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2016-17 North London Rheumatology Welcome Pack Amy MacBrayne, Trainee Representative Judith Bubbear and Henry Penn, Training Programme Directors Last updated August 2016 QMUL 1/1/2016 Contents Training Programme Directors . 2 Trainee Reps . 2 Training . 2 Portfolio . 3 Annual Review of Competence Progression (ARCP) . 3 Training Days . 4 Other regular meetings/courses . 4 National and International Meetings, Courses and Conferences . 4 Teaching and Management . 5 Speciality Certificate Exam (“Exit Exam”) . 5 Application for Certificate of Completion of Specialist Training . 5 Training Sites . 6 North Central and North East London . 6 North West London. 6 Points from Previous TPMC Meetings . 7 Maternity Leave . 7 Before You Start . 7 Appendix 1: Description of Roles and Responsibilities at each Training Site . 8 North Central and North East London . 8 North West London. 12 Appendix 2: Rheumatology ARCP Decision Aid (revised November 2014) . 16 Appendix 3: GIM ARCP Decision Aid

. 20 1 Congratulations! Welcome to Rheumatology training in London. It’s arguably the best place to live and train in the country and we hope that you will gain a great deal from your time in the programme. Training Programme Directors Rheumatology training in London is divided into three areas with their own Training Programme Director (TPD). However, North London (NW/NCEL) have joint training days and tend to work collaboratively- previously North London was one area (and in the next few years due to restructuring may become so again). • Health Education North West London (TPD – Dr Henry Penn, henrypenn@nhs.net) • Health Education North Central & North East London (TPD – Dr Judith Bubbear, judith.bubbear@bartshealthnhsuk) • Health Education South London (TPD – Dr Sophia Steer) Trainee Reps Each area similarly has its own trainee representative, with an additional Pan-North London Trainee Rep. Your training reps will keep you informed of upcoming training

days and ARCPs, updates from TPMC meetings, and are a good first point of contact for concerns and queries regarding training. • Pan North London: Dr Amy MacBrayne (acbmacbrayne@gmail.com) • North Central & North East: Dr Arti Mahto (artimahto@doctors.orguk) • North West: Dr James Glanville (jimmyglanville@hotmail.com) Training • All Rheumatology trainees in London will dual accredit with Acute Medicine i.e 5 years. • Most ST3 trainees will start in a post with acute medicine commitments • You will have an Educational Supervisor and a Clinical Supervisor • Mentoring: Senior trainees have a wealth of experience to help new ST3s. We aim to match each new trainee with a senior SpR working within the same area. Please contact your trainee rep for further information. • Due to the current structure of training, with separate lead providers for North East and North West London, most people can expect their rotation to remain 2 within one half of North

London. There may be occasions however, when due to training needs, registrars may be asked, or may ask to be moved into a post on the other side. In the event of that happening, they remain part of their original rotation, and their training programme director and responsible officer remains with the original rotation. • Less than full-time training: Trainees who wish to take up less than full-time training must work at least three days per week to have the time counted against their training. They also must seek agreement in advance to do so It is expected that wherever possible to less than full-time trainees will job share. If however there is a gap in the rotation, or an odd number of less than full-time trainees in North London, they may be placed in a post with the expectation that the duties of the poster commensurately reduced. Portfolio • The NHS e-portfolio continues to be used, and requires registration with the JRCPTB. Please follow this link for information

regarding enrolment http://www.jrcptborguk/enrolment Bear in mind that failure to register (and pay!) will result in your access to your portfolio being blocked. • Please use this regularly • Reflective practice is encouraged • There is limited space to save documents – converting to PDF helps. We suggest creating a file for each year of training so it easy to navigate. • Rheumatology Curriculum: http://www.jrcptborguk/sites/default/files/2010%20Rheumatologypdf • GIM Curriculum: http://www.jrcptborguk/sites/default/files/2009%20GIM%20%28amendmen t%202012%29.pdf • It’s wise to double check that you have both curricula installed on your eportfolio when you start. Contact your local postgraduate centre if there are any issues. Annual Review of Competence Progression (ARCP) • Either June or November • Pre-ARCP checklist: http://www.jrcptborguk/sites/default/files/JRCPTB%20PreARCP%20checklist%20%28updated%20April%202015%29pdf

http://www.shapeoftrainingcouk/reviewsofar/1788as 3 • See attached ARCP Decision Aid (Appendix 2&3) • Separate supervisor reports are required for Rheumatology & GIM – even if the supervisor is the same. • All documentation for ARCP must be up-to-date, and supervisors’ reports completed, two weeks before the ARCP date. Training Days • 70% attendance required • There are separate GIM and Rheumatology Training Days. In order to receive information on GIM training days please ensure that you are registered as a GIM trainee on Synapse. • Trainees are expected to complete 100 hours of GIM CPD credit by CCT. This can include up to 15 hours of E-learning e.g BMJ Learning This needs recording in your eportfolio. Other regular meetings/courses • RCP Teach-ins (monthly) • Monthly SpR teaching (currently the last Thursday of the month at the RCP – two hours on a given topic, led by other SpRs) • NWL Rheumatology Forums (monthly) • RSM

