BSUH Postgraduate Medical Training Prospectus 2018-19

Postgraduate Medical Training Prospectus 2018-19 1

2

CONTENT

Content ................................................ 3 Welcome .............................................. 4 Location................................................ 6 The Trust ............................................. 7 Facilities and Resources ................... 8 3T’s Hospital Redevelopment ......... 10

Foundation Programme .......... 12 Core Medical Programmes Acute Care Common Stem (ACCS) .. 14 Core Medical Training (CMT) ............ 16 Core Surgery ...................................... 18 GP Vocational Training Scheme ...... 20

Higher Specialty Programmes Acute Medicine ................................. 22 Anaesthetics ..................................... 24 Cardiac Surgery ................................ 26 Cardiology ......................................... 28 Dermatology....................................... 30 Emergency Medicine ......................... 32 Endocrinology ................................... 34 Gastroenterology ............................... 36

General Surgery ................................. 38 Genito-urinary Medicine .................... 40 Haematology ...................................... 42 Histopathology................................... 44 Intensive Care Medicine ................... 46 Microbiology/Infectious Diseases ... 48 Neonatology ...................................... 50 Neurology .......................................... 52 Neurosurgery ..................................... 54 Nuclear Medicine ............................... 56 Obstetrics and Gynaecology ........... 58 Oncology ........................................... 60 Ophthalmology .................................. 62 Orthopaedics ..................................... 64 Otorhinolaryngology ......................... 66 Paediatric Surgery ............................. 68 Paediatrics ......................................... 70 Radiology ........................................... 72 Renal Medicine................................... 74 Respiratory Medicine ........................ 76 Rheumatology .................................... 78 Urology ............................................... 80 Vascular Surgery ............................... 82

Disclaimer: BSUH has made every effort to ensure that the information in the prospectus is both helpful and accurate at the date of publication. However the information is subject to change over time, so please check our webpage or contact us for updates.

Thank you to all trainees and staff, who helped us with their profiles and photographs.

3

WELCOME Dear Trainee Colleague, Welcome to the Brighton and Sussex University Hospitals NHS Trust, the largest University Teaching Hospitals group in Kent, Surrey and Sussex. We provide high quality medical education for medical students, junior doctors and many other healthcare professionals.

Health Education England, South Thames Foundation School, as well as our local universities.

Our expertise in a wide variety of specialties makes BSUH an excellent and exciting place for postgraduate training; our services span the entire spectrum from standard DGH services to Regional specialities. Our services spread over different hospitals including the Princess Royal Hospital and the Royal Alexandra Children’s Hospital.

I am looking forward to welcoming you warmly to our community and would like to wish you every success in the future.

We foster an ethos of multi-disciplinary learning which sets the tone for high quality patient care.

Over one million patients come through our doors per year and you will see a broad range of interesting cases. With the 3T’s (Teaching, Trauma, Tertiary Care) development underway, the Royal Sussex County Hospital in Brighton is well on its way to becoming an established Major Trauma Centre, offering our trainees unique experiences and development opportunities.

We also have thriving Simulation, Human Factors and Leadership training programmes.

Mr. Varadarajan Kalidasan Consultant Paediatric Surgeon and Urologist Director of Education and Knowledge

Central to our ambition is our role as an academic centre, a provider of high quality teaching, and a host hospital for cutting edge research and innovation. On this we work with our partners, Brighton and Sussex Medical School,

4

WELCOME Dear Trainees, BSUH Hospitals are in easy reach of London with frequent trains going to London Bridge and Victoria stations. A free bus service runs hourly between the hospitals in Brighton and Haywards Heath enabling you, whatever site you are based, to enjoy a wide range of recreational facilities.

Welcome to the Brighton and Sussex University Hospitals NHS Trust. Every year over 700 junior doctors train with us and contribute to patient care in our hospitals as well as the communities in Brighton, Hove and Mid-Sussex.

Training at our Trust is varied and includes face to face teaching, bedside teaching, formal and informal teaching, as well as elements of simulated training and e-learning . A multitude of courses and training materials are available on IRIS, the Trust internal e-learning portal.

BSUH offers amazing opportunities for personal and professional development and I trust that you will enjoy a happy and fulfilling career with us.

Our library and Knowledge service provides access to the most up-to-date, evidence based information to help staff make the best decisions for our patients.

As a trainee, your feedback is invaluable for us in our continuous drive to improve our service. The Medical Education Department organises regular feedback sessions with our trainees and I want to encourage you to participate in them.

Nora Tester Medical Education Manager

BSUH is a great place to work and Sussex is a great place to live . We are very fortunate in that both Haywards Heath and Brighton enjoy close proximity to the beautiful countryside of the South Downs.

Haywards Heath and the surrounding countryside has a wide variety of pubs and restaurants. Brighton offers an eclectic mix of entertainment, including theatres, festivals and clubs as well as an extensive range of bars, pubs and restaurants.

5

LOCATION The Royal Sussex County Hospital, Brighton

The Princess Royal Hospital Haywards Heath

6

THE TRUST Brighton and Sussex University Hospitals (BSUH) is an acute teaching hospital working across two sites: the Royal Sussex County Hospital (RSCH) in Brighton and the Princess Royal Hospital (PRH) in Haywards Heath.

tology, respiratory medicine and elderly medicine from the site.

Hurstwood Park houses the trusts neurology department, providing a full range of services for patients suffering disorders of the brain and nervous system. Specialty services include Neurophysiology, Neurology Research and Neuropsychology services. The clinical neurophysiology service at BSUH provides inpatient and outpatient diagnostic investigations for patients of all ages.

Both hospitals provide many of the same acute services for their local populations.

In addition, the Princess Royal is our centre for elective surgery and the Royal Sussex County Hospital is our centre for emergency and tertiary care. Our specialised and tertiary services include neurosciences, arterial vascular surgery, neonatal, paediatrics, cardiac, cancer, renal, infectious diseases and HIV medicine.

We are also the major trauma centre for Sussex and the South East.

The Royal Alexandra Children’s Hospital (RACH) is located within the grounds of the Royal Sussex County Hospital in Brighton. It provides outpatient services, inpatient facilities, intensive care and a 24 -hour emergency care service for children referred by GPs and other specialists.

The Clinical Investigation and Research Unit (CIRU) is one of the country’s 19 NIHR funded Clinical Research Facilities and base of the trust’s clinical research activities. In partnership with the Brighton & Sussex Medical School, the University of Sussex and the University of Brighton our staff have developed an experimental medicine portfolio that involves clinical trials, translational research as well as genetic-, behavioural -, physiological - and prevention studies. Our research is delivered across a wide variety of specialities, including cardiology, cancer, digestive diseases, HIV and sexual health, immunology, neurology, ophthalmology, paediatrics and neonatology, rheumatology, surgery and trauma.

The Sussex Eye Hospital (SEH) provides a comprehensive ophthalmology service in Brighton, with satellite clinics held at the PRH in Haywards Heath. Ophthalmic surgery is performed at PRH (cataracts) and SEH (all ophthalmic surgery including cataracts).

The Brighton General Hospital (BGH) is the headquarters of South Downs Health NHS Trust and home to more than 100 departments and services, more than 1,100 staff from three different NHS trusts. It is visited on average by more than 550 patients a day. BSUH operate some clinical services, including derma-

7

FACILTIES AND RESOURCES Library and Knowledge Service The Library and Knowledge Service provides access to a range of online resources and exam preparation tools, as well as articles, books, and evidence searches on request. Trainees are encouraged to subscribe to KnowledgeShare, a service designed to keep users up to date with the latest evidence.

Trainees have access to point-of-care information tools such as UpToDate and can use many of our online resources with the NHS OpenAthens account for Brighton and Sussex University Hospitals NHS Trust.

The Sakula Collection was gifted to Brighton and Sussex Medical School by the family of Dr Alex Sakula and comprises approximately 400 books and pamphlets. Subjects covered include the history of medicine, pioneers of medicine and some specialist subjects such as infectious diseases. The collection is available on a reference only basis and is located in the “Senior Common Room� at the Audrey Emerton Building

For more information or to join the library, please see our www.bsuh.nhs.uk/library The Library The Audrey Emerton Building Royal Sussex County Hospital Eastern Road, Brighton East Sussex BN2 5BE Tel: 01273 523300 The Library Princess Royal Hospital Lewes Road, Haywards Heath West Sussex RH16 4EX Tel: 01444 441881 x5463 The Library, Sussex Education Centre Mill View Hospital Nevill Avenue, Hove East Sussex BN3 7HZ Tel: 01273 265897

8

FACILTIES AND RESOURCES Simulation Simulation training in the health care sector is now an essential teaching tool grown out of the need to provide safe, realistic and repeated practice for clinical staff at all levels.

Its evolution over recent years means that it now encompasses a wide spectrum of both delivery methods and modes ranging from high fidelity simulation suites and virtual on line environments to ‘low tech’ clinically based delivery systems that offer training to single or multiple users within or across healthcare disciplines.

Neonatologist) as the Deputy Faculty Lead, who work closely with clinical and educational staff to drive forward simulation and human factors activities across both sites.

BSUH has a dedicated Local Faculty Group (LFG) of Simulation and Human Factors. The LFG is led by Dr Amit Mishra (Consultant Anaesthetist) as the Faculty Lead and Dr Cassie Lawn (Consultant

The Trust maintains three Sim Suites, the David Read Simulation Suite, the Hurstwood Park Simulation Centre and the KSS Children’s Simulation Centre.

9

3T’s HOSPITAL REDEVELOPMENT

The 3T’s: Teaching, Trauma, Tertiary Care hospital redevelopment programme started in January 2016 and will, through an investment of GBP 486 million, improve a wide range of health services at the Royal Sussex County Hospital.

py, Chemotherapy, Diagnostic Imaging and Nuclear Medicine (X-ray, CT and MRI), Clinical Infections Service (including HIV), ENT and Rheumatology. The project will also improve way-finding and logistics across the hospital site. Some of the most significant improvements will include:

The programme will, over a ten year period, replace all of the buildings along the front of the hospital site with two new state-of-the-art facilities that will bring key emergency and specialist services together on the site.

Teaching BSUH is an acute teaching hospital trust, playing a key role in the training and development of students and staff across all areas of healthcare.

Overall, the 3Ts project will offer improved services to patients in the following areas: Elderly Care, General Medicine, Neurosciences, Major Trauma, Critical/Intensive Care, Cancer, Haematology, Radiothera-

The 3Ts project will develop teaching and research facilities, including a new Centre for Innovative Therapies, which will be developed with the Brighton and Sussex Medical School, as well as a Simulation

10

3T’s HOSPITAL REDEVELOPMENT Training Suite. These facilities will support leading edge research, education and training for health professionals.

Trauma RSCH is the region’s Major Trauma Centre. The redevelopment will provide purpose built facilities to enhance trauma care. This includes a helideck which is being built on the Thomas Kemp Tower and will open early in 2018.

Neurosciences All aspects of neurosurgery and neurology services will move into purpose built facilities in the first of the redevelopment’s new buildings.

Inpatient Accommodation The 3Ts project is already improving ward accommodation for patients. The wards from the Jubilee Building, which opened in 1887, have moved to the brand new Courtyard Building to make space for Stage 1 of the redevelopment. The facilities on offer in this temporary location far outstrip those available in the Jubilee Building. In total 200 beds will move from the Barry and Jubilee Buildings to Stage 1 of the Redevelopment when it opens.

There will be twice as many beds and an additional neurosurgical theatre that will focus on emergency care. The redevelopment will co-locate elements of the Neuroscience Service with the Major Trauma Centre, general ITU and Stroke Unit facilities, in line with best practice.

Cancer The Sussex Cancer Centre will be moved into Stage 2 of the redevelopment. The improvements to the Centre will include the expansion of the Chemotherapy Day Unit, the introduction of more linear accelerators for radiotherapy and doubling the number of beds for cancer patients.

The beds will go from being managed in approximately 7,000m2 of space to 34,000m2 of space, with all the improvements in privacy, dignity and care that a modern hospital facility can offer.

11

FOUNDATION PROGRAMME The Foundation Programme is the general training programme leading from medical school to specialist- or general practice training. The programme covers the first two years of clinical practice and primarily teaches generic skills needed by all doctors in any area of practice. The central theme of the curriculum is achieving competence through clinical practice and therefore most learning is grounded in the clinical setting. The Brighton and Sussex University Hospital NHS Trust (BSUH) is part of the South Thames Foundation School (STFS).

nal Medicine, Respiratory Medicine, Trauma and Orthopaedic Surgery, Urology.

Most posts are based in the acute setting with the exception of General Psychiatry , GP, Community Paediatrics and Palliative Care which are community based and part of the remit of Sussex Partnership NHS Foundation Trust.

There are regular teaching sessions arranged by the Foundation faculty, covering a wide range of topics including Key Clinical Information, Managing Clinical Emergencies, Prescribing, Thromboembolism, Infection Control, Palliative Care, Careers Advice and Stress Management.

At BSUH, trainees rotate through a set of three training placements in F1 year and three in their F2 year, each of which is four months in duration. In addition to acquiring professional skills such as teamwork, communication, and learning to prioritise tasks, trainees cover the foundation learning curriculum.

Each post encompasses a range of opportunities from learning new clinical skills to clerking patients and presenting on ward rounds. Supervised Learning Events (SLEs) and reflective practice are used to maximize the learning experience from clinical episodes. Trainees are part of a multidisciplinary team and work alongside allied healthcare professionals.

Placements at BSUH cover a range of specialties including Acute Medicine, Anaesthetics, Cardiology, Emergency Medicine, Endocrinology and Diabetes Mellitus, Gastroenterology, General Medicine, Psychiatry, Surgery, Genitourinary Medicine, Geriatric Medicine, Haematology, Infectious Diseases, Medical Oncology, Obstetrics and Gynaecology, Otolaryngology, Paediatrics, Palliative Medicine, Re12

FOUNDATION PROGRAMME A minimum of 70% attendance at teaching sessions is required to be signed off at the end of year. Most departments also provide teaching sessions covering more specialist topics. In addition, Foundation trainees do further training courses such as ILS, ALS and Simulation training.

trainee must demonstrate that they have met the standards of competence set out in the Foundation Programme Curriculum.

The main additional learning priorities for F2 Doctors should be:  decision making through communication with patients  team-working and communicating with colleagues  understanding consent and explaining side effects and risk  managing risk and complaints and learning from them  being aware of ethics and law as part of clinical practice  using evidence in the best interest of their patients  understanding how appraisal works to promote lifelong learning and professional development  taking responsibility for the future of medical care in the UK by teaching others effectively

Foundation trainees have many other opportunities off the wards to take part in extra activities such as teaching medical students, or undertaking audits. They are encouraged to arrange taster sessions in a specialty that they are considering for their future career and training. F1s can do this during their last rotation by borrowing study leave from their F2 year. F2 trainees are not restricted to arranging ‘Tasters’ within this Trust.

The main learning priorities for F1 Doctors should be:  diagnostic reasoning, problem solving, and clinical decision making  effective time management, prioritisation and organisational skills  clinical accountability, governance and risk management  safe prescribing in clinical practice  the frameworks needed to ensure patient safety  legal responsibilities in ensuring safe patient care  the recognition of diversity and cultural competence

Foundation Year 2 (F2) The second year of the Foundation Programme builds on the first year of training and focusses on the assessment and management of acutely ill patients.

