East Yorkshire Rotations
Harrogate District Hospital
Harrogate is a very friendly, organised DGH that's great for general elderly medicine training. The consultants are all really supportive and dedicated and will make you feel very welcome. Elderly medicine trainees will get experience of working on the acute floor with the excellent short stay elderly team and the frailty wards with lots of other opportunities for training. You should spend four months on AMU managing patients from day two of admission learning comprehensive geriatric assessment, triaging and MDT skills with a really great team. The team are also working on an in-reach ED service which should be coming soon! Eight months are spent on the frailty wards; four on each of the 30 bedded wards. There will be consultant and registrar lead ward rounds as well as daily MDTs. There are clinics in falls, polypharmacy, continence and general geriatrics outpatients.
Additional opportunities include:
- Orthogeriatrics: Harrogate has an excellent team lead by 2 dedicated and passionate consultants. They work largely independently managing patients with fractured neck of femurs, medical outliers and supporting the surgical team. You are encouraged to spend a 2 week block or weekly half-day sessions with them.
- CATT clinic: during the acute elderly rotation you should spend 2 weeks with the CATT team; the ambulatory service for the hospital. Dealing with 10-20 patients per day from ED or follow-up patients from the ward. This is good experience for general medicine training.
- Rehabilitation: This consists of Ripon Hospital and Station view. These are covered by a mixture of GPs and community geriatricians.
- ICU: Offer a 1 week placement on ICU which has really positive reviews.
- Palliative care: previous trainees have arranged 2 week blocks at St. Michael's Hospice.
There is weekly elderly medicine teaching and a journal club has recently been set up. Harrogate has weekly grand round which is generally very good. There are opportunities for teaching medical students and junior doctors including simulation training. Assessments have been fairly easy to obtain so you should be able to get through mini-CEX and ACATs etc. For signing off the curriculum focus on:
Harrogate is a beautiful spa town with lots of lovely shops - including Betty's! House prices are probably the highest in the region but it is commutable from Leeds and York. If you need to stay overnight there is hospital accommodation readily available.
Hull Royal Infirmary
Hull Royal Infirmary is an excellent teaching hospital to work in as a geriatrics trainee. There are a wide range of training opportunities and many elements of the curriculum can be covered. The consultants are all approachable and friendly and will do what they can to help you complete assessments and fulfil your learning needs.
At the start of the rotation the consultant in charge of rota coordination will discuss your learning needs. A rota is designed heavily based on what comes of these meetings. You will also be assigned a base ward, guided by your needs, as each of the consultants has a special interest. These include continence, falls, orthogeriatrics, dementia, delirium, peri-operative medicine and community geriatrics.
There are four 27-30 patient base wards where you will see a great variety of pathology (Hull has a complex, multi-morbidity, multi-mortality population with differing social needs) and a 21 bedded EAU (elderly assessment unit) that takes patients with frailty needs. EAU is predominantly needs-based rather than age-based system but most appropriate patients are 80 and over. You will spend between four and six months on each ward and there are opportunities to spend some time at Dove House Hospice or with the stroke team. The stroke team are involved in thrombolysis calls and have a hyperacute stroke unit. Your week will normally involve one consultant led ward round, one ward round you lead with support around if needed, one clinic, a session on the EAU or with the FIT (frailty intervention team- more on this further down), speciality time and some admin time. You will normally have one day a week where you will manage any referrals from other wards but these are infrequent and are negotiated around that day’s activities, with help from your colleaguesas time allows.
As already mentioned, there is lots of speciality work available in Hull, so it is great for achieving competency in curriculum areas. The community geriatrics team is made up of four consultants who are all keen to teach and there are three local intermediate care facilities that afford opportunities to be involved in MDTs and rehab planning. The community team also run care home visits to review the frailest patients and are setting up a one stop shop for Comprehensive geriatric assessment in the community. The hospital has a Frailty Intervention Team (FIT); this entails reviewing frail patients in the emergency department to facilitate discharge and improve pre-discharge management and they give timely specialist input to patients who will be admitted. The orthogeriatrics team review all the patients with fractured neck of femurs and will assist with care of other patients with ongoing medical concerns. There are regular falls clinics where the focus is comprehensive geriatric assessment and getting the specialised falls therapists to the patients that need them. There are nurse- and consultant-led continence clinics with the opportunity to attend uro-gynae and uro-dynamics sessions. Sessions can also be arranged with the psychiatrists at the memory clinic or part of inpatient liaison. Time can be spent at the hospice and/or with the inpatient palliative care team, usually based at Castle Hill Hospital in Cottingham. They really can meet all your needs in Hull!
Hull has good transport links or alternatively the housing in the local villages and Beverley is very affordable; many doctors come for a year and end up staying!
Core Competencies to focus on in Hull:
- Community geriatrics including rehabilitation and MDT working
- Frailty and acute geriatrics
- Orthogeriatrics and falls
- Palliative Care
- Movement Disorders
Mid Yorkshire Hospitals
Pinderfields General Hospital (PGH), Pontefract General Infirmary (PGI) and Dewsbury and District Hospital (DDH) together form the Mid Yorkshire Hospitals NHS Trust. Following reconfiguration, all acute services are based at PGH, with step downstream wards at DDH and PGH. However, DDH does run an acute frailty unit as well. Trainees are likely to spend most of the year at PGH with a rotation to DDH to support the frailty unit. There is a large, dynamic and supportive elderly medicine department which runs a selected take and offers a great breadth of training opportunities. These include weekly nutrition ward rounds, front door acute frailty service, orthogeriatrics and stroke including thrombolysis. A palliative care placement can be undertaken combining hospice and inpatient work. ICU and CCU placements are also encouraged. Registrar involvement at weekly departmental and monthly clinical governance meetings are encouraged.