Rheumatology meetings National and International Meetings, Courses and Conferences • Ten Topics in Rheumatology: Annual; July • Frontiers in Rheumatology: Annual; February • Acute & General Medicine: Annual; November • Rheumatology & Microbiology: Annual; October • BSR • Main conference: Annual; April • • Abstract submission deadline: November Autumn conference (more trainee focussed): Annual; October • Abstract submission deadline: 4 • EULAR Conference: Annual; June • • Abstract Submission Deadline: End of Jan ACR conference: Annual; November • Abstract Submission Deadline: June Teaching and Management • Most trainees do this in the latter years of their training • RCP runs the ‘physicians as educators’ accreditation https://www.rcplondonacuk/education-practice/course/rcp-educatoraccreditation - quite expensive but there are other courses available • UCLP regularly runs management and other opportunities for

trainees, details of which can be found at: http://www.uclpartnerseducationcom • RCP also has a doctors as leaders programme https://www.rcplondonacuk/education-practice/course/doctors-leadersaccreditation Speciality Certificate Exam (“Exit Exam”) • Usually taken during the later years of training (ARCP decision aid advises should have attempted by end of ST5 year) • Delivered once a year (June) • Computer-based test centres at various locations (driving theory test centres) • On line questions for the exam : https://www.studyprncom/p/rheumatology Application for Certificate of Completion of Specialist Training In order to prepare for your final ARCP (Outcome 6), please ensure that you have fulfilled your PYA requirements for Rheumatology and if dual accredited, GIM and make sure that you have provided evidence on your eportfolio. Guidance on the final ARCP process is on the JRCPTB website as below:

https://www.jrcptborguk/training-certification/completing-training Once the final outcome forms are issued, please sign your ARCP Outcome 6 for both GIM and Rheumatology and make sure there is an update to date CV in your personal library and send in your up to date CV to the Rheumatology inbox. Once received the 5 Rheumatology team will send this and your final ARCP to the JRCPTB and copy you in. The JRCPTB will take 4-6 weeks to process this and they will then then contact the GMC. Training Sites The sites for each training area are outlined below. The hospitals that provide ‘pure’ Rheumatology training (without GIM commitments) are starred. Please refer to appendix 1 for a short description of the roles and responsibilities at that site, written by current trainees. North Central and North East London • Royal London & Mile End Hospital* • Whipps Cross Hospital • Homerton Hospital • King George Hospital • University College London Hospital* •

Royal Free Hospital* • Royal National Orthopaedic Hospital* • Whittington Hospital • North Middlesex Hospital North West London • Northwick Park Hospital (& Central Middlesex) • Ealing Hospital* • Charing Cross Hospital • Hammersmith Hospital* • St Mary’s Hospital* • Chelsea & Westminster Hospital • West Middlesex Hospital • Wexham Park Hospital 6 Points from Previous TPMC Meetings 1. Serious incident: If a trainee is involved in a serious incident they need to let their ES know and declare it on their e-portfolio. 2. There is a drive to do more Quality Improvement Projects (QIP) rather than audit UCLP and Imperial are running QIP workshops. 3. OOPE (Out of Programme Experience): Maximum length 3 years Exit permitted in October only and requests must be approved 6 months in advance Maternity Leave •

http://www.nhsemployersorg/your-workforce/pay-and-reward/nhs-termsand-conditions/nhs-terms-and-conditions-of-service-handbook/parents-andcarers/maternity-leave-and-pay-section-15 • This link provides more information specific to doctors in rotational training: http://www.nhsemployersorg/~/media/Employers/Documents/SiteCollection Documents/Maternity%20Factsheet.pdf • To qualify for Statutory Maternity Pay, Employees must have 26 weeks continuous service with their current employer for 26 weeks into the 15th week before the Expected week of childbirth • To qualify for Occupation Maternity pay, Employees must have 12 months’ continuous service with the NHS by the 11th week before the Expected Week of Childbirth (EWC) and intend to return to work in the NHS for a minimum of 3 months. • Under a single lead emplyer arrangement, a move between posts on rotation will not break the 26 week continuity of employment required for SMP purposes. • You are entitled to one year

of Maternity Leave per pregnancy • You continue to accrue annual leave allowance whilst on maternity leave • NB: For OOP, it is advisable to retain an NHS contract even if its honorary as Mat Leave and Pay is based on continuous NHS service Before You Start • Most of what you need you will learn as you go • Don’t be afraid to ask questions! • Keep a log of patients seen in clinic (date, new or f/up, background, learning point), ward referrals and acute take. • Try to keep up with e-portfolio. • If there are any issues, contact your Clinical or Educational Supervisor, Trainee Rep or TPD 7 Appendix 1: Description of Roles and Responsibilities at each Training Site North Central and North East London Royal London & Mile End Hospital: There are two training SpR’s at the Royal London, both doing ‘pure’ Rheumatology jobs. The department of Rheumatology is actually based at Mile End Hospital, with all OP clinics there. The department has a

research interest in inflammatory arthritis and stratified medicine, with MSK ultrasound being a big part of this so it’s a great place to get US training. Both SpRs have three of their own clinic lists a week, plus the opportunity to attend an Ultrasound Clinic weekly, and additional specialist clinics including sports and exercise medicine and CTD clinics. XR meeting/post grad meeting Tuesday afternoon On-call 5-7pm 1 in 4 weekdays, 830 to 1230 1 in 4 weekends Specialist clinics: Friday Ali Jawad does Behcets clinic at Royal London. Bruce Kidd Ank Spond, Dev Pyne SLE, Nurhan Sutcliffe Sjogrens, Ali Jawad metabolic bone, Stephen Kelly joint dermatology clinic Inpatients- either patients with new presentations of rheumatological disease or existing patients who have presented with an acute (not necessarily rheumatological) problem Referrals for patients under acute medics or other teams- typically gout or lateral headache misdiagnosed as temporal arteritis. The latter is usually due

