (+/- Amersham hospital) to attend one clinic and one endoscopy session.
Endoscopy Training
The Endoscopy Suite at Wycombe Hospital has two procedure rooms equipped with Fuji endoscopes. The Endoscopy Suite at Stoke Mandeville Hospital has two procedure rooms equipped with Olympus endoscopes. Most of the lists are run by the Gastroenterology Department with a handful run by Consultant Surgeons. Training opportunities vary widely from the ability to teach basis diagnostic endoscopy and flexible sigmoidoscopy, through to colonoscopy for those in their third year. For those in more senior years advanced colonic polypectomy techniques, PEG insertions and oesophageal stenting are available. A wide range of haemostatic techniques including injection, banding, clipping and heater probe therapy are available. Depending on a trainee’s experience, appropriate lists are allocated and adjusted to allow for optimal training and experience. There is one ERCP list at Wycombe and one at Stoke Mandeville Hospital each week – although these are available for training those who wish, such training is supplemental to more formal training elsewhere.
Teaching and Training
Specialist Registrars in Gastroenterology are released on Thursday afternoons each week to attend central training in Oxford. Trainees are also released to attend general medical training one day a month. Within the hospital there is a weekly grand round. The gastroenterology journal club runs approximately fortnightly at Wycombe Hospital. There is a weekly upper GI cancer MDT meeting and a weekly lower GI cancer MDT meeting, involving review of X-rays and histology. There is a once monthly joint gastroenterology and surgical clinic meeting where X-rays and histology are discussed. At Stoke Mandeville there is a weekly Wednesday morning general medical teaching session and there are opportunities for the Registrar to teach junior doctors and medical students on secondment from Oxford.
Research
Wycombe has been a productive department in terms of gastroenterology research and audit. Time is allowed for Registrars to develop and supervise projects and most Registrars have successfully completed papers or abstract submissions whilst being at the hospital.
Examples of timetables
4 months at Wycombe Hospital:
Mon / Tues / Wed / Thurs / FriDG clinic (AH) / DG clinic / SC clinic (AH) or Endoscopy / 8.15 Upper GI MDT
Endoscopy / Lunchtime: Journal Club & GI meeting/ lower GI MDT
Endoscopy / admin / Endoscopy or EJ clinic / Oxford / Endoscopy
On calls at WH as per WH stroke/cardiology rota
8 months at Stoke Mandeville Hospital:
Mon / Tues / Wed / Thurs / FriWard Work / Ward Work or endoscopy / SC clinic (AH) or Endoscopy / 8.15 Upper & lower GI MDT
Ward work / Ward work
Ward Work / Ward Work / WH: Endoscopy or EJ clinic / Oxford / Ward work or Endoscopy
On calls at SMH, as per SMH acute medical registrar rota.
General Internal Medicine at Stoke Mandeville and Wycombe Hospitals
Acute services at Wycombe Hospital consist of dedicated Cardiology Services (fully functional angiography Unit) and Acute Stroke services. There are no gastroenterology or general medical inpatient services at Wycombe Hospital. The gastroenterology registrar when based at Wycombe will participate in an out-of-hours on call rota for cardiac/stroke patients at Wycombe as part of GIM training.
Acute medicine is centred at Stoke Mandeville Hospital which receives unselected medical take, apart from cardiac and stroke patients who are admitted to Wycombe Hospital. The gastroenterology registrars will participate in an on call rota for unselected medical patients at Stoke Mandeville as part of GIM training.
Experience will include:
Acute general medicine.
including CCU experience and ward follow up clinic.
Gastroenterology
a) Management of gastroenterology inpatients
b) Gastroenterology outpatients to include general gastroenterology, inflammatory bowel disease and hepatology clinics.
c) Experience of emergency gastroenterology (in particular upper gastrointestinal bleeding) and including emergency endoscopy under consultant supervision.
d) Therapeutic upper gastrointestinal endoscopy including variceal injections/ variceal banding, oesophageal dilatations, insertion of oesophageal stents, insertion of feeding gastrostomy tubes.
e) Colonoscopy including training in colonoscopic polypectomy.
f) ERCP training where appropriate
g) Experience in parenteral nutrition
ROYAL BERKSHIRE HOSPITAL
Dr Margaret Mysor, Dr Jonathan Booth, Dr Jon Simmons (Training Lead), Dr Des deSilva, Dr Caroline Green, Dr Nish Chandra, Dr Alex Evans
The Royal Berkshire NHS Foundation Trust (650 beds) is the District General Hospital serving West Berkshire, an area extending from Hungerford in the west to Henley-on-Thames in the east, and including Wokingham and parts of Hampshire to the south and parts of Oxfordshire to the north. The resident population served by the Trust is around 550,000. The hospital provides all those services normally associated with a very large District General Hospital. Only cardio-thoracic surgery, complex hepato-biliary and transplant surgery, neurological surgery, plastic and major neonatal surgery are referred outside the district to specialist centres in Oxford or London.
Gastroenterology , Endoscopy and General Internal Medicine
There are five speciality based medical firms within the Trust. Each team has a home base ward, and looks after any patients admitted to their ward. Where possible, patients are triaged to the ward most relevant to their specialty problem.
All acute medical patients are currently admitted via the Acute Medical Unit (AMU), which is based near the X-ray and A+E Departments. Within the AMU there is a Higher Monitoring Area (Medical HDU) of four beds providing care of the critically ill including non-invasive ventilation, CVP monitoring and step down from ITU. The HMU is supported by the ITU outreach team. The gastroenterology ward consultant and registrar provide daily input into AMU to see new admissions with gastroenterological problems
The Gastroenterology unit is currently based on 28-bedded Sidmouth Ward and in the Endoscopy and Outpatients’ Departments. Outpatient clinics and endoscopy lists are also carried out at West Berkshire community hospital in Newbury. Approximately 2000 new patients and 3500 follow-up patients are seen annually in the Department’s outpatient clinics. In addition to general gastroenterology, we have specialist inflammatory bowel disease, intestinal failure and viral hepatitis clinics.
Endoscopy: The trust runs a modern purpose built 4 room endoscopy unit with xray facilities in one of the rooms. The unit perform in excess of 6000 procedures a year and offers the full range of endoscopic modalities including diagnostic and therapeutic upper and lower GI endoscopy, push enteroscopy, endoscopic ultrasound and ERCP. The unit is managed by gastroenterology but work is shared with the surgical specialities with pooling of lists. The unit has JAG accreditation and is a screening centre for the National Bowel Cancer Screening programme. In addition to hospital based medical staff the unit is staffed by 2 GP assistants and 2 nurse endoscopists. There is also a GI physiology lab, managed by the surgical directorate, providing pH monitoring and manometry for oesophageal diseases. Reduced points training lists are provided and active participation with JETS is strongly encouraged.