There are no required procedures for F2.

The core procedures from F1 do not need to be repeated in F2, but evidence of the F1 sign off is required for successful completion of the Foundation Programme.

Foundation Year 1 (F1) The first year of the Foundation Programme builds on knowledge, skills and competences developed in undergraduate training. The learning objectives for this year are set by the General Medical Council and at the end of the year each

It should also be recognised that with practice, the doctor will be expected to achieve and demonstrate continuing improvement of skills within the programme’s spiral curriculum framework.

13

ACUTE CARE COMMON STEM Acute Care Common Stem is a two-year programme which covers the acute specialties of anaesthesia, acute medicine (general internal), emergency medicine and intensive care medicine. The ACCS programme is an alternative route into anaesthesia and acute medicine instead of core anaesthesia or core medicine training and the only route to enter training in emergency medicine.

The two-year training programme is broken down into four component parts.

Trainees complete six months in emergency medicine, acute medicine, anaesthesia and intensive care medicine. The anaesthesia training in ACCS is identical to the first six months of training core anaesthesia trainees receive.

PROGRAMME DESIGN The ACCS programme is designed to reflect acute care clinical practice and focusses on the following areas for 18 of the 24 months:  Major presentations of patients with a core symptom who will need resuscitation;  Acute presentations of patients with a core general symptom who are seen in either the Emergency Department, the Intensive Care Unit, the Acute Medical Ward and those areas where anaesthetics are administered;  Airway management (training completed in the anaesthesia component of the programme).

14

ACUTE CARE COMMON STEM All trainees must pass the initial assessment of competence in their anaesthesia placement. On completion of the two years ACCS programme, trainees return to their parent specialty for a third year, to meet the entry requirements detailed for Higher Specialty Training.

care professionals such as psychiatry, ancillary services, GPs and ENPs. The ACCS curriculum is delivered through trainee led, weekly teaching sessions and the Acute Medicine teaching. Weekly Grand Round lectures at the RSCH and monthly Grand Rounds at the PRH complement the teaching programme.

BSUH trainees will be based in the Emergency Departments of both hospitals, the Royal Sussex County Hospital (RSCH) and the Princess Royal Hospital (PRH). CT1 ACCS trainees will also rotate to Medical Wards and the Medical Assessment Ward in both hospitals.

EXAMS AND ASSESSMENTS The ACCS Committee expects that you will have passed the first part of your chosen specialty exam by the end of the two years in ACCS i.e. MCEM Part A, MRCP Part 1, FRCA Primary MCQ. It would be advisable to attempt the MCEM and MRCP during your time in these specialties to help preparing

The first six months ACCS trainees will spend in the Emergency Department, where their training will be similar to that of non-ACCS trainees, but with a higher proportion of critical care patients. The more acute aspect of emergency work can be experienced in the resuscitation room and during their time in the Medical Assessment Unit, trainees will see and assess GP admissions and regularly undertake ward rounds with the Acute Assessment Medical team.

The ARCP assessment is e-portfolio based and trainees are expected to gather and log evidence of their learning to record their progress. The assessment tools are DOPS, Mini-CEX, CbD, MSF, ACAT, Interim Appraisal Forms and end of year Structured Training Report.

The training period in Respiratory Medicine will give a broader picture of life behind the acute floor, with insight into clinics and ward rounds and interaction with other medical specialties. The CT2 year consists of nine months Anaesthetics and three months Intensive Care.

In order to assist with documenting learning, trainees are issued with a logbook for 100 cases and 10 procedures to describe the spread of cases they have seen and explain the specific learning points they took away.

10 random sets of notes are usually reviewed with the trainee, in order to gain an overview into current practice and also to form the basis of Case Based Discussions (CbDs) in individual patients.

There is a huge range of cases to be seen in the Emergency Department, making it uniquely valuable in training for all hospital specialties as well as General Practice.

Trainees also benefit from the opportunity to work with a wide range of other health

15

CORE MEDICAL TRAINING Core Medical Training forms the first stage of specialty training, following completion of the Foundation Programme. It prepares trainees for participation in the acute medical take at a senior level as well as the management of patients with acute and chronic medical problems in outpatient and inpatient settings.

CMT is a two year, broad based training programme and at Brighton and Sussex University Hospital Trust (BSUH) it consists of posts in specialities including Oncology, Cardiology, HIV Medicine, Infectious Diseases, Endocrinology, Respiratory Medicine, Gastroenterology, Geriatrics, Stroke Medicine, Dermatology.

Each post is four months in duration and most include direct involvement in the acute medical take, providing the building blocks for all the physician specialties, particularly in preparing doctors for the demanding role of Medical Registrar.

Core Medical Trainees follow a spiral curriculum consisting of curriculum elements from General Internal Medicine (GIM) and Acute Internal Medicine (AIM). Topics are revisited with increasing levels of difficulty, new learning is related to previous learning and the competence of the trainee increases.

Trainees must complete CMT and acquire the full MRCP (UK) Diploma in order to enter specialty training at ST3.

The CMT programme accepts transferable competences from Acute Care Common Stem (ACCS) Anaesthesia, ACCS Emergency Medicine and ACCS Intensive Care Medicine.

16

CORE MEDICAL TRAINING Features of the CMT programme: Trainee led: the e-portfolio is designed to encourage a learner centred approach with the support of Educational Supervisors. It contains tools to identify educational needs, enables the setting of learning goals, reflective learning and personal development.

Competency based: the curriculum outlines the competencies that trainees must reach by the end of the programme.

The curriculum is directly linked to the eportfolio as it defines standards required for good medical practice and formal assessments including the MRCP(UK) for Core Medical Training.

Continuation of Good Medical practice: building on Foundation training the curriculum contains important emphasis on generic competencies necessary for practice as a physician.

Supervision: each trainee has a series of people with clearly defined roles and responsibilities overseeing their training including Clinical Supervisor, Educational Supervisor, College Tutor, CMT Programme Director, and Head of School.

Appraisal meetings with Supervisor: regular appraisal meetings and review of competence progression are mandatory and set out in the ePortfolio.

These include the Acute Care Assessment Tool (ACAT), Case Based Discussion (CbD), mini-Clinical Evaluation Exercise (mini-CEX) and Multisource Feedback (MSF) with additional methods to assess Audit (AA) and Teaching (TO).

Workplace-based assessments: regular workplace-based assessments (also known as Supervised Learning Events) are conducted throughout training, building on those used in the Foundation programme with an annual ARCP.

MRCP(UK) examination: the various parts of the MRCP(UK) have been mapped to the curriculum for CMT, providing a knowledge base assessment for CMT.

17

CORE SURGICAL TRAINING Core Surgical training is the general training programme leading from the Foundation Programme to specialist surgical training and allows trainees to try and experience certain specialities.

Core Surgical training usually takes two years and prepares doctors for ST3 selection. The training at Brighton and Sussex University Hospital NHS Trust (BSUH) will prepare junior doctors for the MRCS examinations part A and part B and help them expand their portfolio, take part in audits, research presentations and publications.

Within the early years of training and prior to entry into ST3, much of the content is shared across all the surgical specialties.

During this period, trainees will acquire the competences that are common to all surgical trainees (defined as common competences) together with a limited range of competences that are relevant to their chosen surgical specialty.

At BSUH core surgical training covers trauma and orthopaedics, urology, otolaryngology, hepatobiliary surgery, colorectal surgery, upper GI surgery, paediatric surgery and maxillofacial surgery.

Year 1 rotations cover three posts and include either general surgery coupled with two posts in trauma and orthopaedics, or paediatric surgery coupled with two posts in otolaryngology.

Year 2 rotations cover two six-months posts and include general surgery combined with paediatric surgery, trauma and orthopaedics with plastic surgery (in East Grinstead), or two six months posts in ei-

ther general surgery, trauma and orthopaedics or urology. The majority of posts are a year in one specialty.

18

CORE SURGICAL TRAINING Advanced Trauma Support (ATLS )

and

Life

is a multidisciplinary course held at the Royal Sussex County Hospital twice yearly and open to all doctors at Foundation level 2 and above.

The course teaches a simple, systematic approach to the management of trauma patients through interactive tutorials, skills teaching and simulated patient management scenarios. ATLS is widely accepted as the standard of care for initial assessment and treatment of patients in trauma centres.

Fresh animal tissue is used during the course (cow/sheep/pig), all classed as grade A type tissue. Please note that places are not allocated on a first come first served basis.

Critically (CCrISP)

Ill

Surgical

Teaching The Surgical Faculty at BSUH runs five core surgical training days per year, of which two are teaching days and three are simulation days.

Patients

The course will be held twice yearly and is open to doctors at Core Surgical level and above.

On the three simulations days we provide an opportunity to practice basic surgical skills using animal tissue and specially made models. On the teaching days there will be simulated scenarios.

It is designed to develop skills that are necessary in the management of critically ill patients, integrating practical skills and knowledge, as well as communication and leadership.

In addition to bedside teaching, teaching at MDTs, seminars and journal clubs, the trust offers training in basic surgical skills, Care of the Critically Ill Surgical Patients CCrISP) Courses, and Advanced Trauma and Life Support (ATLS) courses.

Participants learn to assess critically ill patients accurately and, supported by experienced faculty, develop action plans to achieve clinical progress.

19

GP VOCATIONAL TRAINING SCHEME The GP training is spread across two schemes in this area, the Brighton scheme and the Mid Sussex scheme.

During ST1 and ST2 trainees from both schemes undertake 4-monthly posts in both, Brighton and Haywards Heath hospitals as well as surgeries in the surrounding communities.

trainee’s ST1 GP post. This 12-month placement enables trainees to become part of a team and gain the necessary insight and skills for qualification. Trainees have the opportunity to extend the ST3 year to build expertise in research, education or commissioning.

VTS teaching is half a day per week followed by a half day of private study, and is spread across three 10-week terms. It is held within the allocated scheme, either Brighton or Mid Sussex, and both have consistently received positive feedback on the quality of teaching and support from the Programme Directors.

One of the ST1 posts is General Practice, with the opportunity to apply for an ITP (Integrated Training Post), spending part of the week in another speciality e.g.

Palliative Care or Dermatology. The remaining posts may include a mix of A&E, Medicine, Paediatrics, Gynaecology, Psychiatry, Orthopaedics, ENT, Sexual Health and HIV medicine. The entire ST3 year is spent at a GP training practice, which will be a different surgery to the

The mornings are normally split into two sessions, group discussions and updates from the Programme Directors, followed

20

GP VOCATIONAL TRAINING SCHEME by a talk from speakers covering many topics including Diabetes, Respiratory and Neurology. Teaching is mandatory whilst in a GP post but trainees in hospital posts are always welcome to come whenever they are granted study leave. There is a joint residential biannually, covering practical topics such as resilience and job applications, and providing a fun opportunity to get to know each other.

Each scheme also has their own GP Faculty Administrator who is there to assist them throughout their time in VTS.

WHAT OUR TRAINEES SAY Dr Sara Bradford I have felt well supported during my training, in particular towards the CSA exam and life after VTS. We are always encouraged to provide feedback and I have appreciated the opportunity to help shape GP training, both informally and as trainee representative for my cohort.

Communication and support is an essential part of VTS. Every trainee will be allocated an Educational Supervisor, who will be a GP Trainer and the trainer they work alongside in ST3. They will also be assigned a Clinical Supervisor for each 4 month rotation to support them during their time in that specialty.

Each year group, in both Brighton and Mid Sussex schemes, has one or two trainee representatives that attend meetings on the trainee’s behalf. They raise issues at Local Faculty Group meetings which are held three times a year. They also arrange socials, normally in a Brighton pub, where trainees from all years and both schemes have a chance to meet up in an informal environment.

I have valued having a generous study leave allocation and budget, which has enabled me to tailor my learning towards my own needs. I’ve used this to develop interests in Palliative Care, Family Planning and Medical Acupuncture, which will enable me to have a more varied career in General Practice.

I have gained a wealth of experience through serving the diverse socioeconomic populations across inner city Brighton and rural Sussex over a wide variety of specialties.

The Trust also operates a ‘buddy’ scheme where each trainee is linked up to another GP trainee in the year above, who can be contacted for advice and support.

There is always plenty to do and see within Brighton, and having the coast, South Downs and London on your doorstep means there is something for everyone. I enjoyed my time here and highly recommend this area for GP training.

Trainees also receive monthly newsletters that discuss issues including teaching, up and coming courses and VTS dates.

Brighton and Mid Sussex have their own websites with relevant information, news and contact details.

21

ACUTE MEDICINE The Acute Medical Department provides a high quality rapid acute medical assessment service to an urban and rural population of around 250,000 within Brighton and Hove as well as the surrounding areas.

and semi-elective procedures and investigations whilst also offering a space for ambulant medical patients to be assessed and managed.

The Acute Medical team provides an 8am until 8pm consultant led service seven days a week at the RSCH and a 5 day service at the PRH.

The department operates across two sites- the Royal Sussex County Hospital (RSCH) in Brighton and the Princess Royal Hospital (PRH) in Haywards Heath. The Acute medical team works closely with GPs and the hospitals’ A&E department’s to review and manage patients with acute medical problems.

The team consists of 11 consultants, one specialist registrar, one ACCS, one CMT and three foundation doctors at the RSCH. PRH is covered by the acute medical consultants along with one registrar and the on call team.

The department at RSCH incorporates an acute medical unit and ambulatory care unit and PRH has a rapid access medical unit. Both sites can also therefore offer a service for planned elective

Teaching The Acute Medical Team runs an active educational programme for all trainees, including a weekly ‘hot cases’ meeting

22

ACUTE MEDICINE and a monthly clinical governance meeting as well as daily bedside teaching.

Trainees are also encouraged to attend the weekly medical Grand Rounds as well as their own weekly Foundation and Core Medical teaching.

skills, including thoracic ultrasound, echo, stroke thrombolysis, practical procedures such as ascitic and pleural drains and the running of ambulatory and rapid access clinics.

Research Trainees are encouraged to take part in audit, quality and service improvement projects as well as patient experience initiatives. Research results should be presented at departmental meetings as well as events and conferences.

The unit runs daily AMU Review Clinics, Weekly Rapid Access Infectious Diseases Clinics, VTE clinics and there are twice weekly clinics specifically for ascitic and pleural procedures. The ambulatory care unit also provides a temporal artery biopsy service.

The department has strong links with Brighton and Sussex Medical School and is currently involved in several research projects alongside the emergency department at both sites.

The department has a strong team ethos with close working between the other specialities. This setting stimulates the development of a variety of specialist

tor 4th year medical students and was involved with OSCE revision and examinations, as well as teaching PACES.

WHAT OUR TRAINEES SAY Dr Gareth Watts I started my training as an ST3 in Brighton not only because of its great location, but because it offered a wide range of interesting opportunities for acute internal medical training.

The hospital is currently undergoing a big redevelopment and trainees became involved in shaping the acute floor. As a trainee you have many opportunities to develop your leadership skills, especially in the role of chief registrar .

As part of the AMU team, I contribute towards the day to day running of the department, including reviewing inpatients, seeing patients on ACU and working with junior and senior colleagues to ensure patients are looked after safely, compassionately and efficiently.

I have seen a lot of interesting cases and had many opportunities to practice a wide range of procedures, including pleural procedures, which are done on ACU in a pleural clinic twice a week.

