Accident & Emergency York District Hospital

Mark Gibson & Mike Williams

The post is based in the Accident & Emergency Department of York District Hospital, which sees over 50,000 new attendances a year. There are currently six Senior House Officers. Three are on the GP Vocational Training Scheme, one is on the Surgical Fellowship and two posts are ‘free standing’.

The posts are recognised for General Surgical, General Medical and GP training. The trainee is responsible for the initial assessment and treatment of the broad range of patients presenting to the department.

There is full time middle grade cover to the department consisting of two SpR posts and two Staff Grade posts. There is twenty-four hour consultant cover to the department.

The department has an active postgraduate teaching programme with weekly protected time for SHO teaching.

The department also runs ALS and ATLS courses, which the trainee is encouraged to attend.

Medicine for the Elderly York District Hospital

Dr A Corlett, Dr J Coyle, Dr D Heseltine, Dr J Harbison, Dr A W McEvoy, Dr S Kesavan & Dr P Pearce

The service is 75 and over age related service divided into 2 main sectors (East – Dr Kesevan, Harbison and Heseltine)  (West – Dr Corlett, Coyle, McEvoy and Pearce – Dr Pearce covers Selby)

Acute services

These are based at York Hospital. There are 125 beds on 5 Wards.  When the department’s bed are full, patients are admitted to the other Wards but remain under the care of the DME.   The number of admissions averages 15 daily.   The length of stay is approximately 10 days.  The majority of patients are discharged directly from hospital but those who require further rehabilitation are transferred to one of the two Community Rehabilitation Hospitals in York or to Selby War Memorial Hospital.

Joint Assessment Ward (with psychiatry) 

These are 21 specialised beds under the joint responsibility of  physician for the elderly (Sandeep Kesavan and psychiatrist for the elderly Linda Brown).  The aim of the Ward is joint assessment of acutely ill elderly people where the cause may be psychiatric or physical.  There are weekly joint MDT rounds involving staff from the community.   Other units with effective working practices are  hard to find and therefore this represents an excellent training opportunity exploring the interface between medicine and the psychiatry of old age.

Stroke services

These are currently based at York Hospital.  There are 24 stroke rehabilitation beds based on two Wards.  These offer services for stroke patients of all ages.   There are current plans to create an Acute Stroke Ward and there is a Community Stroke Rehabilitation Team  for patients up to the age of 75 (plans to make this open for patients of all ages).

 General rehabilitation services

These are based in York Hospital to support the in-patients.  In addition, there are extensive rehabilitation services at White Cross Court and St Helen’s Rehabilitation  and Selby War Memorial Hospitals.  Each of these units offers slow stream rehabilitation and palliative care.  There are also Occupational and Physiotherapy departments and the hospitals are the basis for the Community Outreach/Intermediate Care Teams. 

Medical staff

The team includes 7 consultants (one part-time), 2 registrars, 8 Senior House Offices and 2 House Officers.  Duties include management of acutely ill patients as well as these needing rehabilitation.  There are weekly multidisciplinary team meetings.   The medical teams conduct an audit  project every 6 months and there are monthly audit meetings.  Also, Education is offered through weekly academic seminars which follow a syllabus for training in Medicine for Old Age and x-ray meetings.

General Medicine York District Hospital

There are five teams, with each team headed by a Consultant Physician with a particular interest, and the rest of the team comprising a Registrar or SHO and a pre-registration HO. In addition, Senior Registrars on rotation work in some of the teams.

The Consultant Physicians have a particular interest in the following specialities -

Cardiology Maurice Pye, Rob Crook & Simon Megarry

Chest Medicine Alan Hunter & John White

Endocrinology Paul Jennings & Jonathon Thow

Gastroenterology Alastair Turnbull, Sean Kelly & James Turvill

Renal Medicine David Worth, Colin Jones, Donald Richardson & Paul Laboi

The junior medical staff establishment is currently comprised of 10 SpRs, 11 SHOs and 7 PRHOs, all working shifts paid at Band 2B.  SHOs will be moving to a split week of nights in 2004.

