Rotations

Currently Rheumatology has 20 training posts in the East of England

All Rheumatology training posts are in combination with General Internal Medicine, resulting in a dual CCT in Rheumatology and G(I)M. The 5 year rotation is normally split with 3 years training in both Rheumatology and GIM, and 2 years in pure Rheumatology. At least 12 months will be in a tertiary centre either Addenbrooke’s or Norfolk and Norwich.

Although the East of England is a large Deanery geographically, rotations are constructed to prevent excessive commutes or moves between jobs. The following are illustrative of our usual rotations. They were constructed in conjunction with our existing Registrar body who have indicated that these rotations strike a good balance between training experience and acceptable commuting distances. (For those new to the East of England, the maps below might help decisions regarding where to settle in the region).

Individual rotations are not set prior to appointment to the training programme, to allow a degree of flexibility. Successful candidates will be approached by the Training Programme Director shortly after starting to discuss the rotation.

Map of East of England Rheumatology Rotation Sites

West Rotations (not in order of placement)

Watford, Hemel Hempstead, Luton, East and North Hertfordshire, Cambridge (blue)

Hemel Hempstead, Luton, East and North Hertfordshire, Cambridge, Hinchingbrooke (purple)

Luton, East and North Hertfordshire, Cambridge, Hinchingbrooke, Peterborough (yellow)

East and North Hertfordshire, Cambridge, Hinchingbrooke, Peterborough, West Suffolk (red)

South East Rotations

Southend, Basildon, Mid-Essex, Cambridge, East and North Hertfordshire (burgundy)

Southend, Basildon, Mid-Essex, Cambridge, West Suffolk (blue)

Southend, Basildon, Mid-Essex, Cambridge, Colchester (yellow)

Basildon, Mid-Essex, Cambridge, Colchester, Watford (orange)

North Rotations

Norfolk (x2), West Suffolk, Cambridge, Peterborough (pink)

Norfolk (x2), West Suffolk, Hinchingbrooke, Colchester (red)

Norfolk, West Suffolk, Ipswich, Colchester, Mid-Essex (orange)

Norfolk, Hinchingbrooke, Peterborough, East and North Hertfordshire, Luton

Click below for maps of potential West, South East and North Rotations

Watford

Pure/GIM	Dual
Hospital Type DGH/Teaching hospital/Outpatient only	DGH
On call commitments Rheum or GIM, day/night/weekend/ACC cover	GIM, nights and weekends
Inpatient Work Rheum or GIM, if GIM what type of ward	General medicine ward, including oncology and renal patients
Rheum ward reviews per week	4-5, Ward referrals covered by Hemel SpR 1-2 days/week
Clinics/week	3
USS access and supervision	Nil
Unique Selling Points e.g. specialist clinics and OOPR and OOPE opportunities	Excellent GIM experience, most rheum consultants dual accredited, with high tunrover GIM on calls and largest AMU in the country. Can easily get GIM curriculum procedures signed off via elective cardioversion clinic, pleural Clinic and paracentesis clinic. Opportunity to attend Northwick Park regional teaching, in addition to EoE Regional training Days.

Hemel Hempstead

Pure/GIM	Pure
Hospital Type DGH/Teaching hospital/Outpatient only	DGH (across 3 sites, Watford, St Albans, Hemel Hempstead)
On call commitments Rheum or GIM, day/night/weekend/ACC cover	Nil
Inpatient Work Rheum or GIM, if GIM what type of ward	Inpatient rheumatology reviews at Watford Tuesdays and Fridays
Rheum ward reviews per week	3-5
Clinics/week	5 (2 St Albans, 2 Hemel Hempstead, 1 Watford emergency clinic via ACU)
USS access and supervision	1 Machine available for Hemel Hempstead clinics, no formal supervision
Unique Selling Points e.g. specialist clinics and OOPR and OOPE opportunities	Weekly CTD clinics Good research and development team Opportunity to gain experience in DEXA reporting and performing skin punch biopsies Can also attend Northwick Park Regional Teaching

Luton

Pure/GIM	Dual
Hospital Type DGH/Teaching hospital/Outpatient only	DGH
On call commitments Rheum or GIM, day/night/weekend/ACC cover	GIM 7 days long days on call and 7 night shifts on call every 10 weeks
Inpatient Work Rheum or GIM, if GIM what type of ward	Endocrine/rheum ward
Rheum ward reviews per week	Mainly consultant led, SpR’s can volunteer to see instead
Clinics/week	3-4
USS access and supervision	4 machines, no formal supervision
Unique Selling Points e.g. specialist clinics and OOPR and OOPE opportunities	Opportunities to observe/partake in paediatric rheum clinic, fast track GCA clinic (including large vessel vasculitis US) and metabolic bone

East and North Herts

Pure/GIM

Combined

Hospital Type

DGH/Teaching hospital/Outpatient only

DGH - providing care to 600,000 patients in area

On call commitments

Rheum or GIM, day/night/weekend/ACC cover

GIM on call with intermittent rota gaps (nights, weekends)

1st (take) and 2nd (ward referrals and reviews) on call as well as ACC SpR on call

No Rheum on call OOH

Inpatient Work

Rheum or GIM, if GIM what type of ward

Paired with medical outliers team, other SpR (elderly medicine SpR) - there can be a gap for this as well - I was only SpR for most of the rotation this year.

