Health Education England, working across the East of England: Gastroenterology

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Gastroenterology covers a wide range of disorders including those of the gastrointestinal tract in its entirety, the liver, the pancreas and the biliary tree. The diversity of organs affected and the numerous diseases afflicting these organs makes Gastroenterology a particularly attractive specialty. 

Endoscopy is a central component of Gastroenterology with sub-specialty training in oesophageal therapy, endoscopic retrograde cholangiopancreatography, endoscopic ultrasound, portal hypertension, small bowel studies, as well as more conventional upper and lower gastrointestinal endoscopy. Gastroenterologists in East Anglia also contribute to general medicine and the majority of trainees to date have achieved dual accreditation. A major attraction of Gastroenterology has been the evolution of critical collaborations with radiologists, pathologists, GI surgeons, liver transplant teams, and a variety of clinical nurse specialists, nutritionists and psychologists. 

Gastroenterologists in most district general hospitals cover a variety of disorders including inflammatory bowel disease, oesophageal disease, hepatology, small bowel disorders and perform most routine endoscopies. Within the region, sub-speciality interests have evolved including hepatology, liver transplantation, inflammatory bowel disease, intestinal failure small bowel transplantation. New government initiatives have stressed the value of rapid throughput for patients with potential malignancy, which forms a critical component of the speciality.

Training Programme

The deneary tends to be geographically split into East (Norwich based) and West (Cambridge) but with the option to move according to preference and to remain for several years within a sub-region – the programme director being as accommodating as possible in this regard. Bedford, HuntingdonIpswichGreat YarmouthKing's LynnBury St EdmundsBasildonColchesterStevenageWatfordChelmsfordPeterborough and Luton & Dunstable hospitals are smaller units with between three and six lead gastroenterologists.  Each of these offers an excellent mix of Gastroenterology and general medicine as well as variable specific training including ERCP, oesophageal manometry, capsule endoscopy, balloon enteroscopy and EMR.  The units at Norwich and Cambridge are larger and allow sub-specialty exposure in Hepatology, Nutrition, Inflammatory Bowel Disease and advanced endoscopy (EUS and ERCP), which can be either as part of the rotation or a dedicated Advanced Training Programme (ATP).

Research

The opportunities for research are outstanding and range from basic science to translational medicine and clinical trials. The majority of research opportunities within East Anglia are on offer in Cambridge and Norwich medical schools. There are currently several ACFs and NIHR/University Clinical Lecturers in place at the two centres as well as many opportunities for out of programme research. Cambridge has a Chair of Gastroenterology and has several established academics with internationally acclaimed research pedigree. The main research areas are in inflammatory bowel disease, Barrett’s oesophagus and oesophageal cancer as well as in various aspects of hepatology. Cambridge is a Biomedical Research Centre and CRUK Experimental Medicine Centre with particular strengths in metabolic and inflammatory diseases as well as cancer. Norwich Medical School has a vibrant research programme in Gastroenterology with a number of Chairs and Academics.  Out of programme experience for research is encouraged provided that advance notice is provided to Health Education England, Working across the East of England - Information can be found here. . 

Essential Qualifications
  • Completion of a core medical training programme or equivalent.
  • Documented evidence of achievement of level 1 competencies in general internal medicine (acute) and generic curricula.
  • Full MRCP with PACES is now essential for progression to ST3.
Further Advice

 

Further Advice

Position

Location

Dr Arun Shankar 

Training Programme Director,
& Consultant Gastroenterologist 

Norfolk and Norwich University Hospital

Dr Ian Gooding

Training Committee Chair 
& Consultant Gastroenterologist

Colchester University Hospitals NHS Foundation Trust

Dr Fraz Mir

Head of School of Medicine
& Associate Postgraduate Dean

Health Education England, working across the East of England

Dr Rebecca Fitzgerald

Academic Representative & MRC Programme Leader
& Hon. Consultant Gastroenterologist

Hutchison/MRC Research Centre,
Cambridge

Professor Alastair J.M. Watson

Academic Representative, Research Director & Hon. Consultant Gastroenterologist

Norwich Medical School, Norfolk & Norwich University Hospital.

 

Detailed guidance on the Gastroenterology assessment blueprint and curriculum is available from the JRCPTB website - 

 

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:

GASTROENTEROLOGY FROM A TRAINEE PERSPECTIVE by Dr Richard Warburton & Dr Kiran Bundhoo (Trainee Representatives)

GASTROENTEROLOGY FROM A TRAINEE PERSPECTIVE

 

Introduction to specialty from a trainee perspective

Gastroenterology is a hugely rewarding specialty to embark upon with a wide variety of sub-specialties that can be chosen from. The Eastern Deanery allows a real balance of training with both teaching hospitals in the region renowned for research as well as providing excellent Gastroenterology training.

There are several axes within the region – Cambridge, Norwich, M1 corridor and Essex. You will get at least 1 year in one of the two teaching hospitals. Geographical constraints will be accommodated but you should be positively seeking out specific training opportunities.

