JOB DESCRIPTION by MfT85YYG

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YORKSHIRE AND THE HUMBER
 POSTGRADUATE DEANERY



   POST AND PROGRAMME
       INFORMATION



JOINT CCT SPECIALTY TRAINEE

             in


 INTENSIVE CARE MEDICINE
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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.
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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
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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.
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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.
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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.
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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.
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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.
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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
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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)
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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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