4 consultants: Dr. Ellis, Dr. Rippingale, Dr. Lines and locum consultant

Rheum ward reviews per week

On average (when not on call or undertaking ward duties) - 1-2 per day, 4-5 per week

Consultant discussion undertaken for complex cases

Clinics/week

3 clinics per week

Tues AM - General clinic with Dr. Ellis

Tues PM - GCA/general clinic with Thirau

Friday PM - Injection or emergency clinic

Once monthly QEII metabolic bone clinic with Endocrine team (Tuesday PM)

Opportunity to join thursday AM clinic - CTD clinic with Dr. Ellis and ENRAD MDT (8-9am)

USS access and supervision

Currently minimal but in the process of setting up USS clinic. USS machine available but no set timetable for SpR training

Unique Selling Points e.g. specialist clinics and OOPR and OOPE opportunities

Excellent opportunities to undertake in terms of honing your GIM skills - two out of the four consultants do combined GIM/rheum.

Very effective and consistent supervision -with timetabled teaching with consultants countered in.

For senior trainees, opportunities to undertake management roles - PACES registrar, interview panel for acute medicine SpR recruitment, faculty for medical SpR training.

Weekly morning report teaching sessions by Dr. Ellis - for those with teaching interest, opportunity to run a few sessions to medical juniors.

Cambridge

Pure/GIM	Pure
Hospital Type DGH/Teaching hospital/Outpatient only	Teaching Hospital
On call commitments Rheum or GIM, day/night/weekend/ACC cover	Rheumatology, one in 4 weekdays and one in 5 weekends
Inpatient Work Rheum or GIM, if GIM what type of ward	Rheumatology
Rheum ward reviews per week	1-5 reviews per week, consultant ward round weekly
Clinics/week	4
USS access and supervision	Yes 1 clinic per week
Unique Selling Points e.g. specialist clinics and OOPR and OOPE opportunities	Specialist clinics in bone, GCA and CTD Good learning opportunity on consultant ward round OOPR and OOPE opportunities Good US experience

Hinchingbrooke

Pure/GIM	GIM
Hospital Type DGH/Teaching hospital/Outpatient only	DGH
On call commitments Rheum or GIM, day/night/weekend/ACC cover	GIM, nights and weekends
Inpatient Work Rheum or GIM, if GIM what type of ward	GIM on a respiratory/cardiology ward with 3 ward rounds per week. Respiratory teaching Wednesday morning (will be asked to present rarely).
Rheum ward reviews per week	5
Clinics/week	2 Rheumatology Respiratory clinic once per fortnight
USS access and supervision	Not available
Unique Selling Points e.g. specialist clinics and OOPR and OOPE opportunities	Combined rheum/respiratory clinics for CTD-ILD occurring once per month. Plenty of teaching opportunities. Excellent one to one feedback from consultant on seeing rheumatology patients in clinic, so very easy to acquire WPBA's, well suited to early training.

''Hinchingbrooke Hospital Rheumatology Department is a small friendly department which provides a general rheumatology service to patients in the Huntingdon area (where the hospital is based). We are closely linked with Peterborough Hospital (as part of North West Anglia Foundation Trust) and many of the doctors and nurses work on both sites.

Being attached to Hinchingbrooke will give you a good general rheumatology experience and you will work closely with our specialist practitioners to get good experience of multi-professional working.

We are particularly involved in teaching and education and there are lots of opportunities for trainees to develop their educational portfolio during this placement, including linkage with the University of Cambridge Undergraduate Clinical Supervisor programme, which enable trainees to become accredited with the Higher Education Academy at Associate Fellowship level.

Within the clinical service we focus heavily on observation of practice for trainees so you will be able to focus on improving your clinical assessment skills, explanation and planning skills and diagnostic/therapeutic reasoning skills during this placement.

Being a small department we can often tailor your clinical experiences to your particular training requirements and previously we have been able to facilitate trainees developing lab based research skills (through Cambridge), ultrasound skills (through Peterborough and Cambridge), management/leadership skills (through the Senior Resident programme) and particular clinical interests (including previously fibromyalgia, spondyloarthritis and autoimmune disease) as well as the educational/teaching skills highlighted above.''

Dr Mark Lillicrap

Consultant Rheumatologist and Clinical Sub-Dean Cambridge University

Peterborough

Pure/GIM	Pure
Hospital Type DGH/Teaching hospital/Outpatient only	DGH
On call commitments Rheum or GIM, day/night/weekend/ACC cover	Nil
Inpatient Work Rheum or GIM, if GIM what type of ward	Rheumatology ward reviews only, no base ward
Rheum ward reviews per week	5 reviews per week
Clinics/week	5
USS access and supervision	1 machine shared across clinics, no formal supervision
Unique Selling Points e.g. specialist clinics and OOPR and OOPE opportunities	No on calls or routine inpatient work allows for a lot more outpatient clinic experience to be gained. Relatively good amount of admin time enables other interests/CPD to be pursued. Great deal of teaching opportunities with students from 2 different medical schools present.

