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
• Continence
• Stroke
• Palliative Care
• Movement Disorders

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.