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Specialty Information

Find local specialty specific information.

Acute Internal Medicine

Following on from the statement released on 5th February 2009 by the Joint Royal Colleges of Physicians Training Board (JRCPTB) regarding plans to reinstate the system for award of dual certificates of completion of training (CCTs) in General (internal) Medicine (GIM) and Acute Medicine, JRCPTB is pleased to announce that trainees can now achieve separate CCTs in General Internal Medicine and Acute Internal Medicine.

The specialty of Acute Internal Medicine (AIM) reflects the on-going change in clinical practice in hospitals where there is an increasing need for physicians dedicated to providing prompt, high quality and effective management of patients who present with acute medical illness. This is essential to improve patient care and outcomes, and recognises the increasing number of patients with complex medical problems and associated acute exacerbations. Effective acute multiprofessional pathways and processes are critical to the delivery of best care. Trainees in Acute Internal Medicine will therefore acquire competencies relevant to:

  • the prompt practical management of acute presentation of medical illness,
  • the management of medical patients in an in-patient setting,
  • the development of new patient pathways to maximise safe, effective care in the community where feasible,
  • the provision of leadership skills within an acute medical unit,
  • the development of multi-professional systems to promote optimal patient care,
  • the care of patients requiring more intensive levels of care than would be generally managed in a medical ward. These competencies are generally acquired from experience within a critical care unit. 

Entry to acute internal medicine

Entry into Acute Internal Medicine training is possible following successful completion of both a Foundation Programme and a Core Training Programme.

Core Training Programmes

There are two core training programmes in Acute Internal Medicine;

Core Medical Training (CMT)

Acute Care Common Stem                                                                                                                              JRCPTB 2012

Entry to Higher Training requires completion of full MRCP. More information can be found on the JRCPTB website.

Further information on the specialty

For further information on the specialty and on the curriculum covered can be found on the JRCPTB website.

Upcoming ARCP's / PYA's

To be confirmed.

Cardiology

Cardiology is generally stereotyped as the most high profile and practical skill based of the medical specialties. Despite this not entirely unfair image of cardiologists, the subject of cardiovascular medicine embraces a very wide range of clinical activities. Cardiovascular medicine enjoys an unrivalled evidence base of effective preventive and therapeutic options. The new imaging modalities such as magnetic resonance and CT scanning will certainly complement and probably challenge the invasive investigations performed in the cardiac catheter laboratory. The expert clinical management of patients with heart failure, cardiomyopathy or atrial fibrillation is as rewarding as the quasi-surgical skills demanded of the coronary or electrophysiological interventionalist. 
 

If you are decisive, energetic, interested in effective therapies, and enjoy working in a team that includes specialist nurses, cardiac physiologists and cardiac surgeons, then cardiology may well be the Specialty for you. Cardiology is determined to evolve in a way which continues to make it attractive to the brightest medical graduates irrespective of gender. Despite out-dated perceptions, cardiology welcomes female doctors.
 

There is a wide variety of opportunities for research in Cardiology and the broader field of Cardiovascular Medicine. The new (2007) Curriculum is likely to facilitate opportunities for academic careers. The SAC and its academic sub-committee, will help to advise trainees wishing to develop their academic potential whilst obtaining a CCT in Cardiology. 

JRCTB
Jan 2009

 

Further information on the specialty

For further information on the specialty and on the curriculum covered can be found on the JRCPTB site.

Cardiology provides training across Yorkshire and the Humber in the following Trusts:

 Yorkshire East

  • Hull and East Yorkshire Hospitals NHS Trust
  • North Lincolnshire and Goole Hospitals NHS Trust
  • Scarborough and NE Yorkshire Healthcare NHS Trust
  • York Health Services NHS Trust

 

Yorkshire West

  • Airedale NHS Trust
  • Bradford Teaching Hospitals NHS Trust
  • Calderdale and Huddersfield NHS Trust
  • Leeds Teaching Hospitals NHS Trust
  • Mid Yorkshire Hospitals NHS Trust
  • York Health Services NHS Trust

 

Yorkshire South

  • Barnsley Hospital NHS Foundation Trust
  • Doncaster and Bassetlaw Hospitals NHS Foundation Trust
  • Chesterfield Royal Hospitals NHS Foundation Trust (until August 2016)
  • Sheffield Teaching Hospitals NHS Foundation Trust
  • The Rotherham NHS Foundation Trust
Clinical Genetics

Clinical Genetics is the diagnosis and management of genetic disorders affecting individuals and their families. The rapid increase in understanding of biological variation and its role in health and disease make it an exciting and expanding specialty. The training programme in clinical genetics is four years as a Specialist Registrar and research experience is actively encouraged. Entry requirements are general professional training and MRCP or equivalent – see curriculum.

Clinical genetic services run on a ‘hub and spoke’ principle with central and district counselling services. There is close team working between Consultants, SpRs and Genetic Associates as well as interaction with cytogenetic and molecular laboratory colleagues. Members of the SAC in Clinical Genetics welcome queries from those considering a career in clinical genetics.

From the JRCPTB website, March 2010

Further information on the specialty

For further information on the specialty and on the curriculum covered, go to the JRCPTB website.

Clinical Neurophysiology

Clinical Neurophysiology offers an exciting and varied career within the neurosciences for those interested in combining considerable patient contact with technical skills. It is primarily a diagnostic speciality concerned with recording electrical activity from the nervous system to aid the diagnosis, classification and management of neurological disease. Increasingly neurophysiological techniques are used to identify surgically remediable conditions such as nerve entrapments and aid safer surgical interventions. Electroencephalography is used to classify seizure disorders and select patients for surgical amelioration of epilepsy.

The work involves interaction with a wide range of specialities, including Neurology, Neurosurgery, Orthopaedics, Rheumatology, Paediatrics, Ophthalmology and Psychiatry, and environments that include theatre and intensive care. Most Clinical Neurophysiologists work in Regional Neuroscience Centres.  As well having as general responsibilities many develop subspecialty interests, such as in the work-up of patients for epilepsy surgery, specialised neuromuscular disease or theatre work. For those with more academic interests the speciality also lends itself to clinical and basic science research.

