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

 

 

 

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