Merseyside Hospitals for Core Surgical Training
Two out of 9 T&O tracks (track no 1 and 5) provide enough experience and credentials to the CSTs that they will be able to apply for orthopaedics ST3, plastic surgery ST3 and Neurosurgery ST3. T&O track no 3,4 and 6 will allow application to ST3 Ortho as well as for ST3 neurosurgery. Two out of 9 T&O tracks provide enough credentials to the CSTs that they will be able to apply for both orthopaedics ST3 and plastic surgery ST3 (T&O track no 7 and 9). Four CSTs in orthopaedics do have opportunity to work in pediatric orthopaedics (T&O track no 2,3, 4,5). T&O track no 2,6, 7,8,9 have 6-month placement in general surgery. All these placements have been designed with a purpose of getting extra-mark in ST3 selection. T&O track 7 and 8 during their general surgery posting in year 2 have been placed in Aintree because of this reason. They will be doing on-call in general surgery while doing elective and semi-elective list in this unit. Mr Ian Braithwaite, who leads a robust teaching and training in orthopaedics, provides enough opportunity for ST3 applicants to have good practice of all the interview stations.
In general surgery 9 out of 10 CST themes will provide experience good enough for application in 2 or more specialties at ST3 selection. Track no 1 and 2 in general surgery are focused on colo-rectal training, no 1 of these will allow application for general surgery and urology as well. Four CSTs tracks (GS 3,4,7,8) are being developed to maximise the use of this superb training facility in vascular surgery. Two of them at a time will rotate every 6 months in the first year between vascular surgery department and the cardio-thoracic hospital to have a complete exposure to all types of vascular operations. CSTs in all these 4 vascular themes will be able to apply for general surgery ST3 as well cardiothoracic ST3.
High quality upper GI surgical training is available in this region at Royal Liverpool and in Aintree. Four CSTs tracks (GS 5,6,9,10) are being developed to maximize the use of this superb training facility in Upper GI surgery. Two of them at a time will rotate every 6 months in the first year between upper GI surgery and the cardio-thoracic hospital to have a complete exposure to all types of upper GI and thoracic operations. Even though these are upper GI themes, the emphasis will remain on general surgical training, for this reason these CSTs will placed in other specialties of general surgery (such as colo-rectal and breast-endocrine) when the training opportunities are there and the service requirements indicate.
All the ENT consultants in the region are very enthusiastic about surgical training. ENT track no 1 and 2 will rotate in between ENT departments in Aintree, Royal and Arrowe Park, the addition of OFMS makes these tracks especially attractive. ENT departments together with the Maxillofacial surgery in University Hospital Aintree is one of the biggest Head and Neck Cancer Centres in the Europe, catering for a population of about 2 million. The ENT departments in the Royal and Arrowe Park (Wirral) Hospitals complement the training programme nicely, offering ample training opportunities in Otology, Rhinology and paediatric ENT as well as thyroid surgery.
Urology training in this region is of high quality. The urology programme director Mr John Macabe has given personal assurance that he will organise high quality training. See below for Whiston Hospital to read more details. There are 3 urology themes for CSTs (urology 1,2,3) and one of colorectal interest (general surgery track no 1) will be able to apply for both.
Pediatric Surgery theme (track no1 and 2) will involve posting in AlderHey Hospital of world fame, and Warrington general surgery, where a you will be placed in a theatre list with some pediatric surgery patients in theatre list for adult general surgery. CSTs will also be posted in neonatal ICU in Arrowe Park for 6 months each.
Plastic Surgery core trainee (the only one) will be posted in Whiston hospital ,a hospital of national fame and in Warrington Breast unit for breast onco-plastic surgery and general surgery. For 6 months, this theme involves AlderHey Plastic surgery unit and another 6 moths in a superb OFMS unit in Aintree.
- Aintree University Hospitals NHS Foundation Trust
Emergency General Surgeryand Trauma at Aintree is based in one of the oldest dedicated Emergency General Surgery units in the country and a level one Major Trauma Centre receiving patients from the entire Merseyside and Cheshire region. There are 80 - 100 trauma calls per month covering both blunt and penetrating trauma. Consultant cover is provided by specialist Emergency and Trauma Surgeons with a commitment to high quality teaching. As well as the management of acute surgical cases, those posted in the emergency surgery unit will have the opportunity to attend elective sessions and receive training in ‘routine’ laparoscopic and general surgery. The unit has close links with other specialist units both nationally and internationally and there is potential for trainees to undertake research fellowships overseas, leading to a higher degree (MD/PhD) if desired. The unit has a commitment to clinical academic research and has a number of on going projects in which trainees are actively encouraged to participate.CSTs are encouraged to do audits and research. A significant number of completed projects from the unit have been presented at both international and national meetings in the previous year. T&O track 7 and 8 during their general surgery posting in year 2 have been placed in Aintree because of this reason. They will be doing on-call in general surgery while doing elective and semi-elective list in this unit. When there are more interesting learning opportunities in other surgical units of Aintree during a particular week, the CSTs will be moved to those lists.
