Welcome to Diabetes and Endocrinology Medicine

Diabetes and Endocrinology in East of England 

Endocrinology and diabetes is a fascinating specialty encompassing basic mechanisms of physiology and pharmacology coupled with the ability to improve quality of life and long-term outcomes through effective disease control, and often cure. Endocrine and metabolic diseases are commonly encountered in the UK population and are increasing in prevalence and impact emphasising the need to continue to improve health care delivery in the specialty. Endocrine diseases and diabetes affect every physiological system of the body and specialists need a wide range of skills and expertise and make a major contribution to general medicine in its broadest sense. 

The specialty has something to offer for everyone. Many of the endocrine diseases we encounter are rare ones and pose diagnostic and therapeutic challenges, and present considerable intellectual stimulus. There are equally challenging less rare conditions that require working closely with many different multiprofessional colleagues.  A broad training in endocrinology and diabetes provides the basis for progression to specialist posts in a wide range of settings from the smaller hospital to the large tertiary referral centre, from the community base to the University academic department.

 

Why Train in the East of England?

ImageThe East of England provides a high standard of living combining city, country and coast, internationally recognised teaching and research, and great weather! One of the advantages of training in the east of England is the number of opportunities open to every trainee.  In addition to high quality clinical training there are extra opportunities to develop skills in research, teaching, management or leadership both in and out of programme. If you choose to train in the East of England you would join a team of diabetologists and endocrinologists with a wide range of clinical and research interests who deliver nationally and internationally recognised services and contribute to clinical practice in the UK through their work on national networks, societies and guideline committees.

Unlike many other schools, successful trainees are aware of the location of all five years of their training programme at the time of appointment, which helps domestic planning. The East of England School of Medicine is located in a large region but as a school we prioritize arranging rotations to prevent unreasonable commuting distances. All trainees spend a minimum of 20 months in a teaching hospital either rotating to Addenbrooke’s Hospital or the Norfolk and Norwich University Hospital.

Post Graduate Certificates in Medical Education: many of our trainees have completed PGCE, sponsored by the School.

Research: There are well established academic clinical fellow (ACF) and clinical lecturer (CL) programmes within the region and we support all clinical trainees wishing to take time out of programme to undertake a higher degree. There are a wide range of research opportunities encompassing diabetes, obesity, endocrinology and metabolic medicine.

Clinical Excellence and Expertise in Diabetes and Endocrinology in East of England:

If you choose to train in the East of England you would join a team of diabetologists and endocrinologists with a wide range of clinical and research interests who deliver nationally and internationally recognised services and contribute to clinical practice in the UK through their work on national networks, societies and guideline committees.

Nationally  recognised services in in several areas:

The National Severe Insulin Resistance Service at Addenbrookes provides a multidisciplinary NHS service for patients with severe insulin resistance and/or lipodystrophy from throughout England.

Diabetes in pregnancy: there are large research active Diabetes Antenatal Services at Addenbrookes and Norwich and throughout the region with studies using closed loop (“artificial pancreas”) led by Prof Helen Murphy. A recent Eastern Academic Health Science Network Diabetes Pre-pregnancy Care Project has ensured region-wide engagement with GPs, practice nurses, community diabetes teams, health visitors, sexual health teams and the public to promote diabetes preconception care.

Insulin pumps/ artificial pancreas: There are large insulin pump services at Addenbrookes and Norwich (paediatrics, transition, adults, pregnancy) with research into artificial pancreas or closed loop models at Addenbrookes.

Diabetic foot disease: there are large research-active diabetic foot clinics at Norwich and Ipswich.

The Metabolic Bone Clinic run by Prof Jeremy Turner and Prof Bill Fraser at Norfolk and Norwich University Hospital NHS Foundation Trust is one of only 10 centres to have been awarded the Paget’s Association Centre of Excellence award

 

Trainees Persepective 

Dr Shoib Ur Rehman

Endocrinology and Diabetes is the most exciting subject in medicine as it encompasses the most variety of organs and conditions starting from hypothalamus down to the toes . Embedded with in it is the physiology of rhythm and delicate harmony of almost all human hormones and their far reaching affects . Diagnosing subtle abnormalities and restoring the balance is the most satisfying feeling one gets with this specialty .

