3 month placement
A & E Teaching Programme
The A & E department at the James Paget sees 78000 cases per year. The caseload covers the entire spectrum of medical conditions and trauma. The department is staffed with 8 Consultants, 1 Associate Specialist, various middle grade doctors including Staff Grades and Specialist Registrars, 4 GPStR’s, 4 F2 trainees and 2 ACCS trainees. We also have a 3 ACP’s and 3 PA as part of our Tier 1 and 2 rotas.
It operates a full shift system of 44 hours per week. There is 24 hour middle grade cover in the department. There are regular teaching sessions with protected time once per week, and the training requirements of all junior staff are assessed to allow a profile of individual training needs.
Attendance at weekly VTS teaching and emergency medicine teaching is encouraged and protected. Attendance on Life Support courses and VTS Courses is encouraged also. The post offers excellent experience for anyone wishing to enter general practice as a career as the workload to a large extent reflects the type of cases presenting at a doctor’s surgery, and experience is gained making rapid assessment of patient’s needs, a skill essential in general practice.
3 month placement
ENT Teaching Programme
A 3 month placement in the ENT Department at the James Paget Hospital will give a Trainee in General Practice a good opportunity to become familiar with most aspects of the Specialty.
ENT actually comprises a significant proportion of General Practice workload and also a significant proportion of Hospital referrals.
The Department at the James Paget carries out all aspects ENT surgery and has an active and well supported Audiology Department. There is close collaboration with the Department at the Norfolk and Norwich Hospital where patients with major head and neck cancer are jointly managed.
There are three Consultants in the Department, Mr Prinsley, Mr Al’Omari and Prof. Philpott, there is one Registrar on the Eastern Regional Rotation and three Specialty trainees one post in General Practice Training GPStR, one post in basic training for ENT surgery (CT1 and one FY2).
Trainees in General Practice will be expected to take a full part in the work of the Department attending Theatre and Out-patients. Three months is certainly long enough for Doctors who wish to learn some basic ENT operations such as tonsillectomies and also to become familiar with the management of most ENT emergencies and to attend routine clinics to familiarise themselves with common ENT pathology.
3 month placement
The department of medicine comprises 6 medical wards and a 10- bed coronary care unit and 5 bedded Hyper Acute Stroke Unit (HASU). Each of the wards caters for patients with acute general medical conditions but also have subspecialty interests in respiratory medicine (ward 7 & 15), cardiology (ward 2), gastroenterology (ward 3), Care of the elderly (ward 12) stroke care (Ward 1) and Hematology/oncology/GIM (ward 17) and hematology (ward 17). Acute medical admissions, usually between 35 and 50 daily, are admitted through the Emergency Admission and Discharge Unit (EADU).
There are 16 physicians who participate in acute unselected medical take, all with an interest in general medicine each with a special interest in respiratory (4), gastroenterology & hepatology (6), cardiology (1), endocrinology (3) Acute Medicine (6) and care of the elderly medicine (1). There are also consultants in hematology (3) and rheumatology (2) and Stroke Medicine (4).
The department works from a ward-based system in 4 teams.
1) Stroke and Care of the elderly team (4 consultants 3 middle grades, 5 FY2/IMT/GP trainees and 2 FY1
2) Respiratory Team (4 consultants, 2 Registrars, 4 FY2/IMT/GPT and 4 FY1.
3) Gastroenterology Team (6 consultants, 2 Registrars, 3 FY2/IMT/GPT, 2 FY1and 1 PA
4) Cardiology/Endo Team (3 consultants, 3 visiting consultants, 5 middle grades, 5 FY2/IMT/GPT two FY1 and one Physician Associate.
Junior doctors work on a full shift system.
There are 4 GP trainees. The department offers a wide variety of experience in clinical medicine both acute and at outpatients. Our education programme fulfils training requirements and allows half-day educational release for GPSTR trainees. Moreover there are lots of opportunities to attend teaching sessions including weekly Grand rounds
3 month placement
Obs & Gynae Teaching Programmes
There are eight Consultant teams and eight Middle Grades at the second on call level. There are seven doctors at first on call level, three GP trainees and four F2 trainees. All Specialty / GP Trainees are on a full shift pattern of work.
We have an up to date delivery suite which offers training in all aspects of modern management of labour and antenatal care. There are approximately 2200 deliveries per annum. The hospital has a new midwifery led birthing unit called the Dolphin Suite.
The Unit undertakes all general aspects of Gynaecology including a colposcopy, minimal access surgery, infertility, PMB, urogynaecology and gynae oncology services.
Thursday morning are reserved for weekly postgraduate meetings which include a rolling programme of 21 tutorial sessions specifically aimed at junior doctors and GP trainees. In addition an Educational half day teaching takes place once a month, please see example programme attached. Every Wednesday afternoon - Journal club meeting. Further education meetings are:- caesarean section meeting, perinatal morbidity and mortality meeting.
