-1- YORKSHIRE AND THE HUMBER POSTGRADUATE DEANERY POST AND PROGRAMME INFORMATION JOINT CCT SPECIALTY TRAINEE in INTENSIVE CARE MEDICINE -2- Programme Description SPECIALTY TRAINEE IN INTENSIVE CARE MEDICINE Objective To provide Joint CCT training in intensive care medicine for Specialty Registrars in any acute specialty, who intend to make intensive care medicine the major part of their consultant career. Summary This is an exciting opportunity to gain comprehensive, advanced training in the theory and practice of intensive care medicine. The programme will be tailored depending on the primary specialty of the applicant and will also deliver training in those aspects of anaesthesia, medicine or surgery relevant to intensive care in which the trainee has had little or no previous experience. A research interest will be established within the first month. Training will meet the requirements of the Faculty of Intensive Care Medicine. Satisfactory completion of training will result in a Joint CCT in Intensive Care medicine being awarded with the individuals base specialty. It is expected that the trainee will undertake the FICM examination (for further details see www.ficm.ac.uk) and should be registered with the Faculty for training in ICM. Location There are currently five posts in Yorkshire based at Bradford Royal Infirmary (1), Hull Royal Infirmary (1), Leeds General Infirmary (1) and St James’s University Hospital, Leeds (2). The training scheme in Hull includes York District Hospital and both are affiliated to the Hull and York Medical School. On average the trainee can spend about a quarter of their time at York District Hospital, but this will vary according to the needs of the individual trainee. In Leeds the specialist expertise available in the two teaching hospital sites is complementary resulting in a complete training programme being delivered in one city (See table) however consideration can be given to the inclusion of other centres in or near the base hospital. Both hospitals are affiliated to the University of Leeds. The case mix in all four centres provides superb training for a consultant whose work will predominantly be in intensive care medicine. The overall content of the training programme and research activities will be supervised by the Regional Advisor and/or Deputy Regional Advisor in Intensive Care Medicine plus the relevant Faculty Tutor. -3- Table: Special Expertise Bradford Hull / York St James’s The General Infirmary General Adult General Adult and General Adult and General Adult Intensive Care Paediatric Paediatric Intensive Intensive Care Intensive Care Care Stabilisation of Adult and Paediatric patients Adult Pancreatic Adult and Paediatric Paediatric for and Hepatobiliary nephrology and Neurosurgery transfer/retrieval Surgery. transplantation Cardiac Surgery Adult pancreatric Major Head and Adult and Paediatric (includes surgery Neck Cancer liver failure, trauma, Paediatric) Major head & neck surgery transplantation and Regional Paediatric hepatobiliary service surgery GI surgery inc. Intensive Care and bariatric surgery Adult and Paediatric retrieval service GI surgery Vascular surgery oncology & bone Neonatal Surgery Urological surgery marrow Adult nephrology transplantation Interventional Vascular surgery Cardiology Adult and Acute Lung Injury Adult nephrology Paediatric service Non-invasive Noninvasive Neurosurgery ventilation ventilation Cystic fibrosis Cardiothoracic service Neurosurgery Surgery Noninvasive Adult and Interventional ventilation Paediatric Cardiology Orthoplastic Thoracic surgery Trauma Noninvasive ventilation Adult orthoplastic trauma -4- Facilities of Teaching Hospitals In addition to general intensive care training, the specialist expertise available is excellent and more specific information on each centre is as follows. Bradford Royal Infirmary The Adult Intensive Care Unit at the Bradford Teaching Hospitals Foundation Trust currently has 16 beds, which are used flexibly for a mixture of Intensive Care and High Dependency patients. Each year the Unit admits in excess of 1000 patients who are admitted with a wide variety of both surgical and medical conditions covering all the major specialties except Cardiothoracic Surgery and Neurosurgery. Recent service developments have seen BTHFT attracting tertiary referrals for major Urological, Gastro-Intestinal and Head & Neck cancer sites. Furthermore the centralisation of major Vascular work at the BTHFT for the Bradford, Calderdale and Airedale conurbations alongside the launch of a Bariatric Surgery Service has increased the demand for critical care beds to support elective and emergency surgery. Since Spring 2009, as part of the recognised need to expand critical care services in Bradford, there has been an additional four bedded High Dependency Unit located on the floor above the ICU. This provides a current critical care bed base in Bradford of 10 ‘level 3’ beds and 6 ‘level 2’ beds. The unit is managed by a team of 6 Intensivists. Dr Davidson (Deputy Regional Advisor ICM, Dr Fletcher (Director of Critical Care), Dr Cramp, Dr Hughes, Dr Stonelake (FICM Tutor) & Dr