In the UK Clinical Neurophysiology is a specialty in its own right, though with close links to Neurology. With Foundation competencies Trainees may apply to enter a run-through training scheme, normally in Medicine. After successful completion of two years of Core Medical Training (or Core Neurological Training, the Acute Common Care Stem or Core Paediatric Training) and the acquisition of MRCP or MRCPaeds interested candidates may apply for allocation into Specialty Training in Clinical Neurophysiology. Specialty Training lasts four years and is well supported regionally and nationally through the SAC and professional organisations for both Consultants and specialist registrars. With limited on-call commitments the speciality permits a more sensible balance between work and outside interests than most other specialities. At present there are excellent recruitment opportunities for those interested in joining the speciality.

JRCTB

Further information on the specialty

For further information on the specialty and on the curriculum covered, go to the JRCPTB website.

Key Contact

Training Programme Director

Dr Arup Chattopadhyay
Royal Hallamshire: 0114 271 2039 

Secretary
Adele Wilde
0114 271 2526 

Clinical Oncology

Clinical Oncology is the non-surgical management of malignant disease, using both radiotherapy and systemic therapy (chemotherapy, hormone therapy and biological agents). Managing cancer in all its various forms requires an enquiring mind, excellent communication skills, a secure general medical background, good practical skills and a real commitment to patient care.

Clinical oncology is a clinically focused specialty, with much of the working week spent in direct patient contact in outpatient clinics and on the wards. However, the challenging nature of the diseases that are treated means that using and contributing to research through clinical trials or translational research is integral to patient management. A period of time in research during training is actively encouraged and may lead to a higher degree. Teamwork is crucial; all clinical oncologists work in multidisciplinary teams which may include  specialist nurses, radiographers, radiation physicists, surgeons and other clinicians, all of whom must integrate and communicate effectively. Good communication skills are essential, both to patient management and to teamworking.

During specialist training, success must be achieved in the Fellowship Examination of The Royal College of Radiologists (FRCR). The First FRCR Examination covers the basic cancer sciences of medical physics, medical statistics, radiobiology, cell biology and clinical pharmacology. It is usually taken after the 1st year of specialist training. Most trainees are ready to sit the Final FRCR Examination two years later having learnt the basic management of most common and some less common malignant diseases. The final phase of training after the FRCR Examination allows the trainee to broaden and deepen his or her experience, and also provides time for research and gaining the management skills that are so important to a career as an NHS consultant. The indicative total duration of training is five years (or the whole-time equivalent if training is undertaken on a less than full-time basis).

Further information

Please see the RCR website for further details regarding training in Clinical Oncology.

Core Medical Training

Welcome to Core Medical Training (CMT) in Yorkshire and the Humber!

We think Yorkshire and the Humber is a fantastic place to start your physicianly training due to its fantastic mix of world leading hospitals, forward thinking training programme with years of experience of incorporating simulation, highly developed trainee engagement programme and the wonderful opportunities outside of work in both our major cities and beautiful countryside with the east coast on one side and pennines on the other! We strongly support less than full time training in the region and have a nationally leading approach towards this (see the link on the left of this page). Our significant investment over the last few years in PACES preparation has meant we're the only region in England to have a continuous year on year improvement in our MRCP (UK) pass rate by the end of CT2 since data collection started in 2013/14 (MRCPUK Data, November 2017)!

Yorkshire and the Humber is divided into three regions (North and East, South and West) and trainees are appointed to one region. To give as broad an experience as possible trainees generally spend one year in a teaching hospital and another in a nearby district general hospital.

Learning Opportunities

We provide both local and regional teaching with the regional teaching days run in duplicate to ease attendance difficulties and around ten days of protected bleep free teaching per year. We fully fund both our acute simulated core medical emergencies (ASCME) simulation course and advanced procedural skills lab training as well as a full weekend of PACES revision and support trainees to get a full 5 days of study leave per year to prepare for exams. We've developed over 60 PACES revision podcasts and an online video led induction for trainees to refer back to throughout the year and in February 2018 are having our first fully funded CMT conference including 3 course meal! We're presently developing a CT2 simulation day and this has already been trialled so can hopefully be expanded to more trainees in 2018!

Trainee Engagement

We have a quarterly trainee forum that rotates around the region and is led by trainees with the first half a "safe" space being trainee only and senior staff including TPDs, Heads of School and Deputy Postgraduate Deans coming to the second half to both hear concerns and answer questions. This is augmented with a trainee WhatsApp group for trainees to raise issues and ask questions throughout the year. Since 2016 We've employed a full time "Leadership Fellow" (often a medical registrar on an Out Of Programme year) to both engage with trainees and work with the TPDs to develop the programme.

Thinking of applying?

If you’re thinking of applying to CMT in Yorkshire and the Humber or want further information about either the local programme or training in Yorkshire and the Humber generally please get in contact with Dr Matthew Roycroft one of our medical registrars and leadership fellows who's happy to answer any of your questions or if suitable direct you onto one of our current trainees.

Further information on CMT recruitment to Yorkshire and the Humber can be found in the CMT Recruitment section of our website.

Dermatology

Specialist training in Dermatology consists of a 4 year training programme and entry to the scheme is at ST3.

There are two different training sites in Yorks and Humber:

The North, West and East Yorkshire training rotation offers 10 full time Speciality Registrar posts, mainly based in Leeds Teaching Hospitals at Chapel Allerton Hospital and St James’s University Hospital, with 1-1.5 years spent in a District General Hospital.  The District General Hospitals in the scheme are York Health Care NHS Trust (1 post), Harrogate and District NHS Foundation Trust (1 post), The Mid Yorkshire NHS Trust (1 post) and Hull and East Yorkshire NHS Trust (1 post).

The South Yorkshire Training programme offers 6 full time Speciality Registrar posts based in Sheffield with possible 6 month placements in Doncaster, Chesterfield, Rotherham and Barnsley.

Both Training sites offer comprehensive training in general and sub-specialty dermatology.

The specialty

For further information on the specialty and on the curriculum covered, go to the JRCPTB site.

