Nhs Education for Scotland West Region

NHS EDUCATION FOR SCOTLAND – WEST REGION

SPECIALIST/SPECIALTY REGISTRAR IN STROKE MEDICINE

Job Description

1. INTRODUCTION

The Specialist/Specialty Registrar post forms part of the West of Scotland Training Programme in Stroke Medicine. The post has training approval from the SSAC in Stroke Medicine and will conform to the guidelines laid out in the SSAC documents.

The post of Specialist/Specialty Registrar in Stroke Medicine provides 12 months of training in Stroke Medicine. Additional time may be made available to achieve necessary competency when parent specialty training does not meet minimum criteria for stroke training eligibility. A particular strength of the West of Scotland programme is the extensive exposure to acute thrombolysis for stroke.

During the training programme, the trainee’s education and progress is supervised by the Regional Specialty Training Committee in Stroke Medicine and by the designated Regional Educational Supervisor. The Committee is chaired by the Programme Director. Individual trainees are required to sign a training programme agreement, and performance assessment is carried out on a regular basis throughout training. Summative assessment is conducted after one year and is based on in-house training assessment criteria laid down by the SSAC. Study leave conforms to terms and conditions of service for the Specialist/Specialty Registrar grade. Trainees will be expected to achieve the competencies as set out by the SSAC for Stroke Medicine. Provided that the training and experience of the trainee is compatible with the regulations leading to a CCT in a relevant/eligible medical specialty the successful completion of the training and achievement of the competencies required may lead to the aware of a CCT with Stroke Sub-specialty recognition.

A brief outline of the services provided within Stroke Medicine are contained in the appendix.

1. ENTRY REQUIREMENTS

The Trainee will be appointed by a Committee comprising representatives of the Postgraduate Dean, Speciality Training Committee, teaching hospitals, University of Glasgow.

Applicants must currently be in a Type 1 training post, hold a National/Visiting Training Number in CPT, Geriatric Medicine, Rehabilitation Medicine, Cardiology, Neurology or G(I)M and should by the time of taking up the post usually have completed 3 years of training towards Certificate of Completion of Training. Applicants who are in or have transferred to the ST programme should be at an equivalent stage in their training, but also are eligible to undertake specialist stroke training after award of their CCT. Applicants from outwith the West of Scotland should have the agreement of their Postgraduate Dean to retain their original training number and to return to their original deanery at the end of the year of training.

Applicants must have an MB ChB, or recognised equivalent and MRCP or equivalent qualification.

On successful completion of the programme applicants will return to their base specialty and the relevant SAC will be informed that they have had special training in Stroke Medicine. The base specialty will retain responsibility of the award of CCT.

1. DUTIES OF THE POST

Training

The trainee must make full use of the training opportunities provided in each placement.

Clinical

Under the supervision of the Stroke Consultants, the Specialist/Specialty Registrar will be expected to participate in duties in Stroke Medicine and other relevant clinical attachments appropriate to his/her previous experience.

Administration

The Trainee will be expected, when appropriate, to participate in the day to day running of the department in administrative activities such as organisation of on-call rotas, organisation of undergraduate training, patient reports and letters. The Trainee will have the opportunity to develop management skills as required by the College.

Communication

This will include:

Communication with patients and relatives.

Discussion with Consultants regarding clinical problems.

Communication with General Practitioners – this will include telephone discussion of problems and writing of letters about cases seen in the Department.

Liaison with specialists in other hospitals and with other agencies such as district nurses, ambulance service, police etc.

4.EDUCATION

Continuing Education

The trainee will be expected to participate in educational activities on a local and national basis.

Trainees are expected to further their education through attendance at meetings and courses held both locally and nationally. Management development is encouraged and the Trainee will be expected to attend appropriate courses.

Teaching

The Trainee will be expected to take part in departmental teaching of junior staff, undergraduates, nursing staff etc.

1. RESEARCH AND AUDIT

Research

There is a strong tradition of research in the West of Scotland. Facilities and support for research activities are available through the University Divisions of Medicine & Clinical Neurosciences and within hospital departments. The trainee will be encouraged to participate in clinical research and time will be allocated consistent with current Terms & Conditions.

Audit

Audit is an essential component of Stroke Medicine practice and the Trainee will be required to participate in local and national audit activities.