Brighton is a great place to work. The hospital has a great view of the sea, and there’s plenty to do to relax . Summertime is really great – after a busy day at work, sitting on the seafront in the sun with a cold drink is the best way to relax!

I enjoyed arranging departmental teaching and demonstrating procedures to junior doctors. I had the opportunity to men-

23

ANAESTHETICS The combined Anaesthetic Department of the Brighton and Sussex University Hospitals Trust has offices at the Royal Sussex County Hospital (RSCH) in Brighton and at the Princess Royal Hospital (PRH) in Haywards Heath.

for high risk patients. This has recently included the use of CPEX testing in some patient groups.

We provide anaesthetic training for Novice Anaesthetists who have a specific 3 month programme culminating in their Initial Assessment of Competence, Core Trainees (including ACCS) and Intermediate and Higher Trainees.

We provide anaesthetic services for General Surgery, ENT and Max Fax (including major airway surgery), Gynaecology and Urology, Orthopaedics and Trauma, Paediatric and Neonatal Surgery (at the Royal Alexandra Children’s Hospital), Neurosurgery and Cardiac Surgery. There is an Orthopaediac Treatment Centre at the Princess Royal Site and Ophthalmic Services at the Eye Hospital in Brighton. Chronic Pain Services are provided at PRH and Day Surgery both at PRH and at Lewes Victoria Hospital.

We run a modular training programme at all levels and take care to ensure that the individual training needs for each anaesthetic trainee are met. This is achieved by having a well established and motivated group of Educational and Clinical Supervisors who meet every three months at the Local Faculty Group Meeting.

We provide anaesthesia to a total of 31 Operating Theatres and support Critical Care facilities at the Royal Sussex County Hospital, Princess Royal Hospital, Cardiac Unit and Paediatric High Dependency Unit. The anaesthetic department consists of 70 Consultant Anaesthetists, 2 Associate Specialists, 38 Training posts 6 Research Fellows and 6 Clinical Fellows.

The department provides 24 hour a day anaesthesia and analgesia for labour and operative delivery at both RSCH and PRH. There is also a preoperative assessment and high risk antenatal anaesthetic assessment for RSCH’s and PRH’s Obstetric services.

Due to the high number of complex patients that pass through our hospitals, there is an Anaesthetic Review Clinic set up providing Consultant pre-assessment

24

ANAESTHETICS We have 2 College Tutors in Anaesthetics due to the large numbers of trainees and their diversity in training needs. There are currently opportunities to undertake fellowships in Airway management and enhanced recovery with a vascular anaesthesia fellowship planned.

Teaching There is a timetable of fortnightly teaching sessions to cover the FRCA syllabus and more senior trainees are expected to attend regional study days which take place in Brighton and around KSS . In addition to this there are regular teaching sessions/tutorials specifically to support those taking the FRCA examinations.

There is a ‘neophyte’ course for those new to anaesthetics to complement their in theatre workplace based assessments in order to achieve of Initial Assessment of Competence (IAC). There are opportunities to take advantage of locally run simulation training in neuroanaesthesia, paediatric anaesthesia and obstetrics.

The School of Anaesthesia, BSUH and Brighton and Sussex Medical School collaborate on the MSc, PGCert and PGDip for Anaesthesia and Perioperative Medicine, jointly run at the University of Brighton and the PRH and trainees have the opportunity to gain experience in teaching undergraduates, Foundation doctors and other allied health professionals.

sent these at department’s Clinical Governance meetings.

Research There are research opportunities within the anaesthetic department and we currently have 6 Research Fellows involved in ongoing projects led by a small group of Consultants. This includes projects in hip fracture care, hypothermia management and blood conservation strategies. All trainees are expected to participate in audit/clinical improvement projects and present at local meetings where appropriate.

Departmental audit and clinical incident meetings are held regularly and trainees are expected to participate in them. All members of the department are encouraged to conduct audit projects and pre-

25

CARDIOTHORACIC SURGERY The cardiothoracic surgery team at BSUH is part of the Sussex Cardiac Centre that provides a local and tertiary cardiac service to a population of 1.2 million. All adult invasive, non-invasive cardiology and cardiac surgery is undertaken. There are three cardiac catheter laboratories; two cardiac theatres as well as a hybrid theatre, an eight bedded coronary care unit, four cardiology wards, cardiothoracic HDU, cardiac surgical ward, as well as a cardiac day-case unit. In addition there is an active research department, supported by seven research nurses.

defibrillators as well as having an active structural heart interventional program including trans-catheter aortic valve replacements (TAVI) and cutting-edge interventional mitral valve procedures.

The Surgical team in Brighton consists of five consultant cardiothoracic surgeons, two cardiothoracic specialist registrars (NTNs), six trust grade or staff grade registrars and three ST1-2/ F2 doctors .

Teaching In addition to routine procedures, trainees will be involved in specialist procedures, including off-pump CABG, mitral valve repair (including minimally invasive repair), surgery for aortic root (including valve preserving procedure), arch surgery and de-branching techniques.

The unit undertakes a high volume of percutaneous coronary interventional procedures, electrophysiological studies and ablations, implantation of simplex and complex pacing devices and implantable

26

CARDIOTHORACIC SURGERY

Trainees also have the opportunity to participate in trans-catheter valve implantation, mini-bypass, mini aortic valve replacement and VATS AF ablation.

sia per annum of the cardiothoracic section of the Royal Society of Medicine available to all trainees and the annual meeting of the Society of Cardiothoracic Surgery of Great Britain and Ireland.

The department runs weekly joint meetings with the cardiology team to discuss complex cases and virtual teleconferences every week with the cardiology centres in the West and East. In addition to this there are monthly full clinical governance meetings, which have an educational component with respect to emerging guidelines and therapies. Trainees will be involved in new patient as well as follow up patient clinics.

Research Trainees are also encouraged to support our 1st class research team headed by Prof Hildick-Smith. The team researches all aspects of cardiovascular disease with an emphasis on interventions in Cardiology, Cardiac Surgery and Cardiac Anaesthesia. Key areas of interest include coronary artery disease intervention and structural heart disease intervention. The unit has a strong national and international presence and leads many international studies for the UK, including projects for the British Heart Foundation (BHF), the Medical Research Council (MRC) and Health Technology Assessment (HTA).

Regional study days are delivered every two months and includes events like the Valve Technology Symposium, organised annually by St. Thomas’ and King’s College Hospital. There are also two sympo-

27

CARDIOLOGY The Sussex Cardiac Centre provides a local and tertiary cardiac service to a population of 1.2 million. All adult invasive, non-invasive cardiology and cardiac surgery is undertaken. There are three cardiac catheter laboratories; two cardiac theatres as well as a hybrid theatre, a six bedded coronary care unit, four cardiology wards, cardiothoracic HDU, cardiac surgical ward, as well as a cardiac day-case unit. In addition there is an active research department, supported by seven research nurses.

structural heart interventional program including trans-catheter aortic valve replacements.

The non-invasive cardiac department is equally busy, undertaking 4000 echocardiograms annually, 300 transoesophageal echocardiograms and 150 bubble contrast studies. A primary angioplasty service is provided 24 hours a day for patients with acute infarction.

The medical team in Brighton consists of 11 consultant cardiologists (six interventionists, three electrophysiologists, one heart failure / device specialist and two specialists in imaging / adult congenital heart disease. At present there are eight cardiology specialist registrars (years five to seven) and two cardiac fellows.

The unit undertakes a high volume of percutaneous coronary interventional procedures, electrophysiological studies and ablations, implantation of simplex and complex pacing devices and implantable defibrillators as well as having an active

28

CARDIOLOGY Teaching Trainees will be involved in the day-to-day care of elective and non-elective patients admitted under cardiology. They will be expected to participate in CCU ward rounds, post-take ward rounds and the daily review of inpatients.

Much of the elective work no longer requires routine clerking allowing the trainees to focus on more complex medical management of cardiac in-patients with the support of middle grade doctors, consultants and nursing staff.

Trainees are actively encouraged to attend lab sessions as well as non-invasive investigations to gain exposure to all aspects of cardiology.

There is a weekly educational meeting for cardiology trainees. In addition the department runs weekly joint meetings with the cardiothoracic surgical team to discuss complex cases as well as monthly full clinical governance meetings, which have an educational component with respect to emerging guidelines and therapies.

Regional study days delivered by world renowned speakers are organised in conjunction with the British Cardiovascular Society and facilitated by the Royal Society of Medicine in London.

Key areas of interest include coronary artery disease intervention and structural heart disease intervention. The unit has a strong national and international presence and leads many international studies for the UK, including projects for the British Heart Foundation (BHF), the Medical Research Council (MRC) and Health Technology Assessment (HTA).

Research Trainees are also encouraged to support our first class research team. The team researches all aspects of cardiovascular disease with an emphasis on interventions in Cardiology, Cardiac Surgery and Cardiac Anaesthesia.

29

DERMATOLOGY The Dermatology Department is based at the Brighton General Hospital and delivers outpatient services at local hospitals in Lewes, Peacehaven, Haywards Heath as well as the Royal Alexandra Children’s Hospital in Brighton. The department provides about 12,000 consultations per annum, approx. 7,000 new patients are seen and 2,600 minor procedures conducted in the dermatology day-case theatres and minor treatment rooms.

Teaching Academic sessions are held at the Brighton General Hospital with a monthly journal club and clinical governance meetings. There is a weekly physician’s grand round and weekly multi-disciplinary skin cancer meetings.

Trainees are invited to attend the weekly departmental meetings to discuss the day -to-day running of the service, the weekly histopathology meetings with the pathology department and the quarterly Sussex dermatology meetings.

Inpatients are cared for in general medical beds at the Royal Sussex County Hospital. The dermatology department runs specialist clinics for patients with skin cancer, paediatric disease, vulval disease, hair disorders and leg ulceration.

The department’s facilities include operating theatres, treatment rooms and consultation suites and the department is fully integrated with plastic surgery. A phototherapy unit provides a full range of treatments including narrowband TLO1, PUVA treatment, and hand/foot PUVA. Clinical photography is supported by the audio-visual department and medical photographers are available for some of the outpatient clinics. The department has a small library and six major dermatology journals are available for review.

The dermatology team is comprised of five consultant dermatologists, an associate specialist, three part-time plastic surgeons, three specialist registrars and two clinical fellows. The specialist dermatology nursing service supports clinics including phototherapy, wound care, iontophoresis, patch testing and community paediatric eczema clinics.

30

DERMATOLOGY

The Pan Thames dermatology teaching programme at St Thomas’ Hospital London is mapped against the dermatology curriculum and trainees will be expected to attend this fortnightly programme.

Venereology meetings and the American Academy of Dermatology Annual Meeting.

Research Trainees are encouraged to participate in audit and research projects. The department is involved in a number of research studies, including BLISTER (Bullous Pemphigoid Steroids and Tetracycline Study) and STOPGAP (Study of Treatments for Pyoderma Gangrenosum Patients), which are run by the UK Dermatology Clinical Trials Network.

Higher Specialty Trainees are involved in teaching medical students and postgraduate trainees, either informally in clinics, or by delivering lectures and interactive sessions at the hospital grand rounds or at the morning rounds.

They are encouraged to attend and present at national and international meetings, for example the British Association of Dermatologists’ Annual Meeting, the European Academy of Dermatology and

The team also contributes to the Genetics in Acne study at the St John’s Institute of Dermatology and a study on the treatment of actinic keratoses with Leo Pharma.

31

EMERGENCY MEDICINE The Emergency Department provides a comprehensive service at both sites, the Princess Royal Hospital (PRH) and the Royal Sussex County Hospital (RSCH).

Working as one department across two sites the unit treats over half a million patients a year and refers 50–70 patients per day to the hospital.

At the RSCH an average of 220 –260 patients are treated per day via a 24/7 consultant delivered service. Currently, the Emergency Department is rebuilding its facilities to include 8 new resuscitation rooms, one dedicated to children, and a further 10 Majors cubicles in addition to the existing 28 Majors cubicles with an assessment area for new arrivals.

A CT scanner and plain X-ray are placed at the front door to comply with best practice in the treatment of Major Trauma.

The department has two fully equipped operating theatres where suturing, manipulations and minor surgery are performed.

A mix of Emergency doctors, GPs and ENPs see the walk-in patients in our adjoining Urgent Care Centre which is run by the Emergency Department.

mately 150,000. It has four well-equipped operating theatres, plus a separate obstetric operating theatre. It also has a four -bed Intensive Therapy Unit and 4-bed High Dependency Unit. RAMU (Rapid Access Medical Unit) is situated adjacent to the Emergency Department, providing fast turnaround care for medical patients.

There is a 30 bedded Medical Assessment Unit adjacent to the department where directly-referred medical patients are assessed. A 15 bedded Observation Ward/Clinical Decision Unit is managed by the team and used for patients with minor head injuries, minor overdoses, postmanipulation of fractures, soft-tissue infections and elderly patients awaiting Social Services back up.

The team comprises 16 consultants, three Associate Specialists, five registrars, six senior clinical fellows, three core trainees, 16 Foundation doctors, six GPVTS, two flexible trainees and two trust grade doctors, supported by approximately 110 nursing staff.

The Emergency Department at the PRH has a catchment population of approxi-

32

EMERGENCY MEDICINE opportunity to gain experience in high quality UK Emergency Medicine and develop sub-specialty interests in Toxicology, Medical Education, FCEM & CEM preparation, Ultrasound, Pre-hospital Care and Critical Care.

Teaching Trainees are encouraged to attend the daily multidisciplinary ward round with medical and nursing staff, social workers, occupational therapists, physiotherapist, psychiatric liaison nurses and alcohol team nurses, as well as the department pharmacist.

Research The department has a longstanding involvement in high quality research. Recently completed or ongoing projects include •RCT of Valdecoxib vs Tramadol.

•The CRASH trial of corticosteroids in head injury (RLC UK Co-ordinator).

•CRASH2 trial into bleeding in trauma (RLC UK Co-ordinator) •Evaluation of the LUCAS CPR device (joint study with SECAMB) •The GO-CART study (Blood Gases on arrival in cardiac arrest).

•Interaction between the SMART bag and the LUCAS device.

•Use of low dose naloxone after heroin overdose (Joint study with SECAMB)

A weekly participatory session delivered by internal and external speakers provides a platform for auditing trauma and severe illness data, and is used to provide educational opportunities for staff. The session is followed by a weekly business meeting. Trauma Audit Meetings are held fortnightly.

The department also runs Advanced Trauma Life Support Courses (ATLS), Advanced Life Support Courses (ALS), Paediatric Advanced Life Support (PALS) and Advanced Paediatric Life Support Courses (APLS) courses. As part of a dynamic and innovative team, trainees have the

33

ENDOCRINOLOGY The Department of Endocrinology and Diabetes at Brighton and Sussex University Hospitals (BSUH) provides collaborative care across the Royal Sussex County Hospital (RSCH) in Brighton and Princess Royal Hospital (PRH) in Haywards Heath.

We hold pituitary, adrenal, parathyroid, and thyroid cancer, as well as thyroid eye disease MDTs. General diabetes care is provided by a consultant-led community diabetes service, ‘Diabetes Care for You’ giving exposure to community diabetes.

BSUH is also the regional centre for nephrology, neurosciences, trauma, cardiology, vascular surgery, HIV, paediatrics, ophthalmology, obstetrics and oncology all of which impact on the diabetes and endocrine services. This provides lots of opportunity to collaborate and interact with colleagues in other departments and well as across the wider region.

