James Paget University Hospital NHS Trust

 

                  

Top reasons to train with us at the James Paget University Hospital:

 

1. We are a hospital that looks after our core trainees with a time-table designed to fit in their training needs.
2. Has a large and varied work load of basic surgery and hernia work load required for basic junior surgical trainees, including laparoscopic surgery
3. Has a state of the art Day Case Centre – where surgical activities are not affected during winter pressures
4. Emergency work load while on-call is busy with good operative exposure to all trainees
5. Receives 1/3^rd of Norwich Medical School students from the University of East Anglia (UEA) with great opportunity to be involved in designing and conducting teaching sessions

In addition we are surrounded by beautiful beaches and the Norfolk Broads is on our door step; traffic is fairly calm.

Background

The James Paget University Hospital is a District General Hospital serving a population of 230,000. The Hospital is named after Sir James Paget who was born and grew up in Great Yarmouth.  All Staff are friendly and senior medical staff is very supportive. The core surgical training programme offers training in General Surgery – including sub specialities, orthopaedics and otolaryngology. Despite challenges with rota patterns and the new contract, the rota has been redesigned and SMART criteria for core trainees are well met. 

 

The Hospital has been the originator of 2 award winning e learning programmes (Mastership in Oncoplastic Breast, Colorectal and Regional Anaesthesia) and Health Education England Emergency Surgery ST3 pilot. The consultants hold laparoscopic training courses on site and an anatomy course at UEA. Most consultants are MRCS examiners and interview at the National Selection Process for Higher Surgical Trainees.

 

Hospital size

The Hospital has 500 beds.

 

Surgical Specialties

Orthopaedics, one core trainee,

ENT, one core trainee

General Surgery (Upper GI, Colorectal and Breast each one core trainee)

 

Rotations

Core trainee 1 – 2 posts, CT2 - 3 posts

 

Travel information

There is a regular bus and train service to and from Norwich. The Hospital lies just next to A12 and approached via the A47 & A12.

 

Teaching

There is weekly Wednesday a.m, teaching for the General Surgery department running across several themes including journal club, interesting case review, current best practice and research & audit.  Also, 2 weekly lunchtime core surgical training teaching on Wednesdays. Core trainees have the opportunity to attend all training days held at the Deanery. Grand rounds are held weekly on Thursday lunch times. There is a monthly educational half day for surgical department. 

 

Research and innovation

The colorectal and general surgery department has been recruiting patients in many national cancer and non-cancer trials. The trainees have opportunities to conduct various audits, research and quality improvement projects.

 

Typical timetables

General Surgery core trainees have a dedicated time-table to ensure that they have 2 clinics and 4 operating sessions each week. To maximize training opportunities during day time hours the on-call has been designed to ensure core trainee training needs are protected including maximizing training during day times.

 

Training facilities

A dedicated purpose built Education and Training Centre with seminar rooms, clinical skills training room, wet lab room, simulation suite and a Laparoscopic simulation room

 

A Separate library with 15 study spaces, access to a wide variety of books and online journals and point of care resources including, BMJ best Practice and Up-To-Date.

24 hour library access

 

Junior Doctors Mess

The Doctor’s Mess is located in the centre of the hospital and the Mess Committee organizes a variety of social activities.

 

Meet the Surgical Tutor

Kamal Aryal

I was appointed as a Consultant Colorectal and General Surgeon following completion of my training in North West of England and post CCT fellowship in Lap colorectal Surgery in Dundee in 2011. I have been Educational Supervisor since my appointment and Surgical Tutor since 2014. I have interest in medical education and to this effect I am towards completion of Masters in Medical Education with dissertation on ‘Work Based assessments in higher general surgical training programme – trainer and trainee views and way for improvement.’ I am MRCS Examiner, member of faculty of surgical trainers, panel member for core and higher surgical training national selection interviews. I am lead for MCh Coloproctology University of East Anglia Course.

 

I have conducted 3 laparoscopic courses and one NOTSS courses at James Paget hospital for trainees from the East of England.  I have helped trainees to design and conduct several courses for medical students and trainees including ‘surgical skills for future surgeons’ at the James Paget.

 

Outside of work I am a keen hill walker. I spend much of my time in charity work relating to health education to general population and training and teaching in laparoscopic surgery and non-technical skills in the third world.  

 

Watford Hospital Guide

Watford General Hospital is a 521-bed acute District General Hospital situated on Vicarage Road, Watford, Hertfordshire. Watford General Hospital is a 521-bed acute District General Hospital situated on Vicarage Road, Watford, Hertfordshire and is split between 3 sites: Watford, St Albans and Hemel Hempstead.