Trauma and Orthopaedics department provides a comprehensive trauma and elective service. Aintree is part of the Cheshire and Merseyside Major Trauma Centre, in partnership with the Walton Centre and the Royal Liverpool Hospital. The directorate also employs a full time research coordinator to work with the medical and professional staff on numerous research projects.The research unit specialises in joint movement analysis, using a magnetic tracking system and computerised imaging equipment.
Oral & Maxillofacial Surgery: Aintree is home to the largest Maxillofacial unit in the country. It operates a"Hub and spoke" modelcovering Merseyside and North Cheshire with centralised operating of all major cases at Aintree.The maxillofacial specialty works very closely with the Ear Nose and Throat department, particularly in the field of head and neck cancer surgery, providing an excellent micro-vascular reconstruction service The unit possesses a number of internationally recognised specialists and there is a high academic output. Opportunities are available for trainees to undertake research and audit and they are encouraged to do so.Approximately 100 new cases of oro-pharyngeal malignancy are managed in the Unit each year. There is a weekly multidisciplinary team meeting and close links exist with oncologists, palliative care, dieticians and speech and language therapy.Maxillofacial Trauma remains a core activity and there are over 600 operated cases at Aintree per annum. Trauma is managed by a dedicated acute care consultant, the ‘Consultant of the Week’, a role into which all the consultants rotate and link into the trauma service that Aintree provides.
The unit provides a large facial plastic surgery service carrying out a large volume of facial skin oncology, laser, post traumatic deformity and orthognathicsurgery.They also provide specialist TMJ and complex dento-alveolar surgery service. It has close links and joint operating with the Neurosurgery and Occuloplastic Surgery Units, both based on site. The Regional Maxillfacial Unit also continues the care of children with congenital craniofacial deformity and cleft lip and palate transitioning into adult care from Alder Hey Childrens Hospital.This unit was preferred by the top candidate for ST1 in OMFS at specialty recruitment. Besides, CSTs with an ENT theme will get an opportunity to rotate.
Upper GI Surgery atAintree is a superb unit for surgical training. Besides cancer and elective upper GI surgical work, CSTs will get the opportunity to work in bariatric surgery. Trainees get an excellent training in laparoscopic cholecystectomy and laparoscopic hernia surgery.
The Liverpool Hepatobiliary Centre at Aintree is a world renowned institution serving a population in excess of three million people across Liverpool, Merseyside and Cheshire, North Wales and the Isle of Man. The centre specialises in providing a supra-regional service dealing with all aspects of benign and malignant diseases involving the liver and biliary tract. The centre also provides a supra-regional service for retroperitoneal sarcomas.
Colorectal Surgery unit provides excellent surgical training open and laparoscopic surgery and audit opportunities in colorectal cancer, inflammatory bowel disease and faecal incontinence.
- Alder Hey Children's NHS Foundation Trust
Alder Hey Children’s NHS Foundation Trust is one of the largest children’s hospitals in Europe. Its Department of Paediatric Surgery and Urology provides all general and urological surgery at secondary and tertiary level to the children of Merseyside and Cheshire and working with Central Manchester Children’s Hospital, tertiary services to the North West of England and North Wales including the Isle of Man. This includes neonatal surgery, oncological surgery, paediatric gynaecology and reconstructive urology; providing one of the few transitional urology services in the country. In 2012 AlderHeywere commissioned as a Major Trauma Centre and together with Central Manchester Children’s Hospital provide major trauma services for North West England.
In 2012-13 6,868 children were seen in the general surgery/urology outpatients department. 3,235 children underwent elective surgical procedures and 2,012 children had non-elective (emergency surgery). Inpatient capacity was reduced by 20% in 2012-13 as the operating theatre complex was refurbished. All the consultants at Alder Hey, many of them of international repute, are committed to provide a number of opportunities for audit, presentation and research. A large number of publications and presentations in national and international meetings are the result of the disciplined and well organized research work at AlderHey. In 2014 selections the candidate from Mersey CST rotation, had the highest rank in general surgery as well as paediatric surgery.
3, Countess of Chester Hospital NHS Foundation Trust (COC)offers training in benign and malignant surgical diseases with specific sub-specialty interests in upper and lower gastrointestinal surgery, breast (oncoplastic) surgery and vascular surgery. It is the site of the South Mersey Vascular Centre and offers high level exposure to all acute and elective vascular disease as well as a range of interventions to treat diseases of the biliary systems, laparoscopic cholecystectomy, hernia repair, colonic resection and anti-reflux surge and thyroid/parathyroid surgery. As the bariatric centre exposure to morbid obesity surgery is another merit of working as CST in COC. COC surgery department has been a very popular part of the rotation for surgical trainee at all the levels. The longstanding link with the department of Anatomy at the University of Liverpool in one core rotation has proven very popular.
In the second year, 4 CSTs with vascular theme will go to Chester where they will work in elective general surgery and vascular surgery and will do on-call in general surgery. In the second year, 2 of the 4 CSTs with upper GI surgery theme will go to Chester where they will work in orthopaedicsfor 4 out of 5 days and in ENT clinic for 1 out of 5 days for elective work and will do on-call in general surgery. The college tutor Ms Claudia Mackean-Harding takes keen interest in furthering the careers of her trainees based in COC.