During the six month attachment, the GP SHO works solely for one consultant.  This gives considerable experience in a wide spectrum of medicine, including the Coronary Care Unit and also more detailed training an individual specialty.  This combines both experience in both In patient and Out patient acute medicine.

There are excellent IT facilities, including : Internet, email, and a developing electronic patient record, which includes pathology, XRay results and patient letters.

The post is designated non-resident but resident accommodation is available.

Otolaryngology/Head and Neck Surgery York District Hospital

Andrew R H Grace, Andreas R Nicolaides, P Gerard Reilly & Andrew Coatesworth

The SHO forms part of a team of three Consultants, two Registrars and three SHOs. There is a 1 in 5 cross cover oncall rota for weekday evenings and weekends, shared with Maxillofacial Surgery.

Principal duties include the day-to-day management of patients on Ward 15 (adults) and Ward 17 (children). There are nurse-led pre-admission clinics as well as Emergency admissions.

During the first two to three weeks the SHO is instructed in ENT examination, including head mirror, fibreoptic and microscope equipment and thereafter sees new and review patients under supervision.

During the six months the SHO is expected to learn the basics of many areas of ENT, such as audiology, procedures such as nasal packing and cautery, removal of foreign bodies from the ears, nose and pharynx, as well as various other skills.

There are also up to three outpatient sessions in Dermatology each week.

The SHO takes part in active weekly tutorials in ENT and monthly X-Ray and Audit meetings.

ENT/Ophthalmology York District Hospital

Michael Hayward, Paul Jacobs, Robert H Taylor, Tim Manners, Roger Ellingham & Nicola Topping,

This is a six-month post shared between ENT and Ophthalmology. There is a 1:5 oncall rota for weekday evenings and weekends covering the ENT department.

In the ENT department, the SHO forms part of a team of three consultants, two registrars and three SHO’s. 

In the Ophthalmology department, there are six consultants, one staff grade, three specialist registrars and two full-time trainee SHOs

Principal duties include the day-to-day management of patients on the ENT and Eye wards for both adults and children. There are nurse-led pre-admission clinics as well as emergency admissions.

During the first two to three weeks, the SHO is instructed in ENT and Ophthalmic examination, including head mirror, fibreoptic, microscope equipment, slit lamp examination and fundoscopy, and thereafter sees new and review patients under supervision.

During the six months, in ENT, the SHO is expected to learn the basics of many areas such as audiology, procedures such as nasal packing and cautery, removal of foreign bodies from the ears, nose and pharynx and suction clearance of the mastoid cavity and ear canal.

A new Eye Department with self-contained Outpatients, Ward, Theatres and Seminar Room was opened in August 2003.  Here the SHO will be expected to work to a curriculum designed by the Department and Vocational Training team. This includes ophthalmic emergencies and common eye disorders such as blepharitis, cataracts, age-related macular degeneration, glaucoma and diabetic retinopathy. There will be a cyst list where he/she can learn how to deal with chalazia and other minor lid abnormalities.

The SHO takes part in weekly tutorials in ENT and Ophthalmology and also monthly x-ray and Audit meetings.

Paediatrics York District Hospital

There are six Consultant Paediatricians based at York District Hospital with the following special interests:

Robin Ball : Asthma, ambulatory paediatrics & child protection

David Beverley : Neonatology & cystic fibrosis

Michael Harran : Neonatology, diabetes & growth

Dominic Smith : Rheumatology, Selby clinics

Robert Smith : Neurology, epilepsy & child development

Senior Clinical Medical Officers and Clinical Medical Officers, provides the School Health Service. Two of the consultants are examiners for the Diploma in Child Health. There is an integrated Child Health Service to meet the needs of children in the area served by the Trust - both in hospital and in the community.

Junior medical staff in the Department include seven SHOs, four Specialist Registrars and three Staff Grades. The on call rotas are in keeping with the requirements of the "Junior Doctors Hours Initiative" and are now full shift patterns. Medical students are attached to the firm from time to time.