St Albans City Hospital is the Trust’s elective care centre. It provides a wide range of elective care (both inpatient low risk surgery and day-case) and a wide range of outpatient and diagnostic services with in excess of 70,000 outpatient appointments. It has 40 beds and 6 theatres.

The surgical department boasts 14 General Surgery Consultants, 16 Orthopaedic consultants and 4 Urology consultants. There is a weekly bleep-free (and catered) surgical programme for juniors on Thursdays.

A state-of-the-art simulation suite costing £300,000 has just been opened at Watford general Hospital. The suite replicates an acute care environment and provides realistic training by enabling staff to take part in simulated scenarios, and includes a fully functional “Sim Man” with which all junior doctors complete mandatory simulation training.

Colchester Hospital

 

Colchester Hospital is a District General Hospital Serving a population of 370 000. It has recently merged with Ipswich Hospital to form East Sussex & North East Essex Foundation Trust. However, trainees at an SHO level are not currently expected to cross cover between sites.

 

Colchester is an extremely friendly place to work, there are plenty of training opportunities and good senior support. The current core surgical trainees have found it easy to get their logbook numbers and to get sufficient numbers of workplace based assessments for ISCP. There is also senior support in developing projects for publication and presentation at conferences.

 

There are opportunities to be involved in teaching at medical student and foundation doctor level. There are also surgical skills courses run at the hospital where you can be part of the faculty.

 

Surgical Specialties:

• ENT – 1 core trainee
• Breast Surgery – 1 core trainee
• Trauma and Orthopaedics – 1 core trainee
• Urology – 1 core trainee
• Vascular Surgery – 1 core trainee
• Colorectal – 1 core trainee
• Upper GI

 

Core Surgical Trainees:

There are 5 CT1 doctors and 1 CT2 doctor based at Colchester. On call patterns vary by specialty. At night, the SHOs cross cover specialties – one covering ENT and T&O; one covering general surgery, urology and vascular surgery. All specialties have senior cover by ST3 or above (aside from general surgery, they are NROC out of hours).

 

Teaching:

Fortnightly local teaching is organised on topics surrounding MRCS and delivered by consultants in the trust.

 

Travel:

The hospital is a 10-15-minute walk from Colchester Train Station and is on multiple bus routes.

 

Some trainees choose to live locally. Others commute from further afield with frequent, regular trains running from London Liverpool St to Colchester (50 minutes). Staff discount can give reduced fares for the train and bus.

 

There is staff parking at the hospital.

 

There is free rest accommodation available following night shifts if you are unable to travel home – this can be booked through switchboard.

Top reasons to train at Lister Hospital, ENHT:

• Excellent track record of CST obtaining HST posts in desired regions.
• Broad range of surgical specialties enabling CSTs greater flexibility in changing their rotations (with TPD permission) to suit the changing interests of the CST !
• Large volume of surgery – plenty of opportunity to fill your log book, and to gain exposure in surgical areas unfamiliar to the CST.
• Friendly atmosphere with approachable consultants.
• Currently training both CSTs and ISTs.

 

Background

 

The Lister Hospital (part of the East and North Herts NHS Trust) is a large DGH (730 beds), located just off the A1, in Stevenage. It serves a population of around 600,000. In 2015, all inpatient activity was moved across from Welwyn Garden City to the Lister Hospital, and a new QEII hospital was built. By Train, Stevenage is 20 mins from Kings Cross and 40 mins from Cambridge.

 

The Lister Hospital has a 24/7 primary percutaneous coronary intervention service and a hyper-acute stroke service. The hospital has around 20 operating theatres and has 3 ITUs that can accommodate >20 patients (16 level 3 and 6 level 2). The site is a level 2 trauma centre. The Interventional Radiology Service is currently undergoing expansion with the intention of providing a 7 day service. The Trust has a good training success rate with 50-70% of CTs going straight into a HST post after CT2 in recent years.

 

The LH has 14 CSTs.

In 2019, 3 of the CT posts have been changed to IST posts (General surgery x 2 , Urology x1)

 

Specialties:

 

ENT

6 dynamic consultants all with their own special interests. CTs spend more time in theatre than GPVTS in order to gain their surgical proficiencies. On calls cover ENT patients only. An ear simulator is available at all times for training.

 

Plastic Surgery

Covers a sub-regional catchment population, comprising a large area of Hertfordshire and Bedfordshire (approx. 800,000). The busy department has a workload that is approximately 70% elective surgery.