The department run the following subspecialist diabetes clinics: insulin pump clinics, renal diabetes, high-risk foot diabetes, monogenic diabetes, HIV and diabetes, transitional diabetes care, and diabetes in pregnancy clinics.

BSUH is the regional centre for pituitary surgery, and the team includes neurooncologists, neuro-ophthalmologists, neuro-radiologists, pituitary specialist surgeons and specialist nurses. The team runs monthly, multidisciplinary pituitary clinics as well as fortnightly, regional case discussions via telelink.

In additional to general endocrine clinics, there are subspecialist endocrine clinics for transgender patients; people with HIV; managing the late effects of childhood cancer; transitional care for young adults; thyroid nodules; thyroid cancer; and osteoporosis/metabolic bone disease.

34

ENDOCRINOLOGY The diabetes centre offers retinopathy screening services and images are captured into the software application Diabeta3. Endocrinology and diabetes inpatients are cared for in the 17 bedded Bristol ward at the RSCH. Teaching At BSUH, there are many learning opportunities for trainees. We have weekly ‘Cake and Cases’ meetings and fortnightly, departmental educational meetings.

We strongly encourage trainees to participate in audit, service development as well as writing up cases or short reports and present them at departmental meetings.

An MSc (including certificate and diploma) course in diabetes is run jointly with the Postgraduate Medical School.

There is also the opportunity to be involved in teaching undergraduates. The department teaches pre-clinical medical students about diabetes and endocrinology and hosts third year and final year clinical students in their general medical and speciality training.

ticularly those with acute complications and emergencies. Endocrinology and diabetes training combines specialist and general (internal) medicine leading to an excellent grounding as a physician. The diversity of the specialty means many consultants subspecialise and are involved in cutting-edge research.

Careers Advice Endocrinology and diabetes is one of the most challenging, rewarding and wideranging of the medical specialties. Endocrinology covers the abnormal production of hormones from endocrine glands and aspects of metabolic disease while diabetology is concerned with the management of patients with diabetes mellitus using a complex interplay of education, behaviour and technology. The specialty is predominantly out-patient based but also includes management of in-patients, par-

Hormones are one of the basic ways in which the body regulates its function.

When these controls go wrong there can be profound effects on a person’s life.

These can range from changes in physical appearance, through important functions such as sex and reproduction, to psychological wellbeing. As endocrinologists and diabetologists, we are privileged to share the most intimate aspects of our patients’ lives and by correcting the underlying hormonal problems issues, relieve their problems.

35

GASTROENTEROLOGY The Digestive Diseases Centre is a joint medical and surgical department within the Directorate of Abdominal Surgery and Medicine and managed by a multidisciplinary group.

colonoscopy. The RSCH has the only JAG-approved endoscopy training centre in South East England, outside of London, and has been running JAG-approved Basic Colonoscopy skills courses for the past five years. The unit also initiated the Bowel Cancer Screening programme across Sussex in 2008.

The centre includes a combined medical and surgical GI ward with 58 beds. There is one endoscopy room at the Princess Royal Hospital (PRH) for upper and lower GI procedures and four endoscopy suites at the Royal Sussex County Hospital (RSCH) as well as a digestive diseases out-patient suite adjacent to the consultation and examination rooms.

The physician team comprises nine full time and one academic consultant gastroenterologists/hepatologists, three F1 doctors, two CMT doctors, and five specialist trainees. Specialist interests include ERCP, cholangioscopy and EUS, oesophageal manometry/pH investigations, video capsule endoscopy, EMR/ESD, as well as nutrition and hepatology.

The purpose built endoscopy unit at the RSCH undertakes flexible sigmoidoscopy, OGD, ERCP, endoscopic ultrasound and

36

GASTROENTEROLOGY Trainees can attend the weekly inflammatory bowel disease ‘super clinic’ consisting of a consultant gastroenterologist, consultant colorectal surgeon, specialist GI pharmacist and IBD specialist nurse.

Teaching The department offers an extensive local teaching programme and trainees are expected to participate in the weekly GI radiology meetings, hepatology meetings, GI pathology meetings, the IBD MDMs as well as the upper and lower GI cancer MDMs. Additionally, all trainees are encouraged to attend and present at the monthly clinical governance meetings and academic afternoons.

Research Staff at the Digestive Diseases Centre are involved and lead on research projects into alcoholic hepatitis, hepatitis C virus (HCV) infection, HIV related liver disease, as well as clinical trials assessing new HCV drugs. Trainees are encouraged to contribute towards research activities within the department.

There are daily consultant-led ward rounds and twice a week specific nutrition ward rounds are performed.

The ward is well staffed with junior doctors and daily consultant ward rounds offer plenty of teaching and learning opportunities. The weekly timetable is very flexible and allows me to attend four endoscopy sessions as well as two clinics and I still have time to conduct my research.

WHAT OUR TRAINEES SAY Dr Nabil Siddique

I enjoyed working with the endoscopy team, because the unit is well run and the consultants are very supportive. I also appreciate that I have the opportunity to teach medical students and junior doctors and I find this aspect of my work particularly rewarding.

I chose to do my final year at BSUH because of the department’s nutrition and endoscopy, one of my subspecialties. I am the senior Registrar and my post has a General Internal Medicine (GIM) commitment, however my GIM commitment is significantly less than in previous placements and I can spend more time on my work on the wards and in endoscopy.

Living in Brighton is a fantastic experience with its cosmopolitan population and the lure of both the bright lights of the city and the wide open spaces of the Sussex countryside nearby. The sea is visible from most of level 9 in the Thomas Kemp Tower, where the Digestive Diseases Centre is based, which can be a much needed tonic after a long day.

37

GENERAL SURGERY General Surgery is a wide ranging specialty and incorporates surgical conditions of the GI tract from oesophagus to anus, the breast, transplantation (kidney, pancreas, liver), trauma (abdomen, thorax and general management), endocrine surgery, hernia, some skin conditions, initial assessment of patients with peripheral vascular disease, as well as the general surgery of childhood.

testinal surgery and competency levels defined for ST4 in breast, transplant, vascular and endocrine surgery.

In order to gain the CCT in general surgery all trainees will acquire the knowledge, clinical and technical skills to the competency levels defined for ST8 in elective and emergency general surgery.

Digestive Disease Unit In the Digestive Disease Unit the full range of GI surgery is undertaken, with the exception of hepatobiliary resections.

There is a large volume of endoscopy performed, both therapeutic and diagnostic and the department has a large emergency commitment with an average of 15 admissions per day.

Trainees at BSUH are based within the Digestive Diseases unit or the Department of Vascular Surgery and have access to the following subspecialties: colorectal, benign UGI, upper GI restrictions, breast oncoplasty and vascular surgery.

They will all accumulate the knowledge, clinical and technical skills to the competency levels defined for ST6 in gastroin-

There are three upper GI and six colorectal surgeons, five registrars and five senior staff grade surgeons supported by a full compliment of foundation doctors and core trainees, as well as nursing staff.

Teaching In addition to daily ward rounds, the department is involved in the Inflammatory Bowel Disease MDT meetings and the Anal and Colorectal Cancer MDT meetings. Trainees are encouraged to attend the regular departmental meetings, the colorectal surgery team meetings, the clinical governance as well as the morbidity and mortality meetings.

There are weekly operating lists at both RSCH and PRH sites as well as x-ray meetings, journal clubs and academic sessions with the opportunity to present research or interesting cases.

38

GENERAL SURGERY interventions. The unit is approved by the Vascular Society for Fellowship in Endovascular Surgery sponsored by Cook Ltd. There is a high volume and quality service for carotid surgery with multidisciplinary group of stroke physician, neurologist, vascular sonographers, radiologists and anaesthetists. Carotid endarterectomy under local anaesthesia and also under General anaesthesia with Trans cranial Doppler monitoring is performed.

There is a well equipped Endovascular Theatre (mobile Unit) and an Interventional Radiology suite in the Radiology department. Magnetic Resonance Angiography is routinely used and there are several CT scanners including a 64-slice CT scanner at the PRH site.

There are six Vascular Surgeons supported by four Interventional Radiologists who provide a round the clock service for Vascular Emergency. The non invasive vascular laboratory is well equipped and staffed by three full-time, one part time and one trainee vascular scientist, providing a high quality service for duplex scanning and other non invasive assessment.

The Unit took part in the pilot scheme for training of Vascular surgeons in Vascular ultrasound jointly organised by the Vascular Society, Royal College of Surgeons and Society for Vascular Technologists.

Vascular Surgery The Department of Vascular Surgery provides emergency services to a catchment population of approximately 800.000. The unit performs the entire range of vascular and endovascular procedures, including thoracic aortic interventions, supported by the Regional Cardiothoracic centre. The regional renal service is also based at the BSUH and the vascular surgeons and radiologists provide support for creation and maintenance of renal access for dialysis.

Teaching There is a weekly multi-disciplinary meeting between the surgeons and radiologists, and once a month there is a Carotid / stroke MDM. There is a wide variety of opportunities to participate in new and ongoing research projects.

On an average two Endovascular aortic aneurysm repairs (EVARs) are performed every week. As a high proportion of aneurysms are treated by endovascular technique, these procedures include complex

39

GENITO-URINARY MEDICINE The Genitourinary Medicine (GUM) department provides sexually transmitted infection (STI) contraception and HIV management services for the local population of over 250 000.

nationally and internationally recognised for its contribution to HIV research and participates in a large number of HIV studies, both commercially sponsored and funded by external bodies.

HIV Medicine Brighton has a high HIV sero-prevalence (13.7% in men who have sex with men) and has one of the largest cohorts of HIV positive individuals in the UK with over 2350 patients currently under follow up.

The team works within a multidisciplinary framework of care and management: there is a pharmacist-led antiretroviral clinic and a dedicated dietetic service and the department has well-established links or joint clinics with renal medicine, endocrinology, hepatology, psychology, psychiatry, gastroenterology, oncology, neurology, cardiology and obstetrics.

There are strong links with neighbouring clinics via the Sussex HIV Network, including those in Hastings, Eastbourne, Crawley, Worthing and Chichester. The services link closely with the Community HIV Team and the Sussex Beacon, a continuing care facility based in Bevendean Road, and there are also strong links with voluntary services providing HIV health and social care, such as THT, Lunch Positive and Peer Action.

GUM/contraception Genitourinary Medicine and Contraception now offer an integrated Sexual Health and Contraception (SHAC) service in Brighton and Hove (a partnership between BSUH and Sussex Community Foundation Trust)., which includes the local Chlamydia Screening Programme.

HIV and HBV/HCV co-infected patients are managed in joint clinics and BSUH is now an operational delivery network for the treatment of Hepatitis C. The Unit is

40

GENITO-URINARY MEDICINE Clinics are provided at the SHAC East, (at the Royal Sussex County Hospital site, with approx. 25,000 annual attendances) at the Morley Street site, SHAC Central, (central Brighton, with approx. 12,000 annual attendances) and newly opened SHAC West for <25â&#x20AC;&#x2122;s all offering both walk in and booked clinics. The department provides specialist clinics for adolescents, sex workers, gay and bisexual men, trans men and women, complex contraception and individuals with chronic genital problems. There is rapid testing for HIV and a fast-track service for victims of sexual assault and sex workers.

Teaching There is formal teaching in the form of a weekly academic morning on Wednesdays with a rota encompassing internal and external invited speakers, conference feedbacks, Audit/QIP, M&M, journal club, research and therapeutics as well as management meetings. As well as a weekly viral load meeting where all patients starting or switching anti retroviral therapy, resistance tests and TDM are discussed. Informal teaching is available in the form of multiple joint clinics as listed above, team meetings a weekly MDT ward round, MDTâ&#x20AC;&#x2122;s in TB and radiology, as well as a weekly ID case presentation.

Engagement in research is strongly encouraged and trainees are supported with submission of abstracts to annual BASHH and BHIVA conferences.

broadened its activities to include more nationally funded projects in collaboration with Brighton and Sussex Medical Schools and the National Institute for Health Research. Main areas of research include HIV treatment studies, HIV prevention studies, HIV co-infection with Hep C, HIV and Ageing and Sexual Health.

The HIV/GUM department has a strong track record of clinical research in several fields, including antiretroviral therapy for HIV infection (commercial and MRC-led studies), the epidemiology of gonorrhoea and syphilis, primary HIV infection and transmitted drug resistance, and home testing for sexually transmitted infections in MSM. The department is involved in the EUROSIDA study, and within the UK is involved in UK CHIC and the National HIV drug resistance database.

Research The HIV/GUM Research Department is based in the Elton John Centre in Sussex House on the RSCH site. The unit has been involved in clinical research since 1988, however more recently it has

41

GERIATRICS The Department of Elderly Care at Brighton and Sussex University Hospitals NHS Trust (BSUH) operates collaboratively across the Royal Sussex County Hospital (RSCH) and Princess Royal Hospital (PRH) sites, admitting unselected medical patients over the age of 80 years.

ble testing, wound care as well as continence services. The department maintains a strong presence at the â&#x20AC;&#x153;front doorâ&#x20AC;?, and has recently introduced a team based system to help cover the daytime acute admissions for older patients throughout the week.

At RSCH, we care for patients across four specialist acute elderly medicine wards, including the Emerald Unit, an awardwinning unit treating medical problems in patients with cognitive impairment. At the PRH, the department has a ward based operational structure with the focus on Care of Elderly on Ardingly ward and Hurstpierpoint ward.

The unit supports community care for patients following discharge in various rehabilitation units around the city.

Across both sites, the department comprises 12 consultants, eight registrars, eight F1 doctors and twelve F2/SHO doctors.

Teaching Trainees will be based at RSCH or the PRH, depending on their individual training requirements, and attend sessions at the Intensive Care Unit (ICU) , the BSUH Hip Fracture Unit as well as the Orthogeriatric Rehabilitation Unit.

As part of a dynamic team, trainees are able to gain excellent experience in managing problems affecting older patients, including frailty, multipathology, polypharmacy, falls, dementia, delirium and palliative care and become involved with tilt ta-

42

GERIATRICS Trainees will be involved in dementia care at the Neville Hospital in Hove to receive training in psychiatry for the elderly. Junior doctors will support care of elderly through community care facilities and work as part of a multi-professional team to provide palliative care.

sessments, a regular falls and osteoporosis clinic, the weekly Parkinsonâ&#x20AC;&#x2122;s Disease clinics at both RSCH and PRH, the dementia neurology clinics, as well as weekly clinics at the PRH for older patients with multidisciplinary needs.

Working closely with the Hospital Rapid Discharge Team (HRDT) and the acute medical team, the department has instituted daily MDT board rounds.

Research The department has a strong research base through and all trainees will be encouraged to participate in research projects. Research interests include antibiotic -associated diarrhoea, vascular compliance and better targeting of antidepressant therapy. There is an active audit program which trainees will be expected to contribute towards.

Stroke Medicine The 23-bedded stroke unit looks after patients across the whole stroke pathway, from hyperacute presentation to discharge. There is an active multidisciplinary team including nursing staff, physiotherapists, occupational therapists, speech and language therapists as well as social services.

There are close links with A&E and the early supported discharge team and colleagues at the Sussex Rehabilitation Centre (20% of our complex stroke patients are transferred here for further rehabilitation). The unit is busy seeing around 500 stroke patients a year, with an average length of stay of 6-7 days. The Trust also provides a consultant-led 24 hour thrombolysis service for patients.

