Health Education Thames Valley: Academic Clinical Fellowship in Genomic Medicine

HEALTH EDUCATION THAMES VALLEY: ACADEMIC CLINICAL FELLOWSHIP IN GENOMIC MEDICINE –

ACUTE (INTERNAL) MEDICINE [AIM] (ST3)

Academic Clinical Fellowship (ACF) posts are awarded by the NIHR to University/NHS Trust/Deanery partnerships nationally through a formula mechanism and by competition. These posts form part of the NIHR Integrated Training Pathway, further details of which can be found on the NIHR TCC website

Please note: in addition to the academic interviews, candidates will be required to attend and pass a clinical interview for thespecialty in which they wish to train, unless they already hold an NTN in that specialty. Offers made will therefore be conditional upon meeting the required standard in the clinical interview. Please check the FAQs ( Applicant NIHR ACF FAQs.pdf) on the HETV website for more information.

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.

About Research in Oxfordand Genomic Medicine Research Opportunities

Oxford University Hospitals NHS Trust and Oxford University, in partnership have an international reputation for research excellence. Patients benefit from world-class discovery and innovation and a growing portfolio of studies addressing major conditions including cancer, dementia and stroke. Oxford is a National Institute for Health Research Biomedical Research Centre, an Experimental Cancer Medicine Centre and a CRUK Major Cancer Centre. Oxford University Hospitals NHS Trust is the host NHS Trust for the Oxford Academic Health Science Network – one of 15 AHSNs across England and an Academic Health Science Centre. Opportunities for research are extensive and often involve novel collaborations with research groups outside of medicine e.g. with engineers.

• work on genetic causes of ‘sudden cardiac death’ (Watkins FMedSci) translated into clinical practice through the Oxford NIHR BRC, leading to an NHS commissioned national DNA diagnostic service
• the first large scale application of whole genome sequencing in a clinical setting (Taylor et al. Nature Genetics 47 717-26 (2015).

Oxford University Hospitals is home to the Oxford Molecular Diagnostics Centre (MDC), headed by Professor Anna Schuh and which is a fully CPA-accredited NHS laboratory that comprises the Oxford Regional Genetics Laboratory (ORGL), the Molecular Pathology and Haematology Laboratory, a clinical Next Generation Sequencing (NGS) core facility and the Oxford GEL BioRepository. Heads of Bioinformatics and Clinical Informatics are responsible for the analysis of NGS data and aggregation of phenotypic data, respectively. The MDC receives referrals from NHS, industry, clinical trials and research groups. It comprises a BRC funded R&D unit to develop, innovate, validate and evaluate clinical utility of genomics.

Description of the Post

This is a post for up to 3 years duration. The post is for trainees who will be starting in year 3 of their training at the time of commencement of the post (ST3) and is open to trainees in any of the following clinical specialties Neurology, Cardiology, Acute General Medicine, General Internal Medicine, Medical Oncology, , General Surgery, Neurosurgery, Plastic Surgeryor at ST1or 2 in Histopathology.

This is a 75% clinical post with a 25% academic component. Clinical training may be split between Oxford and the regional DGH's. Configuration of the academic component is flexible; the precise configuration will be arranged to accommodate the needs of the project, the appointee and appropriate clinical training.

Trainees could join research groups applying genomic techniques in their chosen clinical area; alternatively they may choose to work on developing advanced technologies for use in the NHS (including health economic evaluation), training in cutting-edge bioinformatics and statistical genetics to analyse genome sequence data and complex genomic datasets (McVean), or consider ethical aspects of this work (in conjunction with ETHOX Centre, Director: Parker). Examples of projects that might interest trainees include chromatin remodelling (Gibbons FMedSci), mitochondrial disease (Poulton), ataxias/neurogenetics (Nemeth), diabetes (Gloyn/McCarthy FMedSci); breast/ ovarian cancer (Harris FMedSci / Ahmed / Schuh), sepsis (Knight), motor neuron disease (Talbot), inflammatory bowel disease (Uhlig). Where appropriate training will be provided through courses run within the Oxford Genomic Medicine and Statistics DPhil programme (Director: Knight). Trainees will attend Oxford’s Genomic medicine MDT meetings.