Useful contacts

 

 

 

 

 

 

Curriculum

1. ARCP Decision Aid

https://www.jrcptb.org.uk/sites/default/files/2010%20Gastroenterology%20and%20Hepatology%20ARCP%20Decision%20Aid%20%28revised%202014%29.pdf

2. Curriculum

https://www.jrcptb.org.uk/sites/default/files/2010%20Gastroenterology%20Curriculum%20%28amendments%202013%29%20V2.pdf

https://www.jrcptb.org.uk/sites/default/files/2010%20Hepatology%20Curriculum%20%28amendments%202013%29%20V2.pdf

 

 

Endoscopy Training:

  • Unless you are doing a very specialist attachment you should have access to a minimum of 1 training list per week with the option of additional adhoc list based on other clinical commitments.
  • For new starters you should be reasonably up the learning curve for OGD before doing colonoscopy (say at least 50 OGDs) and can start flexi sigs early on.
  • Basic OGD and Colon courses are mandatory but discounted if done at Norwich. Your lists should be tailored to your needs.
  • Before attempting ERCP you should be JAG accredited in OGD and have reasonable therapeutic OGD experience.
  • You should have an endoscopy trainer and log all procedures via JETS.
  • Please note 10 DOPs per year needed for anything you are not yet accredited in.
  • 2 DOPs per year to show you have maintained your skill level if accredited.
  • JAG accreditation is required for CCT in diagnostic upper GI endoscopy and colonoscopy for non Hepatologists. Therapeutic OGD, ERCP and EUS are not yet JAG accredited but may well be in the near future

 

GIM

  • If you are doing GIM which most are then your CCT will tie in with the Gastro one. You will have separate PYAs and ARCP outcomes. GIM issues to be directed to Dr Gareth Corbett (gareth.corbett@addenbrookes.nhs.uk).

 

Academic

  • Training for academics (NTNA, typically a CL post) is competency based although there is a minimum training period of 48 months – 24 months gastro if an academic Hepatologist. In order to complete in a timely manner your training layout needs discussion well in advance. Dropping GIM is an option but the decision needs to be made early.

ATPs

  • If you look at the 2010 Gastro curriculum there is a diagram showing that year 4 is meant to be a specialist year. Hepatology and Nutrition are run nationally (recruit November – NHS jobs) but there are IBD and endoscopy ATPs established now in both Norwich and Cambridge which are recruited to around Febuary/March time ahead of the ST3 round. They can be done in ST5-ST7 – latter if no other outstanding training requirements apart from a few GIM on calls

Eportfolio

  • For each post you need an educational supervisor assigned. He/she needs to do an induction, mid-point and end appraisal.
  • In addition, a supervisor report needs completing at the end of each post and prior to any ARCP be it interim, absentia or a formal one face to face. This needs to be done for both GIM and Gastro (i.e. 2 reports per year) if you are dual accrediting.
  • If you have any problems with educational supervision please email the TPD.
  • There is some new guidance (JRCPTB website) so common competencies won’t necessarily need signing off but most of them do bar the advanced curriculae which are only for those doing the relevant ATP.
  • Look at the latest decision aid to see how much needs signing per ST year and note there is now a limit to how much you can spread a piece of evidence.
  • Competencies need both trainee and supervisor ratings (red and blue icons).
  • You should have the latest GIM and Gastro curriculae uploaded
  • ESEGH – European wide specialty exam (previously called SCE) held annually and a pass is mandatory for CCT. Usually attempted in ST4 or ST5. There are training courses held in Nottingham and St Marks.
  • Audits - You need to do an annual audit in gastro/hep and 3 GIM audits over your lifetime as an SpR. Try and enhance the various aspects of your CV as you go along – teaching, leadership, management (course essential but leave until final years), courses/meetings, presentations/publications
  • CCT - There is now a CCT calculator which you are meant to use. This will be checked at ARCP and you can get a copy from your deanery contact. If you are new and trying to count previous LATs then this needs sorting within a few months of your NTN. Note that you can’t count 3 months for mat leave anymore and all time counted from OOP needs prospective approval by the JRCPTB and GMC. The 6 months grace period is currently subject to review and may end up being abolished.

Reading list

Reading list: Join the BSG and BASL (if interested in hepatology) or BAPEN (if interested in Nutrition)

 

Diary

Training Days:

  • These are mandatory but also include the East Anglian Gut Club (an afternoon twice a year) and the Cambridge Liver Symposium (end Sept).
  • A register needs to be signed to confirm attendance and if you cannot make it, the Trainee Reps should be emailed in advance.
  • The list of training days is circulated well in advance so no excuse not to cancel routine commitments although on call is understood. If you don’t know when the days are, the Trainee Reps should be the first port of call.

 

AOB

  • Check out our Facebook Page; EoE Gastro SpRs

 

Tuesday, 13 November, 2018
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