Useful Links

The new curriculum for training specialty registrars is available on www.jrcptb.org.uk

Further information on a career in dermatology is available at www.bad.org.uk

Endocrinology and Diabetes

Endocrinology and diabetes is a broad ranging subject and therefore an enticing one for trainees and consultants alike since it encompasses basic mechanisms of physiology and pharmacology coupled with the ability to improve quality of life and long-term outcomes through effective disease control, and often cure. Endocrine and metabolic diseases are some of the most commonly encountered ones in the UK population, and are increasing in prevalence and impact in terms of health of the nation, emphasising the need to continue to strive towards improved health care delivery in our speciality. Endocrine diseases and diabetes affect every physiological system of the body determining that our specialists enjoy a wide range of skills and expertise and make a major contribution to general medicine in its broadest sense.

The speciality has something to offer for everyone. Historically, endocrinology and diabetes have been at the forefront of both basic science and clinical research determining that much of what we do has a strong evidence base. Every trainee and specialist has the opportunity to contribute further to that growing evidence base, which has led to so many innovations in recent years. There are many common conditions we help to manage, and in doing so we work closely with many different multiprofessional colleagues. Particular intellectual stimulation arises because many of the diseases we encounter are uncommon ones, presenting special diagnostic and therapeutic challenges. A broad training in endocrinology and diabetes provides the basis for progression to specialist posts in a wide range of settings from the smaller hospital to the large tertiary referral centre, from the community base to the University academic department. 

Our SAC has a long track record of successful delivery of training and education to trainees in our speciality. The SAC itself reflects a broad range of expertise, including input from the major specialist societies (The Society for Endocrinology and Diabetes UK) and input from trainees. The SAC has faced many recent challenges in these changing times but has striven with enthusiasm to maintain its high standards in terms of curriculum development and development of appropriate assessment tools.

The new Specialty Training curriculum, previously updated in 2003, has now been re-designed in the context of MMC and to meet the requirements of the GMC and to reflect on-going developments in our speciality. The SAC regards it as a “living” document which will be subject to regular review and revision as the speciality develops along with its trainees. 

JRCPTB
Jan 07

 

Further information on the specialty

For further information on the specialty and on the curriculum covered, can be found on the JRCPTB site.

 

Upcoming ARCP's / PYA's

ARCP - HEE, Willow Terrace, Leeds

08/06/2017 

15/06/2017

 

 

PYA (Face to Face) - HEE, Willerby, Hull

20/07/2017 

Gastroenterology

The medical specialty of gastroenterology has been expanding rapidly from the early 1970s with the development of endoscopy. Training after MRCP or it's equivalent takes 5 years one of which may be pure research while the remaining four years are usually combined with general medicine. At least one year in a busier hospital with different constraints from those in teaching hospitals is expected and six months at least of specialised liver disease training is also required.

The trained gastroenterologist will be able to develop and run endoscopy services for diagnostic, therapeutic and screening endoscopy. All trained gastroenterologists will be competent at upper and lower GI endoscopy and some will have had additional training in hepato-biliary endoscopy. Most will be expected to participate in the acute medical receiving units of all cases including GI disease and to be expert in the management of the broad range of gastrointestinal disease either in out-patients or following admission. Consultation and communication skills are important in addition to organisational and managerial training.

The training curriculum and all training units and rotations in England, Scotland, Northern Ireland and Wales are overseen by the Specialty Advisory Committee (SAC) answerable to the JRCPTB. This group embraces all the goals and targets set by the separate joint advisory group on gastrointestinal endoscopy (JAG) and both the Chairman and Secretary of the SAC sit on JAG. Representation on the SAC is nominated by the British Society of Gastroenterology, The Combined Royal Colleges of Physicians, The British Association for the Study of Liver diseases (BASL) and an observer from Ireland.

JRCPTB
April 2010

For further information on the specialty and on the curriculum covered can be found on the JRCPTB site.

Genito-Urinary Medicine

Genitourinary Medicine involves the investigation and management of sexually transmitted infections and HIV. It is mostly outpatient based but does include inpatient care of HIV infection. It can also include more specialised services such as young people’s clinics, genital dermatoses, sexual dysfunction and psychosexual medicine, and outreach services for sex workers and drug users.

Essential requirements of a genitourinary physician are enjoying contact with patients, being able to work as part of a multidisciplinary team and good communication skills. It is essential to be non-judgemental and feel comfortable about discussing sensitive issues such as sex.

There is also a public health element to the specialty with the need to perform partner notification (contact tracing), and to collect and report surveillance data in order to detect changing trends of infections.

JRCPTB
March 2010

 

For further information on the specialty and on the curriculum covered can be found on the JRCPTB site.

Elderly Medicine

Geriatric Medicine is one of the largest specialties in the UK. It offers a stimulating intellectual challenge: illness may present in unusual ways in older people, they frequently have multiple pathologies that interact, and they are particularly prone to adverse drug reactions. It allows you to maintain a generalist approach while also developing a subspecialty interest. This can range from stroke to Parkinson’s Disease, falls and fracture prevention, diabetes or cardiovascular disease, to name but a few. It also offers the chance to work both in community and hospital settings. Research is at last generating an ever-expanding evidence base for the management of many conditions in old age and the National Service Framework for Older People has laid out some challenging targets for health care provision. There are presently around 800 consultants in the specialty but numbers are expanding, so career prospects are excellent.

The most effective Geriatrician is an excellent general physician with good communication skills, who is able to work well in a team with other disciplines and can empathise with older people. Most people are attracted by the holistic way that the specialty takes on acute investigation and management together with subsequent rehabilitation and discharge planning, all tailored to each individual’s needs.

The Specialty Advisory Committee (SAC) in Geriatric Medicine includes representatives of the London, Glasgow and Edinburgh Medical Colleges, the British Geriatrics Society and the Specialist Registrars themselves. It meets four times each year, and works with the JCHMT to maintain training standards in the specialty across the country. This is achieved by close contact with Regional Advisers, attendance at Specialist Registrar annual assessments and regular inspections of training programmes across the UK.

JRCPTB
April 2010

Further information on the specialty

For further information on the specialty and on the curriculum covered can be found on the JRCPTB site.