The ACF will have an academic supervisor and an educational supervisor. Given the array of opportunities on offer, the ACF will have strong mentorship whilst exploring research options during their first year in post, then probably undertake a research block during the second year to obtain pilot data and ultimately prepare a doctoral fellowship application or postdoctoral funding application (if they already hold a doctorate). The 9 months of research will be distributed in the most beneficial way to support the ACF in these goals. At the end of the ACF post in the event that funding for doctoral or post-doctoral work is not secured the appointee will return to full-time clinical training.

Duties of Post

The AIM Training Programme

The AIM training programme is a four year training programme, starting at ST3. It is possible to dual accredit in GIM and AIM over a period of five years. 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 Royal College of Physicians. 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:

Rotation Information

Rotations may at times change in response to clinical need from the Trusts. Expected rotation arrangements for this programme are:

• Trainees will typically spend 24 months based in the Oxford University Hospitals NHS Trust and 24 months in two different District General Hospitals (approximately 12 months in each). During their rotation, trainees will spend at least 3 months working in the Adult Intensive Care Unit on the John Radcliffe Site. When working in Acute General Medicine on the John Radcliffe site, the trainee will form part of a Consultant-led team in a delivery model characterised by continuity of care. At the District General Hospitals, contemporary ‘AMU’ / Acute Medicine models are in operation. Attention will be paid to ensuring experience of various AMU models and exposure to cardiology and geratology in order to enable the trainee to achieve the requirements of the AIM 2009 curriculum.

Trust Information

JohnRadcliffeHospital

Up to 7 posts are available in Acute General Medicine. The Specialty Registrar forms part of a Consultant-led team where continuity of patient care is paramount. The rota involves working for an eight week period with 1 in 4 on-calls (each 24 hour period is split into two take periods), followed by a four week period including night duties and fixed leave. Supervising consultants have a wide variety of specialty interests.

Up to 3 posts are available in Intensive Care Medicine. Dr J Millo is the co-ordinating Consultant for these placements. Depending upon prior experience, the specialty registrar will typically work alongside a more senior colleague with specific airway skills. A full shift system is in operation. The specialty registrar may be expected to work in other intensive care units in the Trust (including Neuro ITU and Churchill ITU).

HortonGeneralHospital

Up to 2 posts are available at the HortonGeneralHospital. The Specialty Registrar will work as one of eight middle grade doctors on site. A ward-based system is in operation.

WexhamParkHospital

3 posts are available at WexhamParkHospital. The relevant sub-specialties are cardiology, respiratory and AMU. The Specialty Registrar will typically rotate through each of these specialties over the course of a year at Wexham Park.

Milton KeynesGeneralHospital

2 posts are available at Milton KeynesGeneralHospital. The relevant sub-specialties are rheumatology and AMU. The Specialty Registrar will typically rotate through both of these specialties over the course of a year at Milton Keynes.

Stoke MandevilleHospital

1 post is available at StokeMandevilleHospital. The relevant sub-specialty is AMU.

Teaching

• A dedicated curriculum based teaching programme is in place for GIM, all of which is applicable to AIM trainees. Topic-based teaching occurs for an extended afternoon each month on the John Radcliffe Site. Occasional sessions specific to AIM are also scheduled. This teaching amounts to approximately 60 hours per year. All hospitals participating on the rotation operate other teaching opportunities including Grand Rounds, governance meetings and radiology conferences.

Duties of Post

• The duties of the post are specified in the detailed Trust job descriptions. They include (but are not limited to) the assessment and management of patients in both inpatient and outpatient clinics; teaching of junior colleagues and students; and, participation in other educational meetings and audit.