Educational opportunities include weekly multidisciplinary meetings, daily board rounds as well as weekly/monthly grand rounds. Trainees will also be encouraged to attend specialty clinics, including the daily rapid access clinic for older people, covering most medical investigations, therapist as well as specialist nursing as-

43

HAEMATOLOGY The Haematology Department at Brighton and Sussex University Hospitals NHS Trust (BSUH) provides care for the population of around 500,000 people spread over an area of around 100 square miles.

other medications, providing treatment to over 5000 patients per year.

The physician team comprises four full time consultants, two part time consultants and one academic senior clinical lecturer. The team has two SpRs on rotation from Kingâ&#x20AC;&#x2122;s College in London, two Core Medical Trainees and one F1.

Every year over 8000 patients with blood disorders and conditions such as myeloma, myelofibrosis, acute myeloid leukaemia (AML), chronic myeloid leukaemia (CML), acute lymphoid leukaemia (ALL), chronic lymphoid leukaemia (CLL), essential thrombocythaemia, are seen in outpatient clinics, either referred by their GP or for appointments to review their health.

The Laboratory The Haematology Department is also responsible for the running of the hospital laboratory, where blood tests from all over the hospital and the surrounding GP practices are analysed. 900 full blood count blood tests are processed every day, a proportion of these requiring blood film examinations. The unit also processes blood transfusion requests along with platelet transfusions.

The haematology ward has ten beds and four side rooms for about 1000 in-patients per year. In the Haematology Day Unit there are 6 seated areas for patients to receive chemotherapy, transfusions and

44

HAEMATOLOGY

Every year around 5100 blood transfusions are organised. The unit comprises a routine and specialist coagulation laboratory and specialist immunophenotyping takes place on site.

A programme of weekly haematooncology teaching sessions has been set up for juniors.

Research The Brighton Haematology team are involved in on-going research at the haematology research laboratory at the University of Sussex as well as the Clinical Investigation and Research Unit at the Royal Sussex County Hospital.

Teaching Trainees are encouraged to participate in the weekly governance and educational meetings, the multidisciplinary team meetings, the lunchtime journal clubs as well as the regular audit meetings.

Trainees participating in research and audit projects are required to complete the Research and Research Governance induction session. The current local portfolio of clinical trials includes those for patients with MDS, AML, Myeloma, CLL and NHL.

Training activities are balanced to enhance clinical, diagnostic, morphological as well as lab skills, with regular teaching sessions on morphology and practical microscopy sessions in the Lab.

45

HISTOPATHOLOGY The Histopathology training at Brighton and Sussex University Hospitals NHS Trust (BSUH) is based in the Cellular Pathology service, which is managed as one department across two sites.

The Trust is a Calman Cancer Centre, and primary and review work from the Sussex Cancer Centre represents a significant proportion of the caseload. The annual workload includes about 35,000 Cervical Smears, 6,600 NonGynaecological Cytology Requests and 33,000 Histopathology Requests.

Histopathology and cytopathology laboratory facilities are located primarily at the Royal Sussex County Hospital (RSCH).

Frozen section facilities are located at both the RSCH, as well as the Princess Royal Hospital (PRH). At both sites, the department is in purpose built accommodation and located close to the other pathology disciplines and units.

The team comprises ten consultant Histopathologists, two clinical specialist registrars and six specialist registrars ranging from ST1 to ST6.

The Laboratory The pathology laboratories at BSUH are part of Frontier Pathology NHS Partnership, a joint venture between Surrey and Sussex Healthcare NHS Trust and BSUH.

The department supports a wide range of clinical specialties. These include Breast Screening and Surgery, Cardiology, Chest Medicine, Dermatology, Head and Neck Surgery, Gynaecology and Cervical Screening, Medical and Surgical Gastroenterology, HIV medicine, Orthopaedic Surgery, Urology, Ophthalmology, Oncology, Thyroid and Renal Medicine.

The unit provides comprehensive and responsive pathology services for BSUH hospitals, GPs and other communitybased primary care services, as well as other hospitals outside BSUH.

46

HISTOPATHOLOGY

Teaching Trainees are encouraged to participate in regular governance and educational meetings, the multidisciplinary team meetings and audit meetings.

principally supported by the lead pathologist for each specialty, with cover provided internally as required. Most MDT meetings are held in the Sussex Cancer Centre, in a dedicated meeting room with AV equipment, microscope projection and teleconferencing facilities.

In the weekly â&#x20AC;&#x2DC;Black box meetingsâ&#x20AC;&#x2122; staff discuss up to ten particularly interesting or challenging cases. Training activities are balanced to enhance clinical, macroscopic assessment and microscopic interpretation with regular one on one microscopic reporting and teaching with consultants.

Trainees will participate in cut-up, microscopy including both histology and cytopathology. The option to perform post mortems is also available, although these are not on site at the Hospital.

Multidisciplinary team meetings are held regularly with the main clinical specialties.

The department supports 11 regular MDT meetings each week, together with five additional monthly meetings. These are

Audit work is an ongoing process within the department and involvement with such work is expected as part of the training.

47

INTENSIVE CARE MEDICINE The Critical Care Department provides intensive care services to both, the Royal Sussex County Hospital in Brighton (RSCH) and the Princess Royal Hospital in Haywards Heath (PRH).

cases. The RSCH Intensive Care Unit admits around 2000 patients a year; 42% surgical and 58% medical specialties. The PRH Intensive Care Unit admits around 600 per year with 62% medical and 38% surgical admissions.

The Critical Care Unit at the PRH has 12 beds, the RSCH in Brighton has 31 beds for medical and surgical intensive care and additional ten beds for patients requiring cardiac, level 2 -3 care.

There are 22 consultants in critical care covering the units at all times. The junior critical care team consists of 22 junior doctors with varying parent specialties.

These posts are mainly based at the RSCH, with a portion of training delivered at the PRH.

The department has the computerised medical records system Metavision and the front-end terminals allow access to PACS images, TOXBASE, Internet and multidisciplinary department guidelines.

Teaching The training programme will be tailored to every traineeâ&#x20AC;&#x2122;s specific requirements and is significantly influenced by the traineeâ&#x20AC;&#x2122;s experience in previous posts and placements. Specialty Trainees in year 3-4

Critical Care admits an unselected take of medical and surgical adult patients, in addition to booked elective post-surgical

48

INTENSIVE CARE MEDICINE fields, including Emergency Medicine, Medicine and Grand Rounds.

Trainees also have access to an extensive PowerPoint lecture presentation library, a reference library with ready access to bench books in the Consultantâ&#x20AC;&#x2122;s office, the Clinical Information System (CIS e-library), the European online modular teaching programme in ICM (PACT) and IRIS (an online e learning resource).

Local teaching is also delivered in the daily, multidisciplinary ward rounds in the morning, the lunchtime microbiology consultant lead ward rounds, as well as at the evening ward round.

Trainees are encouraged to participate in the monthly journal club, the morbidity and mortality meetings as well as the clinical governance meetings. The department provides dedicated, bleep-free, weekly teaching on Tuesday afternoons.

Research The Intensive Care Research team has a good track record of conducting, presenting and publishing clinical research in ICM related topics. Projects include research into sepsis, acute respiratory distress syndrome (ARDS), shock, biochemical markers, optimisation and nutrition, as well as risk assessment in patients with traumatic brain injury.

usually focus on further developing their core competencies and extend their ICM experience. ST5 to ST6 level training emphasises sub-specialty ICM including cardiothoracic, neurosciences and paediatric ICM, in addition to general ICM. A series of training courses are delivered in house, including the BASIC Course, ICM for Anaesthetists, Transfer course, ALERT course, FICE and FICM exam revision course. BSE training is specifically offered to the Echo ICM fellows. Trainees also have the opportunity of attending meetings with invited speakers in related

ICM staff are also involved in a significant number of audit projects. Trainees are expected to complete and present an audit project, collaborate in other audits and collect data for ICNARC during their time in critical care.

49

MICROBIOLOGY/INFECTIOUS DISEASES The Microbiology and Infectious Diseases Service provides specialist services for neurosciences, paediatrics, cardiac surgery, cancer, renal and HIV medicine. Approximately 35% samples come from general practice. The Microbiology and Infectious Diseases laboratory is accredited under the IBMS as a training laboratory for Bacteriology and Virology and it participates in a comprehensive range of quality control schemes (UKNEQAS).

The Infection team consists of 8 consultants (three Medical Microbiologists, one Medical Virologist, four infectious diseases consultants), four registrars and three Foundation/CMT Trainees. The microbiology and infectious diseases consultants work closely together to provide an integrated Clinical Microbiology and Infection Service and to support the programme for joint trainees in Microbiology and Infectious Diseases. The team receives an average of 30-40 consultation requests per month from other teams.

Teaching The department runs a Rapid Access Infectious Diseases clinic on Wednesday mornings and a routine ID clinic on Wednesday afternoons, each of which is followed by a detailed debrief with the consultant in charge. There is also a weekly OPAT clinic on Fridays.

present cases regularly at the Friday clinical meetings and to supervise presentations undertaken by the CMTs, F2s and F1s. They also attend and present at the monthly Research, Audit and Governance meetings. Attendance and regular presentation at the Grand Rounds is another weekly fixture.

Trainees are expected to attend the weekly ID radiology meetings and Clinical Infection meetings (held jointly with the HIV team and Microbiology colleagues) as well as the weekly, consultantmoderated journal clubs and clinical teaching. Registrars are encouraged to

Each trainee is funded by HE-KSS to attend the Oxford Bone Conference, Liverpool Neurological Infections day and PHE Infection Control workshop at least once during their time on the programme.

50

MICROBIOLOGY/INFECTIOUS DISEASES There are extensive opportunities available to undertake audit and research, taking advantage of our close academic links with BSMS and the Institute of Global Health. Trainees are encouraged to apply for NIHR academic clinical fellowships or clinical lectureships (as well as other research funding bodies such as the MRC and Wellcome Trust) to support research for a higher degree.

Herpes simplex. Other equipment includes Abbott Architect, Diasorin Liaison, Rotagene 3,000, Roche Light-cycler 2.0 and 480, Magnapure Classic and Compact, Abbott M2000 and M2000 RT, BD Viper, Biomerieux BacTalert, BacTalert 3D,Vitek and Menarini Sedimax. It is planned to fully establish Abbott HIV protease sequencing, BD Bactec FX, Midgit and Phoenix plus BD Epicentre.

The Laboratory The laboratory provides routine bacteriology and mycology analyses to Brighton and Sussex University Hospitals and general practices in the Brighton and Hove PCT, as well as the Mid-Sussex PCT catchment areas. Virology and food/ water/environmental work is undertaken for East and West Sussex and the southern part of Surrey. Laboratories in Kent, Sussex and Surrey are provided with a series of specialist tests.

The laboratory information management system is Clinisys for Clinical Microbiology and GP Order Comms (Anglia Ice) is being rolled out. An electronic reporting system communicates test results to wards and general practice.

There are 53 Biomedical Scientific staff on site (35 bacteriology, 11 virology, seven FEW) and their current annual workload figures are as follows: Bacteriology 250,000 samples Virology/serology 160,000 samples Food/water/environment 18,000 samples

The unit has a molecular suite to facilitate PCR-based tests for a variety of agents, including influenza, cytomegalovirus and

51

NEUROLOGY The Sussex Neurological Centre is a tertiary referral centre based within the Princess Royal Hospital (PRH) providing a full set of services to patients suffering disorders of the brain and nervous system. The Department maintains close links with the Neurosurgical Team based at the Royal Sussex County Hospital (RSCH) through multidisciplinary meetings and joint educational sessions, and is complimented by the on-site Neuropsychology, Neuroradiology and Neurophysiology Teams.

guage therapists compliment the role of our junior doctor team which comprises four registrars (ST3 and above) and three SHOs (one FY2 and two Core Medical Trainees).

There are 18 Consultant Neurologists linked to the Centre providing expertise throughout Sussex including specialist clinics for MS, Cognitive Disorders, Epilepsy, Sleep Disorders, Movement Disorders, Neuro-Ophthalmology and Motor Neuron Disease.

The Neurology ward, Clayton Ward, has capacity for 15 inpatients including a dedicated side-room for EEG Video Telemetry. A Planned Investigation Unit also operates on a daily basis to enable rapid investigation and review for patients requiring Neuroimaging and CSF analysis as well as regular infusion treatment for chronic conditions such as MS and CIDP.

Teaching The inpatient Neurology service operates a â&#x20AC;&#x153;Consultant of the Weekâ&#x20AC;? model providing an excellent basis for training on ward rounds and following review of ward referrals within PRH, where the majority of training is provided.

Registrars undertake two general or specialised neurology clinics per week under consultant supervision with additional rotation between hospitals in Worthing, Brighton and Hastings.

An excellent team of highly-experienced and friendly nursing staff, healthcare assistants, physiotherapists, occupational therapists, dieticians and speech and lan-

52

NEUROLOGY There are weekly Neuroradiology meetings, Departmental educational afternoons and ward-based teaching sessions for all trainees which provide great opportunities to present and discuss interesting cases and share ideas with colleagues.

Registrars will attend the excellent monthly teaching days at the National Hospital for Neurology and Neurosurgery in London which are logged towards achievement of the yearly ARCP.

Research Trainees are encouraged to participate in clinical audit and present these and interesting cases at local, regional, national or international conferences. There is an expanding portfolio of research the field of neurodegenerative disorders.

The Department is very active in clinical trials and has a dedicated trials team involved in Phase II and III interventional trials into Epilepsy, Motor Neuron Disease, MS and Atypical Parkinsonian Disorders such as MSA, PSP and CBD.

Medical students from Brighton and Sussex Medical School are regularly attached to the ward and each of the Registrars and SHO trainees is assigned their own small group with whom to arrange bedside teaching of clinical skills. Trainees are also encouraged to participate in clinical audit and present these and interesting cases at local, regional, national or international conferences.

The clinical research studies that we participate in are supported by the National Institute for Health Research Clinical Research Network, the Dementias and Neurodenegerative Disorders Research Network and the Surrey and Sussex Local Comprehensive Research Network. tients, many of whom have built up trusted staff relationships over a number of years.

The welcoming atmosphere and a wellsupported environment made my decision to return for SpR training an easy one.

WHAT OUR TRAINEES SAY Dr Andrew Barritt The Sussex Neuroscience service has evolved significantly since I first began working within the Neurology Department as a core medical SHO. Initially located within the Hurstwood Park building, the Neurological and Neurosurgical services are operating across two sites within the Trust until the completion of the 3Tâ&#x20AC;&#x2122;s Project.

The advantage of the Sussex Neurology training programme being based primarily at the PRH has enabled me to establish strong and friendly links with colleagues, and follow patientsâ&#x20AC;&#x2122; progress over extended periods of time. I have also had the privilege to work at The National Hospital for Neurology and Neurosurgery for one year and further develop experience of complex and subspecialty Neurology.

I am currently working on an exciting PhD research project within the field of Motor Neuron Disease with Professor Nigel Leigh based at the University of Sussex.

The spirit of the Neurology Department throughout has been very much towards multidisciplinary team working and a personalised, professional service to its pa-

53

54

NEUROSURGERY The Neurosurgery Department at the Brighton and Sussex University Hospitals NHS Trust (BSUH) deals with the diagnosis and treatment of pathological processes, which affect the nervous system. Its remit includes the operative, nonoperative, intensive care management and rehabilitation of patients with disorders affecting the brain and skull, spine, as well as the nervous system.