Quinn. Additional on call support is provided by colleagues who have occasional sessions in ICU. Teaching The intensive care unit pioneered the introduction of competency based training across the Pennine School of anaesthesia. The ICU has recently become an examination centre for the EDIC part 2 examination Audit The unit participates in the ICNARC programme Development The unit is currently developing a computerised, paperless charting system due to be implemented in 2013. This will significantly expand our research and audit capability. We are also planning a new build ICU consisting of 18 beds to replace the current unit. This also expected in 2013. -5- Research Our vision is to make Bradford Teaching Hospitals a significant research centre for critical care, and to help the West Yorkshire Comprehensive Local Research Network in meeting its aim of doubling recruitment to Portfolio trials. We are currently conducting a variety of own account studies, ranging from randomised controlled trials through observational studies to database analyses (using our excellent data manager and with an ICU database of over 5000 patients). We have been successful in the past in becoming a centre for large commercial RCT’s. We are expecting funding from both commercial and Research Network sources to fund expansion of the current research nurse provision. There is huge potential for a motivated prospective advanced trainee to create, conduct and publish worthwhile studies using existing data and to participate in ongoing patient-level research. Our aim is to publish work that is of value to the critical care community and our patients, and that provides stimulation and intellectual challenge to investigators. Hull Critical Care Services within Hull and East Yorkshire Hospitals are divided across 2 sites, Hull Royal Infirmary (HRI) and Castle Hill Hospital, Cottingham (CHH). HRI is a predominantly acute site and CHH is predominantly a cold elective site. Hull Royal Infirmary The Critical Care Units in Hull Royal Infirmary consist of 2 adjacent areas which incorporates a total of 22 beds (12 level 3, 10 level 2). These units admit around 1200 adult patients annually. The Critical Care units admit a wide range of patients with the exception of post-operative cardiothoracic surgery which are accommodated within the Cardiothoracic ICU at Castle Hill Hospital within the city. In addition to general medical and surgical intensive care patients, regional services are provided for renal medicine, major head and neck cancer surgery, neurosurgery and vascular sugery. Within the adult Critical Care units there is the possibility to admit upto 2 paediatric critically ill patients. This service is supported by 2 paediatric intensivists. The unit admits around 50 paediatric patients per year. There is also a peadiatric high dependency unit within the hospital. The units are managed by a team of 9 Consultant Intensivists: Dr Cowlam, Dr Felgate (Clinical Lead & Faculty Tutor HRI), Dr Gratrix (Regional Advisor ICM), Dr Gray, Dr Hibbert (Clinical Director Anaesthesia and Critical Care), Dr Locker (Regional Advisor Anaesthetics), Dr Pettit, Dr Smith and Dr Ventour (Faculty Tutor CHH). The consultants are supported by a tier of Specialty Registrars in Anaesthesia and a tier of non-anaesthetic doctors from various specialties including respiratory medicine, acute medicine, emergency medicine and CT’s in anaesthesia. We also have a number of FY1 doctors at any one time. -6- Teaching opportunities exist in the form of alternate Friday morning tutorials and small group discussions and various other meetings throughout the week including radiology teaching, morbidity and mortality meetings, journal clubs and access to anaesthetic department teaching programs. Monthly audit meeting are held with the department of anaesthesia. Research We are developing an active research program within Critical Care at Hull and East Yorkshire Hospitals NHS trust. We have received significant support from the North East Yorkshire and North Lincolnshire Comprehensive Reasearch Network (CLRN) to enable us to appoint 2.3 WTE research nurses which has made it possible to become involved with numerous national studies including RAIN, FIRE, GAINS, Eurotherm, Spotlight, Promise and Harp II and several others in the near future. Castle Hill Hospital, Cottingham Castle Hill Hospital contains a 10 bedded general ICU (Mixed Level 2 and 3) which admits around 520 patients annually. This is mainly in support of elective colorectal and upper GI surgery but also includes emergency work from cardiology, general medicine and Haematology and Oncology. This is staffed by the same group of Intensivists and supported by a rota of FY2 and CT1/2 doctors. The Cardiothoracic Intensive Care Unit is also on the CHH site and admits approximately 700-800 patients annually following cardiac procedures. The units deal with all aspects of cardiothoracic surgery except transplantation. York Hospital General Description Critical Care Services at York Hospital consist of a new 17-bed unit (9 ICU / 8 HDU beds) used flexibly according to caseload. The unit is managed