Geriatric Medicine provides training across Yorkshire and the Humber in the following Trusts:

 Yorkshire East

  • Harrogate Health Care NHS Trust
  • Hull and East Yorkshire Hospitals NHS Trust
  • Scarborough and NE Yorkshire Healthcare NHS Trust
  • York Health Services NHS Trust

 

Yorkshire West

  • Airedale NHS Trust
  • Bradford Teaching Hospitals NHS Trust
  • Calderdale and Huddersfield NHS Trust
  • Leeds Teaching Hospitals NHS Trust
  • Mid Yorkshire Hospitals NHS Trust

 

Yorkshire South

  • Barnsley Hospital NHS Foundation Trust
  • Doncaster and Bassetlaw Hospitals NHS Foundation Trust
  • Sheffield Teaching Hospitals NHS Foundation Trust
  • The Rotherham NHS Foundation Trust
  • North Lincolnshire and Goole Hospitals NHS Trust
Haematology

Haematology is an intensive, exciting and rewarding but demanding specialty that encompasses both clinical and laboratory practice. As a result, this dual role provides a unique opportunity to combine clinical skills with appropriate, often cutting edge, science to make a diagnosis, choose the optimal treatment plan and monitor progress.  Clinical care is delivered in both in-patient and out-patient environments and the haematologist frequently contributes to diagnosis and management in other specialties and in the intensive care setting. This holistic approach to clinical care is a highlight of the specialty.

Within haematology there is the opportunity to further develop special interests in a wide variety of clinical and laboratory areas (e.g. haemogloginopathies, haemostasis and thrombosis, transfusion medicine, malignant haematology, transplantation). The specialty may suit a wide variety of individuals including those who may wish to combine a clinical and academic career.

The duration of specialist training is normally five years. Satisfactory completion of training requires that the trainee acquire the competencies set out in the haematology curriculum. The completion of training also requires that the trainee obtains FRCPath.  As specialists in haematology are involved in direct patient care and in management of haematology pathology laboratories, specialist training covers both these components, including training in transfusion medicine.

One year of specialist training may be approved for research, which is relevant to the specialty and in an area approved by the Specialty Advisory Committee (SAC).

Entry into Haematology training is possible following successful completion of both a foundation programme and a core training programme. There are three core training programmes for Haematology training:

  • Core Medical Training (CMT)
  • Acute Care Common Stem - Acute Medicine
  • Level 1 Paediatric Training - visit the Royal College of Paediatrics and Child Health website for details

JRCPTB
July 2016

Immunology

The clinical practice of Immunology, as defined by the World Health Organisation (WHO) encompasses clinical and laboratory activity dealing with the study, diagnosis and management of patients with diseases resulting from disordered immunological mechanisms, and conditions in which immunological manipulations form an important part of therapy. In the UK, the practice of immunology largely conforms to this WHO definition, with Immunologists providing combined clinical and laboratory services for patients with immunodeficiency, autoimmune disease, systemic vasculitis and allergy.

Clinical Immunology has evolved over the past two decades from a predominant laboratory base to a combined clinical and laboratory specialty. The clinical work of Immunologists is largely out-patient based and involves primary immunodeficiency, allergy, autoimmune rheumatic disease and systemic vasculitis (jointly with Rheumatologists), joint paediatric clinics for children with immunodeficiency and allergy and immunoglobulin infusion clinics for patients with antibody deficiency. On the laboratory front, Consultant Immunologists are responsible for directing diagnostic immunology services and perform a wide range of duties including clinical liaison, interpretation and validation of results, quality assurance and assay development.

What makes Clinical Immunology an attractive specialty?

The variety of clinical problems encountered by an Immunologist and the opportunity to solve difficult diagnostic problems in patients with undefined immunodeficiencies or complex multi-system disease brings with it a huge intellectual buzz, not to mention the excitement of working in a specialty, which is closely linked to cutting edge science and new immunomodulatory therapies.

JRCPTB
April 2010

For further information on the specialty and on the curriculum covered can be found on the JRCPTB site.

Infectious Diseases

The specialty of Infectious Diseases, although small in comparison to the system based specialties, provides the opportunity of a career ranging from challenging and constantly varied clinical management to intellectually stimulating frontier research into diseases of worldwide importance. The specialty has encompassed the requirements of a clearly objective based training curriculum and offers training programmes ranging from pure Infectious Diseases to combined training in Infectious disease and General medicine, Infectious disease and Medical microbiology, and Infectious disease, Tropical medicine and General medicine.

The essential (generic) training tracks in the curriculum are designed to train to competency in:

  • Community acquired infection and its management
  • Geographical medicine
  • The management of immunocompromised patients including HIV/AIDS
  • Antimicrobial therapy
  • The management of Hospital acquired infection including Infection in the Intensive / High dependency setting
  • The understanding of the role of Microbiology in the management of infection
  • Research methodology and its application to clinical practice
  • A variety of optional subjects such as virology, clinical pharmacology, public health, epidemiology vaccinology and overseas practice

The challenge to rationalise antibiotic use in the light of increasing microbial resistance, to combat clinical problems of healthcare acquired infection and worldwide pandemics of HIV, hepatitis and malaria and to respond to emerging infection problems such as SARS makes Infectious diseases an exciting and contemporary specialty.

JRCPTB
April 2010

Medical Oncology

Medical oncologists are physicians who have specialised in the assessment and management of patients with cancer. They are trained to use systemic drugs in the treatment of cancer, and to administer these therapies to patients who either have localised or metastatic malignancy in need of systemic therapy or whose cancer has potentially been cured by surgery but for whom further adjuvant systemic therapy improves their outlook. The role of the medical oncologist is to discuss the treatment options with patients, supervise the therapy and manage any complications of disease and/or treatment that may arise. All such patient management is done in consultation with other clinicians within the context of multidisciplinary meetings and clinical networks.

Some people are confused about the distinction between clinical and medical oncologists. They are the two main medical specialities that actively manage patients with non-haematological malignancy. They often work in partnership, and both give systemic therapy to patients, but only the clinical oncologists administer radiotherapy. However, this simple definition by exclusion hides a number of other differences in work-pattern, approach and focus.

