Health Education England, working across the East of England - Diabetes and Endocrinology:

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?

Advantages of training in the East of England

The 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.

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The Chief Resident Programme, run in conjunction with The Judge Business School Cambridge, gives senior trainees world class management training and opportunities to deliver QIPs.

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.

 

ARCP Dates for Current Trainees:

ARCP's for current trainees will take place on the 12/6/19 and 19/6/19 - anyone requiring a PYA will need to attend on 12/6/19 only. 

 

 

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

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.

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 Chair, Esther 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 NHSFT, Professor 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

Research Opportunities and Trainee Prizes and Achievements

All trainees on the training programme have the opportunity to undertake research, either as time out of programme (OOPR) leading to the submission of an MD or PhD thesis, or smaller projects alongside their clinical training. All trainees are encouraged to submit abstracts to conferences and present at local, national and international meetings and our trainees have a successful track record:

  • British Thyroid Association Award; ‘A Novel, Missense, Mutation (P81R) in the TRHR gene in Congenital Central Hypothyroidism’, SfE BES meeting, Edinburgh, 2015.
  • Highly commended poster prize; ‘A role for 11C-methionine PET/CT-MRI in the management of de novo and residual acromegaly’, SfE BES meeting, Edinburgh, 2015
  • 2nd prize for oral presentation; ‘17 years an acromegalic’, 17th Clinicopathological Conference on Pituitary Disease, London, 2015.   
  • Winner of Poster Competition. Resisting ‘resistance’ in the management of prolactinomas National Pituitary CPC, London, 2015.

Highly commended poster prize; ‘The effect of SSA on the HPT axis and peripheral thyroid hormone dependent tissues in patients with TSHoma’, SfE BES meeting, Liverpool, 2014.

  • 1st prize for oral presentation; ‘A challenging case of microTSHoma’16th Clinicopathological Conference on Pituitary Disease, London, 2014.
  • Presidential Poster Prize Competition Nomination;  Sleep disordered breathing in acromegaly revisited: novel insights from the largest study of polysomnography in de novo acromegaly ICE-ENDO, Chicago, 2014.
  • Presidential Poster Prize Competition Nomination; 11C-metomidate PET-CT facilitates definitive diagnosis in patients with primary aldosteronism and ambiguous previous imaging: a sequential analysis of 61 cases, ICE-ENDO, Chicago, 2014.
  • Highly Commended Poster Prize;  Disordered sleep architecture is a common finding in acromegaly Society for Endocrinology BES, Liverpool, 2014.
  • Winner of Poster Competition;  Sibling apoplexy; lightning strikes twice National Pituitary CPC, London. 2014.                                                                                                                                   
  • 2nd prize for poster presentation; ‘When too much thyroxine isn’t enough’15th Clinicopathological Conference on Pituitary Disease, London. 2013.
  • Travel Grant Award Winning Abstract.  Investigation and management of insulinoma; strategy and outcome in a single centre. UK and Ireland Neuroendocrine Tumour Society Meeting, London. 2013.
  • 1st prize for oral presentation; ‘Refractory thyrotoxicosis: TSHoma or not?’14th Clinicopathological Conference on Pituitary Disease, London. 2012                                
  • 3rd prize for oral presentation; ‘A complex case of Nelson’s syndrome’; 12th Clinicopathological Conference on Pituitary Disease, London. 2010.
Academic Opportunities at Norfolk and Norwich University Hospital

There is a strong academic culture in the directorate of diabetes and endocrinology at NNUH. The department includes 3 substantive university chairs and an honorary chair in medicine at the Norwich Medical School/ UEA as well as an honorary Reader in Medicine and 6 honorary Senior Lecturers. Potential research opportunities include:

  • Dr Frankie Swords has recently supervised trainee projects including a review of the management of thyrotoxicosis and radioactive iodine, investigation of spontaneous hypoglycaemia, amiodarone induced thyroid dysfunction, and effects of oestrogen route of administration on growth hormone dose requirements. She also contributes to national projects, currently examining the long term effects of Pituitary radiotherapy, the genetics of endocrine tumours with a particular focus on Pituitary and adrenal disease as well as contributing to the acromegaly database, the PATRO GH surveillance programme and 100,000 genome project.
  • Prof Jeremy Turner’s principle research interest is the role of matrix remodelling and inflammatory signalling in adipose tissue dysfunction in obesity. He has previously secured funding from BHF and the Diabetes Research and Wellness charity to fund ACF and SpR research projects and has supervised 2 endocrine trainees’ PhDs. He has also previously supervised a clinical MD, 2 basic science PhDs and is currently supervising 2 PhD students in this field. He works with scientific collaborators across the Norwich Research Park including Dr Jelena Gavrilovic (BIO, UEA), Dr Sam Fountain (MED, UEA) and Prof Uli Mayer (BIO, UEA).
  • Prof W Fraser: A major research interest exists in metabolic bone disease with particular emphasis on the role of hormonal regulation of bone metabolism. Hyper and hypoparathyroidism is being studied in detail particularly the role of vitamin D and its metabolites in the regulation of calcium metabolism and studies on the use of PTH replacement therapy in hypoparathyroidism including first in man studies of oral PTH replacement in hypoparathyroidism. http://www.uea.ac.uk/medicine/people/profile/w-fraser
  • Prof Helen Murphy runs a diabetes pregnancy research programme which aims to improve the glucose control and infant health outcomes of pregnant women with diabetes. Her research interests include improving access to preconception care, developing novel continuous glucose monitoring and artificial pancreas technologies and the role of maternal dietary intake in gestational diabetes. https://www.uea.ac.uk/medicine/people/profile/helen-murphy
  • Prof Mike Sampson leads one of the largest diabetes prevention studies globally, the “Norfolk Diabetes Prevention Programme” which is funded by a £1.2M NIHR programme grant and has screened over 10,000 East Anglian residents at high risk of future development of diabetes and is currently in follow up providing abundant opportunities for data analysis, health economic modelling and other Health Service Research academic opportunities for research fellows.
  • Dr Swe Myint has an academic interest in transition services for teenagers and young adults with diabetes and has recently held a DUK project grant funding a large national university-student T1DM services survey and is currently working with DUK and other national bodies to inform future development of university diabetes clinical services.
  • Dr Ketan Dhatariya supervises projects on many aspects of inpatient diabetes, diabetes and surgery and the diabetic foot.
Upcoming Multi - Speciality Training Days and Study Courses

For a full list of upcoming training events and study courses aimed at all medical specialties within the region - Please visit the following links:

ENDOCRINOLOGY & DIABETES FROM A TRAINEE PERSPECTIVE by Dr Shoib Ur Rehman (ST7, Diabetes and Endocrinology, Trainee Representative)

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 hormony 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 atleast 20month of University Hospital placement (Cambridge University Hospitals/Norfolk & Norwich University Hospitals)where trainees gain experience in more complex and specialists clinics like NET, Pituitary disorders , Bone Metabolism , Reproductive Endocrinology and obesity to state a few.

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, EOE Diabetes & Endocrinology Programme is a well-structured training setting which enables trainees to meet circullum 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 and teaching environment and good schools and beautiful landscapes and beaches . 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 . 

 

Useful Contacts: 

 

Dr Shoib Ur Rehman– ST7 Endocrinology and Diabetes 

Specialty Training Represetative 

Shoibur.rehman@nnuh.nhs.uk

 

Dr Tara Wallace – Training Programme Director

 

Tara.Wallace@nnuh.nhs.uk

 

Curriculum/Eportfolios

 

For more information on the curriculums and eportfolios, see link below:

 

http://www.jrcptb.org.uk/specialties/endocrinology-and-diabetes-mellitus

 

 

Teachings and Meetings

 

The Deanery teaching consists of two parts: Specialty and General Medicine teachings. There will be several ‘teaching days’ for both these areas every year and trainees will have the opportunity to attend them depending on the rotas. There is also a regional meeting (EASE meeting) that takes place every term. This meeting is a great opportunity for the Endocrinology and Diabetes trainees to showcase interesting cases/audits/research work. It is also the time when trainees can catch up and learn from each other.

 

 

Exams

 

There is a Specialty Certificate Examination (SCE) for Endocrinology and Diabetes Specialty. You are encouraged to consider taking this exam during your ST5+ training.

 

 

ARCP

 

ARCPS are performed on a yearly basis (with occasional interim meetings) to review a trainee’s evidence of training and assessment demonstrated in the eportfolio. Workplace based assessments should be spread throughout clinical attachments and minimum numbers for progression are set out on the ARCP decision aid (see below).