There are 8 consultants and 1 SAS doctor. The core strengths of the Department include: skin cancer services (hosting the region’s Specialist Skin Cancer Multi-disciplinary Team), breast reconstruction (immediate and delayed breast reconstruction as well as aesthetic breast surgery), hand surgery (elective and emergency) and paediatric plastic surgery. Approximately 3 all day plastic surgery theatre lists run each weekday.

 

General Surgery

9 consultants. Undertakes around 250 cholecystectomies and >150 major colonic cancer resections (open + lap) per year.

 

Breast Surgery – 3 consultants. Around 500 breast procedures performed per year and offers immediate reconstruction where applicable.

 

Vascular Surgery

4 consultants. Around 40 carotid procedures, 40 AAA (open and EVAR), 40 leg bypasses and 200 AV fistula procedures currently performed per year. This department has recently been granted permission to expand to become the Vascular Hub for Hertfordshire and West Essex. With this expansion, the vascular workload is expected to double, along with the consultant numbers. Design for a hybrid theatre began in 2018.

 

Trauma & Orthopaedics

16 consultants. Dynamic and busy trauma and elective unit. >600 joint replacements including shoulder and ankle, 500 NOFs, >100 revisions.  Suitable for a keen trainee who wants to gain further experience especially in trauma. Approximately 4 all day orthopaedic lists run each weekday.

 

Urology

8 consultants. Busy mix of general urology and specialist Urology Robotic cancer (for over a decade) offering partial nephrectomy, prostatectomy and cystectomy. Also offers laparoscopic nephrectomy, valuable paediatric Urology exposure, complex stone management and reconstructive procedures for incontinence. It is the main centre for urological cancers in Hertfordshire.

 

Research and innovation

There are close links with the School of Life and Medical Sciences, University of Hertfordshire. Renal Medicine (and thus vascular surgery) and Urology in particular have good recent records. Audits and research projects are strongly encouraged. Numerous opportunities to present work is available.

 

Timetables

Departments have on-call frequencies that vary between 1 in 7 and 1 in 10. CSTs are on site when on call. Timetables give a preference to CSTs to attend the most suitable training opportunities.

 

Training facilities

24hrs library access

Simulation training available in Lister Education Centre

Surgical skills training room (in main theatre block) is accessible 24hrs a day.

‘Animal tissue’ workshops are run in the Lister Education Centre.

 

 

 

Broomfield Hospital

Core training positions in general surgery, urology, plastics and ENT.

Mid Essex Hospital Services, which was established as an NHS Trust in 1992, has an annual turnover of £261m and employs approx 4,400 staff. It provides local elective and emergency services to 380,000 people living in and around the districts of Chelmsford, Maldon and Braintree (including Witham). The Trust also provides a regional wide plastics, head and neck and Upper GI surgical service to a population of 3.4 million and a supra regional burns service to a population of 9.8 million.

The facilities at the hospital include three integrated laparoscopic theatres as well as robotic surgical facility. There is access to a skills lab and library.

 

Located in the City of Chelmsford, with all major road connections, frequent mainline rail services to and from London and a major airport at Stansted just 40 minutes away, the Trust is in an ideal location for commuting.

 

In November 2010 the Trust opened a brand new PFI funded hospital wing which enabled the organisation to centralise the majority of its clinical services onto the Broomfield Hospital site.

Duties of the Core Post

Your duties will be arranged with the Consultant to whom you are responsible, who has final medical responsibility for all patients under his/her care. Any clinical problems beyond your experience or problems causing anxiety should be referred to the Consultant or a more senior member of your team.

Day to day duties include:

Performing Operations and Assisting in Theatres

Seeing patients in Out Patient Clinics

Responsibility for continuity of care for patients on the ward

Examining and making management plans with on call consultant of all admissions when on duty

Attending ward rounds

It is the doctor’s responsibility to ensure that they take natural breaks as required under New Deal and EWTD and to keep to rostered hours of work.

Participation in audit/research

Participation in teaching

Department of Colorectal and Upper Gastrointestinal Surgery

The department of Upper GI Surgery is the regional cancer center performing around 120 resections a year. The unit performs all aspects of the management of oesophageal cancer, minimally invasive oesophagectomies and gastrectomies as well as benign and functional upper GI surgery.  

 

The colorectal department at Broomfield Hospital undertakes a wide range of elective colorectal surgery, including minimally invasive surgery for colorectal cancer, inflammatory bowel disease, pelvic floor pathology and anorectal conditions. We perform robotic cancer and pelvic floor surgery. We have a JAG accredited endoscopy department. There is a full outpatient colorectal service, including streamlined services for rapid diagnosis in suspected cancer and a unique remote surveillance programme for the follow-up of cancer patients.