to migraine, tooth decay or recently an intracranial bleed! Whipps Cross Hospital There are two SpR’s at Whipps Cross, which is a busy East London DGH, both doing combined Rheumatology/GIM posts. The ‘senior’ SpR post is a 72:25 Rheum:GIM split, with 4 Rheumatology clinics a week, and the GIM mainly coming from participation in the (busy) acute medical rota, and providing occasional support on the Acute Medical Unit. The ‘Junior’ SpR does the reverse split, predominantly being based in the hospital’s busy Acute Medical Unit, participating in the Acute Medical Rota, and doing two wellsupervised clinics a week. Whilst the General Medicine is busy, the Rheumatology is generally well supported by the 5 Rheumatology consultants (3 of which also do GIM). Ward referrals are split between both SpRs and reviewed by the daily ward consultant. The Woodlands day care unit requires input for prescribing biologic and cytotoxic drugs and occasional patient reviews. Educational meetings

occur weekly and you will be expected to take a role in their organisation, as well as presenting. Both SpRs have regular medical student teaching slots. Audits are encouraged and well supported Homerton Hospital This a 50-50 rheumatology/general internal medicine post. Homerton is a small hospital and the rheumatology department is staffed currently by 3 rheumatology consultants (one of them also does GIM), 1 rheumatology registrar, 1 clinical fellow and 3 rheumatology nurse specialists. The registrar does 4 rheumatology clinics a week, one of them is early inflammatory arthritis clinic and the others are general rheumatology 8 clinics. There are 6 patients booked in every list and the clinic can be overbooked with up to 2 extra patients. The medical on-calls are in blocks of 4 weeks including adequate zero days between on-calls. During a 24 hour take there are on average 30 admissions, 20 during the day and 10 during the night. There are 2 months on-call free following each

block. The registrar also covers a medical ward called Edith Cavell that has a mixture of rheumatology, gastroenterology and general medicine patients. The ward is staffed by 2 teams, the gastroenterology and the rheumatology team and the latter is staffed by a core medical trainee and 2 FY1s. The registrar is expected to do ward rounds twice a week. Overall, Homerton offers great general rheumatology exposure, good balance between medicine and rheumatology and is a supportive environment to work in. King George Hospital This is a 80:20 general medicine / rheumatology post. KGH is a small hospital but actually has quite a large rheumatology department split across two sites – KGH and Queens with 8 consultant / associate specialists. The registrar is based at KGH and does two rheumatology clinics a week: one early arthritis clinic and one general rheumatology clinic at Brentwood community hospital, both with excellent supervision. They are also in the process of acquiring an

ultrasound machine so there may be some opportunities to get some experience soon. There are one or two rheumatology ward referrals per week, and you also carry the bleep for any GP queries. There is a once a month Essex rheumatology meeting which is hosted by various Essex hospitals which is a good mix of case presentations, general teaching and audits, plus there are Tuesday afternoons at the Royal London if you can make it. On the GIM side you are attached to the diabetes and endocrine team, with two excellent consultants and the option of doing one or two general endocrine clinics per week. The on calls are not too busy and well supported by the consultants, the average take in the winter is about 30 patients in 24 hours and slightly less in the summer. This is a good GIM job with opportunity to learn some extra skills in diabetes and endocrine whilst not being madly busy! Nearest station is Newbury park and then a bus, but it does help to have a car to get out into Brentwood.

University College London Hospital The UCLH post is a pure Rheumatology year with plenty of academic and teaching opportunities. Dr Vanessa Morris is the Educational Supervisor for all trainees You rotate through three 4 month blocks as follows: 1. Ward Covering the adult Rheumatology inpatients which are divided into lupus and general. Dr Jessica Manson is the consultant covering the general patients and you work closely with her. The lupus patients are covered by Profs Isenberg/Rahman/Ehrenstein and Dr Ian Giles who do 3 months at a time each. You are supported by an SHO (who is split with Dermatology) and an FY1. During this rotation you do two clinics a week including the New Therapies biologic clinic. You are also responsible for chairing a weekly MSK X-ray meeting. 9 2. Referrals You take all Rheumatology referrals from other teams based at UCLH and also (occasionally) from Queen square. There are 3-4 clinics a week including the Rituximab for RA clinic. You are also

responsible for weekly teaching of year 4 medical students 3. Adolescents Working with the Adolescent Rheumatology consultants Drs Nicky Ambrose, John Ioannou, and Debajit Sen. There are occasional adolescent inpatients, a weekly adolescent clinic, and two day ward sessions a week, where patients come for infusions, ad hoc review (including tertiary referrals) and joint injection. During this rotation you also cover the lupus clinic. During the year you will also be asked to take responsibility for either arranging speakers for the weekly departmental academic meeting on a Thursday afternoon, for arranging clinical governance meetings (3-monthly), or for organising the on-call rota. The latter is a one in six with weekday on calls from 5-8 pm and weekends Sat 10-7, Sun 10-3 and currently attracts a 1B supplement. Royal Free Hospital Very busy job but great clinical cases and good training. Currently involves 3 clinics a week. Some very overbooked! There is an educational meeting on

