Internal Medicine training at Derriford Hospital (University Hospitals Plymouth NHS Trust)

Background

University Hospitals Plymouth NHS Trust (UHPNT) is the largest hospital in the South West peninsula with over 500 medical inpatient beds. It provides a comprehensive range of secondary care services for a local population of 450,000, and tertiary-level services for up to 2 million. As well as being the regional major trauma centre, other specialist services offered at UHPNT include renal transplant; pre- and post-operative liver transplant care; stem cell transplant; the regional hyperacute stroke unit, including thrombectomy services; cardiothoracic surgery; and neurosurgery. The demographic of the local population is very mixed, with a median age above the national average, and a socioeconomic spread from some of the most affluent areas in the country to the most deprived. The wide variance in health and life expectancy means training in, and practising medicine at UHPNT presents unique challenges and extensive learning opportunities. There are strong links with Plymouth University both in terms of active clinical research and medical education. The introduction of Internal Medicine (IM) training provides its own opportunities, and UHPNT is looking forward to welcoming trainees to a programme that has been developed locally to meet the requirements of this new curriculum.

 

 

Local curriculum and training delivery - outpatient clinic experience

The current Core Medical trainees at UHPNT have benefited from fixed “clinic days” built into their regular rota throughout the training year, allowing them to spend protected time in the outpatient setting whilst working in different medical specialties. This will continue for the new cohort of IM trainees, but with the addition of a new one-month “clinic block” that is part of the 4-month ICM rotation (i.e. 3 months ICM, 1 month clinics). This “clinic block” will provide IM trainees with a sustained and well-supported experience of work in the outpatient setting whilst attached to a specialty that is not traditionally part of the inpatient medical rotation (e.g. immunology, dermatology, genitourinary medicine). This will allow trainees to develop skills, competencies, and confidence in this important area of medical practice. There will also be the opportunity to spend time on the Acute Assessment Unit during this one-month “clinic block”, further enhancing trainees’ confidence and capability in the growing and important area of ambulatory care for general medical patients. 

 

 

Local curriculum and training delivery - medical rotations

All IM trainees at UHPNT will spend time in the following three key specialties:

 

Acute Medicine (Clinical Lead: Dr Aileen Coupe)

MAU provides 51 assessment beds and assesses 18,000 patients annually. We also incorporate one of the biggest Acute Assessment Units in the South West, which sees in excess of 60 patients a day, with input from a dedicated frailty team and acute GP service. Trainees are fully integrated into the acute medicine team with duties in both areas as part of the rotation. There is an enthusiastic consultant group who will provide clinical and educational support. You will be rostered alongside our junior doctor group, physician associates and advanced clinical practitioners.

 

60% of our medical take is through self-referral to ED. We work closely with this department and provide consultant cover and junior support for direct review of these referrals. Our medical take at junior doctor level is unselected but speciality review is provided by the neurology, gastroenterology, cardiology and hepatology teams. This provides a wide breadth of training relevant to the IM curriculum. There are regular opportunities to attend speciality clinics and to gain competence in relevant procedural skills.    

 

We have a dedicated teaching fellow to support our undergraduate training and organise ongoing training for our postgraduate trainees. Work is ongoing to introduce regular simulation-based training for all staff groups in acute medicine with a dedicated SIM room. Teaching time within MAU is protected and it is expected that trainees will perform a Quality improvement Project within the rotation. Trainees are well supported within acute medicine and we encourage them to make the most of their time here!    

 

 

Healthcare for the Elderly (Clinical Lead: Dr Tim Hall)

The Health Care for the Elderly (HCE) Department in Plymouth is centred on 4 wards providing 120 acute HCE beds. There is also an Orthogeriatrics Ward and Community Hospital beds.  Training is delivered by consultants and their teams across these wards and through attendance at sub-specialty clinics. IM trainees can expect to receive broad and high quality training in all aspects of elderly care. Sub-specialty areas include: dementia and delirium; falls and syncope; Parkinsonism and movement disorders; stroke; frailty; bone disease. However, IMTs can also expect to be exposed to the full range of clinical medicine, whilst learning the vital implications of reduced body reserve and frailty, multi-morbidities, polypharmacy, and atypical presentations in older people. 