by a team of 8 consultants; Dr Redman (Lead Clinician for Critical care), Dr Priestley, Dr Paw, Dr Urwin, Dr Stone (Faculty Tutor), Dr Pretorius, Dr Wasawo & Dr Yates, with an additional 2 consultants providing on-call cover. There is also a well-developed critical care outreach service providing twenty-four hour support for ‘at risk’ patients throughout the hospital. This is nurse-led with critical care medical support. There are currently seven critical care consultants providing 'week-at-a-time' daytime cover and ten consultants on a rota providing exclusive out of hours cover to critical care. The consultants are supported by core trainees, specialty registrars and Dual CCT trainees, on two shift rotas. The combined unit has nearly 800 admissions per year (over 300 at Level 3) and offers the full range of non-tertiary treatment, including full renal support, with an additional workload from the North Yorkshire centralisation of maxillo-facial surgery, vascular surgery and renal medicine on the York site. On-unit ultrasound and echocardiography is provided by the critical care team. There is an active programme of weekly critical care tutorials and participation in these would be expected. -7- Research There is an active research programme and York has gained an international reputation for research into preoperative optimisation. Other current research includes work into comparing monitoring modalities for optimisation, and into the effect of the introduction of critical care outreach into the hospital. There is also a rapidly developing interest in CPX testing. Furthermore York participates in multicentre trials such as OSCAR, Optimise and FIRE. The General Infirmary at Leeds General Description There are currently 42 intensive care beds at the General Infirmary, opened in purpose built accommodation in 1997. These are distributed in four adult units (8 general, 14 cardiothoracic, 7 neurosurgical) and a 13 bedded paediatric facility (8 general, 5 cardiothoracic). In addition there is a 6 bedded Orthoplastics High Dependency Unit and a 6 bedded Neurosurgical High Dependancy Unit, both of which are managed independently. A Critical Care Outreach Service was established in 2002 and there is a monthly follow-up clinic. The General Intensive Care Unit admits approximately 700 patients per year. There is a varied casemix provided by a regional interventional cardiology service, a regional vascular unit and a developing regional trauma service. The unit is managed by a team of six consultants: Dr Bodenham (Clinical Director), Dr Bell (Faculty Tutor), Dr Pittard (Regional Advisor), Dr Mallick, Dr Howard (Training Programme Director ICM) and Dr Jackson (Royal College Anaesthetists College Tutor). Senior specialty registrars (1) and specialty registrars (5) from anaesthesia and specialty registrars (1) from respiratory medicine rotate through the unit in 3 month blocks. Trainees from other specialties are accommodated on an individual needs basis. 24 hour dedicated cover is provided by a consultant and resident specialty registrar. Medical students are regularly attached to the unit as part of their undergraduate curriculum. The Cardiothoracic Intensive Care Units admit approximately 1500 patients annually following cardiac procedures. The units deal with all aspects of cardiothoracic surgery except transplantation. The Paediatric Intensive Care Unit (Director - Dr Mark Darowski) admits approximately 400 children annually. Children are admitted with the whole range of medical and surgical paediatric intensive care problems. A large number of regional referrals are received and the unit offers a consultant led retrieval service with a specially equipped ambulance for this purpose. Teaching A weekly teaching programme is organised by the department of anaesthesia and a critical care core topic programme occurs every Tuesday afternoon. Informal teaching on the intensive care unit occurs during delivery of care. -8- Research All Intensive care units have ongoing research projects and interests. These include:- New forms of percutaneous tracheostomy devices and techniques for optimal airway management, including long term follow-up Brain injury (trauma and cardiac surgery): N-methyl D-aspartate (NMDA) channel blockers, 21-aminosteroids, jugular bulb oximetry, multimodality monitoring Ultrasound scanning Various multi-centre pharmaceutical studies coordinated by a full time senior research nurse Audit Monthly audit meetings are organised by the department of anaesthesia. The unit participates in the ICNARC programme. There are a number of audit projects in progress at any one time including an annual audit of the effectiveness of outreach and psychological impact of ICU focusing on the follow-up clinic. St James’s University Hospital General Description The intensive care unit was opened in purpose built accommodation in late 1994. It currently has 14 staffed beds and admits approximately 1000 patients per year. There is a Surgical High Dependency Unit which admits 900 patients per year and this is part of the Critical Care Service at St James’s Hospital. There is also an established