 

For more information:

http://www.jrcptb.org.uk/sites/default/files/2010%20Endocrinology%20and%20Diabetes%20ARCP%20Decision%20Aid%20%28revised%202014%29.pdf

 

 

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: 

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

  • Friday 18th January 2019 
  • Friday 15th March 2019 
  • Friday 5th July 2019 - Deakin Centre, Addenbrooke's, Cambridge. Register here.  
  • Tuesday 1st October 2019 - Deakin Centre, Addenbrooke's, Cambridge.  

RSVP; alice.smith@nnuh.nhs.uk ; latika.sibal@addenbrookes.nhs.uk

SPR Training Days:

  • Tuesday 30th April 2019 - Addenbrooke's
  • Friday 21st June 2019 - NNUH
  • Friday 27th September 2019 - Addenbrooke's

RSVP; shoibur.rehman@nnuh.nhs.uk ; craig.parkinson@esneft.nhs.uk

How is the region broken down geographically? Will I have to do lots of commuting?

The East of England School of Medicine is located in a large region but as a speciality we prioritize arranging rotations to prevent unreasonable commuting distances.

Examples of rotations are listed below (the order of posts varies) – actual rotations are advertised at the time of each round of recruitment and trainees are offered and appointed to specific rotations in order to assist with domestic planning. Candidates express a preference for  rotation at interview/application and these are offered based on ranking at interview with the candidates achieving the highest scores having the first choice of rotation.

Rotations may change due to many reasons including trainees taking time out of programme to undertake research (OOPR), train less than full time (LTFT) or taking maternity leave but every effort is made to accommodate trainees’ requests on their return to clinical training.

Repatriation

The repatriation project, which commenced in February 2017, sees the gradual return of Higher Speciality Training (HST) posts to the East of England. These posts are currently aligned with the London Schools of Medicine. 14 diabetes and endocrinology HST posts will return to the East of England School over a 5-year period. The posts are based at the following hospitals: Chelmsford, Colchester, Southend, Basildon, Princess Alexandra (Harlow), Lister (Stevenage) and Watford.

For the time being, rotations will vary depending on spaces/repatriated posts coming in the system

Addenbrooke's  (20 months)

Luton (20 months)

Bedford (20 months)

Addenbrooke's  (20 months)

Peterborough (20 months)

Bedford (20 months)

Addenbrooke's  (20 months)

Colchester (20 months)

Chelmsford (20 months)

Addenbrooke's  (20 months)

Hinchingbrooke (20 months)

Luton (20 months)

Norfolk and Norwich (30 months)

Ipswich (30 months)

Norfolk and Norwich (30 months)

West Suffolk (30 months)

Norfolk and Norwich (30 months)

James Paget (30 months)

Addenbrooke's  (24 months)

Watford (18 months)

E+N Herts (18 months)

Addenbrooke's  (30 months)

Basildon / Chelmsford / Southend (30) 

Addenbrooke's  (20 months)

Harlow (20 months)

Basildon / Chelmsford / Southend (20)

How many posts are there each year and what hospitals are in the East of England?

On average, there will be 5-7 posts per year

The following hospitals are part of the East of England region:

Tertiary Centres

District General (DGHs)

Addenbrooke's Hospital, Cambridge

Bedford Hospital

Norfolk and Norwich University Hospital

Ipswich Hospital

 

James Paget University Hospital, Great Yarmouth

 

Luton and Dunstable Hospital

 

Peterborough City Hospital

 

Queen Elizabeth II Hospital, King's Lynn

 

West Suffolk Hospital, Bury St Edmunds

 

Princess Alexandra Hospital, Harlow

 

Southend University Hospital*

 

Colchester Hospital

 

Hinchingbrooke Hospital, Huntingdon

 

 

 

Posts undergoing phased repatriation

 

Basildon University Hospital*

 

Broomfield Hospital, Chelmsford*

 

Lister Hospital, Stevenage

 

Watford General Hospital

 

Southend University Hospital

 

 

 

*Anticipated to become one trust in the near future

Ipswich Hospital

Ipswich Hospital

The Ipswich Hospital NHS Trust offers a large, busy and friendly unit to train in the speciality of endocrinology and diabetes and GIM. The Diabetes and Endocrine service at the Ipswich Hospital is led by 5 consultant physicians all of whom have an equal interest in both endocrinology and diabetes and are supported by a full team of specialist staff including endocrine and diabetes specialist nurses, podiatrists, dieticians, laboratory technicians and secretaries. The service is based in a purpose built endocrine/diabetes specialist unit and there is an internationally recognised foot service based in a dedicated unit.