Research The department is research active with links to the BSMS medical school and research projects with the School of Biological Science, School of Life Science, Department of Psychiatry, Clinical Imaging Science Centre and Department of Psychosocial Oncology.

Trainees are encouraged to be part of the British Neurosurgical Trainees Research Collaborative and the department prides itself in having trainee principal investigators currently running the RESCUE-ASDH study and DEX-CSDH study.

Neuroscience services are co-located with cardiac, renal and other essential specialist services at the Royal Sussex County Hospital (RSCH), enabling the Brighton site to develop as the Sussex Regional Centre for Trauma care.

Staff have been major contributors to the BNTRC run Chronic Subdural Haematoma and External Venticular Drain Audit. and have recently contributed to the RESCUE-ICP study and STASH Study.

The unit covers all aspects of Neurosurgical practice, including Cranial & Spinal Trauma, Neuro-Oncology, Complex Skull Base Surgery, Complex Cerebro-Vascular Surgery, Pituitary Surgery, Spinal Surgery Including Spinal Tumors, Neuromodulation For Pain, Surgery For Trigeminal Neuralgia, Surgery For Hydrocephalus and Neuro-Endoscopy.

The research team includes a neurosurgical research nurse as well as a research registrar and is supported by the Trustâ&#x20AC;&#x2122;s R & D department.

55

NUCLEAR MEDICINE The Nuclear Medicine Department forms part of the department of Imaging and Nuclear Medicine and delivers a wide range of diagnostic radionuclide imaging and therapeutic services.

Across all sites, Nuclear Medicine conducts approximately 12500 examinations per year, including FDG PET/CT, bone, static and dynamic renal, lung, endocrine, tumour imaging, nuclear cardiology, brain imaging and lymphatic and haematopoietic imaging, infection/inflammation imaging studies and in vitro non-imaging studies.

More than 800 paediatric studies are performed each year.

The Imaging and Nuclear Medicine department provides over 330,000 diagnostic and interventional examinations per year, of which about 100,000 are required by in- and outpatients at the Royal Sussex County Hospital (RSCH), the Royal Alexandra Childrenâ&#x20AC;&#x2122;s Hospital (RACH) and the Hove Polyclinic in Brighton, as well as the Princess Royal Hospital (PRH) in Haywards Heath and the Clinical Imaging Science Centre (CISC) based at Falmer.

The department was benchmarked as one of the top five departments on governance, patient involvement and good practice sharing and since January 2015 has achieved ISAS (Imaging Services Accreditation Scheme) accreditation.

Overall, the unit employs around 260 staff across all sites, including 37 consultants, 20 Registrars (plus five occasional Ministry of Defence trainees) and F2s.

The Nuclear Medicine service has a state of the art 16 slice Siemens Symbia SPECT/CT camera at RSCH and a GE Infinia Hawkeye SPECT/CT camera at PRH along with a PET-CT 64 slice Biograph Siemens which is located at CISC. At RSCH there is a dedicated cardiac gamma camera (GE Ventri), a GE D630 dual head gamma camera with a Xeleris GE workstation, as well as an In Vitro Sample counter.

56

NUCLEAR MEDICINE monthly together with a cytologist and endocrine surgeon. Other treatments include a bone targeted 223-Radium dichloride treatment clinic that is held weekly.

Radiopharmacy The department also has an in-house Radiopharmacy unit which produces the radiopharmaceuticals for 4 hospitals within BSUH and East Sussex Healthcare Trust (ESHT). The team also run a blood labelling service which includes white cell labelling for infection imaging and red cell mass studies for patients suffering from Polycythaemia. Equipment includes an Amercare Isolator and a dedicated Cell Labelling Isolator.

Trainees are involved in regular reporting sessions and clinics with consultants who contribute towards the lymphoma and thyroid MDT meetings.

Research Trainees have extensive opportunities to contribute towards the departmentâ&#x20AC;&#x2122;s nuclear medicine research trials as well as other research and audit projects, particularly the departmentâ&#x20AC;&#x2122;s dynamic functional molecular imaging and multi-modality research activities.

Teaching Twice weekly thyroid clinics are held dealing with patients with benign thyroid conditions and a multidisciplinary Fine Needle Aspiration (FNA) thyroid clinic is held

57

OBSTETRICS & GYNAECOLOGY The Department of Obstetrics and Gynaecology provides a comprehensive service at both sites, the Royal Sussex County Hospital (RSCH) in Brighton and the Princess Royal Hospital (PRH).

Across both sites the team comprises 17 consultants, 16 specialist doctors at registrar level, four ST1/2 -, four Foundation and nine GP trainees. Specialist areas including infertility, uro-gynaecology, fetal and maternal medicine, early pregnancy and gynae-oncology are covered by consultants within the department.

At the RSCH, the department deals with approximately 3500 deliveries per annum.

The labour ward consists of 10 delivery rooms, 2 high risk delivery rooms, a theatre and a pool birthing room.

Teaching The department provides weekly ST1/2 and ST3+ tutorials, regular simulation sessions in obstetrics as well as monthly journal clubs.

There are antenatal clinics and wards with ultrasound and Doppler facilities, a post natal ward, as well as a 10 bedded gynaecology ward. The department comprises a fetal assessment unit (DAU), and an early pregnancy unit, equipped with ultrasound and hormonal assays. The Sussex Gynae Cancer Centre, the Day Case Unit and a dedicated Outpatients Department and Colposcopy Unit are located at the RSCH. At the PRH the department deals with over 2,400 deliveries per year and the maternity ward for ante and post-natal patients has 34 beds. Facilities for intrapartum monitoring as well as an excellent ultrasound service are provided and a 24hour epidural service is available.

The Gynaecology Unit (Horsted Keynes Ward) comprises 12 in-patient beds, an early pregnancy assessment service and an ambulatory diagnostic and therapeutic gynaecological endoscopy service.

The unit provides in a purpose-built gynaecological endoscopy and colposcopy suite and trainees are able to obtain RCOG recognised special skills training in gynaecological ultrasound and gain experience in outpatient office hysteroscopy.

58

OBSTETRICS & GYNAECOLOGY Trainees are encouraged to participate in the monthly multidisciplinary perinatal meetings, the weekly CTG meetings and the monthly half-day Audit and Clinical Governance meetings. There are weekly risk management and monthly maternity risk management meetings, regular consultant ward rounds and skills drills.

Uro-gynaecology & urodynamic clinics are provided at Lewes Victoria Hospital.

BSUH provides supervision for the majority of ATSMs (Advanced Training Skills Modules) relevant for ST6/7 trainees. In addition to the skills training, the department facilitates training in minimal basic and operative laparoscopic and hysteroscopic procedures.

Trainees can choose to attend joint antenatal clinics with neonatologists and surgeons, which include high-risk medical/ obstetrics clinics and birth option clinics, as well as a large GU/HIV clinic. Colposcopy clinics, oncology clinics and infertility clinics are held on a regular basis.

Research The department facilitates research opportunities for trainees and encourages students to participate in its Independent Research Program (IRP). dealing with interesting and unusual maternal and fetal cases.

WHAT OUR TRAINEES SAY Dr Katie Fraser

I particularly appreciated the learning opportunities I had in gynaecology. The RSCH has the main oncology department in the region, with an excellent body of consultants and nurse specialists and I had access to major operating lists and colposcopy clinics.

I have spent all of my training – medical school, foundation years and specialty training – in London and moving to Brighton was initially a life-style decision for me.

In London I felt claustrophobic and detached from the patient group and I realised that I needed a change.

I had the opportunity to train in minimal access surgery and at the PRH I was involved in a multitude of day-case procedures. Because RSCH and PRH are teaching hospitals, there is always the chance to engage in training of junior doctors and medical students – an activity which I found very rewarding.

At BSUH my work is varied and interesting. We have a busy labour ward and several specialist antenatal clinics. With good neonatal facilities we are able to accept complex cases from other units and I gained valuable experiences from

My life’s ambition is to care for patients with whom I can build relationships and I want to be able to provide them with continuity in their care. Moving to Brighton has re-energised me and my drive to being a competent and effective doctor.

59

ONCOLOGY The Sussex Cancer Centre provides cancer treatment for the majority of patients who live in Sussex extending from Rye in the east, to Worthing in the west, and north to Haywards Heath with a catchment population of approximately 1.1 million people.

clear categories: Neutropenic fever / sepsis, Investigation, Chemo-therapy, Adioiodine therapy and brachytherapy, Elective procedure (intrathecal chemotherapy, biopsies, pleural drain etc.), Symptom control. Patients with lymphoma may be admitted to the Haematology ward.

This region has an incidence of cancer above the national average due to the higher average age of the population.

Clinics and treatment also take place in Hastings, Eastbourne, Haywards Heath and Worthing hospitals with local delivery of chemotherapy and planned radiotherapy satellite units.

The department comprises 25 consultants, two Foundation doctors, a ST1/2 and a Specialist Registrar.

Teaching Trainees are encouraged to contribute towards the daily ward rounds, the weekly ward meetings with all consultants, as well as the X-Ray meetings and â&#x20AC;&#x2DC;Difficult Casesâ&#x20AC;&#x2122; presentations. A weekly Journal Club and Speaker meeting also take place and focus on modern oncology practice including chemotherapy, molecular therapeutics and radiotherapy.

The majority of cancer patients are admitted to Howard One ward, which has nine beds including one room suitable for radio -iodine treatment. The patients admitted to the ward will usually fall into one of five

60

ONCOLOGY

The team of Foundation Doctors coordinate a long standing audit of the care of neutropenic patients. In the Oncology clinics, trainees will be able to gain experience in managing acute infection and oncological emergencies, diagnostic and therapeutic interventions such as paracentesis and pleural aspiration.

Currently the centre is involved in a high profile research project with Brighton and Sussex Medical School, The Royal Marsden Hospital and The Beatson West of Scotland Cancer Centre, examining the management of elderly patients with aggressive brain tumours. The study aims at individualising treatment strategies and assessing patientsâ&#x20AC;&#x2122; clinical parameters alongside research activity into imaging and molecular biomarkers.

Research The Sussex Cancer Centre is actively involved in research and employs a full time research manager, as well as several research nurses and radiographers. The research trials run by the Centre are endorsed by the NCRN (National Cancer Research Network) and are often national or international studies requiring many hundreds of patients.

Another national study is looking at the quality of life experienced by patients after treatment for bladder cancer and the long term side effects of surgery or radiotherapy treatment. The project involves the use of a mobile app as a platform for novel data collection tools.

61

OPHTHALMOLOGY The Sussex Eye Hospital (SEH) serves a population of approximately 500,000 and a sub specialist referral population of over 1 million. The ophthalmology department provides a comprehensive service at the SEH and holds satellite clinics at the Princess Royal Hospital (PRH).

Our ophthalmology services comprise a 24-hour ophthalmic accident and emergency service as well as diagnosis and treatment of cataract, glaucoma, agerelated macular degeneration and diabetic eye disease. Trainees have the opportunity to gain experience in paediatric ophthalmology, neuro-ophthalmology, orthoptics, vitreo-retinal surgery, corneal service, as well as lid, oculoplastic and ophthalmic reconstructive surgery.

County Hospital (RSCH) allows for specialist investigations and co-operation with other disciplines.

The Sussex Eye Hospital has a complement of nine Consultant Ophthalmologists, five Fellows (vitreoretinal, med retina, ant segment, plastics, glaucoma), four ophthalmic surgical trainees (OST2-7), one Associate Specialist and one Trust grade doctor.

Ophthalmic surgery is performed at the PRH (cataracts) and the SEH (all ophthalmic surgery including cataracts). The close proximity to the Royal Sussex

62

OPHTHALMOLOGY

and trials and trainees are invited to contribute to projects on wet macular degeneration, vein occlusions, genetic polymorphism, optic neuritis treatment, diabetic macular oedema and macular oedema.

Teaching A weekly regional study afternoon takes place in Brighton and twice a term in Eastbourne or Hastings. The events are in the format of clinical grand rounds, lectures delivered by visiting speakers or local speakers, as well as audit and clinical governance sessions.

Staff is also involved in projects investigating corneal astigmatism and modern intraocular lenses as well as femtosecond laser cataract surgery. The team has a particular interest in intraocular lens delivering systems and anterior segment anatomy with ultrasound biomicroscopy.

Trainees from Brighton, Redhill, Eastbourne and Hastings are invited to the weekly lunchtime fluorescein and OCT teaching sessions. They also have opportunity and are encouraged to present in these sessions.

Other projects investigate central retinal vein occlusion and diabetic retinopathy as well as nanoparticle behaviour in human as well as artificial skin-muscle tissue.

Research The ophthalmology research team is involved in high profile research projects

63

ORTHOPAEDICS The Orthopaedic Department is spread across all the Brighton and Sussex University Hospital trust (BSUH) sites including the Royal Sussex County Hospital (RSCH), the Princess Royal Hospital (PRH), the Royal Alexandra Childrenâ&#x20AC;&#x2122;s Hospital (RACH) and the Sussex Orthopaedic Treatment Centre (SOTC).

Acute trauma including fracture clinics are held at the RSCH and elective work is done at the PRH either within the Trust or SOTC. The department sees over 3000 acute admissions and approximately 5000 elective cases per year and covers all specialties, including spinal surgery and paediatrics. The department comprises 25 consultants,12 registrars and 10 CT 1/2 level doctors. tre and are expected to regularly and proactively seek training opportunities to develop their surgical expertise. In addition to the weekly, formal teaching sessions, Clinical Governance meetings and Journal Club offer additional learning opportunities on a regular basis.

The Trust has also recently received national awards for its innovative Virtual Fracture Clinic service.

Teaching Trainees are allocated to attend clinics, including the new patient fracture clinic and a full spectrum of follow up clinics.

Junior doctors are also assigned to thea-

The department can offer training in trauma including trauma reconstruction with frames, pelvic trauma as well as arthroplasty, spine surgery, hand surgery, shoulder surgery, paediatric orthopaedics, knee surgery and foot and ankle surgery.

To complement their surgical skills, trainees can gain management experience, teaching, research and audit skills.

Research Trainees are encouraged to contribute towards research activity in the department and to produce at least one audit project per six months, using data from the patient management system.

64

ORTHOPAEDICS There is opportunity for clinical and nonclinical research including anatomical and biomechanical projects in conjunction with Brighton and Sussex Medical School.

to share best practice. All trainees are encouraged to present their academic work at these fora, in particular their clinical cases and audits, their clinical and basic science research, systemic literature reviews as well as their research on educational and clinical management.

The department runs a bi-monthly forum to discuss on-going research issues and

WHAT OUR TRAINEES SAY second registrar year with 4 days in elective theatres and 1 day in clinic per week.

Dr Simon Bellringer I first worked in the department as a Year 1 Core Surgical Trainee and have been fortunate enough to return and complete my first year as a Specialty Registrar here.

As a teaching hospital, there are regularly 4th year Brighton medical students attached to the department. Bedside teaching is arranged weekly to allow trainees to deliver teaching in small groups and there is an opportunity to be involved in giving lectures to the students as part of their 4th year Musculoskeletal Module.