- Liverpool Heart and Chest Hospital NHS Foundation Trust is the single largest Cardiothoracic Surgical unit in the country andis proud to have some of the most talented and experienced Consultant surgeons in the country of national and international reputation. It is a standalone Trust which accommodates Cardiac and Thoracic Surgery, Thoracic Aortic Surgery, Cardiology and Chest Medicine, Anaesthesia and Radiology. The CST training programme at the LHCH is being revamped and redesigned to ensure that all the CSTs get good surgical experience in cardiac and thoracic surgery and some exposure to postoperative critical care. There will be adequate opportunities to perform audits and present them, and participate in ongoing research projects.
Four CSTs tracks are being developed in vascular surgery. Two of them at a time will rotate every 6 months in the first year between vascular surgery department and the cardio-thoracic hospital to have a complete exposure to all types of vascular operations. Vascular themed trainees will have an opportunity to get familiar with saphenous vein harvest, sternotomies, thoracotomies, principles of lung resections, and understand the principles of cardiopulmonary bypass.
Four CSTs tracks are being developed in Upper GI surgery. Two of them at a time will rotate every 6 months in the first year between upper GI surgery department and the cardio-thoracic hospital to have a complete exposure to all types of upper GI and thoracic operations. Upper GI themed trainees will be able to get familiar with opening and closing chests, and management of patients in postoperative critical care, which are all generic skills useful for upper GI training.
These 8 CSTs (4 each in vascular and upper GI tracks) will have good opportunity to learn thoracotomy, an uncommon skill among general surgeons, even if these trainee at a later stage of their career do not opt for these specialties in future. All these 8 posts will be good enough not just for ST3 general surgery but also for ST3 in cardiothoracic surgery.
CTC clinical posting is an excellent opportunity to become proficient in critical care of a surgical patient and in learning procedures. In a day 15-20 CVP lines are inserted in CTC theatres and ITU. A good surgical trainee will not be waiting for invitation to learn these key skills. An active participation with the anaesthetic team will go a long way.
- Mid Cheshire Hospitals NHS Foundation Trust (Leighton Hospital), Crewe, was a designated national training centre in the North-West for laparoscopic surgery as part of the LAPCO training for laparoscopic colorectal surgery and now performs the majority of its colorectal work, benign and cancer, laparoscopically. It is a centre of excellence in TransanalHaemorrhoidalDearterialisation (THD), the advanced procedure that is revolutionising the treatment of piles. For CSTs this is the farthest hospital from Liverpool. However, the clinical placements of all the tracks involving Leighton has been arranged in a way that the CSTs do not have to crisscross the region. Those who prefer a rural setting would not mind driving throughrural Cheshire when commuting to Leighton. The college tutor is Mrs Caroline Bruce, a colo-rectal surgeon and a very enthusiastic trainer and teacher. General surgery CSTs track no 2 with colo-rectal theme will be placed with her for this specific reason. In the second year, 2 (general surgery track no 5 and 6) of the 4 CSTs with upper GI surgery theme will go to Leighton where they will work in general surgery for 4 out of 5 days and will be in ENT clinic for 1 out of 5 days for elective work and will do on-call in general surgery.
- Royal Liverpool and Broadgreen University Hospitals NHS Trust
The Royal Liverpool is the biggest university teaching hospital in Merseyside and Cheshire, with many internationally, nationally and regionally renowned services. Vascular surgery services are now centralized at the Royal. Royal is part of the Merseyside and Cheshire Cancer Network. DaVinci Robot was introduced to patients at the Royal in July 2011, and patients have benefitted by having their Prostatectomies for prostate cancer carried out using the most innovative and successful robotic surgery currently available. The use of the DaVinci robot is to be extended to other cancers such as bladder, kidney, colon and gynaecological cancers. The Royal is one of seven centres nationally to have this type of robotic equipment. Royal Liverpool provides world class cancer facilities providing regional cancer facilities for 11 cancers.
Vascular team at the Royal Liverpool University Hospital is both nationally and internationally recognized as an innovative and respected clinical unit. With a team of ten consultant surgeons, specialist nurses and dedicated 'round the clock' vascular interventional radiology support, it is one of the largest vascular services in the United Kingdom. LiVES team was also awarded the Royal Liverpool University Hospital’s Team of the year for 2013.The team of consultants is committed to provide a number of opportunities for audit and research. The consultants in vascular surgery promise to ensure that the CSTs with vascular theme develop excellent credentials for ST3 interview. Four CSTs tracks are being developed to maximise the use of this superb training facility in vascular surgery. Two of them at a time will rotate every 6 months in the first year between vascular surgery department and the cardio-thoracic hospital to have a complete exposure to all types of vascular operations. However, they will do on-call in general surgery when posted in Royal Liverpool for vascular surgery. In the second year the focus will be on general surgery training that would enable these 4 CSTs with vascular theme to apply for both ST3 in general surgery and in ST3 vascular surgery. In the second year, these CSTs with vascular theme will go to Chester where they will work in vascular surgery for part of their time and do on-call in general surgery.