The training programme designed for East of England deanery is unique in terms of delivering high quality education and experience through regular regional training days and clinical work . Consultant colleagues across the region are extremely approachable and have keen interest in teaching and preparing consultants of future who meet high standards of patient care and expertise in the field.

The training programme takes 5 years and results in dual accreditation and CCT in Endocrinology & Diabetes and General Medicine. Being ‘The Medical Registrar’ is a challenging experience but is also very rewarding in developing leadership skills ,managing all medical admissions and acting in charge of hospital organisation specially at night shifts. The rotations are usually set so most of general medical experience is expected to be achieved during smaller district general hospitals placements along with general Diabetes and Endocrinology exposure and at least 20 months of University Hospital placement (Cambridge University Hospitals/Norfolk & Norwich University Hospitals)where trainees gain experience in more complex and specialists clinics such as NET, Pituitary disorders , Bone Metabolism , Reproductive Endocrinology and obesity.

As a highly academic field of Medicine, there are also plenty of opportunities for research/audit/education. In fact, trainees are highly encouraged to pursue their academic interest. There are many world leading researchers of different interest within the Deanery (e.g. genetics in obesity, thyroid disorders, lipid disorders, etc.). This gives you a variety of research options that you can choose to embark on based on your interest.

Overall, the EOE Diabetes & Endocrinology Programme is a well-structured training setting which enables trainees to meet curriculum requirements set by JRCPBT coupled excellent guidance and support from consultants and senior registrar colleagues . It is a friendly deanery with good network of support, a great teaching environment with excellent local schools and beautiful landscapes on your doorstep. Most of the trainees on completion of their training stay in the region which in itself speaks volumes of trust development between trainers and trainees - as well as the quality of life in the East of England. 

 

Contribution to National/International guidelines and Training resources

Endobible: an online resource developed by Dr Frankie Swords (Norwich)

http://www.endobible.com/

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Diabetesbible - an online resource developed by Professor Jeremy Turner (Norwich)

http://www.diabetesbible.com/

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Contributions to National Endocrine / Diabetes Guidelines
Contributions to National Endocrine Guidelines

Society for Endocrinology Endocrine Emergency Guidance: Emergency management of acute hypocalcaemia in adult patients. Jeremy Turner (Norfolk and Norwich University Hospital), Neil GittoesPeter Selby, the Society for Endocrinology Clinical Committee.

Guidelines for the management of thyroid cancer.  Third edition.  British Thyroid Association July 2014. Perros P, Colley S, Boelaert K, Evans C, Evans RM, Gerrard GE, Gilbert JA, Harrison B, Johnson SJ, Giles TE, Moss L, Lewington V, Newbold KL, Taylor J, Thakker RV (Addenbrookes), Watkinson J, Williams GR

Management of primary hypothyroidism: statement by the British Thyroid Association Executive Committee. Onyebuchi Okosieme, Jackie Gilbert, Prakash Abraham, Kristien Boelaert, Colin Dayan, Mark Gurnell (Addenbrookes),  Graham Leese, Christopher McCabe, Petros Perros, Vicki Smith, Graham Williams and Mark Vanderpump

Society for Endocrinology Endocrine Bone and Calcium Network: Convenor: Jeremy Turner (Norwich).

Contributions to National Diabetes Guidelines

National Institute for Clinical Excellence

  • Dr Amanda Adler (Addenbrookes) chairs a multi-disciplinary Technology Appraisal Committee at the National Institute for Health Excellence (NICE) 
  • Catherine Gooday (Principal Podiatrist, Norwich) is an expert adviser for the NICE Centre for Guidelines (CfG). Member of the group that developed the NICE guidance; Diabetic foot problems: prevention and management (2015).

The Hospital Management of Hypoglycaemia in Adults with Diabetes Mellitus.  JBDS 01

Lead authorship: Esther Walden (RGN), Norfolk and Norwich University Hospitals NHSFT, Debbie Stanisstreet, Christine Jones, Norfolk and Norwich University Hospitals NHSFT, Dr Alex Graveling.

