Health Education Thames Valley – Academic Clinical Fellowship in Intensive Care Medicine (ST3) in partnership with NHS Blood and Transplant

Background

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 ACF posts are for a period of 3 years.

Thispost offers outstanding academic training opportunities through collaborations with the Kadoorie Centre for Critical Care Research and Education and the Institute of Biomedical Engineering as well as through the partnership with Transfusion Medicine.

The University of Oxford is one of the world's leading higher education institutions undertaking teaching and research across a very wide range of academic subjects to the highest international standards.

Clinically, HealthEducationThamesValley has an established reputation for high quality training in intensive care medicine (ICM) reflected in a recent GMC training survey ranking of the program as the highest in the country for overall satisfaction. All previous CCT post-holders in ICM have secured consultant posts in ICM at the end of their training with a speciality post-graduate examination pass rate of above 90%.

Please note: for 2016, in addition to the academic interviews, candidates will be required to attend and pass a clinical interview for the specialty they are applying to for academic training, if appropriate. 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 HealthEducationEnglandThamesValley

We are the Local Education and Training Board (LETB) for ThamesValley 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 ThamesValley. Thames Valley LETB is responsible for the training of around 2000 Foundation and Specialty trainees.

HealthEducationEnglandThamesValley 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 HealthEducationEnglandThamesValley as a whole. This may mean that you may be allocated to any geographic location within the deanery depending on training needs. Currently hospitals involved in the ICM programme are The Oxford hospitals group, High WycombeHospital,Milton KeynesUniversityHospital, the RoyalBerkshireHospital, StokeMandevilleHospital and WexhamParkHospital.

Selection criteria

The Academic Clinical Fellowship Programme will offer training to new (ST3) entrants to specialist ICM training who can demonstrate that they have outstanding potential for development as a clinical academic in research and/or education. Training will be flexible and trainee-centred, as far as possible, with mentoring to ensure the attainment of both academic and clinical goals. The specialty trainee selected for the Fellowship Programme will be awarded an NTN(a) at the start of the Programme. There are a number of nationally set selection criteria and applicants must be qualified for specialty training at ST3 level. Candidates with a higher degree are welcome to apply.

Training objectives

The main objectives of the ACF programme will be to:

  1. Work within a successful and supportive research environment to undertake research projects allowing the post-holder to develop an understanding of research methodology and generic research skills.
  2. Publish research results and present them at a national or international conference as appropriate.
  3. Enable a competitive application for a doctoral fellowship or clinical academic post.
  4. If appropriate, achieve the Postgraduate Certificate/Diploma in Health Research which is provided fee-free through Oxford to ACFs.
  5. Acquire appropriate clinical training and learning to enable progression from ST3 to completion of specialist training in ICM and the award of a certificate of completion of specialist training (CCT).

Research and academic training

The Academic Clinical Fellowship programme will provide academic training in Intensive Care Medicine (ICM) in preparation for a career in academic critical care.

The fellows will be supported by a mentor and an academic supervisor and have access to academic training courses in research and teaching held by OxfordUniversity. The Fellow will be a member ofOxfordUniversity’s ClinicalAcademicGraduateSchool ( which organises a vibrant academic programme. Through the School the Fellow will have fee-free access to the Postgraduate Certificate/Diploma in Health Research which provides a wide range of research training modules and is highly rated by participants. Additionally there are many opportunities locally to present work and meet clinical academics from other specialties through the interdisciplinary programme organised by OUCAGS.

The successful applicant will be supported in preparing applications to continue their research either by obtaining funding to undertake a higher degree or to obtain post-doctoral funding if they already hold a PhD or equivalent higher degree.

Protected research time will usually be allocated part-time in blocks (minimum duration 3/12) in order to ensure that the ACF has nine months of academic time over the 3 years.

At the end of the 3 year ACF programme if doctoral funding or a further clinical academic post is not secured the Fellow will revert to full-time clinical training within the training programme.

Transfusion Medicine

The post holder will work within a highly successful collaboration with Transfusion Medicine in Oxford.

There are excellent research facilities in Transfusion Medicine in Oxford and an established track record of delivering high quality research in the area of transfusion practice in critical care. It is anticipated that the successful applicant will join the systematic review and clinical trials group led by Professor Murphy and Dr Stanworth based in NHS Blood and Transplant.

The primary objective of the group is to strengthen the evidence base for the effective and safe practice of transfusion medicine. The need to achieve this objective was highlighted in successive ‘Better Blood Transfusion’ Health Service Circulars and from 2000 a supporting infrastructure for clinical research has been established to meet this objective, including a Systematic Reviews Initiative (SRI), a Clinical Trials Unit within NHS Blood and Transplant, and linkage to the National Comparative Audit of Blood Transfusion programme. The group has support from the Oxford Haemophilia Centre for novel laboratory studies of haemostasis.