JRCPTB 
March 2010

For further information on the specialty and on the curriculum covered can be found on the JRCPTB site.

Metabolic Medicine

Metabolic Medicine can be defined as a group of overlapping areas of clinical practice with common dependence on detailed understanding of basic biochemistry and metabolism. It therefore falls within the areas of expertise of both the physician and chemical pathologist.   Other training programmes do not adequately meet all requirements, particularly with respect to nutritional disorders and adult patients with inborn errors of metabolism (IEM).   The areas included are:

  • Disorders of nutrition
  • IEM
  • Disorders of lipid metabolism and CV risk assessment
  • Disorders of calcium metabolism and bone Diabetes
  • Diabetes 

The main objectives of the Metabolic Medicine curriculum is to provide a scientific and clinical training for several areas of medicine which require greater knowledge of:

  • Biochemistry, genetics and molecular biology than most organ-based specialities
  • To develop the clinical training of Chemical Pathologists who wish to practice, predominantly on an outpatient basis, in these areas of medicine
  • To support the academic progress and development of Metabolic Medicine This curriculum is set to the standards required by the JCHMT or Royal College of Pathologists and GMC to ensure that trainees are fully prepared to lead a specialist clinical service in any of the five areas.

For further information on the specialty and on the curriculum covered can be found on the JRCPTB site.

Neurology

The specialty of neurology is changing rapidly. Traditionally neurology had been thought of as an intellectual pursuit, concerned with diagnosis of rare conditions of the nervous system. The advent of accessible imaging, and the emergence of potential therapies, has led to neurologists concerned with the treatment and on-going care of disorders which are in fact very common such as stroke, epilepsy, multiple sclerosis and Parkinson’s disease.

Presently higher medical training consists of 5 years, one of which may be relevant research. Usually the training is based around regional neurosciences centres with rotation to other units. Exposure to DGH type neurology is mandatory. Entry to HMT is following a period of general professional training (usually with completion of MRCP or overseas equivalent). The training curriculum, approval of posts and training rotation is overseen by the Specialist Advisory Committee (SAC) in neurology answerable to the JRCPTB. Aspects of training, education and assessment are jointly developed with the Training Educational Subcommittee of the Association of British Neurologists. Membership of the SAC is through nomination by the Royal College of Physicians, Association of British Neurologists, an observer from Ireland, officials from the JRCPTB including the Medical Director, and the lead dean for neurology.

There has recently been a rapid increase in numbers of consultant neurologists and it is likely that new posts will continue to be developed. Most district general hospitals will require at least two neurologists responsible for GP referrals and seeing inpatient referrals from other specialists. Presently many neurologists have sessions as regional neurosciences centres, where they have access to inpatient beds, specialist investigational services (neuroimaging, neurophysiology, pathology) and onward referral to neurosurgical services. Some will develop regional subspecialty services in stroke, epilepsy, neuromuscular disease, dementia, genetics and movement disorders.

In future it is likely that there will be a shift in the emphasis of work towards district general hospitals so that neurologists will contribute more to acute neurological referrals and offer local neurological services for common disorders such as epilepsy, MS and stroke. The completion of specialist training in neurology will ensure competence in all aspects of general neurology so that trainees can take up posts in neurology at district general hospitals and regional centres. There will be opportunities to pursue all aspects of subspecialty training as a specialist registrar, but to practice additionally in a subspecialty it is expected that trainees will have acquired further training, either within their research posts or with intra or post CCT fellowships.

JRCTB
Jan 2009

For further information on the specialty and on the curriculum covered can be found on the JRCPTB site.

Obstetrics and Gynaecology

Health Education England working across Yorkshire and the Humber School of Obstetrics and Gynaecology offers a high standard of training at all levels, including sub-specialty opportunities and academic training opportunities.

If you are a new trainee, please familiarise yourself with this website, particularly what needs to be done when beginning as an obstetrics and gynaecology trainee. All the relevant information can be found in the New Trainee folder.

Our Responsibilities

The School of Obstetrics and Gynaecology believes in working together with trainees and trainers to provide opportunities, guidance and support so that trainees can gain the highest standards of training from enthusiastic trainers who have expertise to share.

We aim to provide training opportunities to challenge trainees to fulfil their potential and to develop clinical and leadership skills. They can then work effectively within multidisciplinary teams in the changing environment of the NHS, underpinned by the GMC’s principles of Good Medical Practice.

Every trainee will be allocated a trained Educational Supervisor, who together with the College Tutor and Training Programme Director, will ensure that appropriate training opportunities and fair assessments are undertaken in line with RCOG annual training targets required to achieve a satisfactory ARCP outcome. In return, trainees are required to agree a training contract and work with their Educational Supervisors to utilise the opportunities available to them.

We welcome feedback from both trainees and trainers. We take comments about undermining very seriously. The school’s Workplace Behaviour Officer will raise awareness of acceptable workplace behaviour and provide confidential support and follow-up.

We hope that training in the Yorkshire and Humber region will be a challenging, rewarding and enjoyable experience. On completion of training, the specialty trained doctor will be able to provide high quality women’s health care during their professional life and become exceptional trainers themselves.

Dr Jacqueline Tay
Head of School

Occupational Medicine

Occupational Medicine is the branch of clinical medicine most active in the field of Occupational Health. Its principal role is the provision of health advice to organisations and individuals to ensure that the highest standards of Health and Safety at Work can be achieved and maintained.

Occupational Physicians must have a wide knowledge of clinical medicine and be competent in a number of important areas. A lot more information is available on the websites of the Faculty of Occupational Medicine of the Royal College of Physicians and the Society of Occupational Medicine.

This is an expanding and exciting specialty, particularly as there is now a great emphasis on improving health through work and also assisting those with health problems to remain and return to work.

Useful links

Faculty of Occupational Medicine of the Royal College of Physicians
www.facoccmed.ac.uk 

The Society of Occupational Medicine
https://www.som.org.uk/

Paediatrics

We are delighted to tell you that a massive breadth of paediatric experience is available within our training programme, including working in one of the few stand alone children’s hospitals. Each rotation provides the core of paediatric experience. Importantly, there is equity of access to the sub specialities available across the region between the rotations.