The department gives 14 sessions in a 6 month placement for attendance at clinics and Theatre of the trainee’s choice.
Each registrar will work with usually two and occasionally three consultants during their six months and the rotation will include three one week blocks of night duty. At the present time the DRCOG examination is held five months after completion of the post and you are expected to attend the Thursday morning tutorials.
There are both hospital and departmental inductions. Each GPStR will have a named Clinical supervisor with whom an induction interview is undertaken to plan individual training needs and requests.
O&G & GP trainees recently gave JPUH teaching and training an excellent report at the regional Deanery meeting. The department’s comprehensive induction programme has also been praised.
‘Excellent, especially for Obstetrics’
‘Really enjoyed well supported and relevant to GP’
‘very strong element of teaching throughout training. Would strongly recommend’
3 month placement at the JPUH
A 3 month placement in the Ophthalmology department at the James Paget University Hospital will give a Trainee in General practice a good opportunity to become familiar with many aspects of the specialty.
Ophthalmic problems cause significant patient morbidity. Nearly 10% of all patients attending a hospital go to the eye department. People with visual impairment are twice as likely to have falls. Sight loss is associated with increased levels of anxiety and depression. Loss of vision is recognized to mean earlier dependency on care homes and care support. More than 10% of over 65s have visual impairment. Eye related complaints account for at least 1.5% of General practice consultations in the UK with a rate of 50 consultations per 1000 population per year. However, many patients may be unaware that they have visual loss which can have a gradual and insidious onset.
The JPUH eye department….
Has a young (at heart) and enthusiastic team of consultants, orthoptists (who test eye movements) and optometrists (who have expertise in spectacles and contact lenses etc). There is an opportunity to work alongside these allied health care professionals. The eye department offers a full range of ophthalmic surgery treating patients from neonates to the elderly. The department benefits from the most up to date equipment both in clinics, and theatres enabling most patients to benefit from receiving treatment locally.
Include Mr Menon, Mr Pharoah, Mrs Hemmant, Mr Butler, Mr Burton, Mr Goldsmith, Mr Prabhu, Mr Raja. Each has a specialist area of interest which cover all areas of ophthalmology. Each consultant is passionate about their area of ophthalmology and all are keen to teach receptive and interested trainees.
Experience to be gained….
The GP trainees in recent times have preferred to spend time seeing casualties with the Ophthalmic surgical trainees and then on their own when experienced enough. This enables them to get a grasp of what conditions do need to be referred to the Hospital eye service (HES) and within what time frame, the likely treatment the patient will receive and long term follow up plan (if necessary). GP trainees will have the opportunity to spend time in theatre. The teaching opportunities are multiple from informal teaching during and after clinics, to teaching timetabled during the week and as part of the weekly departmental teaching on a Friday afternoon. GP trainees are encouraged to take part in the teaching and to present interesting cases with a general practice lean.
The timetable is flexible to an extent and so can be tailored, for example if a GP trainee has a particular interest in doing an eye lid lump and bump list this can be arranged.
Three months should be an adequate period to become familiar with ophthalmic examination techniques and with the management of the most common Ophthalmic emergencies.
"Brilliant teaching very interesting"
"Really really Really good"
"Friendly team, great teaching, way more confident now"
Trauma & Orthopaedic Department JPUH
T&O at Paget provides Acute and Elective specialist services in Trauma, Hips, knees, Shoulder and Upper limb. The department also provides general Foot&Ankle, Paediatrics and Spine service.
There are 2 wards for Trauma & Orthopaedics - Ward 6 for Trauma and Ward 22 for elective surgery. Additional elective admissions come via the Day-Case Ward, Children’s ward (10) and outlying wards occasionally.
There are 3 laminar flow Orthopaedic theatres in use for joint replacement and we also use general and day surgery theatres.
Outpatient clinics are run daily in the out-patient suite.
The department is divided into firms each of which is led by a consultant with a dedicated middle grade. Currently, the department operates a 1:8 on-call rota using a “trauma week” system. During the trauma week all elective lists and clinics are suspended for that particular Consultant firm . A “Trauma co-ordinator” assists in many aspects of the trauma care organisation.
We endeavor to ensure that the training you receive will enhance your career in general practice. A departmental induction course is organised early on in the post to help orientate GPStRs to Orthopaedics and Trauma. You are encouraged to attend out-patient clinics to learn about the Orthopaedic conditions, learn how to examine an Orthopaedic case, inject soft tissues, joints and other basic Orthopaedic procedures that you can perform in GP practice. The Orthopaedic rota provides the facility for adequate involvement in clinics and theatre lists.
The department encourages the use of the ward round and outpatients as a forum for the discussion of clinical problems, interchange of ideas and management planning and is an important facet of training. Orthopaedic cases presenting to the department are discussed daily at the Trauma meeting. Doctor/Patient communication skills are gained via an apprenticeship system on ward rounds and in outpatient clinics by observation and discussion with senior staff.