Our team has also re-engineered the entire process of hospital blood transfusion, introducing hand-held electronic devices and blood fridges that guide staff at every stage, replacing the old manual process with “end-to-end electronic control”.This has been implemented throughout the hospitals in Oxfordshire. This work is now highlighted as one of only 6 recommended interventions for hospitals in a DH initiative called NHS Evidence: Quality and Productivity and is being used by NHS Evidence as a Case Study of ‘helping the NHS to deliver quality and productivity’.

Recent research activities relevant to transfusion in critical care have included:

-A multicentre international randomised controlled trial to study whether patients receiving "fresh" blood up under 7 days storage age do better compared to those given standard aged blood is just beginning (ABLE).

-A multicentre randomised controlled trial of restrictive v. liberal red cell transfusions in acute upper gastro-intestinal bleeding.

-A multicentre observational study to understand the haemostatic derangements in admissions to critical care (ISOC-2).

-A UK wide study of outcomes in trauma patients receiving multiple transfusions

-A pilot trial of early cryoprecipitate use in trauma.

-A multicentre randomised controlled trial of anti-fibrinolytics in patients with acute gastro-intestinal bleeding (HALT-IT).

In many of the group’s clinical studies, an economic cost evaluation is included as it is important to know whether the studies, or the methods used to improve the quality of care, actually represent good value for money.

Future research possibilities include:

-The optimal management by red cell transfusion of patients with coronary artery disease.

-The management of haemostatic derangements and DIC, and the role of plasma transfusion or pro-haemostatic agents including fibrinogen sourses.

-Interventions to define the appropriate use of platelets or alternatives, which are often used prophylactically in critical care.

- Developing and evaluating a ‘decision support’ module for appropriate blood use in critical care, to provide doctors requesting blood with recent blood count and haemostasis test results and an alert to indicate whether their request for blood complies with local guidelines.

- Working with the Oxford Health Informatics Service and other BRC supported groups in Oxford to use the IT infrastructure for blood transfusion for additional clinical applications such as active patient monitoring and medicines management.

- Investigating methods for reducing blood transfusion requirements in critical care patients e.g. reducing blood losses through phlebotomy or use of paediatric samples.

The Intensive Care Medicine clinical training programme

The standard ICM training programme is a 5-year clinical programme, with entry to the programme at ST3. Applicants may be eligible to apply to a second speciality for dual-speciality accreditation with ICM within 18 months of appointment to their primary speciality.

The ICM training programme is a competency-based programme and fully mapped to the GMC-approved Faculty of Intensive Care Medicine (FICM) curriculum leading to a CCT in ICM. The trainee's work will be monitored for satisfactory progress and subject to annual review by a panel of trainers in the form of an Annual Record of Competence Progression (ARCP). Progression on the programme will be dependent upon successful outcomes at these reviews.

Further comprehensive information relating to the ICM curriculum and requirements for ARCP progression are available on the FICM website:

The ICM training programme is based in several different Trusts throughout Health Education Thames Valley. All posts on the rotation have been approved for specialist training by FICM. The posts attract National Training Numbers and provide training towards a Certificate of Completion of Training. The Postgraduate Dean has confirmed that these posts have the necessary educational and staffing approvals.

Whilst it is envisaged that successful applicants will spend at least two of the three years of the ACF post within the Oxford University Hospitals NHS Trust, trainees may find themselves employed by any of the following Trusts and placed in any of the following hospitals as training needs require:

Trust / Hospitals and Locations
Oxford University Hospitals NHS Trust / Adult Intensive Care Unit, John Radcliffe Hospital, Oxford
Adult Intensive Care Unit, Churchill Hospital, Oxford
Neurosciences Critical Care Unit, Oxford Radcliffe Hospitals, Oxford
Cardiothoracic Critical Care Unit, Oxford Radcliffe Hospitals, Oxford
Paediatric Critical Care Unit, Oxford Radcliffe Hospitals, Oxford
Milton Keynes University Hospital NHSFoundation Trust / Milton Keynes University Hospital, Milton Keynes
Frimley Health NHS Foundation Trust / Wexham Park Hospital, Slough
Royal Berkshire Hospital NHS Foundation Trust / Royal Berkshire Hospital, Reading
BuckinghamshireHealthcareNHS Trust / Wycombe General Hospital, High Wycombe
Stoke Mandeville Hospital, Aylesbury

Rotation Information

The clinical training will be competency based to a level equivalent to or in excess of CCT standards. The times required to achieve clinical training below are therefore indicative and will be varied according to the training requirements. The indicative clinical rotation arrangements for ICM programme are:

ST3/49-12 months in acute medicine and/or anaesthesia as determined by individual training requirements.

ST3/49-12 months in the two general adult intensive care units in the Oxford University Hospitals NHS Trust.

ST53-4 months in each of the regional specialist ICUs (Neurosciences, Cardio-thoracic and Paediatric ICU at the John Radcliffe Hospital).