The endocrine service offers a full range of endocrine investigations and treatments, other than pituitary surgery, on site. It includes a whole time specialist endocrine nurse with access to a specialist day unit for dynamic endocrine testing. Appropriate imaging technologies include MRI, CT, radionucleotide and SPECT CT, and thyroid US with elastography. We are a tertiary referral centre for radioiodine treatment of benign and malignant thyroid disease, and have radiotherapy facilities for pituitary disease on site. We have an excellent parathyroid surgeon, and an ophthalmologist specialising in thyroid eye disease.  We hold fortnightly teleconferences with the pituitary MDT based in Cambridge to discuss pituitary cases and undertake all pre and post pituitary surgery investigations locally. A monthly telephone conference MDT for thyroid cancer is also held.  Audits and service improvement programmes are organised regularly.

The Ipswich Diabetes Centre was the first dedicated Diabetes Centre in the country and has been responsible for a number of innovations in diabetes care including the Ipswich Touch Test,  the instigation of the National Diabetes Inpatient Audit (NaDIA) and has become  a pioneer in developing inpatient diabetes services as well as contributing to the early work on CGM and closed loop systems in pregnancy and the Freestyle Libre device. We were also involved in developing the DESMOND education program. The integrated diabetes service has won National Awards and continues to evolve. You will have the opportunity to work in general and specialist clinics including insulin pumps, paediatric and transitional diabetes, renal diabetes, antenatal diabetes and in the diabetic foot clinic as well as seeing the community service in action by visiting practices. DAFNE is held 4-6 times yearly and you will be supported to receive Diabetes Doctors certification if interested.

For trainees interested in research opportunities, we have a dedicated Diabetes Research unit involved in both industry and own portfolio research in diabetes neuropathy. The unit has so far achieved four MD’s, four MSc’s, one PhD and one MA in the last 10 years and in 2016-17 had the highest number of research accruals in the East of England region. The research unit is also now developing close ties with the University of Suffolk to expand the research opportunities . In the last 5 years, the unit has published more than 30 in-house research papers and presented more than 100 papers in international and national conferences.

If you are looking for teaching opportunities, we have supported trainees in pursuing PGME in medical education. We are now also supporting UEA medical students in endocrinology and diabetes medical teaching as well as hosting medical students from the University of Cambridge. There are multiple other opportunities for teaching including in-patient HCP’s and junior doctors.

Ipswich Hospital is merging with Colchester Hospital University Foundation Trust in 2018 and the merged organisation will be the largest service provider in the East of England region.

West Suffolk Hospital

West Suffolk Hospital

West Suffolk Hospital Foundation NHS Trust has six Consultants in Diabetes & Endocrinology. Trainees in the department have the opportunity to take part in Medical Obstetric clinics, Adolescent diabetes clinics, Diabetic Foot MDT clinics, insulin pump clinics, diabetes renal clinics as well as general diabetes clinics. Many of the diabetes clinics are run jointly with other specialists, including obstetricians, renal physicians, vascular surgeons and paediatricians which gives trainees good experience in team working. The Endocrinology service covers most aspects of general endocrinology. We take part in regional MDTs as well as video conferences for training and education.

A recent national audit of diabetes care in the community rates our service as outstanding and the Care Quality Commission recently rated the Department of Medicine as ‘Outstanding’. We encourage our trainees to present work at local, regional and national meetings. Feedback received indicates that trainees in Diabetes & Endocrinology enjoy working at the West Suffolk Hospital which gives them a broad range of experience and close support from senior colleagues

Luton and Dunstable University Hospital NHS Foundation Trust

Luton and Dunstable University Hospital NHS Foundation Trust

The Luton and Dunstable University Hospital NHS foundation trust is a busy DGH in South Bedfordshire. It caters to a multi ethnic population with a wide range of medical problems which contributes to the clinical experience one gains while working at the hospital.