3 month placement
Paediatric Teaching Programme
We will ensure that the training you receive will develop your career in medicine. A departmental induction course is organised early on in the post to help orientate GPStRs to children and paediatric medicine. GPStRs are encouraged to attend sub-specialist clinics to learn about less common conditions.
The department encourages the use of the ward round and outpatients to establish a forum for the discussion of clinical problems, interchange of ideas and management planning and should be regarded as an important facet of training. Experience is offered in Doctor/Patient communication via an apprenticeship system on ward rounds and in outpatient clinics by observation and discussion with senior staff.
Experience will be gained in a wide range of acute, chronic and neonatal problems resulting from exposure to ill children referred by general practitioners in addition to outpatient management. Neonatal experience will include the care of the healthy newborn, resuscitation in cases of birth asphyxia, and some neonatal intensive care depending on the needs and enthusiasm of the GPStRs.
We encourage GPStRs to take time talking to parents and regard time spent reassuring them, discussing investigations, management and follow up as an important part of the experience. The aim of the department is to offer high standards of diagnosis and care both for acutely ill children and also those with less acute and less common conditions seen in outpatients. Bearing in mind their particular needs and the difficulties of ascertaining history and symptoms in children, strong emphasis is placed on liaising carefully with parents, caring agencies and referring general practitioners.
There are 18 beds for paediatric medicine on Ward 10 where around 1300 medical paediatric admissions occur annually. Approximately 250 children attend per annum as ambulatory day cases or ward attendees for investigation or follow up. Sick or premature infants are cared for on SCBU which has nine cots, one of which is equipped for neonatal intensive care. There is also the Newberry Child Development Centre nearby and Out Patient Clinics at Lowestoft.
About 200 infants per annum are admitted to SCBU but a majority of healthy babies (2400 per annum) are cared for alongside their mothers on the postnatal ward where neonatal screening and treatment of minor difficulties is carried out.
The teaching programme is designed to back up clinical experience gained and GPStRs are encouraged to sit the DCH. Medical students from UEA Norwich are regularly attached to the department which forms an added stimulus to learning.
Formal lectures and tutorials occur at lunchtimes four days a week. The induction programme provides departmental orientation, details of neonatal resuscitation and also important paediatric emergencies. Clinical guidelines are issued which are regularly updated and these cover common inpatient, outpatient and neonatal problems. The department firmly believes in the concept of guidelines to aid practice rather than a protocol to be rigidly adhered to.
Individual Training Programme and Educational Supervision
Trainees are allocated to an Educational Supervisor who goes through the individual Training Programme early on during the appointment and objectives/achievements/weaknesses are assessed at regular intervals. A formal system of mutual appraisal and counselling exists, this operates by assessment of the trainee by the Supervisor and of the post by the registrar using the ITP as a guideline. The initial meeting is held with a supervisor during the first week and then further assessments are held on at least two subsequent occasions to judge progress, provide encouragement and advice, and discuss problems and/or suggestions.
The modern children's ward is a bright friendly environment for patients and staff. The result is a congenial, stimulating department led by eight hospital based consultants in addition to one community based consultant.
Dr Stephen Nirmal (clinical lead)
Dr John Chapman
Dr Sudeep Damodaran (Paediatric - College Tutor)
Dr Viji Raman
Dr Himal Gurung
Dr Sue Zeitlin
3 month placement
Psychiatry Teaching Programme
There are a total of 7 General Adult Consultant Psychiatrists employed by the Norfolk & Waveney Mental Health NHS Foundation Trust at Northgate Hospital and Carlton Court. The GP vocational registrar is attached to one of the consultants, whose main commitment is to General Adult Psychiatry.
The services are progressive in respect of developments in community based treatments and the registrar becomes a member of one of the Multidisciplinary Community Mental Health Teams. Thus, considerable emphasis in training is given to Domiciliary visiting with Consultants, Community Psychiatric Nurses, Behaviour Therapists, Social Workers and others. There are active Psychology and Occupational Therapy departments, providing valuable training opportunities.
More usual and extensive training is given on the inpatient unit and at outpatients’ clinics under close Consultant supervision: assessment of cases of deliberate self-harm at the district general hospital is another aspect of training.
One of the Consultants has a special interest in drug and alcohol abuse and another in Perinatal Psychiatry, providing valuable experience, sessional training visits to the Child and Family and/or Learning Difficulties Departments, can be organised for interested individuals. There is also an active Department of Old Age Psychiatry with very good, ongoing research in Dementia, drug trials and Professor of Psychology from the UEA.
There is a good psychiatric library at Northgate Hospital which all GPStRs are encouraged to use. There is an excellent weekly half-day training programme, held locally at Northgate Hospital and a very good research forum that is well linked with the Trust Research Department. There are excellent opportunities for research and audit.
'Wonderful post for learning lots of Psych'
'Don't be "afreud" to give it a go!' Steve ST2