ST3-ST5Within the first three years, a total of 9 months will spent undertaking protected academic blocks provided within The Kadoorie Centre for Critical Care Research and Education and the Institute of Biomedical Engineering

ST6 12 months ICM with special skill training (eg research)

ST7 12 months advanced ICM training in the adult intensive care units, with up to 6 months in a district general adult ICU in the region.

Rotations may vary from this template in response to individual training requirements and on occasion the clinical need ofthe Trusts.

Clinical training centre information

Adult Intensive Care Unit (AICU) and Churchill Intensive Care Unit (CICU) These two high-performing intensive care units admit over 1000 patients per year. The majority of patients are level 3. Approximately 20% of admissions are elective surgical patients. The units also admit critically ill emergency patients with a wide range of medical and acute surgical pathologies. Oxford is the tertiary referral centre for major trauma, spinal, interventional cardiology, oesophageal, vascular, major maxillo-facial surgery, interventional radiology, haematological malignancy and transplantation (including bowel and pancreas). This is reflected in the pathology of patients on the AICU/CICU.

A full range of invasive monitoring and all major forms of organ support are employed. The majority of patients require multi-organ support and invasive monitoring. Trainees can expect to gain experience of oesophageal Doppler monitoring, thrombo-elastography, renal replacement techniques, echocardiography, bronchoscopy, ultrasonography, invasive and non-invasive ventilation as well as core procedures such as line placement and resuscitation.

The units are medically staffed in multiple groups: three groups of trainees (from both an anaesthetic and non-anaesthetic backgrounds) and the consultant tier. The presence of trainees from a variety of backgrounds provides a fantastic training environment and so represents a rare opportunity given the UK system of early specialisation. It is particularly useful for those trainees doing professional exams and helps our high success rate in the FRCA, FFICM and EDIC.

The twelve consultants cover each unit separately on a split week system. The consultants come from a background in anaesthesia, medicine, military services and research. There is local expertise in clinical trials research, bench research, sepsis and genomics, ventilation, difficult airways, teacher training, simulation, international transfer, primary trauma in developing countries, pre-operative assessment, resuscitation, follow up, ultrasound and echocardiography.

The unit has an active teaching programme. This includes protected teaching, weekly unit meetings, daily microbiology rounds and various yearly meetings. The senior trainees have an active exam orientated program in addition to one half-day per month of protected teaching. This contributes to the high success rates in post-graduate examinations.

TheNeurosciences Intensive Care UnitThe Oxford Neuroscience Unit is one of the busiest regional neurosurgical units in the country with an international reputation for the quality of its services. It is involved in many aspects of pioneering work including functional neurosurgery and radiological interventional techniques. The busy unit will provide trainees with unrivalled exposure to all aspects of neurosurgical work. The Oxford Neurosciences Unit moved to a new purpose-built modern facility in the West Wing of the John Radcliffe Hospital in January 2007.

TheNeurosciences Intensive Care Unitprovides level 2 and level 3 specialist critical care to both neurosurgical and neurological patients from the region. The Unit currently contains11 level 3 critical care beds, with planned expansion over the next few years to a 17-bed unit. Training is provided in the management of the full range of neurosurgical and neurological pathologies, with particular emphasis on the management of traumatic brain injury and subarachnoid haemorrhage.

Cardiothoracic Critical Care Unit The John Radcliffe Hospital is a tertiary referral centre for cardiac and thoracic disease. The Cardiothoracic Critical Care (CTCC) is an 11 bedded unit supporting an annual caseload of approximately 950 adult cardiac cases of which 65% represent patients undergoing coronary bypass grafting, 20% valve repair or replacement and 15% combined or complex procedures. About 100-200 thoracic cases are performed each year. Consultants lead twice daily ward rounds of the Cardiothoracic Critical Care (CTCC), and supervise the postoperative intensive care of adult patients undergoing heart and thoracic surgery. There is local expertise and training in trans-oesophageal echocardiography.

The Paediatric Intensive Care Unit The tertiary Paediatric Intensive Care Unit serves the Oxfordshire population and supports a wide range of both surgical and medical paediatric specialties in all the Oxford hospitals. Elective surgical specialties include general and urological surgery, orthopaedics, craniofacial, plastics, neurosurgery, ENT, dental and ophthalmology whilst the medical specialities include oncology, radiology (including MRI), radiotherapy, gastroenterology and cardiology.

Further information on the other training centres in the ICM training programme in Health Education Thames Valley is available separately on request.

Educational and Clinical Supervision

Each trainee will have an individually allocated research and clinical Educational Supervisor (ES) for the duration of the training scheme. In each clinical attachment you will have one or more Clinical Supervisors (CS) who will be responsible for overseeing your clinical training and feeding back to the ES.

Duties of Post

Academic

  • The fellow will record knowledge, experience and skills acquired during the post in the training record.
  • The fellow will work as part of the research team relevant to their project
  • The fellow will arrange regular research meetings with their research supervisor
  • The fellow will agree deliverable milestones that will be assessed at each meeting
  • The fellow will be expected to prepare research results for publication during the post
  • The trainee will be expected to attend courses and conferences 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

Clinical