Paediatric Cardiology

Paediatric cardiology has traditionally included care of patients of all ages with congenital heart disease. Many of these patients require lifelong follow up, leading to a most rewarding, close and long term relationship with patients and their families. Higher medical training in paediatric cardiology has maintained its openness to trainees from either a paediatric or an adult medicine background, although a solid basis of both paediatrics and cardiology (adult or paediatric) is essential for entry into specialist training. Skill requirements for training in congenital cardiology have gradually become less rigid, but paediatric or medical experience up to the level of achievement of MRCPCH or MRCP remains essential. Perhaps the most important attribute of any budding paediatric cardiologist is highly developed skill in communication.

The specialty has changed considerably over the last ten years. In the past it has been expected that a paediatric cardiologist should be capable of dealing with every aspect of congenital heart disease from fetal to adult life with skills ranging from clinical cardiology to cardiac ultrasound and a wide variety of invasive skills such as pacemaker implantation and cardiac catheterisation. Whilst being an expert in all or most of the superspecialties of the field had its attractions, increasing complexity of superspecialization has made such practice obsolete. Modern training in paediatric cardiology reflects these changes and the needs of patients. The new training curriculum, which we hope, will be introduced in 2006 aims to produce trainees who, at the end of a 3-year program, are competent “general” paediatric cardiologists. This entails competence at assessment and immediate management of acute and chronic congenital heart disease with referral to a superspecialist when appropriate – in other words, the great majority of everyday clinical care of patients with congenital heart disease.  It is no longer desirable nor achievable to train all paediatric cardiologists in the superspecialties (cardiac catheterisation, electrophysiology, fetal cardiology, specialist imaging, transplantation management, pulmonary hypertension management and adult congenital heart disease). Those trainees wishing to continue in superspecialty training after the 3 year period of general cardiology training will compete for nationally approved superspecialty training posts, which will be of variable duration depending upon the specific superspecialty.

These changes in training and service provision in congenital cardiology, particularly the removal of the previously obligatory requirement for a very high level of manual dexterity in the catheterisation laboratory, should prove appealing to a wide variety of trainees.

JRCPTB 
April 2010

For further information on the specialty and on the curriculum covered can be found on the JRCPTB site.

Palliative Medicine

Palliative medicine is a relatively new specialty that was first recognised by the Royal College of Physicians as a specialty in 1987. It has continued to grow in size and influence since that time. Originally borne out of the need to improve the quality of life for people with advanced cancer and with its roots in the hospice movement, the specialty is increasingly relevant to any patient with advanced, progressive illness requiring specialist input to improve their quality of remaining life. This has been endorsed in recent years by the publication of several National Service Frameworks, such as Renal Medicine, Long Term Conditions and Cardiology. Its place within cancer management is described in detail in the NICE Guidance “Improving Supportive and Palliative Care for Adults with Cancer, 2004.”

The holistic nature of palliative medicine encompasses the physical, psychosocial and/or spiritual domains of care and as such, good multi-professional working is fundamental to its success. Palliative care is delivered in a variety of settings, including hospice and specialist palliative care units, hospital and community. Many hospice inpatient and community services sit within the charitable sector, supported by the NHS. Doctors are involved in the direct management of hospice inpatients and outpatients and usually act in an advisory capacity in hospital and community teams. The delivery of education and training to a variety of professional groups to improve the standard of general palliative care runs in parallel with the direct delivery of a specialist service.

Due to the nature of their work, palliative medicine physicians enjoy close working relationships with a variety of colleagues including those in general practice, medical and clinical oncology and other medical and surgical specialties.

JRCTB
March 2010

For further information on the specialty and on the curriculum covered can be found on the JRCPTB site.

Rehabilitation Medicine

What is the primary purpose of the specialty?

Rehabilitation medicine is the specialty that is concerned with the prevention, diagnosis, treatment and rehabilitation management of people with disabling medical conditions.  It was developed primarily to meet the needs of young adults and those of working age, but aspects of the specialty, particularly relating to technical aids, provision of wheelchairs, orthotics or prosthetics, are relevant to people of all ages.  The principal aims are to identify the impairments that limit activity and daily tasks; optimise physical and cognitive functioning; and modify personal and environmental factors to enable greater participation and quality of life. Rehabilitation medicine covers a large number of disabling conditions. The majority are acquired, such as traumatic brain injury, stroke, spinal cord injury, multiple sclerosis and limb loss. Congenital conditions or those arising in childhood, such as cerebral palsy, muscular dystrophies and limb deficiency, will continue into adulthood and require ongoing support, advice and assistance. The specialist services that deal with these are neurological and spinal cord injury rehabilitation, limb loss or deficiency rehabilitation and prosthetics, and musculoskeletal rehabilitation.  Rehabilitation medicine consultants also have specialist expertise in assistive technology, including environmental control equipment, wheelchairs and orthotics; these are not disease specific and cover a wide range of complex disabilities.

What are the core skills/competencies in Rehabilitation Medicine?

Rehabilitation medicine physicians are part of the multidisciplinary team and have responsibility for the medical aspects of rehabilitation. This includes establishing a diagnosis and prognosis, appropriate medical management of disease, health promotion and prevention of secondary damage and complications. They use specific diagnostic assessment tools and carry out treatments including pharmacological, physical, technical, educational and vocational interventions. Because of their comprehensive training, they are best placed to be responsible for the activities of the multidisciplinary team in order to achieve optimal outcomes in the treatment of the whole patient.

Is it affiliated with other specialties?

Rehabilitation Medicine Physicians work closely with a range of doctors from other specialties including healthcare for the elderly, stroke physicians, neurologists and neurosurgeons, spinal surgeons and paediatricians.

Where are Rehabilitation Medicine Physicians based?

Rehabilitation medicine consultants work in various facilities from acute care units to community settings.

Why would Rehabilitation Medicine be an attractive option for trainees?