Scarborough District Hospital
Scarborough General Hospital is a busy district general and part of the York Teaching Hospitals foundation trust. Scarborough is a seaside town with a significant proportion of elderly residents in its catchment and the Care of Elderly department covers approximately half of the medical inpatient beds. The acute take is non-selective and elderly patients are defined by an age and on the basis of frailty needs. The department is very friendly and welcoming to trainees and keen to assist with any non-clinical opportunities such as audit and quality improvement projects. The consultants are happy to assist you to obtain any extra training opportunities needed and there is a clear timetable of activities in the week to ensure a variety of work. Though the on-calls can be busy, the work load is definitely manageable to ensure training opportunities happen.
The consultants cover specific wards and all of the patients are under a named geriatrician who they stay under during their admission. The consultants are also responsible for elderly outlying patients on non-geriatric wards, with specific consultants responsible for each ward. The registrars can cover different consultant teams as the need dictates but get a good variety of experience from each team. Well attended lunchtime teachings occur up to 4 times per week, including departmental, acute medicine, general medical and a Grand Round.
As well as the general elderly wards the hospital also has a dedicated orthogeriatric service with daily ward rounds in the week on the orthopaedic ward. They have recently started to introduce a geriatrician led frailty assessment model in the emergency department. There also is a chance to get some experience of the inpatient rehabilitation ward in Bridlington hospital and MDT experience, which is led by the Consultants from York Hospital.
Outpatient clinics are either in Scarborough hospital or Bridlington District hospital. Trainees must take the opportunity to attend the movement disorder clinic as this is a fantastic opportunity to achieve the Parkinson’s and other movement disorder aspects of the curriculum. There is also a dedicated falls clinic in Bridlington with tilt-table testing done on site. They are very easy to access for experience for trainees.
Acute stroke medicine is covered at York Hospital but there remains a stroke rehabilitation service. The Acute Medical Consultants are all very friendly and approachable. They welcome trainees for extra sessions in the week to achieve GIM work based assessments such as ACATs as needed.
Scarborough is a quaint seaside town with plenty of things to do in the summer and tends to be quiet in the winter. Most trainees commute to Scarborough, which in itself offers fantastic scenery and there are rarely any issues with traffic/parking.
York District Hospital
York Teaching Hospital has a large Care of the Elderly take and a busy unselected acute take for General Internal Medicine. Currently, patients defined as elderly by age or on frailty needs come under the care of the Geriatricians. There is an acute care of the elderly ward which is managed by a great innovative team of Geriatricians. As a Specialty Trainee, you will take part in the daily morning ‘Huddle’, which is multi-disciplinary in nature. You will regularly see your own patients and make senior decisions with the supervision of the consultants. The consultants have a great way of making you feel part of the team and know when and how to improve your decision making. Comprehensive Geriatric Assessments are at the centre of everything done for each patient.
Your training needs are strongly considered when being allocated to each service. There are lots of opportunities to learn about subspecialties and elements of the curriculum that may often be difficult to achieve otherwise. Firstly, you will get the opportunity to review patients and lead the MDT at intermediate care centres. Here you will learn more about rehabilitation, the barriers to successful rehabilitation and goal setting. Further in community geriatrics, you may go to satellite units or GPs and assist with decision making with patients in care homes. The Orthogeriatrics unit runs a model where the Geriatrician takes over the care of the patient post-admission. It is supported by a team of knowledgeable Advanced Clinical Practitioners and Fracture Liaison Nurse. There is also scope to work with any of the therapists such as the Speech and Language or Dietetics Teams. In recent years, doctors have attended ward round on the specialist delirium/dementia ward, attended memory clinics and worked with the Mental Health for Older people liaison team. Other opportunities include Parkinson’s Disease Clinics, Emergency Department in-reach service and Balance MDT Clinic which is led by the ENT team.
Every trainee must do a Stroke attachment at some point of their training. York is a great opportunity where there is a small team of very knowledgeable and supportive consultants whom all enjoy teaching. You will take part in thrombolysis reviews in the Emergency Department, work on the Hyper-acute stroke unit and review patients on the Stroke-dedicated rehabilitation unit.
There is a weekly well attended lunch-time meeting. This takes various forms from external speakers to journal club presentations. These are always lively and enjoyable.
York is commutable from most areas of East and West Yorkshire where trainees are traditionally based (Leeds, Hull and surrounding area, Beverley). As a city and a place to live, it needs little introduction. It is beautiful, historic and has a vibrant night life. There are many opportunities to go to theatres, museums, catch some comedy or visit one of the many cafes, restaurants or pubs.
Competencies to focus on at York Teaching Hospital
* Comprehensive Geriatric Assessment
* Diagnosis and Management of Acute illness
* Rehabilitation and Multidisciplinary Team Working
* Psychiatry of Old Age
* Stroke Care