West Suffolk

Pure/GIM	Dual
Hospital Type DGH/Teaching hospital/Outpatient only	DGH
On call commitments Rheum or GIM, day/night/weekend/ACC cover	GIM days,night,weekends and ACC 1:11 rota
Inpatient Work Rheum or GIM, if GIM what type of ward	Renal/diabetes/GIM ward Under renal consultant
Rheum ward reviews per week	1-10
Clinics/week	3
USS access and supervision	1 consultant US clinic, with opportunities for supervision
Unique Selling Points e.g. specialist clinics and OOPR and OOPE opportunities	Potential US supervision Early arthritis clinic Good MDT and team working environment

Southend

Pure/GIM	Dual
Hospital Type DGH/Teaching hospital/Outpatient only	DGH
On call commitments Rheum or GIM, day/night/weekend/ACC cover	Full GIM rota (1B banding), 15wk rota, x2 sets of nights (week off post w/e nights) , x2 w/e day calls. 1 week of late shifts + long days
Inpatient Work Rheum or GIM, if GIM what type of ward	3-4 months rotations in renal/COTE/Pure rheum. Medical wards are normally on Mon/Wed/Thu (am only). Rheum inpatients admitted under medical team.
Rheum ward reviews per week	Tue pm and Fri am rheum WR (cons lead)
Clinics/week	2 clinics with med wards, 5 clinics when on pure rheum block
USS access and supervision	US clinic every FRI pm , reg are welcome if free, 1 reg will be allocated to the US clinic
Unique Selling Points e.g. specialist clinics and OOPR and OOPE opportunities	Paed rheum clinic on Tue am CTD clinic US clinics (2 machines in dept) Research opportunities with Professor Dasgupta’s team (2 research fellow slots x 1yr) and fast track GCA service

Basildon

Pure/GIM	Pure
Hospital Type DGH/Teaching hospital/Outpatient only	DGH
On call commitments Rheum or GIM, day/night/weekend/ACC cover	On call for rheum every weekday until 5
Inpatient Work Rheum or GIM, if GIM what type of ward	Nil
Rheum ward reviews per week
Clinics/week	3-4
USS access and supervision	1-2 sessions/month
Unique Selling Points e.g. specialist clinics and OOPR and OOPE opportunities	Good CTD and USS clinic exposure

Mid-Essex

Pure/GIM	Dual
Hospital Type DGH/Teaching hospital/Outpatient only	DGH
On call commitments Rheum or GIM, day/night/weekend/ACC cover	GIM 1:13
Inpatient Work Rheum or GIM, if GIM what type of ward	Endocrine ward
Rheum ward reviews per week	1-2/day average
Clinics/week	4
USS access and supervision	Nil
Unique Selling Points e.g. specialist clinics and OOPR and OOPE opportunities	Good for GIM experience Involvement in leadership and teaching opportunities

Colchester

Pure/GIM	Dual
Hospital Type DGH/Teaching hospital/Outpatient only	DGH
On call commitments Rheum or GIM, day/night/weekend/ACC cover	GIM day, night and weekend
Inpatient Work Rheum or GIM, if GIM what type of ward	GIM inpatients, do 2 morning ward rounds/week on a Geriatrics ward. No requirement to support with other routine ward work
Rheum ward reviews per week	5-15
Clinics/week	3 clinics per week
USS access and supervision	No US machine available
Unique Selling Points e.g. specialist clinics and OOPR and OOPE opportunities	Very supportive department. Monthly Paediatric Rheumatology clinics

Norfolk and Norwich

Pure/GIM	Pure with GIM night on calls
Hospital Type DGH/Teaching hospital/Outpatient only	Teaching
On call commitments Rheum or GIM, day/night/weekend/ACC cover	Rheumatology one Saturday/month GIM nights every 2 months
Inpatient Work Rheum or GIM, if GIM what type of ward	No GIM inpatient work Rheumatology inpatients
Rheum ward reviews per week	5
Clinics/week	3-4
USS access and supervision	None
Unique Selling Points e.g. specialist clinics and OOPR and OOPE opportunities	Potential opportunity to observe paediatric clinic Potential opportunity to observe SpA and vasculitis specialist clinics Can learn to perform sacral epidural injections

Ipswich

Pure/GIM	Pure
Hospital Type DGH/Teaching hospital/Outpatient only	DGH
On call commitments Rheum or GIM, day/night/weekend/ACC cover	Nil
Inpatient Work Rheum or GIM, if GIM what type of ward	Rheum reviews only
Rheum ward reviews per week	Reg daily, cons 2x weekly
Clinics/week	4x per week
USS access and supervision	USS available but no dedicated sessions
Unique Selling Points e.g. specialist clinics and OOPR and OOPE opportunities	Specialist clinics CTD Expertise in vasculitis, Prof Richard Watts Clinical research opportunities available