1. LOCATION OF DUTIES

The programme will be based in the Stroke Services of the Western Infirmary/Gartnavel general Hospital, Glasgow Royal Infirmary and SouthGlasgowHospitals. Rotation amongst up to 3 of the services is expected - within these, concurrent training on two sites where these form part of a single service is envisaged to provide an appropriate balance of the components of stroke training (acute, prevention and rehabilitation) whilst maintaining continuity. Trainees to date have spent 8 months of the twelve in units with a high throughput of acute stroke thrombolysis cases, with an on call commitment in the remaining time, and training in this aspect is a particular strength of the Glasgow stroke programme. Attachments of suitable duration can be made to units for Neurology, Cardiology, Coronary and Intensive Care. The training programme will however be individually tailored to complement previous experience. The hospitals involved in the training programme are as follows:

Southern GeneralHospital (including Institute of Neurological Sciences) & Victoria Infirmary, Glasgow

WesternInfirmary & GartnavelGeneralHospital, Glasgow

RoyalInfirmary & LightburnHospital, Glasgow

StobhillGeneralHospital, Glasgow

Secondments to other units or departments as appropriate for training.

1. ASSESSMENT

The Trainee will be continuously assessed by the trainers in their place of work with formal interviews each 6 months and annual review by West of Scotland Specialty Training Committee and by the SSAC in Stroke Medicine.

If, in the opinion of the Training and Assessment Committee, the Trainee fails to show adequate commitment or progress, career guidance will be arranged, and exceptionally, in the absence of satisfactory progress, the committee may recommend that the contract be terminated.

Trainees are required to keep a logbook following the requirements laid down by the SSAC for Stroke Medicine. These are currently under review.

1. GENERAL INFORMATION

Hours and Salary

The salary scale currently applicable is appended under general information. The standard hours of duty will remain 40 hours per week and in addition a supplement will be paid for any out of hours duties.

Please note that the hospitals are continually monitoring rotas therefore, the current banding will be subject to change and an offer of Employment may not reflect the current banding. Please also note that at the time of this post going to advert there is no guarantee that banding will be available.

Further Information

For further information on the training programme please contact:

Professor Kennedy R Lees

Department of Medicine & Therapeutics

Western Infirmary

44 Church Street

Glasgow, G11 6NT Tel: 0141 211 2176 or 2780, Email:

APPENDIX

WEST GLASGOW STROKE SERVICE

WesternInfirmary & GartavelGeneralHospital

The acute stroke unit at the Western Infirmary has 14 dedicated stroke beds plus one thrombolysis/research bed. It can also expand into adjacent general medical beds. The unit is staffed by a team of experienced stroke nurses with consultant medical cover from 6 stroke physicians in weekly rotation. There is junior and middle grade medical staff support on secondment from the general medical teams. There is a daily consultant-led ward round (7 days) and 24/7 consultant cover. The unit offers an acute thrombolysis service 24/7 for its own catchment population of 225,000 and for any patients referred from adjacent north Glasgow areas or hospitals, following the local referral policy. Imaging facilities include an internal carotid Doppler and TCD service (training available) plus CT, MRI and MRA via the general radiology department, with research imaging facilities available through the NHS R&D department. Cardiological investigation is provided by the nearby specialist department.

Consultant stroke physicians run5 cerebrovascular clinicsover 3-4 days across which 12-20 new and 16-24 return patients are seen. There is also a consultant stroke psychologist. The stroke trainee assesses new patients within the ward at a further weekly clinic. A daily stroke clinic service is in planning stages. There are dedicated hypertension, lipid, epilepsy, headache, general medical and cardiovascular risk clinics within the same department; and non-invasive cardiology, coronary care, carotid stenting, vascular and cardiac surgery services and general intensive care facilities on site to which access can be provided. Cardiac surgery and invasive cardiology for the city have recently been relocated to a nearby site, the Golden Jubilee hospital, and the Western Infirmary provides stroke support to these patients. There is an active stroke research programme including coordination of acute treatment (thrombolysis, neuroprotection), secondary prevention and mechanistic trials, with developing interest in rehabilitation research; and outcome assessment, data analysis/trial design and stroke training leadership. Resources include a database of acute presentation details and outcome for over 10,000 patients as well as digitally stored brain scans on over 5,000 patients.

Approximately 24 stroke rehabilitation beds are staffed by a consultant geriatrician/stroke specialist, based in Gartnavel General hospital. There is excellent liaison between the two units, with a joint interdisciplinary review meeting of all acute cases joined by radiologist, neurologist, geriatrician and liaison staff; a multidisciplinary stroke meeting on both sites led by a stroke liaison charge nurse (Western Infirmary) or consultant geriatrician (Gartnavel hospital); and by a coordinated approach to follow-up with all discharges attending a single clinic for final review. Regular staff training is linked to the Western MDT meetings. The SpR takes a lead role in providing medical input to the MDT meetings.

Training based in the Western/Gartnavel service involves concurrent exposure to acute, prevention and rehabilitation aspects, with 10-20% of the week based in Gartnavel and 80-90% in the Western Infirmary, and with on call commitments for acute stroke at the Western Infirmary.