The Diabetes and Endocrine Department is a unit working closely with the rest of the hospital and Primary care with good working relationship with the Biochemistry department. All kinds of Endocrine pathologies are seen here with a good tertiary centre link with Cambridge. The diverse population widens the scope of practice in Diabetes and a trainee will be able to gain experience in all possible intricacies in Diabetes management while working here. Work is busy and learning opportunities are extensive, both from general Diabetes and Endocrinology clinic, as well as speciality clinics including Paediatric Diabetes, Paediatric Endocrine, Obesity, Secondary hypertension, Insulin pump, Pituitary, Lipid, Gestational Diabetes, Pregnant diabetes, Multi-disciplinary foot clinics.

Acute medicine gives the breadth of exposure to compliment the speciality training to help trainees develop into a well-rounded physician. There is a good link with the UCL medical school and people interested in teaching will be able to develop their interest and skills in teaching. The team is very supportive, helpful and fun to work with. 

Norfolk and Norwich University Hospitals NHS Foundation Trust

The Norfolk and Norwich University Hospital is a 1,200 bed teaching hospital with state-of-the-art facilities which provides care to a population of approximately 825,000 from Norfolk, neighbouring counties and further afield.

The Department of Diabetes and Endocrinology

There are 9 consultants, 7 Specialist Registrars, 2 Core Medical Trainees, 1 GPVTS trainee, 1 academic clinical fellow / academic foundation year 2 trainee, one FY2 and two FY1 trainees.

Diabetes

You will have the opportunity to work in general and specialist diabetes clinics in a dedicated diabetes centre (the Elsie Bertram Diabetes Centre) as part of a large friendly multi-disciplinary team with 8 Diabetes Specialist Nurses (DSN) and 4 podiatrists .

There are multiple subspecialty clinics: a weekly combined diabetes antenatal clinic, weekly gestational diabetes clinic, as well as a monthly pre-conception clinic in the diabetes centre and these clinics provide excellent opportunities for training. There are weekly transition diabetes clinics with the paediatric team. Young adults (<25) are seen in separate dedicated lists, and multidisciplinary clinics are also offered within the respiratory department for patients with cystic fibrosis associated diabetes. Dedicated DSN led pathways are also available for patients with frequent hypoglycaemic episodes and hypoglycaemic unawareness.

Norwich is a DAFNE centre and also offers hospital and community based structured education programmes and there is the opportunity for trainees to do DAFNE doctor training. There is also a well established multi-disciplinary insulin pump service and trainees have good access to pump clinics. You will have the opportunity to become familiar with the use of Continuous Blood Glucose Monitoring systems

There is a dedicated diabetic foot service, with multidisciplinary vascular, orthopaedic and medical foot clinics and combined ward rounds for the most complex patients.

The department has also recently launched a series of pod- and “vod-“ casts to improve information and advice available to patients with type 2 diabetes throughout Norfolk available on www.nnuh.nhs.uk/podcasts/adultdiabetes. Interested trainees would have the opportunity to be involved with future departmental innovations.

In addition to providing outreach clinics in rural Norfolk, a team of four Diabetes Care Facilitators work to support ‘seamless’ diabetes management between primary and secondary care. The facilitators are managed by the multi-disciplinary central Norfolk Integrated Diabetes Management (NIDM) group, which is also the local Diabetes NSF Implementation Group and diabetes network. This provides trainees with the opportunity to gain insights into this model of collaborative working between primary and secondary care. There is in-house digital retinal photography and a nationally recognized mobile retinal screening service for community patients.

 

Endocrinology

All consultants in the directorate also provide endocrine services, although there is considerable sub-specialisation of these clinics. You will have the opportunity to rotate through all the general and specialist clinics during your time here.

There is a dedicated Clinical Investigation Unit for endocrinology patients which is managed by 3 experienced Endocrine Specialist Nurses. The full range of in and outpatient tests including selective venous sampling, insulin tolerance tests and other dynamic function testing is available and trainees have the opportunity to gain experience in the interpretation of all dynamic tests.

Patients with pituitary and adrenal disorders are seen in the weekly endocrine clinics, and discussed at the weekly endocrine and radiology meetings. Pituitary patients are also discussed at a monthly video-conferenced specialist multidisciplinary team meeting held jointly with The National Hospital, Queens Square, London. Pituitary surgery is undertaken at the National, but all other endocrine surgery is provided locally including laparoscopic procedures for the removal of adrenal tumours.