The department operates over several sites offering trainees a wide variety of opportunities. As a busy Level 1 Major Trauma Centre, the Royal Sussex County Hospital has given me some great experience in dealing with some of the most serious trauma under the guidance of both plastic and trauma surgeons with an interest in major trauma and limb reconstruction.

There are a wide variety of research opportunities available as both a junior and senior trainee and several consultants take a particular interest in supporting those who wish to complete audits, present at both national and international conferences and produce published research.

At the Princess Royal Hospital, a separate Fractured Neck of Femur service working within an established MDM approach, ensures that this vulnerable group of patients receive consultant led care, which is unaffected by the pressures of being a Level 1 Trauma Centre and the Sussex Orthopaedic Treatment Centre offers a wide variety of elective orthopaedic care including primary and revision arthroplasty.

There are also opportunities to get involved in supervising Brighton and Sussex Medical School students completing their Intercalated Research Projects, which has been a most rewarding experience.

Overall, itâ&#x20AC;&#x2122;s busy department, and a great place to work. You are guided by a multidisciplinary team of seniors and paramedical staff who are keen to support you to achieve your potential.

As a first year registrar, I typically spend 4 days in trauma theatres and 1 day in clinic per week and expect to continue this into my

65

OTORHINOLARYNGOLOGY The Ear, Nose and Throat (ENT) Department serves a population of 350,000 and comprises the following three units: 

The Royal Sussex County Hospital (RSCH) in Brighton, with in- and outpatient facilities and where the main administration unit as well as the Audiology Department and Hearing Aid Department are located.



The Royal Alexandra Children’s Hospital (RACH) in Brighton with a mixture of day case and in-patient services and five operating sessions per week.



The Princess Royal Hospital (PRH) in Haywards Heath with in-patient services on a 12 bedded unit, covering 10 operating lists and providing emergency services. The unit has close links with Worthing Hospital as well as other hospitals in the area.

Research Research and audit projects are strongly recommended to every member of the junior staff. Trainees are encouraged to present their research at national and international events.

The ENT department comprises seven Consultants, four Specialist Registrars and one Associate Specialist. There are five Senior House Officers and two clinical fellows (SHO Level). Two of these seven posts rotate after three months with Worthing Hospital for a two month period for hands on surgery.

Teaching The department has a good record in teaching, audit and a high pass rate for examinations. Weekly organised teaching is compulsory and trainees may be asked to present at audit and M&M meetings. In addition to formal teaching sessions trainees are invited to contribute to interdisciplinary discussion fora and multidisciplinary working groups.

66

OTORHINOLARYNGOLOGY WHAT OUR TRAINEES SAY Dr Nicky Seymor I worked as an SHO in the ENT department at BSUH and heard great things about the department so I was delighted to get a job there. I was conscious of the fact that I did not have much ENT experience and glad to find that the department runs an excellent and concise course for new juniors at the start of each rotation.

The course goes through the most important basics of ENT presentations and emergencies, including flexible nasendoscopy, managing epistaxis, tracheostomy care and microsuction. tional conferences and produced published research. The consultants are excellent teachers who made themselves available to help, not just with practical skills, but also for CST applications and advice for working towards ST3. There are compulsory weekly ENT teaching sessions, as well as lots of ad-hog teaching in between.

Working in ENT as a junior allows much more autonomy with regard to managing patients, compared with other specialties. My average week included working in emergency clinic – an SHO lead clinic.

It was always run with a consultant clinic, so senior help was always available.

Otherwise SHOs are on-call, which involves giving advice and taking referrals from GPs and A&E. You quickly get used to draining quincies, suturing, packing noses and scoping patients. I also had a huge amount of protected theatre time, even as an F2. The seniors are keen to teach surgical skills and for you to be scrubbed in for the training.

For somewhere to live and work, it doesn’t get much better than Brighton.

It’s a fantastic city to live in. There more coffee shops and pubs than you can shake a stick at and you can pretty much walk everywhere. The BSUH is near the city centre and has one of the best views of any hospital in the country.

Consultants, fellow trainees and support staff are very approachable, friendly and supportive and there are a lot of opportunities for audit and research available to trainees. I have presented work I did in the department at both regional and na-

I can sincerely recommend the BSUH ENT department both in terms of the training experience and the personal support I received in the department,.

The support I received during my training certainly fuelled my passion for ENT.

67

PAEDIATRIC AND NEONATAL MEDICINE Paediatric Medicine The Department of Paediatrics is located at the Royal Alexandra Childrenâ&#x20AC;&#x2122;s Hospital (RACH) and provides general paediatric services to a local population of 460,000 and paediatric subspecialist services to a wider population. The RACH is equipped with a medical ward, surgical ward, highdependency unit, general day care unit, respiratory day care unit, and an oncology day care unit. A children's A&E department, an assessment unit and short stay unit, as well as a dedicated outpatient suite and a paediatric radiology suite are also located at the RACH. Other facilities include the research suite, the paediatric orthodontics and the dentistry suite. A paediatric dietetics service, a speech and language therapy service, as well as occupational therapy and physiotherapy services are also provided. The team support the regional burns unit at Queen Victoria Hospital, East Grinstead.

tory care and A&E. The consultant of the week provides close supervision and teaching at the bedside, and leads daily ward rounds. There are opportunities to attend outpatient clinics in general paediatrics, as well as specialist clinics and joint clinics with visiting consultants from teaching centres.

The department runs weekly, bleep free teaching sessions, weekly child protection meetings, fortnightly X-Ray meetings and regular guideline update sessions. There is a weekly paediatric Grand Round and trainees have opportunities to present at teaching sessions and meetings and to undertake audit and research projects.

The paediatric medical team comprises 10 Paediatric Consultants, of which 8 operate a â&#x20AC;&#x2DC;consultant of the week system for covering acute and in-patient paediatrics.

There are 14 middle grade & 19 junior paediatric trainees, including GPVTS trainees. The department of academic paediatrics includes the Professor and 2 senior lecturers. The senior nursing team includes Paediatric Emergency Nurse Practitioners, Clinical Nurse specialists in Oncology, Asthma & Cystic Fibrosis, PICU Educator & Nurse Consultant in Child Protection.

Research The departments host many clinical research studies, including local academic research projects, NIHR portfolio and commercial studies. Funding to support the research activities comes from the European Commission, The National Institute for Health Research, the Surrey and Sussex Local Comprehensive Research Network as well as charities such as SPARKS, The Rockinghorse Appeal, and industry partners.

Teaching During the attachment at RACH, trainees gain experience in general paediatrics, neonatal and paediatric surgery, ambula-

68

PAEDIATRIC AND NEONATAL MEDICINE The Asthma Research Centre runs programmes of research into respiratory diseases in children. Its work has developed a greater awareness of response differences to medicines based on genotype variation, and the possibility of introducing personalised treatment according to genotype. The research demonstrated that children carrying a particular genetic configuration respond poorly to common asthma medicines, leading to the first ever randomised clinical trial showing benefit with asthma treatment personalised to the patientâ&#x20AC;&#x2122;s genotype.

(ST6-8), paediatric trainees have the opportunity to specialise in a specific area of paediatrics or to continue in general training. Currently paediatric trainees in Brighton can undertake Grid Training in Neonatal Medicine, Community Paediatrics and Paediatric Emergency Medicine.

There are facilities in the Maternity and New-born Care Centre for fetal assessment and fetal medicine and high risk mothers are accepted for in utero transfer The Sussex Neonatal Transport Service is based from TMBU. Currently there are 9 intensive care, 9 high dependency and 10 special care cots on TMBU.

Trainees at all three levels work within both paediatrics and neonatal medicine.

At Level 3 Training (ST6-8), paediatric trainees have the opportunity to specialise in a specific area of paediatrics or to continue with general training. Currently paediatric trainees in Brighton can undertake Grid Training in Neonatal Medicine, Community Paediatrics or training in Paediatric Emergency Medicine.

Teaching There are daily education sessions on TMBU including Case Presentations, Journal Club, Grand Round, Topic Teaching and in-situ simulation training. There are opportunities to lead ward rounds and to attend neonatal clinics.

Neonatal Medicine

Research Neonatal studies focus on adaptation after birth, the development of age appropriate medicines for babies, non-invasive ventilation and devices and ultrasound. A KSS paediatric trainee has recently been awarded a PhD following research and supervision based on TMBU.

Trevor Mann Baby Unit â&#x20AC;&#x201C; TMBU provides a tertiary level neonatal medical and surgical intensive care service for Kent, Surrey & Sussex. There are approximately 3,500 deliveries per year in Brighton and 2500 a year in Haywardâ&#x20AC;&#x2122;s Heath.. The neonatal service has a total catchment area of approximately 11,000 births per year.

69

PAEDIATRIC SURGERY The Department of Paediatric Surgery is located at the Royal Alexandra Childrenâ&#x20AC;&#x2122;s Hospital (RACH), a purpose-built facility for paediatric services at the Brighton and Sussex University Hospitals NHS Trust (BSUH). Current services include a daycase unit, an inpatient surgical unit, a dedicated theatre suite, and an inpatient medical unit for paediatrics, including a high dependency unit.

Sussex Hospitals, Western Sussex Hospitals, Surrey and Sussex Hospitals and Sussex Community NHS Trusts, as well as Chailey Clinical Services. It is closely linked with the neonatal service based at the Trevor Mann Baby Unit at the Royal Sussex County Hospital (RSCH) and Special Care Baby Unit at the Princes Royal Hospital (PRH), providing a neonatal surgical service for the South East Coast.

A children's accident and emergency department, an assessment unit and short stay unit (PAWS) as well as a dedicated outpatient suite and a paediatric radiology suite are located at the RACH. Other facilities include the Academic Department of Paediatrics and research suite, the paediatric orthodontics and dentistry suite.

A paediatric dietetics service, a Speech and Language Therapy service, as well as Occupational Therapy and physiotherapy services are provided by the RACH. The department of paediatric surgery operates on over 2000 children a year. Of these about 800 are emergencies. About 3000 children are admitted and about 6000 are seen in out-patients every year.

Outreach clinics are run currently at Eastbourne, Hastings, Worthing, Haywards Heath, Chailey Heritage, Chichester, East Grinstead, Redhill and Crawley. There is also day case operating provided at Chichester and Redhill.

The unit has close working relationships with paediatric services in London (Great Ormond Street Hospital, the Evelina Children's Hospital, the Royal Marsden Hospital, and Kings College Hospital) and Southampton. The department is networked with partner organisations at East

70

PAEDIATRIC SURGERY The team comprises of six consultant paediatric surgeons, supported by three staff grade paediatric surgeons, two paediatric surgical registrars and one clinical fellow at registrar level.

The junior staff consists of two core medical trainees, one foundation trainee and one clinical fellow. The service is delivered in co-operation with a team of consultant paediatric anaesthetists, consultant paediatricians, neonatologists, radiologists and pathologists.

strengths of the department include laparoscopic surgery and urology.

Teaching Trainees will experience all aspects of paediatric surgery, with the exception of cardiothoracic surgery and neurosurgery.

There are related tertiary paediatric surgical specialties on site including ENT, ophthalmology, orthopaedics, maxillofacial, dentistry and orthodontics. Other key

Trainees are encouraged to participate in the weekly academic morning, covering presentations on x-ray and pathology, as well as audit and journal club. The weekly teaching sessions are mapped to the Paediatric and Neonatal surgical curriculum and the department runs regular videourodynamics sessions.

71

RADIOLOGY The Radiology Department is part of the Department of Imaging and Nuclear Medicine that provides a wide range of diagnostic and therapeutic imaging services, including CT scanning, MRI scanning, Neuroimaging, Paediatric imaging, Radioisotope scanning, Ultrasound scanning, Fluoroscopy and X ray. The unit provides over 330,000 diagnostic and interventional examinations per year, of which about 100,000 are required by in- and outpatients at the Royal Sussex County Hospital (RSCH), the Royal Alexandra Childrens Hospital (RACH) and the Hove Polyclinic in Brighton, as well as the Princess Royal Hospital (PRH) in Haywards Heath.

gistsâ&#x20AC;&#x2122; Curriculum to ensure trainees gain experience across a range of specialities during their Core Training years (ST1-3).

From ST2, trainees participate in the oncall and troubleshooting rotas. Although trainees in the Sussex training scheme are mainly based at BSUH Trust, there are 4-month peripheral attachments to Eastern Sussex Hospitals NHS Trust, Western Sussex Hospitals NHS Trust and Queen Victoria Hospital, East Grinstead.

The department was benchmarked as one of the top five departments on governance, patient involvement and good practice sharing and in January 2015 it achieved ISAS (Imaging Services Accreditation Scheme) accreditation. Overall, the unit employs around 220 staff across all sites, including 34 Consultants, 20 Registrars (plus Ministry of Defence trainees).

Teaching Trainees are well-supported with teaching from a variety of sources, including consultants, senior trainees and advanced radiography practitioners. Monday afternoon is dedicated to teaching and a film/ film review club. Daily morning teaching takes place from 8 â&#x20AC;&#x201C; 9am, provided by a consultant radiologist.

Deanery-wide teaching occurs approximately once per month, hosted in various hospitals across Kent, Surrey and Sussex.

For specialist training years (ST4-5), advanced training is undertaken to consolidate core training and to focus on one or more declared subspecialty interests.

The training programme modules are mapped to the Royal College of Radiolo-

72

RADIOLOGY The radiology programme has recently developed a 3-year part-time MSc in Clinical Radiology in conjunction with the Universities of Brighton and Sussex which all trainees are encouraged to enrol in. The initial modules incorporate subjects that are covered in the FRCR exams, and later modules cover research methods, communication, teaching, and leadership.

search trials as well as other research & audit projects, particularly the department’s dynamic functional molecular imaging and multi-modality research.

They are encouraged to participate in testing new equipment and procedures, getting involved in clinical trials and local audits as well as contribute to the journal club. The Clinical Radiology MSc mentioned above also provides opportunities for research in the dissertation project at the end of the programme.

Research Trainees have extensive opportunities to contribute towards the department’s re-

come surprise: as with any radiology training scheme, I expected the first year to be a step down in terms of responsibility, but it presents plenty of different challenges in getting to grips with a completely new and exciting speciality.

WHAT OUR TRAINEES SAY Dr Andrew Todd

The exams require hard work, but the change from six modules to one single exam for Part 2A means the studying isn’t as constant as it was in the past. They do however give you the confidence needed to discuss patients with registrars and consultants from all different specialities.

The MSc in Clinical Radiology was developed during my first year and has helped me prepare for my FRCR exams. It also provides a well supported opportunity to complete a postgraduate qualification, which sets Brighton apart from other training schemes. The qualification will be a great addition to my CV.

I chose to do my radiology training in Brighton because I had already lived here a couple of years previously during my F2 year and I love the culture and feel of the city.

Having moved all around the UK it was nice to know that I would be able to stay in the same place for five years.

I can wholeheartedly recommend the Sussex Radiology training scheme, both in terms of the training experience and the personal support I’ve received from others in the department.

Moving to radiology, I found the consultants and other trainees are friendly and supportive. The daily teaching sessions were a wel-

73

RENAL MEDICINE Renal medicine in Brighton is provided by the Sussex Kidney Unit (SKU) which is purpose built and contains a 26 bedded renal ward, the 50 station main dialysis unit, the Buckfield Home Dialysis centre as well as a suite of clinic rooms. SKU provides tertiary level renal care to the 1.2 million people, presenting trainees with a broad range of conditions.

kidney alone and SPK), 500 CKD/low clearance patients, over 500 haemodialysis patients, 150 vasculitis patients and a weekly clinic for those with glomerulonephritis and SLE on immunosuppression.