 The GI unit also runs an advanced abdominal wall reconstruction service (in combination with plastic surgical colleagues). There is therefore a constant stream of major surgery being undertaken, with the obvious training opportunities which accompany such a workload.

 

We have two associate specialist surgeons who provide weekly daycase lists which are ideal for core trainees including hernia repair, pilonidal disease, lumps/bumps, lap cholecystectomy. In addition Mr Adeosun offers a wound management clinic and advanced abdominal vac dressing service which is a valuable learning opportunity.

 

Elective opportunities include hernia repair, port insertion, ileostomy reversal and laparoscopic cholecystectomy in addition to exposure to more complex surgery.

 

Emergency service is separated from elective services with a daily consultant led ward round and operating list. The emergency take is busy and the core trainee covers both general, urological and vascular emergencies. There is a wealth of emergency operating and the core trainee should become proficient in diagnostic laparoscopy/appendicectomy, abscess drainage and opening/closing laparotomy wounds over a years placement with us.

There is weekly colorectal and UGI mdt,  a monthly departmental morbidity and mortality meeting, combined with audit and educational presentation and a weekly journal club.

 

Department of Urology

The urology department offers a wide variety of experience, from minor procedures such as flexible cystoscopy and circumcision to minimally invasive adrenal surgery and nephrectomy. The core trainee is encouraged to attend the emergency theatre weekly to maintain general surgical emergency skills. There is a urology registrar on call 24/7.  There is a renal stone service. The department holds a weekly grand round which is used for teaching, weekly MDT  and monthly audit.

The core trainee is encouraged to attend clinics and MDT. Particular opportunities include complex catheterisation, flexible cystoscopy, minor procedures as well exposure to more complex pathology.

 

The rota is 1:10 full shift.

 

All trainees are encouraged to participate in audit  and teaching and opportunities for management roles such as FY1 mentorship, rota coordination and involvement in induction are provided.

 

The Plastic Surgery Unit based at Broomfield hospital, otherwise known as the St Andrew’s Centre for Plastic Surgery and Burns, is the largest plastic surgery unit in the country. The St Andrew’s name carries with it an internationally recognised reputation for excellence and is considered one of the best centres for Plastics training in the UK. Those placed at St Andrew’s can experience the full breadth of our specialty from burns, to trauma, to complex reconstruction.

 

There is plenty to gain as a core trainee in the unit, even if you do not intend to continue Plastics at ST3. You can aim to improve your general operating skills and soft tissue handling in our minor ops and trauma theatres; you can participate in academic work, with a number of projects running at any one time; and you can link Plastics themes with many other related specialties such as ENT, Orthopaedics, Vascular and Maxillo-Facial Surgery.

 

For those considering applying for a Plastic Surgery training number, there is ample opportunity to gain operating experience in skin cancer, hand trauma and burns – the three domains assessed at the ST3 interview. Working in a large unit with a variety of cases will also allow you to become a confident, capable registrar, which ultimately we aim to help you achieve.

 

Broomfield

Broomfield hospital is based 3 miles north of Chelmsford, Essex and serves a population of 380,000, employing 4,400 staff. The hospital falls within the Mid Essex Hospitals Trust, which serves the populations of Chelmsford, Maldon and Braintree (including Witham). The supra-regional burns centre within St Andrew’s serves a population of 9.8 million and covers most of the East of England. The nearest burns centres are at Chelsea and Westminster and Birmingham.

 

St Andrew’s is viewed as a ‘hospital within a hospital’ and is therefore fairly self-contained. Most of its components, including its operating theatres, lie within the same block.

 

Specialist areas

Many consultants working at St Andrew’s have specialist responsibilities not seen in other plastics departments. These include:

 

Burns

Breast reconstruction

Head and neck reconstruction

Facial palsy

Skin malignancy

Microsurgery

Lower limb reconstruction

Lymphoedema

Hand surgery

Trauma

Cleft lip and palate

Hypospadias

Vascular anomalies

Oculoplastics

Laser therapies

 

Duties / Shift types

The junior grade (SHO) rota includes training FY2, CT1 and CT2 grades alongside non-training Junior Clinical Fellow doctors. Its is a rolling rota over 12 weeks that includes 1:4 weekends. Generally there are 5 types of shift:

 

Day Shift: 0730-1700

Most commonly, this is a ward-based shift to look after the elective patients. This will allow you to become experienced in peri-operative medicine and flap monitoring for our complex reconstruction patients. These patients are generally based across 2 wards, Stock and Mayflower.

