F1 Post in Stroke Medicine Sunderland Royal Hospital

F1 Post in Stroke Medicine – Sunderland Royal Hospital

The Department of Care of the Elderly provides inpatient and outpatient services for older persons in the Sunderland area.

The department has 171 inpatient beds based across six wards, providing acute general geriatric assessment and sub-specialty interests in stroke, orthogeriatrics, falls and syncope, movement disorders, heart failure, dementia and delirium, frailty and community geriatrics.

The department has a range of outpatient clinics which also reflect the sub-specialty interests.

The department has 16.84 WTE consultants, 8 SPR’s, a complement of FY1, FY2, CMT, and GPVTS doctors. The ward teams are all associated with multi-disciplinary teams including OT, Physio and social workers.

The Acute Stroke Unit (ASU) is based on ward E58. The ASU is a 39 bedded unit, with two acute assessment bays and state of the art physiological monitoring networked to the central nursing station. The ward accepts direct admissions from ED, of patients with suspected acute stroke and offers a hyper-acute thrombolysis service 365/24/7, facilitated by telemedicine outside normal working hours. Trainees will therefore have the opportunity to become involved in the early assessment and management of patients presenting with acute ischaemic and haemorrhagic stroke. All new cases are reviewed by a stroke consultant within 24 hours of admission, providing opportunities for feedback on the trainee’s initial assessment of the patient. All new patients, and any patients potentially unwell, are reviewed daily, and the ward operates to the SAFER bundle, with daily board rounds.

The FY1 doctor will gain experience of working within a cohesive multidisciplinary team. There is also a daily TIA clinic on the ward, to which patients with high risk TIAs (ABCD2 score 4) are referred. Trainees will be given the opportunity to attend this clinic. The ASU team is involved in a process of continuous quality improvement, with real-time data entry into a comprehensive national database. Involvement of trainees in audit projects will be encouraged.

The ASU holds a weekly radiology MDT, at which CT and MRI scans of ward and clinic patients are reviewed with a consultant radiologist. Trainees are encouraged to attend this meeting, as it provides an opportunity to improve their knowledge and skills in the interpretation of brain imaging in stroke patients.

The ASU participates in a number of stroke research studies as part of the CLRN. Trainees will be involved in the day to day care of these patients, providing an introduction to clinical trial methodology and a better understanding of the process of informed consent.

The ASU has a strong educational ethos, with nursing and AHP trainees attached to the ward on rotational placements. There is an active educational programme for ASU staff of all disciplines. In addition, one of the stroke consultants holds a senior lecturer appointment with Newcastle University Medical School. Regular clinical teaching of undergraduate medical students takes place on the ward. Trainees are encouraged to become involved in medical student teaching in order to improve their skills as teachers and achieve the relevant FP curricular outcomes.

The doctor will also be allocated a weekly session to observe the joint Sunderland and South Tyneside Community stroke Rehabilitation team, in conjunction with the therapists, and community stroke nurse, to gain experience in the continuation of stroke rehabilitation out of hospital. The doctor will be given the opportunity, in addition to the high risk clinics, to attend at low risk clinics, where they can gain experience (through observation) in new patient assessments, review of stroke patients following discharge, and review of existing stroke/TIA patients, to learn about appropriate investigations and secondary prevention treatments.

Trainees will have the opportunity to participate in a weekly formal MDT process, learning about the different therapy aspects to stroke care, including early supported discharge, the role of longer terms stroke rehabilitation, and palliative, End of Life Care. There is a weekly neuro-radiology meeting where the trainees can learn the imaging modalities used in acute stroke care, in the presence of one of the CHS consultant radiology team. There is also a weekly vascular MDT meeting, where all cases for potential carotid surgery, are discussed, and trainees are encourage to gain experience of this. In addition to sessional teaching on E58, the trainee will participate and be part of the COTE teaching meetings which take place in the F Floor seminar room, and as part of this, each ward team, in rotation, is expected to present a case, with discussion thereafter.

The doctor will be attached to a consultant and will work in a team-based system with the support of an SpR, and 7 nurse practitioners, in addition to other junior staff. Duties will include routine ward work and emergency work. Trainees will attend ward rounds, a weekly MDT meeting and occasional case conferences.

Training Opportunities

City Hospitals Sunderland and the Care of the Elderly Department run an extensive training program. There is a CMT training program and in the department there are two lunchtime educational sessions per week, to which the post holder will be asked to contribute.

Depending on the trainees PDP they will have the opportunity to attend sub-specialty training in ward based, or outpatient based sub-speciality interests.

There will be one to one consultant teaching at ward level.

The post holder may be expected to complete a supervised audit in line with department and Trust requirements.

The post holder may be expected to present cases at departmental educational meetings.

A provisional weekly timetable is shown below with associated notes:

Notes:

a)* this time is flexible to allow for opportunities for attendance at low risk TIA clinics throughout the week

b)* this time is flexible to allow for opportunities to attend ED with stroke nurse practitioners to observe thrombolysis assessments

c)Time spent in daily high risk clinic will depend on numbers of patients booked and doctors requirement for further observation

Team based ward working

The Care of the Elderly department at City Hospitals Sunderland promote a team based ward working ethos within all staff groups. This enables doctors to flex commitments to ensure ward cover is available but also meet their training and educational requirements whilst ensuring appropriate rest periods are taken (after on call or annual leave).

For the F1, the proposed timetable above gives flexibility to do this and the same applies for the other trainees on the ward. The rota management team populate the initial rota’s and maintain these to reflect annual leave, study leave and rest days booked/required but the ward team are expected to review these regularly and agree on weekly ward cover ensuring all have appropriate access to training and teaching resources. Support is provided by the consultant team along with the Clinical Director and Directorate Manager in any instances of rota issues.

Successful transfer of this role from STFT would enhance the experience for the other doctors on placement within the CHS Stroke department through additional ward cover resulting in greater opportunities to access training and teaching opportunities. It will also help reduce the intensity of the current workload and result in a reduction of exception reporting. Due to gaps within the training rotas placements on the Stroke Unit have been unfilled over the last year, transfer of this role would allow the ward to operate with a higher number of doctors on a daily basis providing benefits to all as described.

Booking Leave / On call swaps

The post will be based on ward E58 at CHS but still contribute to the on call rota at STFT. Working relationships and regular communications will need to be in place between Rota Management on both sites to ensure co-ordination of annual, study leave and on call commitments. It is proposed that the trainee should submit leave requests to CHS Rota Management team who will liaise with STFT Rota Management team to inform of leave. The trainee should follow existing practices within STFT for swapping on call commitments and STFT inform CHS rota management of these to ensure appropriate rest days are given from ward based duties.

The standard day shift within COTE at CHS is 0900-1700 hours Mon-Fri. Any changes to day shifts required to allow on call commitments at South Tyneside NHS Foundation Trust will be made and should the trainee require transport between sites, this will be provided.

Community provision

The proposed timetable allows for time to be spent with members of the Community Stroke Rehabilitation Team, who due to the reconfiguration of services, are currently aligning their resources across the two areas also. Benefits of these sessions include:

Educational opportunities:

• Weekly attendance at MDT meeting (in return the CRST would find the presence of a doctor helpful)
• Shadowing team members to ensure understanding of the difference between hospital and community based rehabilitation in each profession.

Clinical opportunities:

• Observing community review for patients with medical needs unable to attend clinic (link with Community Stroke Specialist Nurse).

F1 Job Description, Stroke - 2017