Rehabilitation medicine will be attractive to those doctors who enjoy working in a multidisciplinary setting to ameliorate the impact of disability on people's everyday lives. Rehabilitation medicine physicians will support patients and their families through periods of change and need to be skilled in managing the physical, emotional and behavioural aspects of disabling illness. Many of the patients have recently had significant trauma, stroke, or neurosurgery and confidence in dealing with a wide range of diagnoses and ill patients is essential.  Rehabilitation is an attractive career option for those who wish to enjoy flexibility in their training or ultimate career post in terms of hours and work commitment.  The absence of acute medical and on-call commitments allows time to pursue research, non-clinical and managerial roles. Many consultants develop an interest in medico-legal work.

How big the specialty is anticipated to be in the future

There are currently 173 consultants in rehabilitation, with 36 trainees.  There is a commitment from the BSRM to work to increase these numbers, and initiatives like the NSF for long-term neurological conditions recognize the need for expertise in rehabilitation.

How the training fits in with MMC

Speciality training in rehabilitation medicine starts at ST3.  The curriculum follows completion of core training (core medical training – CMT; basic neuroscience training – BNT; acute care common stem - ACCS), although if vacancies arise trainees from surgical, and other backgrounds are welcome to apply.

JRCPTB 
Feb 07

For further information on the specialty and on the curriculum covered can be found on the JRCPTB site.

Renal Medicine

Renal Medicine is an exciting specialty offering the challenge of looking after both acutely ill patients and those with a chronic disease requiring long term care with the help of a multidisciplinary team. The majority of renal physicians receive training as specialist registrars in both Renal and General Internal Medicine, although not all renal physicians (particularly those in tertiary centres) will undertake acute general medical duties. However most general medical problems in renal patients are managed by the Renal team who have a close working relationship with many branches of medicine reflecting the various problems of co-morbidity present in most patients with chronic renal disease.

Most renal physicians will have responsibility for the care of patients with end stage renal failure requiring long term renal replacement therapy either by dialysis or transplantation They also manage patients with a wide variety of general nephrology problems and those with acute renal failure many of whom may require acute renal replacement therapy in the critical care setting. The majority of patients on chronic dialysis are managed in those District General Hospitals which have facilities for chronic haemodialysis and peritoneal dialysis; renal transplantation is performed in tertiary centres with most patients continuing long term follow up in the referring hospital. There are many opportunities for research either laboratory based (underlying mechanisms of renal disease, immunology of transplantation); clinical based (examining effects of treatment on various renal conditions), or epidemiological (looking at incidence of various renal diseases in different populations which impact on the planning and delivery of renal services).

The majority of applicants for Specialist Registrar posts will have obtained experience as a Senior House Officer in Renal Medicine although this is not an essential requirement. The SAC has a membership reflecting all aspects of Renal Medicine including an SpR representative. The SAC oversees training, which is organised by the Regional Deaneries, and has introduced a new curriculum and is assisting the JCHMT in the development of new methods of assessment.

JRCTB
March 2010

For further information on the specialty and on the curriculum covered can be found on the JRCPTB site.

Respiratory Medicine

Respiratory Medicine is one of the two major specialties of acute General Internal Medicine (GIM). Approximately 30% of all acute admissions in GIM are for a primary respiratory problem and respiratory physicians are essential and major contributors to the acute medical take in all acute hospital trusts. Respiratory Medicine has a close relationship with Intensive Care Medicine.

Most respiratory physicians supervise non-invasive ventilation in the support of patients with acute respiratory failure in the High Dependency Unit environment, and many have sessions helping to run Intensive Care services and expertise in the management of the Adult Respiratory Distress Syndrome. Respiratory physicians have considerable technical skill; they undertake bronchoscopy, pleural procedures, medical thorascopy and have expertise in cardiopulmonary physiology and run lung function laboratories in most hospitals for the interpretation of complex lung function testing, a cornerstone of respiratory diagnosis. 

In the outpatient setting, respiratory physicians run the services for lung cancer and tuberculosis in most Trusts. They are referred patients with a vast range of pulmonary and non-pulmonary conditions, the latter since the lung is involved in many non-pulmonary systemic conditions. A large percentage of their outpatient work involves the investigation, diagnosis and management of patients referred with the non-specific complaints of chest pain, cough and breathlessness of unknown cause such that most respiratory physicians have considerable expertise in dealing with diagnostic uncertainty. For this reason, they are often a port of call for other medical practitioners when there are other more general non-specific symptoms for which a diagnostic explanation is elusive.

Entry into Respiratory Medicine training is possible following successful completion of both a foundation programme and a core training programme. The two core programmes for Respiratory Medicine are:

  • Core Medical Training (CMT)
  • Acute Care Common Stem - Acute Medicine (ACCS-AM)

For further information on the specialty and the curriculum can be found on the JRCPTB site.

British Thoracic Society

Rheumatology

Rheumatology is one of the specialities within medicine and retains a very strong reliance on sound clinical skills despite considerable advance in the understanding of the molecular basis of rheumatological disease. There is considerable demand  for rheumatology expertise. According to the 2009 RCP census there are 640 Consultants and 241 SpRs/STRs in Rheumatology, an 11.3% increase in the Consulant workforce.

Choosing a Career in Rheumatology

Rheumatology provides an excellent opportunity to practice clinical medicine in its broadest sense with principles of acute and chronic disease management at its core. This may often result in the building of satisfying and rewarding long term therapeutic and educational relationships with patients. The speciality may be linked with duties in GIM  if wanted particularly in DGH settings and there are ample opportunities to develop sub-speciality interests and research with a developing academic career pathway which followed the Walport proposals (http://www.mmc.nhs.uk/pages/academic). Increasingly strong links with primary care are also being forged through work at the primary/secondary interface. This may prove to be a developing area of focus for the future. A ratio of 1 consultant rheumatologist per 85000 population is the stated goal and the RCP estimates a 61% expansion in consultant numbers by 2010 so job prospects are good.

Training in Rheumatology

As a speciality of medicine, training will develop through the Foundation stage (http://www.mmc.nhs.uk/pages/foundation) to Core Medical Training (http://www.jchmt.org.uk/specialtyHome.asp) and then to Rheumatology or Rheumatology and GIM at ST1. The detailed entry requirements and outline of training can be found in the Rheumatology Curriculum 

JRCPTB
Feb 07

For further information on the specialty and on the curriculum covered can be found on the JRCPTB site.

