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ROYAL DEVON AND EXETER NHS FOUNDATION TRUST SPECIALIST / SPECIALTY REGISTRAR IN INTENSIVE CARE MEDICINE (Intermediate level) Job Description August 2010 SPECIALIST REGISTRAR IN INTENSIVE CARE MEDICINE Royal Devon and Exeter Hospital Introduction This post is open to Specialist / Specialty Registrars in possession of an NTN in Medicine, Emergency Medicine or Surgery who wish to undergo training in Intensive Care Medicine. It will provide training to the intermediate level as described by the Intercollegiate Board for training in Intensive Care Medicine (http://www.ibticm.org/). The post is available for between 6 and 18 months and will be tailored to meet the training requirements of the successful applicant. In addition to 6 months intensive care medicine, up to 12 months training in the necessary complementary specialties (i.e. medicine and anaesthesia) can be provided. Structure of Post The entire post will be in the Royal Devon and Exeter Hospital and will include the following modules – 6 months Intensive Care Medicine plus 6 months Medicine (for trainees from anaesthesia or surgery) 6 months Anaesthesia (for trainees from medicine, emergency medicine or surgery) Royal Devon and Exeter Hospitals NHS Foundation Trust The Royal Devon and Exeter NHS Foundation Trust is based in the historic cathedral city of Exeter in the heart of the South West of England. With the recent establishment of the Peninsula Medical School by the Universities of Exeter and Plymouth, the Royal Devon & Exeter NHS Foundation Trust has become a partner in the creation of a major teaching hospital. The Trust is the major acute hospital in Exeter and provides secondary medical care principally for the population of Exeter, East- and Mid-Devon (population 420,000). It also provides tertiary services in some specialties for other parts of Devon and beyond. It is a dedicated cancer centre RD&E Wonford is the Trust’s principal hospital and provides a full range of acute services. It houses the main Emergency department for the district, and the main operating theatres (10 general, 5 orthopaedic, 3 gynaecology, 2 ophthalmic).The hospital has approximately 800 in-patient beds and provides the majority of day case and outpatient services The Peninsula Medical School Exeter boasts a fine University which has special links with the Trust, via the Peninsula Medical School which has a strong research base. The school was established on 1 August 2000 and commenced delivery of the Undergraduate Programme in Autumn 2002. All teaching is underpinned by a strong research base with research focused in the Institute of Biomedical and Clinical Science, Institute of Health and Social Care and the Institute of Clinical Education. Recently strong links with the Microvascular unit have been made with the RDE intensive care unit on the subject of the microcirculation in shock states, and research collaboration continues to grow. Intensive Care The ICU has educational approval from the Intercollegiate Board in Intensive Care Medicine for intermediate and advanced training. It has recently expanded and now has 15 beds which are mixed level 2 / level 3. It has approximately 800 admissions per year with a mean Apache II score of 17.9 and an SMR of 0.78. In addition to providing intensive care services for general medical, general surgical, vascular surgery, trauma and paediatric patients, the unit admits patients for sub regional services which are based at Exeter (urology, neurology, thoracic surgery, plastic surgery, renal medicine and maxillofacial surgery). Drs Julia Munn, Sheena Hubble, Chris Day (Clinical lead), Roland Black (educational supervisor), Alisdair Dow and Brett Cullis (Renal Medicine) are the intensive care consultants and are responsible for the clinical management of the patients on a weekly basis. The successful applicant would work along-side 1 ACCS, and 4 Anaesthetic trainees on a full shift rota exclusively for critical care. The unit also has an advanced trainee on an intermediate rota tier. The unit has an experienced Consultant Nurse in Critical Care (Carole Boulanger) who provides unit cover, ward advice and SHO supervision. The post is full time and the hours worked per week will be an average of 48. Clinical Training Under direct consultant supervision the Intensive Care Specialist Registrar will gain experience in the management of the whole range of critically ill patients. He/she will also be involved in calls to the Emergency Department and general wards to advise and assist in the management of critically ill patients. The post-holder will be expected to undertake patient transfers by road or by air (most commonly to Plymouth but also to other centres). Training and supervision in transfer of critically ill patients will be provided if necessary. Teaching and experience will be provided in line with recommendations contained in the Intercollegiate Board’s outline for training to intermediate level in Intensive Care Medicine. At all times they will be under the direct supervision of the ICU consultant (with overall responsibility for training and competency assessment resting with Dr Roland Black). Training will be provided in a broad range of techniques and therapies including mechanical ventilation, non-invasive ventilation, fibreoptic bronchoscopy, percutaneous tracheostomy, advanced peripheral haemodynamic and cardiac monitoring, intra-aortic balloon counter pulsation, continuous and interrmittent