Tuesday afternoon mainly external speakers. Radiology mdt and morning reports at the Royal Free are great with loads of interesting cases. Good exposure to scleroderma Supported by 2 clinical fellows, part time rheum/derm sho and house officer. Supposed to be 2 full time sprs but currently there is only me part time and a part time locum. All in all a good job Royal National Orthopaedic Hospital Royal National Orthopaedic Hospital (RNOH) time table :Monday General Rheumatology Clinic with Dr Wolman. This is a morning clinic and is held at Bolsover St in Central London Tuesday General rheumatology morning clinic with dr mittal at Stanmore started newly this year. Ward MDTs for the rehab unit is in the afternoons Wednesday This is an afternoon clinic at Bolsover St. Which is very hectic & complex Metabolic Bone disease clinic with Dr keen. The patient list increased this year making this clinic a busy one out of all. Thursday Dr Wolman holds a sports and exercise medicine clinic at

Bolsover St in the morning that SPR can attend if interested. Dr wolman has a SEM trainee in this clinic, but one can learn relevant examination and skills. There is also a paediatric bone clinic that runs every 2 weeks, and a twice yearly genetics clinic. These are held at stanmore Friday 10 General rheumatology morning clinic including chronic pain with Dr Helen Cohen. This is held at Stanmore. After there is a weekly Xray meeting and dept teaching with /+lunch Afternoons are spent doing patient queries, prescriptions, clinic admin, ward referrals etc. Staff include: Consultants-Dr Keen, Dr Roger Wolman, Dr Helen Cohen, Dr Gayatri Mittal, ward SHO, Physician Associate, Associate Specialist, Clinical Nurse Specialist. How to get here from kings cross:The nearest tube stations to the RNOH Stanmore are Edgware (Northern line) and Stanmore (Jubilee Line). It takes 40 -60 minutes to reach the nearest tube at stanmore Then take the free courtesy vehicle from the taxi rank outside the

tube station which again may take 30 minutes. North Middlesex Hospital North Middlesex Hospital is predominantly a General medical job in a busy DGH. It includes 2 rheumatology clinics a week, and then we are based on a busy AMU, switching between acute geriatrics and acute medicine. In terms of Rheumatology, Dr Mukerjee is very enthusiastic and extremely supportive. Generally most afternoons, there are joint reviews of ward patients. We have a departmental meeting once a week, usually sponsored, and a x-ray meeting once a week. It is a busy department, still in development, but everyone is very nice and helpful. In terms of general medicine, the acute medical ward is well supported with 3 consultants. Take is generally busy, but quite well staffed. Whittington Hospital 1x FT cons, 3x PT consultants. 4x clinics/week - all general. No specialist clinics but good mix of pathology, although pt cohort mostly inflammatory arthritis/CTD. Inpatients - roughly 2-5 but there is no specific

ward rheum team so patients are cared for by the GIM teams with rheum input advice. Good mix of pathology and some sick CTD patients requiring HDU/ITU support. Teaching - a weekly Friday morning meeting which is business orientated. This is good for gaining some management experience. No specific rheum teaching but there is the option of attending UCLH Thurs PM session. There is lots of GIM teaching, and good weekly grand rounds. Good mess and canteen GIM oncalls: day take variable ranging from 20-25 admissions (x2SHOs x1 FY1). Night shifts: 5-15 admissions (1xclerking SHO, x1 ward SHO). Rota is fair, and shifts are generally busy but not intense. There is 1x Rheum office for both secretarial staff and SpRs - lack of space can be a slight issue, but the mess is good with many computers Good MAU and lots of opportunities to do ACATs Letters are transcribed via dictateIT and is good. There is currently only 1 SpR but this yr, they have 2 currently as I am supernumerary. 11 There is

1x part time CNS which means the SpR is often needs to cover CNS duties if she is away. There is also an infusion suite This is a good place to work if dual training in GIM. They have a very good ambulatory care unit, and many guidelines available online. North West London Northwick Park Hospital (& Central Middlesex) Rheumatology training at Northwick Park Hospital provides breath of experience in a well-supported environment. There are four Registrar posts - 1 senior pure Rheumatology post and 3 GIM/Rheum posts. The department has specialist clinics for Ankylosing Spondylitis, Metabolic Bone Disease, Connective Tissue Disease, Early Arthritis and General Rheumatology Clinics. There are monthly joint injection clinics with consultant supevision - good opportunity for DOPS. There are three Rheum/GIM consultants (Dr Penn, Dr Hamdulay, Dr Mouyis Dr Isaacs starts October 2016) Dr Batten (Metabolic Bone) and Dr Keat (Ankylosing Spondylitis) work less than full time. Clinics are

usually very manageable - almost always with Consultant supervision and usually 6-10 patients for the SpR. Consultant and SpR lists are combined - you will never be left alone to wrap up. The pure Rheum post has 5 clinics a week. The GIM posts have between 2 to 4 clinics a week - rotating between Rheum inpatient ward cover, Acute Medicine, and clinic blocks. GIM commitments are a two month (fairly intensive) acute block, 1:9 weekends (Short stay or HDU SpR) and 1:6 evenings (HDU SpR or clerking in A&E). There is also a two month block covering Central Middlesex Hospital on-calls - excellent opportunity to catch up with letters, paperwork and other general admin. As there is no Rheumatology SpR post at CMH, we have worked the day at NPH and then gone to CMH for 5pm evening shifts. It is an easy 15 minute drive It is an excellent place to train whether at the start of training or for a senior trainee. The Consultants are exceptionally supportive, accessible and want to be involved