Sports Medicine

Sport and Exercise Medicine (SEM) is a discipline which draws upon basic and applied biomedical and clinical sciences for the furtherance of knowledge and ensuring best practice in the diagnosis and management of Sport and Exercise related clinical problems.  The discipline is relevant to the whole population and seeks to promote health, prevent disease or injury, apply optimal treatment and rehabilitation, and to measure outcomes. As a multidisciplinary specialty it sits across primary and secondary care, with a focus on prevention as well as treatment.

Sport and Exercise Medicine represents a distinct body of knowledge, however, there will always be common ground with other specialist areas of knowledge.  As such Sport and Exercise Medicine specialists are particularly well equipped to act as part of multidisciplinary teams working with other health professionals in the management of exercise-related illness and injury, and the use of therapeutic exercise for those with a wide range of diseases and lifestyle issues.

Sport and Exercise Medicine physicians have specialist training which is focused on the beneficial effects of exercise on health, and the effects that medical conditions have on the individual’s capacity to exercise. Giving encouragement and assistance to individuals and groups in their endeavours to be active today, SEM provides a holistic and effective means of addressing the population health challenges of tomorrow. This is increasingly relevant as one of the great medical challenges over the coming century is to reverse the slide towards a sedentary and overweight population. The technological advances seen over the past century have been labour-saving and time-saving. These same advances however have resulted in a population that is generally required to perform less physical activity than at any other stage in human existence. Medical conditions such as obesity, diabetes, hyperlipidaemia, some cancers, osteoporosis, cardiovascular disease and mental illness can all be at least partially attributed to a sedentary lifestyle. Certainly exercise has been well proven to provide therapeutic benefit in each of these conditions. Studies demonstrate that those who exercise regularly are likely to contribute in a positive way to society. Children who exercise regularly are more likely to be successful at sport with its inherent benefits for self esteem and social skills. While governments struggle under the burden of increasing health-care costs, there is a real need for proactive support structures for those who wish to remain physically active and exercise.

However, sport and exercise are associated with injury and illness and Sport and Exercise specialists have the specialised skills necessary for the emergency treatment of such problems and the ongoing management of injuries. It is recognised that inadequate treatment can result in chronicity and permanent disability.

Training in Sport and Exercise Medicine provides doctors with a specialised skill set which enables them to treat and encourage the exercising individual, young or old, recreational or elite. Knowledge of the health benefits of exercise and of optimal exercise regimes for specific subgroups allows Sport and Exercise Medicine specialists to promote an active lifestyle to those groups who can benefit most. Sport and Exercise Medicine specialists require a broad range of clinical skills for dealing with medical illness in those who wish to exercise, as well as for treatment of musculoskeletal pathology.

JRCPTB 
April 2010

For further information on the specialty and on the curriculum covered can be found on the JRCPTB site.

Stroke Medicine

Stroke is the most common cause of death and acquired adult neurological disability in the UK and consumes over 5% of NHS resources.  Clear standards in stroke care have been established; National Service Framework for Older People (NSF), Royal College of Physicians (with recent publication of the 4th guideline in 2012) and in Scotland, the National Clinical Guidelines and the Scottish Intercollegiate Guidelines Network (SIGN).  This has been consolidated by the implementation of the Government's National Stroke Strategy, launched in 2007.  To deliver good quality stroke care, exemplary training is required to meet such standards.

Stroke Medicine is a sub-specialty training programme open to trainees holding a medical specialty national training number (NTN) in Geriatric Medicine, Neurology, Rehabilitation Medicine, Cardiology, Clinical Pharmacology and Therapeutics and Acute Medicine. Although 2 years of training is required, the first year is generally delivered within the parent specialty programme followed by an advanced training year. This advanced year is usually taken in the penultimate or final year of higher medical training and the regional programmes are outlined below. Stroke medicine sub-specialty accreditation is an additional qualification on successful prospective completion of stroke training and trainees would be eligible to have the subspecialty of Stroke Medicine in their entry on the GMC’s specialist register after the award of a CCT in their parent specialty.

It is strongly recommended that trainees who are interested in Stroke Medicine accreditation should discuss this with the Training Programme Director (TPD) for both Stroke and their parent specialty early in their training.

The primary purpose of sub-specialty training in stroke is to promote the development of physicians with the knowledge, skills and attitudes to function as an expert consultant resource within specialist stroke services. 

Within Health Education England working across Yorkshire and the Humber there are four Stroke Medicine programmes currently recognised by the JRCPTB for training.  Funding to date has come through the Stroke Association and the Department of Health.  Each provides the infrastructure to deliver high quality training in cerebrovascular medicine; (hyper) acute stroke, stroke rehabilitation, secondary prevention and also insight into service development / provision either within one centre or across sites. To accommodate experience in all aspects of stroke and advancing technologies, experience in larger centers may be necessary.

  • East Programme (Hull Royal Infirmary, Scarborough and York District General Hospitals)
  • Central Programme (incorporating Leeds General Infirmary, Chapel Allerton Hospital and St James University Hospital)
  • West Programme (incorporating Huddersfield Royal and Calderdale Hospitals, Bradford Royal Infirmary and Airedale General Hospital)
  • Sheffield Programme (Royal Hallamshire and Northern General Hospitals).

We currently run a 'fellowship model' where advanced stroke training is delivered over one year and is designed around the needs of the trainee depending upon their parent specialty, with the aim to develop physicians with the attributes to run a specialist stroke service.  After satisfactory completion of training, trainees will be accredited with the subspecialty of Stroke Medicine on the GMC specialist register following the award of their parent specialty CCT.

Contact

Dr Jon Cooper

TPD and RSA for Stroke Medicine

Vice Chair and Curriculum Lead Stroke sub-specialty SAC 
Leeds Integrated Stroke Services
Leeds General Infirmary
Great George Street 
LEEDS, LS1 3EX
jon.cooper2@nhs.net 

Further Information

Further information including curriculum, assessments and downloads can be found on the JRCPTB site.

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