renal support, inhalational prostaglandin therapy, echocardiography and basic ultrasound imaging. Audit The intensive care unit has an active audit programme and is a member of a national intensive care audit (the ICNARC case mix programme) for which the unit has a dedicated research employee. The post holder will gain experience in intensive care audit and will be expected to undertake an audit project while in post. Research There is an active research programme with regular research submission to both national and international meetings. We have strong links with the Peninsula medical school via the institute of Clinical and Microvascular studies. The post-holder will be encouraged to participate in an original research project or join an active study. Teaching There is a lively journal club on Tuesday mornings to which the postholder will be encouraged to contribute. Informal teaching sessions for the ICM trainees occur during the afternoon when work commitments allow. There is a formal weekly tutorial programme covering all aspects of ICM. Courses available in Exeter include ATLS, ALS, APLS, and CRISP. The neighboring unit at Derriford Hospital runs between 2 and 3 Fundamentals of Critical Care Support Courses (FCCS) per annum which the Intermediate Level Trainee will be encouraged to attend. Local ALERT courses also require help and participation from the intermediate trainee. Regular regional meetings are organised by the Society of Devon Intensive Therapists and there is encouragement to attend national and international meetings. Complementary Specialties: Medicine Up to six months medicine will be provided for registrars from anaesthesia, emergency medicine or surgery. Experience and training provided will be as close as possible to the recommendations of the Intercollegiate Board for the medicine module and will be tailored to the post holder’s requirements. It is anticipated that the module will comprise of 2 months each of renal medicine, respiratory medicine and the Emergency Medical Unit. In addition to the posts detailed below it will also be possible to provide some training in cardiology and gastroenterology. Renal Training will be provided in both in- and out-patient diagnosis and management of acute and chronic renal failure with exposure to the full range of renal replacement techniques. This will be under the supervision of Dr Brett Cullis Respiratory The trainee will be involved in out-patient clinics and the in-patient management of patients under the care of the respiratory physicians on the wards and in the respiratory HDU. Training will be provided in the investigation and management of respiratory disease including fibreoptic bronchoscopy, lung function testing and the provision of non-invasive ventilation. This attachment will be supervised by Dr Nick Withers. Emergency Medical Unit (EMU) All medical emergencies are admitted to this unit for stabilization and initial investigation. Work is supervised by the physician of the week who is dedicated to the emergency take for one week at a time. Experience will be gained and training provided in the whole range of medical conditions which can present as emergencies. Protected time will be given for attendance at the weekly Friday afternoon teaching sessions for medical SHOs. Anaesthesia The department of anaesthesia consists of 36 consultants, 22 trainees and 7 Staff Grade doctors. It is a busy department undertaking anaesthesia for most surgical specialties, with the exception of cardiac and neurosurgery. In addition to the surgical specialties common to most hospitals the Trust provides a sub-regional service in thoracic surgery, major plastic, head and neck surgery and complex spinal surgery. Individual anaesthetic consultants have various areas of interest such as vascular, paediatrics, thoracic or regional anaesthesia. There is also a pain department consisting of 4 anaesthetic consultants and 2 nursing sisters who manage a comprehensive acute and chronic pain service. There are 10 general theatres, 5 orthopaedic theatres, 3 gynaecology theatres and 2 ophthalmic theatres. Clinical training The post-holder will undergo a structured training programme in theatres with a small number of named consultants for the first 3 months of the module. The content of the training will comply with both the guidelines of the Royal College of Anaesthetists and the Intercollegiate Board of Intensive Care and will emphasise the skills most related to intensive care medicine. At the end of the initial 3 month period the post-holder will be expected to be confident to provide anaesthesia for straightforward cases and will undergo a competency based assessment. Upon satisfactory completion of the assessment and by mutual consent the post-holder will progress onto the on-call rota and to the provision of anaesthesia without direct supervision. There is no on-call for the first 3 months. During the second 3 months of the anaesthetic module the post-holder will be first on call for anaesthesia until midnight. Teaching For the first 3 months teaching will be provided in theatre on every list and will follow the outline of topics provided on starting the module. The post-holder will be expected to attend the weekly half-day teaching designed for the primary FRCA and the weekly anaesthetic department audit/M&M meetings. Other teaching and audit sessions and courses are detailed under the description of the intensive care module.
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