with referrals. There is a weekly Radiology meeting (Tuesday 8am), Morning Report (educationally very valuable, often with breakfast provided; Wednesday 8am), Wednesday afternoon programme (teaching/monthly joint injection clinic/M&M/clinical governance). Ground Round is Thursday lunch time and Acute Medicine meetings Friday lunch. We are involved with teaching medical students from Imperial College - usually bedside or small-group teaching once a week or fortnight and in clinic. The Rheumatology Department is very involved in General Medicine at NPH. There are two Consultants on ward duty at any time, usually rotating every month. Inpatient case load is between 25-35. The junior team has 2 F1s, 3 SHOs (1-2 CMTs/ 1-2 GP VTS) but numbers are often lower due to on-calls, leave and zero days. NPH is a busy district general hospital. Acute Medicine is hectic but the department has made a real effort to respond to trainee concerns. There are now two Medical SpRs oncall at any time (one

covering HDU & wards, the other covering A&E), which means you 12 can easily call a friend. At night there are 2 SHOs clerking in A&E and two SHOs covering the ward. There are two medical consultants on-call during the day The HDU team run an HDU training day with small group teaching, practical skills on models (and animal carcass) and scenarios in a simulation suite. As with any large department, there are rota gaps and this can make shifts fairly hectic. The Acute Medicine block is exhausting the zero days are a valuable opportunity to rest That said, during a Deanery visit this year, the Medical SpRs were in agreement that in terms of exposure, support and responding to trainee concerns, this was one of the best Acute Medicine departments in London they had worked in. Ealing Hospital Overview: Lovely department, very friendly & very organised. Main personnel in department Dr Michael Naughton (likely to be supervisor) Dr Maxine Hogarth And Sr Esme Roads (CNS)

Good opportunity in this job to catch up on CV stuff e.g audits and courses Clinical work & duties At the moment the SpR does 4 morning clinics per week- every day except Tuesday. Clinics tend to give 30 mins for new patients and 15-20 mins for follow ups. On average 2 new patients per clinic and about 6 or so follow ups. There are no specialist clinics as such and majority of work is inflammatory arthritis with a good mix of patients (biologics, AS/RA/PSA). The CNS will see patients for drug counselling and follow up with clear instructions for up titration etc. Make sure prescriptions prepared in advance If patients need biologics- generally do the work up and fill in forms yourself with a view for CNS to see for training/checking screening results etc. prior to starting The CNS will also check the blood monitoring and will check with you if any issues. You may occasionally have to cover if she is away. She also runs the helpline and for complex queries may ask for advice.

Dictation is electronic and turnaround for letters is about 24 hours. Ward referrals come via fax and bleep and vary from gout to some interesting complex cases. Other duties include writing up infusions for patients who come to Haem Day care (on the 8th floor) as there is no dedicated rheum unit for infusions- the secretaries and clerk will let you know when patients are coming and will bring the notes. In general, the job is not very busy and it is an opportunity to use afternoons for other things such as audit/grant applications/courses/ writing papers etc. 13 General Admin: Usual 6 weeks’ notice required for clinic cancellation. You will also be in charge of preparing list for Xray meetings (2nd and 4th Tuesday of the month) and organising the business meeting (1st Tuesday of the month)-e.g writing up minutes and setting agenda etc. Teaching: You will be expected to teach Imperial 4th years both formally (2 lectures per groupgroups rotate every 8 weeks approximately) and

bedside teaching in clinic. Charing Cross Hospital A/w trainee information Hammersmith Hospital Working at Hammersmith is a unique training opportunity. There are two rheumatology registrar posts here, and both are pure Rheumatology posts. The inpatient workload is usually low (it is rare to have more than two inpatients at any one time), however these patients tend to be very complicated so keep you busy. Of course, we see referrals from all medical specialities, and there tends to be two consultant ward rounds per week, with one of the three General Internal Medicine accredited consultants (Professors Pickering and Mason and Dr Carulli) covering the wards each week. We also work with Professor Botto who does not cover the wards, and she is the Head of the Centre for Complement and Inflammation Research (CCIR), where Professor Pickering is also based (also on the Hammersmith campus). St Mary’s Hospital This is a pure rheumatology post, with no GIM commitments and no on-calls. The

role consists of 5 clinics a week (one at the specialist lupus clinic at Hammersmith and 4 general rheumatology clinics). The rest of the week is taken up with admin and seeing referrals, and there is usually ample time to undertake other activities - such as teaching and audit. There is a weekly radiology meeting and departmental meeting; and attendance at GIM teaching and Grand Round is encouraged. There are also options to attend specialty clinics, including paediatrics and adolescent clinics, which are jointly run. The job is well-supported and there are plenty of learning opportunities Chelsea & Westminster Hospital Chelsea and Westminster Hospital NHS Foundation Trust is situated on the fashionable Fulham Road. This training post encompasses both Rheumatology and GIM Rheumatology The department consists of 2 rheumatology consultants, Professor Callan and Dr Brand, 1 Specialty doctor (Dr Ho) and 2 rheumatology specialist nurses. The registrar post involves 3 general