Supporting organisations: Tracy Kelly, Diabetes UK, Professor Mike Sampson (Norwich), Joint British Diabetes Societies (JBDS) Inpatient Care Group ChairEsther Walden (Norwich), Diabetes Inpatient Specialist Nurse (DISN) UK Group Chair, Dr Chris Walton (Hull), Association of British Clinical Diabetologists (ABCD) Chair.

The Hospital Management of DKA in Adults.  Revised September 2013. JBDS 02

Lead authorship: Dr Ketan Dhatariya, Norfolk and Norwich University Hospital NHS Foundation Trust, Dr Mark Savage.

Supporting organisations: Tracy Kelly, Diabetes UK, Professor Mike Sampson (Norwich), JBDS Inpatient Care Group Chair, Esther Walden (Norwich), Diabetes Inpatient Specialist Nurse (DISN) UK Group Chair, Dr Chris Walton, ABCD Chair.

Management of adults with diabetes undergoing surgery and elective procedures: improving standards April 2011. JBDS 03

Ketan Dhatariya (Norfolk & Norwich University Hospital), Daniel Flanagan, Louise Hilton, , Anne Kilvert, Nicholas Levy, Gerry Rayman, (Ipswich Hospital), Bev Watson.

Self-Management of Diabetes in Hospital March 2012. JBDS 04.

Lead authorship: Dr Daniel Flanagan, Maggie Watkinson.

Supporting organisations: Esther Walden (Norwich) Diabetes Inpatient Specialist Nurse (DISN) UK Group Chair, Professor Mike Sampson (Norwich) JBDS Inpatient Care Group Chair, Dr Chris Walton, ABCD Chair,  Tracy Kelly, Diabetes UK

Glycaemic management during the inpatient enteral feeding of stroke patients with diabetes June 2012 JBDS 05.

Lead authorship: Dr Aled Roberts, Simone Penfold.

Trust Supporting organisations: Jill Hill TREND UK, Tracy Kelly, Diabetes UK,  Professor Mike Sampson (Norwich), JBDS Inpatient Care Group Chair, Esther Walden (Norwich), Diabetes Inpatient Specialist Nurse (DISN) UK Group Chair, Dr Chris Walton, ABCD Chair

The Management of the hyperosmolar hyperglycaemic state (HHS) in adults with diabetes August 2012 JBDS 06.  Lead authorship: Dr Adrian Scott, Anne Claydon.

Supporting organisations: Tracy Kelly, Diabetes UK, Professor Mike Sampson (Norwich), JBDS Inpatient Care Group Chair, Esther Walden (Norwich), Diabetes Inpatient Specialist Nurse (DISN) UK Group Chair, Dr Chris Walton, ABCD Chair.

Admissions avoidance and diabetes: guidance for clinical commissioning groups and clinical team; December 2013, JBDS 07.

Lead authorship: Dr Belinda Allan, Professor Mike Sampson (Norfolk and Norwich University Hospitals NHSFT).

Supporting organisations: Dr Paul Downie (PCDS), Tracy Kelly Diabetes UK, Fiona Kirkland (PCDS), Esther Walden Chair, Diabetes Inpatient Specialist Nurse UK Group (Norwich),  Dr Chris Walton Chair,ABCD.

Management of Hyperglycaemia and Steroid (Glucocorticoid) Therapy October 2014.  JBDS 08. Lead authorship: Dr Aled Roberts, June James, Dr Ketan Dhatariya, Norfolk and Norwich University Hospitals NHSFT.

Supporting organisations: ABCD Chair: Dr Rob Gregory, Diabetes Inpatient Specialist Nurse (DISN) UK Group Chair: Esther Walden (Norwich), Diabetes UK: Tracy Kelly, Head of Care JBDS Inpatient Care Group Chair: Professor Mike Sampson (Norwich)

Management of glycaemic control in pregnant women with diabetes on obstetric wards and delivery units May 2017. JBDS 12.

Lead authorship: Dr Umesh Dashora, East Sussex Healthcare NHS Trust, Dr Rosemary Temple, Norfolk and Norwich University Hospitals NHSFTProfessor Helen Murphy, Professor of Medicine (Diabetes and Antenatal Care), Norwich Medical School University of East Anglia and Honorary Consultant Addenbrooke’s.