 There is a weekly multidisciplinary one stop thyroid nodule clinic. This enables ultrasound scanning, ultrasound guided fine needle aspiration and laryngoscopic assessment by ENT where indicated to be performed on the spot after assessment by an endocrinologist. There is a fortnightly regional thyroid MDT hosted in Norwich. 

You will have the opportunity to attend weekly metabolic bone and calcium disease clinic held by Jeremy Turner and Bill Fraser, as well as a one stop fracture risk assessment clinic led by Jeremy Turner. We have recently been awarded Paget’s Association Centre of Excellence status and are commissioned as a regional centre for calcium and metabolic bone disorders.

A weekly tier 3 medical weight management service is also offered. This is supported by an obesity specialist dietician, obesity specialist nurse, dedicated HCA and psychologist. These weekly clinics work closely with bariatric surgery providers in Luton and London, as well as local community based tier 2 and 3 services and health trainers.

There is weekly medical antenatal clinic, allowing regular multidisciplinary review of pregnant endocrine patients. Joint transition clinics are also held 6 times a year with the paediatric endocrinologists. Patients with metastatic neuroendocrine tumours are seen within a monthly multidisciplinary clinic held jointly with oncology, and discussed at a monthly MDT. There is a dedicated lipid clinic largely for patients with familial hypercholesterolaemia. Patients with inborn errors of metabolism are seen in a 6 monthly outreach clinic in Norwich with input from the specialist metabolic team from Guys Hospital.

The radiology department provides the full range of endocrine imaging including MRI, CT, endoscopic ultrasound and PET scans, and selective venous sampling.  Most patients are investigated on an outpatient basis. There is a fully equipped Nuclear Medicine Department, which provides isotope imaging eg MIBG and octreotide, and radioiodine therapy for thyrotoxic and thyroid cancer patients.

There are weekly radiology and endocrine meetings where MRI scans, test results and patient management are reviewed. Junior doctors also present a formal case presentation at this forum every week, and all endocrine cases seen by the SpRs are presented and discussed.

 

General Medicine

All acute medical admissions are managed in a dedicated Acute Medical Unit which is staffed by acute physicians and triaged direct to the most appropriate speciality. The Directorate is continuously on-call for diabetes and endocrine admissions, and currently cares for 50% of GIM cases.  The general medical and specialty inpatient workload is supported by two CMTs, a GPVTS trainee and 3 foundation year 1 and 2 doctors. At any time one SpR is on the wards. In addition to protected time for speciality training, all trainees take part in the general medical out of hours rota.

 

Research opportunities

There is a strong academic culture in the directorate of diabetes and endocrinology offering many opportunities for trainees to undertake research. The department includes 3 substantive university chairs and an honorary chair in medicine at the Norwich Medical School/ UEA as well as an honorary Reader in Medicine and 6 honorary Senior Lecturers. Please see section on research opportunities.

 

Teaching Opportunities

There are multiple opportunities for teaching at both undergraduate level (University of East Anglia medical students) and post-graduate level and we are fully supportive of any trainees who are interested in pursuing studies leading to a Postgraduate Certificate in Medical Education. There are also opportunities for trainees to do an MSc in Health Sciences with the University of East Anglia.  

West Hertfordshire Hospitals NHS Trust

HOSPITAL    Watford General Hospital     (West Herts Hospitals NHS Trust)

CONSULTANT(S)  

Dr Thomas Galliford, Dr Arla Ogilvie, Dr Julia Ostberg, Dr Chantal Kong, Dr Ana Pokrajac,

Dr Colin Johnston, Dr Razak Kehinde (recently appointed)

2 further consultants to be appointed in late 2018

GENERAL MEDICINE DUTIES

Ward team: 1-2 SpRs, 3 CMTs and 2 F1 doctors, daily consultant ward input

Acute take rota  1 : 8                       

Number of regular inpatient medical beds   20 (likely to fall to 12)

Approximate number of emergency admissions per 24 hours      80

 

Composition of the medical in-taking team in 24 hrs: 

Day 2x SpR, 6x CMT/F2, 2x F1

Night 2x SpR, 4x CMT/F2, 1x F1

                               

NUMBER OF POSTS: currently 1 from East of England, 2 from North West Thames (both due to be repatriated to East of England)

 

CLINICS PER WEEK:   

The main base is Watford General Hospital, with occasional clinics at Hemel Hempstead and St Albans City Hospital.