rheumatology outpatient clinics. All clinics are shared lists with the 14 supervising consultants. On average, you will see 8-10 patients per clinic The 3 clinics are on Monday afternoon, (Dr Brand), Wednesday morning (Prof Callan), and Thursday afternoon. (Consultant to be appointed) Patients requiring biologic therapy and infusion therapies are seen on the Medical Day Unit. The registrar is also responsible for seeing ward referrals. There is a weekly radiology meeting on Friday lunchtime and a newly established weekly journal club on a Thursday morning at 8.30am GIM As this is a combined GIM post, you also responsible for the management of care of the elderly inpatients, under Dr Bovill (Elderly Care physician). Typically, there are 20 inpatients on David Erskine ward. The team includes a CT trainee and 2 FY1s The consultant ward rounds occur on Monday morning and Thursday morning. On-calls You will be on the medical on call rota covering AAU, Level-1 care patients and the acute

take. The registrar is responsible for overviewing the management of all patients admitted during the day and overnight. There is an expectation to review level-1 patients overnight and as you are often on call with an F2 (the F1 covers both medical and surgical wards), you need to be efficient and manage your time effectively. West Middlesex Hospital Rheumatology and GIM. 1 SpR post 5 busy clinics - currently being reduced to 4 Busy on calls. SpR covers respiratory outliers - approx 20 patients Rheumatology exposure is standard DGH. GIM is busy A lot of paperwork and admin Wexham Park Hospital Its a small friendly rheumatology department. My supervisor is Dr Steuer, but you work under a total of six consultants. There are currently three registrars (one NWL and two Oxford) who share two GIM on call rota slots. All the general medical consultants are great and approachable, and the on calls are well staffed and supported. Rheumatology clinics run everyday, which you share between the

registrars who are around/not on call/not on leave. However with forward planning clinics are cut/cancelled if there are not enough registrars. You are responsible (with a team of FY1s and SHOs) for a medical ward (ward six) which is a 35 bed ward plus a medical outlier ward (ward 20), and you also see the rheumatology referrals and run it by the consultant of the week". Injection clinic is on a Tuesday pm which is registrar led, and there is always a consultant around for help (as we are all junior registrars this can be quite useful). The team are good with ensuring I am getting to my training days and for CV building! I thoroughly recommend rotating through Wexham at some point in your training! 15 Appendix 2: Rheumatology ARCP Decision Aid (revised November 2014) Rheumatology ARCP Decision Aid – November 2014 The table that follows includes a column for each training year which documents the targets that have to be achieved for a satisfactory ARCP outcome at the end of

the training year. This document replaces previous versions from November 2014 Assessment / Evidence ARCP year 3 (End of ST3) ARCP year 4 (End of ST4) Expected competence Trainees should be competent in the initial assessment of patients presenting with a common rheumatological problem. They should be competent in the management of a patient presenting with an acute “hot” joint. Trainees must demonstrate appropriate professional behaviours throughout Trainees should be competent in the assessment of patients presenting with any of the common rheumatological conditions. Trainees should be competent in the assessment and management of all common rheumatological emergencies. Trainees must demonstrate appropriate professional behaviours throughout Rheumatology Specialty Clinical Examination MSF DOPS Satisfactory Have demonstrated competence by DOPS in 2 core techniques Opportunity to attempt at this stage Satisfactory Have demonstrated competence by DOPS in 3 further core

techniques ARCP year 5 (End of ST5 = PYA) Trainees should be autonomously competent in the assessment and management of patients presenting with all common rheumatological conditions. Trainees must demonstrate appropriate professional behaviours throughout Must have attempted Satisfactory Have demonstrated competence by DOPS in 3 further core techniques (+/specialist techniques) ARCP year 6 (End of ST6 = CCT) Trainees should be autonomously competent in the assessment and management of patients presenting with all core rheumatological conditions – ie, those that are common but also those that a non sub-specialised rheumatologist would expect to see in a typical year’s practice. Trainees must demonstrate appropriate professional behaviours throughout Must have passed to obtain CCT Satisfactory Competence should have been demonstrated in the full spectrum of core techniques, covering all types of core injection, but not necessarily every site. Satisfactory* Must have valid ALS

Must have valid ALS Must have valid ALS ARCP year 3 (End of ST3) ARCP year 5 (End of ST5 = ARCP year 6 (End of ST6 = PYA) CCT) SLEs: 4 mini-CEX where the 4 mini-CEX where the 4 mini-CEX on the 4 mini-CEX on the mini-CEX emphasis is on history/exam emphasis is on the assessment and assessment and in common conditions - 1 assessment and management of patients with management of patients with mini-CEX or CBD must be on management of patients with common conditions and all core rheumatological acute hot joint. common rheumatological patients with more complex conditions, with the emphasis conditions rheumatological conditions on complex conditions SLEs: 4 CBD where the emphasis 4 CbD where the emphasis is 4 CbD on the assessment 4 CbDs on the assessment CbD is on history/exam in on the assessment and and management of patients and management of patients common conditions - 1 CbD management of patients with with with all core rheumatological or mini-CEX must be on common rheumatological