Outreach service. In addition there are separate Orthoplastic, Hepatobiliary, and Renal High Dependency Units, a Coronary Care Unit, a Bone Marrow Transplant Unit and Neonatal Unit. There is a separate Paediatric ICU. As part of the reconfiguration of health services in Leeds a new Oncology wing was built on the St James’s site. This houses, amongst other things, a critical care facility. The Adult General Intensive Care Unit admits a wide range of patients of all ages with the exception of post-operative cardiac and neurosurgical cases. In addition to general medical and surgical intensive care patients, a regional service is provided for the management of renal failure including renal transplantation and oncology, haematology and bone marrow transplantation. A supraregional service is provided for hepatobiliary surgery, liver failure, liver and multivisceral transplantation, liver trauma, and malignant hyperpyrexia. A large number of (countrywide) referrals are also received for the management of patients with acute lung injury. -9- The unit is managed by a team of nine consultants, Dr Murdoch (Clinical Director), Dr Dean, Dr Cohen, Dr Bellamy, Dr Snook (Faculty/College Tutor), Dr Duncan, Dr Breen and Dr Jankovic. Senior specialty registrars (1-2) and specialty registrars (2) from anaesthesia and CT’s from surgery (2) are attached to the unit for training blocks and there are also six full time intensive care trainees. Throughout each 24 hour period, dedicated staffing is provided by a Consultant, and two resident trainees. There are regular weekly formal tutorials (based on the ICM core curriculum and competency based training) and monthly audit meetings; joint mortality and morbidity conferences are held regularly with the department of anaesthesia. Research There is an extensive research programme, and in addition to the staffing above, two research fellows are currently in post to coordinate ongoing international trials. Areas of research interest include:- nutrition infection control severe sepsis acute lung injury morphology and immune function of the gut in SIRS hepatosplanchnic blood flow acute liver failure / hepatic encephalopathy / artificial liver support devices -10- The Training Programme Objectives To establish a position in the base hospital Fill deficits in training outside the parent discipline Establish a programme of research to be continued throughout the post. To amalgamate the skills of the parent discipline with intermediate training in Intensive Care Medicine To complete advanced training in Intensive Care Medicine by bringing together - the specific skills of specialist training in Intensive Care Medicine - training in management - training in research methods and evidence based medicine - training in audit and severity scoring - training in ethics To acquire the FFICM examination Plan This will depend upon the previous experience and background of the individual. Training will be tailored to individual needs within the requirements of the Intercollegiate Board for Training in Intensive Care Medicine and the parent specialty College. The following outline is a guide only. Applicants must be familiar with the recommendations of the Intercollegiate Board for Training in Intensive Care Medicine. Competence in basic computing skills is assumed. Training in specific applications will be provided. At this stage in training, considerable self directed learning is needed to upgrade the knowledge and practical experience already gained, and to develop special areas of competence. The latter will usually be driven by a research interest. 1. To spend an initial two month block at one site to establish research to be undertaken throughout the training programme. 2. To spend ten months improving knowledge of other specialities and learning identified skills by attachments in the areas listed below, with the agreement of the programme mentor. Areas of specialist ICM exposure Renal Medicine / transplantation Cardiology / cardiothoracic Neurology and Neurosurgery Respiratory Medicine / Noninvasive ventilation Hepatology / intestinal failure / transplantation Trauma Paediatrics Obstetrics and Neonatolgy Burns (Wakefield by secondment) -11- Management Training in this area includes business planning budgeting and simple accountancy staffing, managing conflict, negotiation NHS and Trust structures including involvement with the relevant Critical Care Network networking, time management, managing meetings Additional Experience Training blocks can also be arranged in other areas in order to learn particular skills according to the needs of the individual . These might include radiology, microbiology, biochemistry, haematology and gastroenterology . SPECIAL NOTE At the end of this training the appointee will return to their own specialty training post in order to obtain specialist status in their base discipline. It is essential that the applicant ensures that their current employer is agreeable to this arrangement. A Joint CCT in Intensive Care Medicine will only be awarded with a CCT from the parent specialty.
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