1-2 endocrine clinics and 1-2 diabetes clinics per week on average.

During a year, likely to get several opportunities to do Watford combined endocrine/diabetes antenatal clinic.

When covering the ward (1:3 weeks), would usually still do one endocrine clinic, and often one weekly diabetes clinic as well.

 

DIABETES EXPERIENCE:

Well-staffed diabetes centre with 7.5 WTE Diabetes Specialist Nurses.

Follow up complex diabetes and Type 1 clinic, young adult clinic, insulin pump clinic, combined antenatal clinic. Close collaboration with excellent team of diabetes specialist nurses. Daily registrar and DSN in-reach to AAU. Daily Foot MDT ward rounds/ clinics.

Potential opportunities for extra experience in Paediatric, transition clinic, renal diabetes clinic, multidisciplinary diabetic foot clinic, ophthalmology clinic.

We are looking to develop SpR access to community diabetes clinics in the context of our new Integrated Diabetes Service. There will also be opportunities to work with the Diabetes Mental Health Team (eg attend MDTs).

 

ENDOCRINE EXPERIENCE:

We have 2 full time endocrine specialist nurses.

Full range of general endocrinology. Weekly post-clinic educational supervision with consultants. Additional weekly meeting reviewing results of dynamic endocrine tests.

We are setting up a pituitary MDT meeting with the National Hospital for Neurology and Neurosurgery, Queen Sqare.

 

G.I.M. EXPERIENCE:

One medical registrar covers the AAU medical take. The second medical registrar (24:7) covers the wards, arrests & sick patients in resus, and also provides OOH orthogeriatric reviews of admissions with fractured NOF and reviews OOH admissions to the acute stroke unit. Well supported with geriatrician & acute medical consultant presence 12 hours per day, 7 days per week. 2 consultant physicians on call on site until 9.30pm.

 

INTERNAL TEACHING PROGRAMME:

Dedicated Medical Education Centre with Simulation Suite and Clinical Skills Lab.

Weekly grand round.

£600 study leave allowance.  Many opportinuities for undergraduate and postgraduate teaching experience (UCL & International; teaching for CMT’s) and involvement with running OSCE’s.

Weekly post-clinic endocrine teaching.

Monthly Team meeting, Clinical Governance Meeting, Mortality review meeting.

Also Radiology and Thyroid Cytology MDT meetings.

Trainees are encouraged to develop undergraduate and postgraduate teaching roles and will have opportunities to develop clinical management/leadership skills.

 

RESEARCH OPPORTUNITIES

Encouraged to undertake audit project. Encouraged to attend external national meetings and present - opportunities to publish and submit abstracts to meetings fully supported.

 

SPECIFIC ATTRACTIONS OF THE POST

Own fully furnished office in the Watford Diabetes Centre, shared with 2 other SpRs.  Well-staffed with 7.5 WTE diabetes specialist nurses and 2 endocrine specialist nurses.  Friendly supportive team environment, crèche on site. A wide range of diabetic, endocrine and general medical experience with close consultant supervision in a large metropolitan hospital, with good transport links to central London.   3 SpRs rotate on and off wards offering ample time to pursue teaching, audit and specialty clinics.

All SpRs at Watford will have access to the North West Thames training programmes based at Hammersmith Hospital, in addition to the East of England training programmes, giving broader scope for study days which can be attended.

CONTACT NUMBERS: Consultants        

Dr J Ostberg 01923 217800

Dr A Ogilvie 01923 217287

Dr T Galliford 01923 217696

Further Advice and Information

Further Advice

Position

Location

Dr Tara Wallace

Training Programme Director

Norfolk & Norwich University
Hospital NHS Foundation Trust

Dr Rahat Tauni 

Joint Trainee Rep

Addenbrookes

Dr Fraz Mir

Head of School of Medicine

Health Education England, working across the East of England

Alice Smith

School of Medicine Administrator

Norfolk and Norwich University Hospitals NHS Foundation Trust

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.

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