common conditions and conditions, with the emphasis acute hot joint conditions patients with more complex on complex conditions rheumatological conditions Supervised learning events (SLEs) should be performed proportionately throughout each training year by a number of different assessors and should include structured feedback and actions plans to aid the trainees’ personal development Audit Evidence of participation in Evidence of completion of an Satisfactory portfolio of audit an audit. Indicative evidence audit – with major involvement, would include an audit involvement in design, proposal, audit report, implementation, analysis and evidence of involvement in presentation of results and the design and/or recommendations. Such implementation of an audit. evidence may be publication or presentation at formal meetings. Evidence may also include audit assessment tool. Research Evidence of critical thinking Evidence of developing Satisfactory academic around relevant clinical

research awareness and portfolio with evidence of questions. Such evidence competence – participation in research awareness and might be via a formal research studies, completion competence. Evidence might Patient Survey ALS Assessment / Evidence Satisfactory* Must have valid ALS ARCP year 4 (End of ST4) 17 Teaching Management Structured Educational Supervisor’s report Multiple Consultant Report research proposal, formal written work, participation within an existing research group. of “Good Clinical Practice” module, critical reviews, presentation at relevant research meetings or participation in (assessed) courses. Evidence of participation in teaching of medical students, junior doctors and other AHPs Evidence of participation in teaching with results of students’ evaluation of that teaching and teaching observations Evidence may include teaching observation tool Evidence of understanding of the principles of adult education. Evidence might include attendance

at relevant courses, accredited qualifications in medical education Evidence of awareness of managerial structures and functions within the NHS. Such evidence might include attendance at relevant courses, participation in relevant local management meetings with defined responsibilities. Satisfactory – to include summary of MCR and any actions resulting 4* Evidence of participation in, and awareness of, some aspect of management – examples might include responsibility for organising rotas, teaching sessions or journal clubs Satisfactory – to include summary of MCR and any actions resulting 4* Satisfactory – to include summary of MCR and any actions resulting 4* include a completed study with presentations/ publication, a completed higher degree with research component (e.g Masters) or a research degree (MD or PhD). Trainees should have completed a recognised “Good Clinical Practice” module. Portfolio evidence of ongoing evaluated participation in teaching Evidence of

implementation of the principles of adult education Evidence may include teaching observation tool Evidence of understanding of managerial structures e.g by reflective portfolio entries around relevant NHS management activities. Satisfactory – to include summary of MCR and any actions resulting 4* 18 The precise interpretation of the ARCP decision aid must take into account the structure of the individual trainee’s programme. For example, where trainees are dual training in GIM supervisors will have to adjust the detail of requirements to allow for the extra training time. Similarly, for trainees spending some time out of programme e.g in research, interpretation of the decision aid is required to take this into account * It is recommended that the patient surveys are performed early in year 4 and just prior to PYA in year 5 * It is recognised that flexibility is required as trainees may struggle to obtain reports from four clinical supervisors in some posts. If trainees

antici 19 Appendix 3: GIM ARCP Decision Aid The table that follows includes a column for each training year within general internal medicine (GIM) training, documenting the targets that have to be achieved for a satisfactory ARCP outcome at the end of each training year. This document replaces all previous versions       The ePortfolio curriculum record should be used to present evidence in an organised way to enable the educational supervisor and the ARCP panel to determine whether satisfactory progress with training is being made to proceed to the next phase of training. Evidence that may be linked to the competencies listed on the ePortfolio curriculum record include supervised learning events (CbD, mini-CEX and ACAT), reflections on clinical cases or events or personal performance, reflection on teaching attended or other learning events undertaken e.g e learning modules, reflection on significant publications, audit or quality improvement project reports

(structured abstracts recommended) and / or assessments, feedback on teaching delivered and examination pass communications. Summaries of clinical activity and teaching attendance should be recorded in the ePortfolio personal library. It is recognised that there is a hierarchy of competencies within the curriculum. It is expected that the breadth and depth of evidence presented for the emergency presentations and top presentations will be greater than that for the common competencies and the other important presentations, which should be sampled to a lesser extent. Procedures should be assessed using DOPS; initially formative for training then summative DOPS to confirm competence where required. Summative sign off for routine procedures is to be undertaken on one occasion with one assessor to confirm clinical independence. Summative sign off for potentially life threatening procedures should be undertaken on two occasions with two different assessors (one assessor per occasion). An

educational supervisor report covering the whole training year is required before the ARCP. The ES will receive feedback on a trainee’s clinical performance from other clinicians via the multiple consultant report (MCR). Great emphasis is placed on the ES confirming that satisfactory progress in the curriculum is being made compared to the level expected of a trainee at that stage of their training. This report should bring to the attention of the panel events that are causing concern eg patient safety issues, professional behaviour issues, poor performance in work-place based assessments, poor MSF report and issues reported by other clinicians. It is expected that serious events would trigger a deanery review even if an ARCP was not due. Guidance for trainees and supervisors is available on the JRCPTB website specialty and assessment pages (www.jrcptborguk) 20 GIM ARCP Decision Aid (revised November 2014)- standards for recognising satisfactory progress Curriculum Domain