The hospital facilities include the Neonatal Unit (where intensive care is undertaken), Post Natal Wards, Children’s Wards, Children’s Assessment Unit, Children’s Out Patient Department and Child Development Centre.

SHO’s will gain experience, under appropriate supervision, in the resuscitation and post natal care of babies in the Delivery Suite and on the Neonatal Unit. The routine examination of babies on the Post Natal wards and their follow up in the clinic provides good experience in the recognition and management of normal and abnormal infant development and associated problems.

On the Children’s ward and Assessment Unit, SHO’s will gain experience of a wide range of childhood problems. The SHO has no regular OPD commitment but is welcome to attend when time permits.

There are weekly meetings, including a joint meeting with the Radiologists and a "Grand Round" on Friday mornings. There is a monthly half-day devoted to Audit.

There is a junior doctors' logbook containing detailed information on the department and clinical guidelines.

Obstetrics & Gynaecology York District Hospital

David Pring, Elizabeth Mattock, Bill Hunter, Susan Mitchell, Jim Dwyer & Adrian Evans

The department includes 30 Gynaecological beds, an Antenatal Clinic, a Delivery Ward with integral operating theatre, and two Obstetric wards with beds that are used flexibly.

The team consists of eight SHOs, a further part-time joint Women's Health post, four Calman SpRs and one Staff Grade Doctor.  There are also two Associate Specialists, who have main commitments with the Family Planning Clinic, and both run different specialist sessions in the Gynaecology department.   There are six Consultants. There is a partial shift system in operation, which includes fixed holidays.

The SHO gains experience in all aspects of care of mothers with normal and abnormal pregnancies, and in all aspects of Gynaecology. There are specialist clinics in the following

Colposcopy Clinic

Postmenopausal Bleeding Clinic

Early Pregnancy Clnic

Vulva Clinic

Urogynaecology Clinic

Gynae-endocrine Clinic

The SHOs are taught and will be expected to undertake minor practical procedures in both disciplines. The department receives excellent support from the Paediatric, Anaesthetic and Pathology Units and works very closely with the Midwifery Department.

Regular, formal and informal teaching are given a high priority by all the Consultants. The posts are recognised for the DRCOG examination. Medical students are regularly attached to the department.  There is active clinical governance, active audit involvement and each SHO is expected to perform an audit project.  Some of these result in publications at a later date.

Jim Dwyer is the RCOG district tutor.

Psychiatry – Bootham Park Hospital, York

Tutor - Jeff Clarke

The North Yorkshire Rotational Training Scheme in Psychiatry includes the four Trusts of York, Harrogate, Northallerton and Scarborough, and has full approval of the Royal College of Psychiatrists. There are 36 Trainees on the Scheme and the York GP Registrar Post is one of the 14.5 Trainees based at Bootham Park Hospital. The option to do Old Age Psychiatry exists on request. 

There is plenty of opportunity to gain experience in the various aspects of general psychiatry and in the special interests of the Consultant he/she is attached to. 

Teaching and Training sessions are held once a week, and in addition, Guest Lectures and other training sessions are arranged. There is a good psychiatry library at Bootham Park Hospital. 

The out-of-hours working pattern is a hybrid shift, equivalent to 1 in 7.

Palliative Care, Community Post St Leonard’s Hospice, York

Sarah Anderson & Anne Garry

This post is split between St Leonard’s Hospice and a GP attachment with the post holder spending four sessions a week in the Hospice.

St Leonard’s Hospice is a purpose-built 20-bedded in-patient unit with Day Hospice facilities. The medical team at the Hospice consists of two Consultants in Palliative Medicine and two part-time Clinical Assistants.

An holistic approach to care is offered and patients are admitted for symptom control, terminal care, rehabilitation and respite care. The GP Registrar will be a valuable member of the multi-professional hospice team.

There are opportunities to spend time with consultants in palliative medicine clinics and a day with the community MacMillan nurses or hospital palliative care team.

There is one tutorial a week and opportunity for informal learning.

The post is non-resident and there is a light on-call commitment.