SOUTH GLASGOW STROKE SERVICE

Southern GeneralHospital & Victoria Infirmary

An integrated acute and rehabilitation service is provided by 4 DME Consultants and 3 Neurologists for all suspected stroke admissions referred by general practitioners or A&E departments of the Victoria and Southern General Hospital. They are admitted to one of 4 high dependency beds in ward 67 in the Institute of Neurological Sciences or to the acute stroke beds in ward 56 in the LanglandsBuilding, which is adjacent to the INS. The acute Unit provides a thrombolysis service for South Glasgow. Those likely to recover rapidly normally remain in Ward 56 and are discharged from there, utilising support of a rapid discharge rehabilitation team (Stroke DART). Those requiring more prolonged rehabilitation and who are in the geographical area of the South remain in Ward 56, those from the Victoria catchment area are moved to the Stroke Rehabilitation Unit of the Mansionhouse Unit, Victoria Infirmary. Post-discharge rehabilitation is also available via a DayHospital based on each site, and Specialist Stroke Liaison Nurse are available to both sites.

The Stroke Consultants are available on a daily basis to assess referrals of suspected strokes admitted to other beds in both Victoria Infirmary and Southern General Hospital.

Each week, 2 fast-track one-stop clinics for suspected TIAs are available on the Victoria site with a weekly follow-up cerebrovascular clinic. There is a further weekly fast-track one-stop TIA clinic at SGH based in the Institute of Neurological Sciences, and a follow-up cerebrovascular clinic in the DayHospital.

In addition this post offers opportunities for wider training. The INS is the regional Neurosciences centre for the West of Scotland, a catchment population of approximately 2.5 million. It has departments of Neurology, Neurosurgery, Neuroradiology, Neuropathology, Clinical Neurophsyiology, and Neuroanaesthesia. Regional referrals with stroke and related cerebrovascular pathologies are routinely admitted through the INS, most under the supervision of three consultants with cerebrovascular interests. There is also a regional Neurovascular clinic, and an acute interventional Neuroradiology service including intra-arterial thrombolysis in appropriate cases. There are regional or national referral clinics for intracranial vascular malformations, CADASIL, and other rare cerebrovascular diseases. Comprehensive neuroimaging facilities include spiral CT, MRI (1.5T and 3T), SPECT, TCD, and angiography.

The Division of Clinical Neurosciences is based at the INS, and includes clinical and laboratory research facilities.

The Glasgow Young Physical Disability Rehabilitation Unit is based at the Southern General Hospital with in-patient beds and spasticity clinics and the regional wheelchair service, Wesmarc are also based at the Southern General Hospital.

NORTH GLASGOW STROKE SERVICE

RoyalInfirmary & StobhillHospital

The stroke service in GRI and Stobhill serves the North and East side of the city providing a comprehensive service operating under a single team of consultants. The service comprises two acute (comprehensive) stroke units, rehabilitation stroke unit, stroke clinics, supported discharge service and day hospital. The acute stroke units at Glasgow Royal Infirmary have 19 female beds and 19 male beds and aim to accept all patients with probable new stroke. Patients are often admitted via the Acute Medical Admissions Unit with selected direct admission in the near future. The Unit emphasises comprehensive stroke unit care; a combination of good acute medical care, early mobilisation and multi-disciplinary team working. Imaging facilities include CT scanning, MRI (including DWI) scanning, MRA and carotid Doppler ultrasound. There are 5 consultants who operate in rotation. Middle grade staffing is provided through the geriatric medicine rotation (at SpR and SHO level). There is a consultant-led ward round four times per week with middle grade ward rounds on the remaining days. A multi-disciplinary meeting takes place every week day morning with a formal (consultant-led) meeting once per week. There is a weekly CT Scan meeting and regular departmental in-service activities.

There are 5 stroke clinics per week between GRI and Stobhill at which 5-15 new patients and 10-20 returns are seen. The clinic includes input from clinical psychology staff (with whom attachments can be arranged). There are also weekly nurse-led clinics for risk factor management.

The acute stroke unit is supported by a 30-bed rehabilitation unit at StobhillHospital which is run by two of the consultant staff and specialises in multi-disciplinary rehabilitation. There are 2 consultant-led ward rounds each week each with a multidisciplinary team meeting. The Rehabilitation Unit has specialist input from physiotherapy, occupational therapy and speech and language therapy along with dietician input as required. Patients are discharged from the unit with rehabilitation follow-up either at the DayHospital or by the stroke Supported Discharge Team.

The stroke supported discharge service is for patients who require support and ongoing rehabilitation at home. It is provided by the multidisciplinary IRIS team with medical liaison on a weekly basis.

Trainees will have the opportunity to participate at various stages in the stroke care pathway plus a range of multidisciplinary research and audit activities hosted in the department.

During attachment to the Royal Infirmary and StobhillHospital, on call for training purposes takes place at the Western Infirmary, allowing continuity for patients transferred between these two services.