With good communication and teamwork, the SHO’s on the ward can often clear the jobs and attend sessions in theatre and clinic. The unit has also recently begun to hire advanced practitioners, allowing trainee surgeons to gain valuable experience in other areas of the unit. For those who are interested, the team who design the rota are open to suggestions and requests for you to be placed in theatre/clinics, especially if the ward has enough SHO’s allocated to it that week.

 

Trauma On-Call: 0730-2000

The ‘Trauma SHO’ bleep holder looks after the trauma patients, who are generally based on mayflower ward. The SHO joins the trauma ward round in the morning and carries out the jobs afterward. Once the jobs are completed, the trauma SHO is expected to join the registrars in the hand trauma clinic. This is a busy clinic with plenty of opportunity to become comfortable in managing simple nailbed injuries to triaging amputated digits. The trauma patient cohort is generally made up of patients with hand injuries, but can also include patients with wound complications, necrotising soft tissue infections and bite injuries. During the day, the nurses on our dedicated hand unit take referrals for trauma and will run any queries by either yourself, or the registrar.

 

Burns On-Call: 0700-1900

The ‘Burns SHO’ bleep holder undertakes the ward round of all the ward burns patients (not those on burns ICU/BICU) and presents them to the burns surgeons, anaesthetists and other specialist auxiliary staff such as pharmacists, dieticians and physiotherapists. They then carry out the jobs and review new referrals to our burns outpatients department. The nurses on the burns unit take all the burns referrals and generally discuss cases with the burns registrar. You will have the opportunity to take part in burns resuscitation and burns surgery in our dedicated operating theatre on the burns unit.

 

Burns Short-Day: 0700-1300

To assist the ‘Burns SHO’.

 

Night On-Call: 1945-0745

Only one SHO is required overnight, therefore the ‘Night SHO’ covers elective, trauma and burns patients. The trauma referrals now come to you, but most plastics patients can be seen on an outpatient basis, and can be booked into hand clinic in the following days. Reserve your time for the true emergencies such as major burns, digital amputations and necrotising fasciitis. In terms of support overnight, there is a junior registrar covering Burns and a senior registrar covering General Plastics. The Night SHO assists the registrars on a ‘flap round’ to check the condition of all the free flaps on the wards. Then in the morning you assists the ‘Trauma SHO’ on the trauma round.

 

Alongside these shift types are opportunities in research, audit and teaching. Te unit sees students from the newly formed Anglia Ruskin medical school, which comes complete with state of the art facilities including a dissection lab using Thiel embalming methods.

 

Whilst St Andrew’s is a busy unit, the key benefits of this rotation include:

• Wide breadth of plastics cases including general and specialist areas such as vascular anomalies
• Internationally renowned burns centre with burns ICU and dedicated operating theatre
• Good opportunities for operating experience including minor ops skin cancer cases and trauma theatre that commonly runs until 10pm!
• Excellent specialist auxillary support staff, including hand therapists, specialist nurses, clinical psychologists, etc.
• Plenty of senior support

 

Due to its size and role in the care of the East of England population, the St Andrew’s Centre for Plastic Surgery and Burns is an exciting place to work. It allows you the opportunity to work alongside world-class consultants who are keen to see trainees progress. For further information please visit https://www.meht.nhs.uk/services/st-andrews-centre-plastic-surgery-and-burns/

The Queen Elizabeth Hospital in King’s Lynn is a DGH which has 500 beds, 28 wards and serves a population of around 331,000 people who live in the three counties of Norfolk, Cambridgeshire and Lincolnshire. We deliver high standards of care for our patients and their families to include both an elective and emergency service.  Alongside this, we play a leading role in research and innovation, being one of the most-research active NHS Trusts in the country compared to similar-sized hospitals.

 

The General Surgery team consists of 11 consultants; 2 upper GI, 5 colorectal, 2 breast and 2 generalists providing a breadth of experience for trainees. There is a dedicated Day Surgery unit consisting of four operating theatres providing further opportunities for training. QEH and the Surgical Department provide several teaching platforms for trainees which includes a two hour general hospital teaching session, an hour of surgical teaching each week and the availability of a suturing and hand tying workshop to improve basic skills before attending the operating theatre. This teaching is in conjunction with attendance and participation at the Surgical Department’s clinical governance and mortality and morbidity meetings held weekly. We also have an active audit department providing the opportunity and assistance to be involved in both local and national audits with a good track record within the Surgical Department of closing the loop.

 

Overall, the surgical team at QEH provide a friendly environment in which to train with supportive and approachable senior team members.