 

IM trainees will gain experience in integrating medical and social care, working in a multi-disciplinary manner whilst looking at the socially adverse aspects of older people. IM trainees will be trained in the range of ethical and legal issues faced by HCE physicians such as Deprivation of Liberty safeguarding, future care planning, end of life care, nutrition approaches, and the vital role of capacity decision making and importance of working with families as well as individual patients.  

 

There is a lively teaching programme with X-ray meetings and departmental seminars, and all trainees are closely supervised and taught daily by consultants and senior specialists. There are consultant-delivered ward rounds on each ward three times a week (Mon, Wed, Fri) and there is consultant input to the wards on the other two days and at weekends. We endeavour to ensure that trainees find their time in HCE a happy one, enjoyable and stimulating, and that by the end they feel well versed in the specialty.  All staff within the department are highly approachable, visible, encouraging, mentoring and supportive.

 

 

Intensive Care Medicine (Clinical Lead: Dr Sam Waddy)

The department provides a flexible capacity of 26 level 2 and level 3 beds to accommodate the high dependency and intensive care requirements of a large acute teaching hospital. A wider peninsula population of almost 2,000,000 can access our specialist services as the regional major trauma centre, and neurosurgery centre.  Ten of the beds are on the regional neuro intensive care unit; again, these are managed flexibly with the general ICU beds to accommodate the variations in acute and elective capacity requirements.  The hospital has separate cardiac intensive care (10 beds) and high dependency (6 beds) units with an independent consultant team, but there are close links to the general ICU and joint rostering of the resident junior doctors and ACCPs.

 

The intensive care unit is mixed medical and surgical with approximately a 70:30 split of emergency to elective work. We have excellent outcomes on national benchmarking through the ICNARC programme and good relations with our colleagues across the region through the South West Critical Care Network.The unit is recognised by the Faculty of Intensive Care Medicine for training at all levels.  We also have a very active Advanced Critical Care Practitioner programme which we run with Plymouth University and provide ACCP training across the region and for the military. 

 

Our IM trainees will spend three months fully integrated into the resident rotation and will experience general, neuro, and cardiac intensive care.  This provides unique learning opportunities in a specialty that is quite different from the other medical sub-specialties.  Your time on ICU will make you more confident in managing the most acutely unwell patients, understanding advanced pathophysiology, and providing you with the opportunity to learn about the scope of multiple organ support and how we can help patients.

 

There is an active protected teaching rota and simulation training.  All trainees receive a formal ICU induction and the vast majority will have a locally delivered Basic Intensive Care Medicine course early in their attachment.There is an effective electronic record and multiple opportunities for local audits and QI should trainees be motivated to engage in a project during their ICU time.  We hope to encourage IM trainees to consider a longer-term career in ICM as a possibility!

 

 

Other medical specialties

Medical specialties on offer as part of IM training rotations at UHPNT include cardiology; gastroenterology (including hepatology); haematology; nephrology; neurology; oncology; and respiratory medicine. All specialties are expected to have a named educational lead for junior medical staff, and to provide a departmental induction and regular organised teaching for their IM trainees (and other junior staff).

 

 

Local curriculum and training delivery - simulation and other training opportunities

There is a well-developed simulation training set-up at UHPNT, with a named Trust lead and strong links to the local medical school where scenario-based learning is already integrated into the regular curriculum. IM trainees can expect to receive high-fidelity simulation, human factors, and procedural training over the course of the training programme with the opportunity to tailor this to any specific needs that might be identified by either the individual or supervisors.

 

As well as departmental teaching opportunities, there are monthly protected teaching days for IM trainees at UHPNT. These are usually organised by the local Associate College Tutors to ensure they are focused on what trainees need and want to know. There is an active and well-attended Medical Grand Round programme with frequent opportunities for direct trainee participation, including the recent introduction of a Trainee Grand Round competition. A range of post-graduate courses are also on offer locally, including opportunities relating to ultrasound skills, acute medicine, maternal medicine, and PACES teaching.

  

Contact details for further information

Dr John Corcoran (john.corcoran1@nhs.net)

Dr Bhu Kathiresan (b.kathiresan@nhs.net)

RCP College Tutors and IM curriculum implementation leads for UHPNT