Educational Supervisor (ES) report Multiple Consultant Report (MCR) ALS Supervised Learning Events (SLEs) GIM Stage 1 Overall Report Satisfactory with no concerns Management and Leadership Demonstrate acquisition of leadership skills in supervising the work of Foundation and Core Medical trainees during the acute medical take Each MCR to be completed by one clinical supervisor Minimum number of consultant SLEs per year. Cumulative totals to be used when a GIM training year spans more than 1 GIM stage 2 CCT Satisfactory with no concerns Demonstrate implementation of evidence based medicine whenever possible with the use of common guidelines. Demonstrate good practice in team working and contributing to multidisciplinary teams. Satisfactory with no concerns Able to supervise and lead a complete medical take of at least 20 patients including management of complex patients both as emergencies and in patients. Comments To cover training year since last ARCP Able to supervise

more junior trainees and to liaise with other specialties. 4-6 4-6 Awareness and implementation of local clinical governance policies and involvement in a local management role within directorates, as an observer or trainee representative 4-6 Valid 10 SLEs (ACATs, CbDs and mini CEX) - to include a minimum of 6 ACATs Valid 10 SLEs (ACATs, CbDs and mini CEX) - to include a minimum of 6 ACATs Valid 10 SLEs (ACATs, CbDs and mini CEX) - to include a minimum of 6 ACATs Summary of the MCR and any actions resulting to be included in ES report SLEs should be performed proportionately throughout each training year by a number of different assessors across the breadth of the 21 training year Multi-source feedback (MSF) ᵃ Minimum of 12 raters including 3 consultants and a mixture of other staff (medical and non-medical) 1 1 GIM Audit or GIM Quality improvement projects Need to have lead one before CCT Teaching Observation Common Competencies 1 before CCT Emergency

Presentations Confirmation by educational supervisor that satisfactory progress is being made Cardio-respiratory arrest Shocked Patient Unconscious Patient Confirmation by educational supervisor that GIM level achieved Confirmation by educational supervisor that GIM level achieved Confirmation by educational supervisor that GIM level Confirmation by educational supervisor that satisfactory progress is being made Confirmation by educational supervisor that level 3 or 4 achieved curriculum. Structured feedback should be given to aid the trainee’s personal development Replies should be received within 3 months for a valid MSF. If significant concerns are raised then arrangements should be made for a repeat MSF Quality improvement project assessment tool (QIPAT) or Audit Assessment (AA) to be completed Ten do not require linked evidence unless concerns are identified ᵇ. Evidence of engagement with 75% of remaining competencies to be determined by sampling and level achieved

recorded in the ES report Evidence of engagement (ACATs, mini-CEXs and CbDs) required for all emergency presentations by end of GIM training. ES to confirm level achieved and complete rating for 22 Anaphylaxis/ Severe adverse drug reaction Top Presentations Other Important Presentations Procedures achieved Confirmation by educational supervisor that GIM level achieved (after discussion of management if no clinical cases encountered) Confirmation by educational supervisor that satisfactory progress is being made Confirmation by educational supervisor that satisfactory progress is being made DC Cardioversion Knee Aspiration Abdominal paracentesis* Central venous cannulation (by femoral approach as a minimum) with ultrasound guidance where appropriate* Intercostal drainage (1) Pneumothorax insertion using each presentation. Evidence to include ACATs, mini-CEXs and CbDs Confirmation by educational supervisor that level is satisfactory for GIM stage completion Confirmation by

educational supervisor that satisfactory progress is being made Confirmation by educational supervisor that level is satisfactory for GIM completion Clinically independent Clinically independent Clinically independent Skills lab training completed or satisfactory supervised practice Able to perform the procedure with supervision / assistance as a minimum Able to perform the procedure with supervision / assistance as a minimum Evidence of engagement required for all top presentations by end of GIM training. Level achieved to be determined by sampling and recorded in ES report Evidence of engagement with this area of the curriculum to be determined by sampling evidence and level achieved to be recorded in ES report Foundation and CMT procedural skills must be maintained. DOPS to be carried out for each procedure. Formative DOPS should be undertaken before summative DOPS and can be undertaken as many times as needed. Summative DOPS sign off for routine procedures to be undertaken on

one occasion with one assessor to confirm 23 Seldinger technique* Intercostal drainage (2) Pleural Effusion using Seldinger technique following ultrasound guidance* Clinical Activity Able to perform the procedure with supervision / assistance as a minimum (may be skills lab) Acute take 1000 patients seen before CCT 186 performed before CCT Clinics ᶜ (or equivalents) Teaching Overall teaching attendance Satisfactory record of teaching attendance Satisfactory record of teaching attendance External GIM Satisfactory record of teaching attendance 100 hours before CCT clinical independence (if required). Summative DOPS sign off for potentially life threatening procedures (marked with asterisk) to be undertaken on at least two occasions with two different assessors (one assessor per occasion. Mini CEX and CbD to provide structured feedback and patient survey recommended. Record of attendance and reflective practice is recommended to document attendance and learning Teaching

attendance requirement should be specified at the start of training programme Includes regional teaching days ᵃ Note: Health Education West Midlands use the 360˚Team Assessment of Behaviour (TAB) instead of MSF ᵇ The following common competencies will be repeatedly observed and assessed but do not require linked evidence in the ePortfolio: History taking Clinical examination Team Working and patient safety Managing long term conditions and promoting patient self-care 24 Therapeutics and safe prescribing Relationships with patients and communication within a consultation Time management and decision making Communication with colleagues and cooperation Decision making and clinical reasoning Personal Behaviour ᶜ The Specialist Advisory Committees for General Internal Medicine and Geriatric Medicine have agreed that there is equivalent outpatient experience for trainees undertaking a Dual CCT in GIM and Geriatric Medicine only. 25