There are close links with the Clinical Infection Team for patients with blood borne viral infections and renal disease and also with the Childrenâ&#x20AC;&#x2122;s Hospital. Home haemodialysis has been well represented in Brighton for many years now and investments in new technology are allowing us to expand this service to include even more patients. The Buckfield Home Dialysis centre contains space to dialyse in a group and alone for all the steps along the pathway to patient independence. Peritoneal dialysis catheters are inserted within the unit so trainees are exposed to all aspects of home dialysis management.

There are two fully equipped procedure rooms with image intensifier and modern ultrasound facilities for central line insertion and renal biopsy procedures. The Stirling Day unit offers a flexible service to patients including the weekly, consultantled renal biopsy procedure list. SKU provides all forms of renal management including haemodialysis, peritoneal dialysis, dialysis for acute kidney injury and plasma exchange. Renal transplant work up is completed locally with trainees exposed to both donor and recipient work-up. Transplant surgery takes place at St Georges or Guys Hospitals. There are currently 450 transplant patients receiving follow up from one month post-transplantation (both

In centre haemodialysis also takes place in satellite units at Eastbourne, Crawley, Bexhill and Worthing with nephrology outreach clinics in Bexhill and Eastbourne.

74

RENAL MEDICINE The department is well staffed with 10 renal consultants, 2 part time consultants, a low clearance nurse consultant, 3 specialist dieticians, 2 specialist pharmacists, a social worker and 3 renal counsellors. We work together as a multidisciplinary team to provide high quality holistic care.

Teaching There are fortnightly 2 hour sessions for the registrars delivered by the renal consultants on curriculum mapped subjects in preparation for the MRCP(Neph), as well as regional training days for both renal and general internal medicine. Weekly medical grand rounds and the fortnightly renal journal club are high quality and feature external speakers.

The department has a biopsy simulator to facilitate upskilling in native renal biopsy procedure. There is time in the rota and encouragement to pursue audit and QIP projects and several trainees have been successful in carrying out clinical research projects whilst in post. There is a supported audit department within SKU to facilitate this process.

Research Several trainees have successfully completed clinical research projects, which have been showcased at national and international for a, including the regional SWEKS meeting. Support in planning and accessing suitable supervisors for out of programme activities are available, with further research opportunities at BSMS. For more information please contact Clare.Castledine@bsuh.nhs.uk, Adam.MacDiarmaidGordon@bsuh.nhs.uk or Sarah.Lawman@bsuh.nhs.uk.

WHAT OUR TRAINEES SAY Dr Kunaal Kharbanda Having completed part of my foundation training and core medical training within the Kent, Surrey & Sussex (KSS) region I was keen to stay on for higher specialist training.

The scheme is geographically friendly so that you can base yourself in one area for most of your training, either in Sussex or Kent.

Spending the majority of my training in a single unit has allowed me to get to know the staff very well with good support from the consultants. There is exposure to a wide range of Nephrology services and ample opportunity to gain competencies in the required practical procedures. The department functions very well as a multidisciplinary team which allows training from a wide range of specialised staff.

I completed my transplant placement in London at St Georges Hospital which has given me valuable exposure to the acute care of kidney transplant recipients. I have also spent a year at Worthing Hospital for my General Internal Medicine placement.

At present, I am out-of-programme, based in Manchester where I have started research in the field of home haemodialysis as part of an MD. Sussex has been an excellent place to live during my training. Brighton is a vibrant and diverse city with the South Downs on your doorstep and London only an hour away.

The training programme has been enjoyable and I feel prepared for my CCT.

75

RESPIRATORY MEDICINE The Department of Respiratory Medicine works across the Royal Sussex County Hospital (RSCH) and the Princess Royal Hospital (PRH) sites to diagnose and treat a wide range of lung conditions. The team offers specialist expertise in asbestosrelated conditions, cystic fibrosis, chronic obstructive lung disease, asthma and allergy,a as well as in HIV-related respiratory conditions, interstitial lung disease and pulmonary fibrosis, lung cancer, pneumonia, sarcoidosis, sleep-disordered breathing and tuberculosis.

(HSTs), five F2/CMT/ACCS ST1/2 doctors and four F1 doctors. There are six specialist nurses who support the care of asthma, COPD, lung cancer, tuberculosis, adult cystic fibrosis and obstructive sleep apnoea as well as a respiratory physiotherapist.

Princess Royal Hospital Pyecombe ward has 27 beds for a mixture of Respiratory and general medical patients. There is a dedicated bay for NIV with capacity for two patients requiring acute support.

Royal Sussex County Hospital Catherine James (10 beds) Egremont (13 beds) and Bailey Ward are the wards for respiratory inpatients. Respiratory outliers are based on the Acute Medical Unit.

Overton ward is in the process of being converted to cohort respiratory patients who require Non Invasive ventilation (NIV) . The department also provides a comprehensive range of services and specialist clinics at the Sussex Cancer Centre, the Hove Polyclinic.

The Sleep Laboratory is based in Hurstwood Park. There are General Respiratory outpatients with a broad range of patients drawn from the Mid Sussex area and dedicated sleep clinics. An additional clinic occurs at the Uckfield Community Hospital. There are twice weekly Bronchscopy lists and a once weekly Pleural Procedure list based in the Rapid Access Medical Unit.

There are weekly, specialist clinics in lung cancer, tuberculosis, allergy & asthma, sleep-disordered breathing and cystic fibrosis, interstitial lung disease and host defence/non-CF bronchiectasis. The Radiology Department supports the lung cancer service with excellent CT, MRI and PET scanning. The unit provides an excellent ultrasound- and CT-guided biopsy service. The Pulmonary Function service is based at the RSCH in Brighton, with access to muscle function assessment and exercise testing.

The team consists of eight consultant physicians, three Higher Specialist Trainees

76

RESPIRATORY MEDICINE

The ward based team consist of three consultants, two HSTs ( one Acute Internal Medicine), a HST level Clinical fellow, one CMT, two F2s and four F1s.

ogists and visiting Thoracic surgeon on Tuesdays, as well as the monthly Interstitial Lung Disease Meetings with a VC link with Royal Brompton Hospital at the RSCH on Wednesdays.

Teaching There are twice weekly Bronchscopy lists which are increasingly populated with patients requiring Endoscopic Bronchial Ultrasound (EBUS). The Ultrasound lists for Pleural disease run twice weekly in the Acute Medical Unit. There is an Endosopy Simulator on level 9 Millenium wing, RSCH, with modules for Bronchscopy.

Formal teaching at RSCH is available on Mondays 1-2pm with a variety of different topics covered and at the regular Thursday meetings with the respiratory consultants centred around interesting cases.

Research Trainees are encouraged to participate in projects, including health effects of air pollution, clinical trials of immunotherapy, cystic fibrosis disease monitoring as well as bronchiectasis and respiratory infection, pulmonary hypertension, interstitial lung disease, COPD and lung cancer.

Trainees are encouraged to participate in multidisciplinary meetings, including the Monday lunchtime TB meeting at the RSCH, the Video-conferenced (VC) Lung cancer MDT across both sites with Oncol-

77

RHEUMATOLOGY The Rheumatology Department offers a wide range of services to diagnose and treat joint, bone and connective tissue diseases in adults and children at the Royal Sussex County Hospital (RSCH), the Royal Alexandra Childrenâ&#x20AC;&#x2122;s Hospital (RACH), the Princess Royal Hospital (PRH) and the Hove Polyclinic.

musculoskeletal physiotherapy, as well as a specialist pharmacist with Hydrotherapy, provided at the PRH. MRI, joint ultrasound, nuclear medicine, plain imaging and bone densitometry are available at the PRH, as well as the RSCH. Currently, there are no dedicated inpatient beds for rheumatology and patients admitted remain under shared care with the acute admitting physician.

Consultants and specialist nursing staff run clinics across these sites and there is close interface with community rheumatology nurse specialists based in units across West Sussex and Brighton.

The Rheumatology Department offers high quality multidisciplinary care supported by nurse specialists, occupational therapists, physiotherapists & excellent specialist radiology services.

The service comprises rheumatology occupational therapy, specialist podiatry,

78

RHEUMATOLOGY The team comprises six NHS (four full-time, one part-time and one rheumatology and acute medicine) and one academic consultant, one associate specialist doctor, two specialist registrars, one academic F2, and four clinical nurse specialists working across two sites.

Teaching Trainees will be involved in general rheumatology clinics and consultant specialist clinics in connective tissue disease, early inflammatory arthritis, paediatrics and adolescent rheumatology.

There are weekly, registrar led emergency/ injection clinics and two-weekly departmental/ academic and X-ray meetings.

Higher specialty trainees should attend teaching sessions for MSc Rheumatology at King’s College in London twice a month, as well as the monthly journal club and the quarterly governance meeting.

Research The department’s research embraces a number of different, though broadly related domains.

Recently the department’s focus has been on lupus and RA and new pathological mechanisms underlying both lupus and rheumatoid arthritis. The team is actively involved in research trials in both rheumatoid arthritis and lupus at the Clinical Investigation and Research Unit.

79

UROLOGY The Urology Department provides care to a population of about 465,000 in Brighton, Hove and the Mid Sussex areas and offers a comprehensive range of urological services. All inpatient surgery and emergencies are managed at the Princes Royal Hospital (PRH), where the department is based. Outpatient clinics are run at the Royal Sussex County Hospital (RSCH) in Brighton, as well as at the PRH in Haywardâ&#x20AC;&#x2122;s Heath and at the Lewes Victoria Hospital in Lewes.

providing a variety of surgical approaches for benign and malignant disease. The unit sees a wide range of endourology and offers laser prostate surgery in addition to other endourology operations and urological reconstruction surgery. Its strengths include upper tract laparoscopy, stones and reconstruction. Pelvic cancer cases are taken to Eastbourne to the regional robotic service.

The new 3D laparoscopic equipment puts the trustâ&#x20AC;&#x2122;s nephrectomy surgery at the forefront of surgical technology. The unit offers regular, nurse lead lower urinary tract symptom clinics, virtual stone clinics and oversees care in a dedicated urology ward. The medical team comprises six consultants, six registrars, two core training doctors and three foundation doctors alongside our nursing colleagues.

A team of urology specialist nurses provide Trial Without Catheter (TWOC) services, urodynamics and intravesical bladder therapy. The enthusiastic nursing team also provides an on-site lithotripsy service, the only such service in Sussex.

The Urology Department is also the tertiary referral centre for renal surgery,

80

UROLOGY University of Sussex investigated biomarkers of response to BCG in nonmuscle invasive bladder cancer. Urology surgeons were also involved in a Smartglasses trial, carrying out simulated data entry of cystoscopy findings, which are used to further investigate suspected bladder cancer.

Teaching Trainees are expected to partake in daily consultant led ward rounds. The theatre sessions are consultant led and offer excellent learning opportunities. The department organises regular governance and multidisciplinary meetings.

Research The department has a strong track record of research and trainees have the opportunity to participate in traditional â&#x20AC;&#x2DC;lab basedâ&#x20AC;&#x2122; projects, educational research or clinical research. For example, the last project conducted in co-operation with the

The urology department also has a research fund to support its projects. As well as research the department has strong audit and teaching credentials and there are excellent opportunities to get involved with projects and education / training. tion and training but also achieving the highest level of care for our patients.

WHAT OUR TRAINEES SAY Miss Katie Chan

Staff in our department is extremely approachable and I am fortunate to have excellent teachers who help me further develop my surgical skills, as well as leadership and communication skills on the road to becoming a consultant.

I was thrilled to get my ST3 training job at Brighton and Sussex University Hospital NHS Trust.

Not only is Brighton a thriving hub of a city it also is a great training hospital and I am very lucky to have started on my urology career here.

The enthusiastic team has helped me to produce high quality audit and research projects during my time here and I have presented regionally and internationally as a result of this work.

I work alongside 2 other training registrars who have chosen to specialise in stone disease and urological oncology to complement their training therefore the urology training jobs can be flexible to suit the training needs of the individual.

I do 3-4 operating lists a week covering a variety of different types of urology surgery as well as 2 outpatient clinics and regular urology emergency on calls. It has been a delight to work alongside the rest of the team who are really enthusiastic in both continuing my own educa-

I have very much enjoyed my time at Brighton and I think it has given me a fantastic start to my Urology career.

81

VASCULAR SURGERY The Department of Vascular Surgery is the hub for a Sussex wide regional vascular service for a catchment population of approximately 1.6 million. The unit performs the entire range of vascular and endovascular procedures, including thoracic aortic interventions, supported by the Regional Cardiothoracic centre.

every week. As a high proportion of aneurysms are treated by endovascular technique, these procedures include complex interventions including fenestrated and branched endovascular procedures.

There are twelve operating sessions each week with excellent learning opportunities for trainees.

The regional renal service is also based at BSUH and the vascular surgeons and radiologists provide support for creation and maintenance of renal access for dialysis.

On an average four endovascular aortic aneurysm repairs (EVARs) are performed

Over the past many years, senior vascular trainees from other deaneries have opted to come to our department. The department is proud to offer a unique training fellowship in renal access surgery.

82

VASCULAR SURGERY The whole range of vascular problems are handled by the department, including carotid endarterectomy under local anaesthesia, endoscopic thoracic sympathectomy, upper limb vascular problems, aorto iliac/femoral bypass, femoro femoral cross -over graft, femoro popliteal and femorodistal bypass, diabetic foot clinics and open aortic aneurysm repair.

The unit provides a high quality service for carotid surgery in cooperation with a multidisciplinary group of stroke physician, and vascular sonographers, as well as radiologists and anaesthetists.

The department frequently performs endovenous radiofrequency closure for varicose vein. There is a well equipped Endovascular Hybrid Theatre and an Interventional Radiology suite in the Radiology Department. Magnetic Resonance Angiography is routinely used and there are several CT scanners.

ganised by the Vascular Society, Royal College of Surgeons and Society for Vascular Technologists.

There are nine vascular surgeons who provide round the clock service for the entire county of Sussex at the hub in Brighton. There is a dedicated vascular on-call registrar rota supported by eight vascular registrars that include teaching fellows, senior fellows and trainees from KSS and other deaneries.

Teaching There are weekly multi-disciplinary meetings with interventional radiology, monthly audit meetings, and once a month there is a carotid / stroke MDM. The department organises regular teaching and journal club sessions and trainees are required to attend the daily vascular ward rounds.

The vascular department is heavily involved in teaching medical students.

The non-invasive vascular laboratory is well equipped and staffed by three fulltime, one part time and one trainee vascular scientist, providing a high quality service for duplex scanning and other non invasive assessment. The Unit took part in the pilot scheme for training of vascular surgeons in vascular ultrasound jointly or-

Research Currently, there are limited opportunities to participate in research projects. However, the department plans to develop research with future appointments as a large regional centre.

83

Contact details Medical Education Department Brighton and Sussex University Hospitals NHS Trust, Princess Royal Hospital Lewes Road, Haywards Heath, RH16 4EX www.bsuh.nhs.uk/med-ed Compiled and edited by Amelia Amon Contact: Amelia.Amon@bsuh.nhs.uk Copyright Š 2017 Brighton and Sussex Hospitals NHS Trust Published and distributed by: Medical Education Department Published: September 2017

84