Supporting organisations: Diabetes UK: David Jones, Head of Involvement and Shared Practice JBDS for Inpatient Care, Chair: Professor Mike Sampson (Norwich), Diabetes Inpatient Specialist Nurse (DISN) UK Group, Chair: Esther Walden (Norwich), Association of ABCD, Chair: Dr Rob Gregory.

Diabetes UK Position Statements and Care Recommendations NHS Diabetes guideline for the perioperative management of the adult patient with diabetes.  Dhatariya (Norwich), N. Levy, A. Kilvert, B. Watson, D. Cousins, D. Flanagan, L. Hilton, C. Jairam, K. Leyden, A. Lipp, D. Lobo, M. Sinclair-Hammersley and G. Rayman (Ipswich) for the Joint British Diabetes Societies

Reading List

Reading list

(As recommended for SCE: https://www.mrcpuk.org/mrcpuk-examinations/specialty-certificate-examinations/specialties/endocrinology-and-diabetes )

1) Textbooks

  • Oxford Handbook of Endocrinology and Diabetes 2nd Edition 2009 (H Turner, J Wass)
  • Oxford Textbook of Endocrinology and Diabetes 2nd Edition 2011 (J Wass, P Stewart)
  • Williams Textbook of Endocrinology 12th Edition 2011 (S Melmed et al)
  • Textbook of Diabetes 4th Edition 2010 (R Holt et al)

2) Journals

3) Guidelines

4) Conferences

5) Online Resources

Regional Endocrine and Diabetes Training
  • Diabetes and endocrinology regional training days: there are 5 full days and 3 half-days (followed by EASE meeting-see below) per year, rotating round the hospitals in the region 
  • EASE-NET (East Anglian Society for Endocrinology- Network for Education and Training): monthly video-conferenced clinical case presentations across the region.  These take place every second Tuesday of the month from 08:00 - 09:00. 
  • East Anglian Society for Endocrinology: meets three times a year in the evening and these are preceded by an afternoon of training for all diabetes and endocrinology Specialist Registrars.
  • There is weekly specialty teaching at Addenbrookes and Norwich, with some of Addenbrookes sessions being accessible across the region via videoconference. There are also bimonthly curriculum-based teaching afternoons at Norwich open to all trainees.
  • There are also separate General Internal Medicine regional training days (7 per year) which all Diabetes and Endocrine trainees attend and these are an opportunity to meet up with trainees from other medical specialities from around the region. Some Acute Medicine training days are also open to D&E trainees.
  • Cambridge  Medical  Seminars:   twice-yearly series of medical seminars providing an update in general medicine .
  • Bedford Diabetes Study Days - These study days take place multiple times per year. The Days will be of relevance to all healthcare professionals and medical students who are interested in a career in Diabetology.

Upcoming Training dates: 

Due to COVID 19 pandemic, the regional training days are currently being held remotely through a modern online learning platform called Bridge. These are all half a day sessions and are hosted by various hospitals across the region. More recently we have started to record and upload the talks on to an e-learning platform called Panopto, this has enabled the trainees to watch these talks even after their on-call commitments.

East of England Diabetes & Endocrinology Update for SPRs and Consultants:

  • 24th April 2020
  • 29th September 2020

Please contact Dr Latika Sibal for more information. 

SPR Training Days:

  • 10th March 2021 -  Bedford Hospital
  • 20th April 2021  - Lister Hospital
  • 15th June 2021 - Norfolk and Norwich University Hospital
  • 5th October 2021 - Norfolk and Norwich University Hospital

Please contact Dr James MacFarlane and Dr Smriti Gaur for more information. 

Further Advice and Information

Detailed guidance on the Diabetes & Endocrinology assessment blueprint and curriculum is available from the JRCPTB website.

Please follow this link for the Endocrinology and diabetes mellitus GMC National Training Survey report of trainee satisfaction.

Entry Requirements

Entry into Endocrinology and Diabetes Mellitus training is possible following successful completion of both a foundation programme and a core training programme. There are two core training programmes for Endocrinology and Diabetes Mellitus training:

•           Core Medical Training (CMT)

•           Acute Care Common Stem (Medicine) ACCS

For further information, please see the JRCPTB website. for further information.

ARCP Dates 2021

Friday 18th June 

Friday 16th July 

 

Monday, 7 December, 2020
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