please note: programme submissions can be withdrawn or ... grid iid programme 2020 -...
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NTN Grid - Programme Information
Paediatric Immunology and Infectious Diseases 2020
Please find below programme information for the above sub-specialty for training programmes starting in September 2020. Page 2 contains a list of all submitted programmes of training; the job descriptions for each post follow on. Each subspecialty grid programme covers the RCPCH curriculum as specified on the RCPCH. Please note: Programme submissions can be withdrawn or amended at any point until an offer of employment has been made to an applicant. Application Process Applications for the NTN Grid open from 12 noon Friday 6 September 2019 and close at 12 noon Monday 30 September 2019. Applications can only be accessed during this period from the College website. For more information on the grid process and to access the Grid Applicants Guide please visit: http://www.rcpch.ac.uk/ntngrid Contact Details For specific sub-specialty information, please contact: Dr Jolanta Bernatoniene Email: [email protected] Dr Kate Swan Email: [email protected] Application enquires: Email: [email protected] Tel: (020) 7092 6139
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Maximum Number of National Training Grid Appointments that may be made in 2020 for Paediatric Immunology and Infectious Diseases
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Deanery Programme of Training Places available
Duration (Years) Page
London
Great Ormond Street Hospital (GOSH),
St Mary’s Hospital or
St George’s Hospital
1 2-3 3
North East and North Cumbria Great North Children’s Hospital 1 3 12
North West Alder Hey Children’s NHS Foundation Trust 1 2-3 15
Scotland West and North East
Royal Hospital for Children, Glasgow,
Royal Hospital for Children and Young People, Edinburgh
1 2-3 19
Severn Bristol Children’s Hospital 1 2-3 26
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London
Hospital / Centre Placement Name
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Great Ormond Street Hospital (GOSH)
Immunology 30 Dr Alasdair Bamford [email protected]
C Y
St Mary’s Hospital or St George’s Hospital
Immunology 6
Additional Information Rotation to start at GOSH.
Trainee will need at least 6 months at St Mary’s or St George’s hospitals.
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Sub-specialty: Paediatric Infectious Diseases, Immunology, and Bone Marrow Transplantation
Base Unit: Great Ormond Street Hospital Deaneries involved: London
Outline of Programme: This post will form part of a 3 year, London-based training programme for those wishing to achieve CCT in paediatric immunology, infectious diseases and allergy
Departmental Information:
- Demographics: There are 7 dedicated immunology/infectious diseases beds, 11 bone marrow transplant beds (shared with haematology, oncology and metabolic diseases), and a 12 bedded day-care unit (shared with haematology and oncology). There is also a Rapid Assessment Infectious Diseases (RAID) unit for day case assessment of Infectious Disease. The ID team also has a very large consult workload supporting other specialities at GOSH and works closely with the microbiology department to provide and develop antimicrobial stewardship within the trust. There is a large HIV family clinic held weekly at GOSH as well as specialist clinics in hepatitis B, hepatitis C and TB. Annual admissions are of the order of 200. Approximately 30-35 bone marrow transplants are performed for immunodeficiency per annum, the department being one of two supra-regionally funded BMT units for immunodeficiency. Gene therapy and thymus transplantation are also performed in highly selected cases.
- Team: ID: Dr Delane Shingadia, Dr Karyn Moshal, Professor Nigel Klein, Dr Alasdair Bamford, Dr Louis Grandjean IMM: Dr Austen Worth, Dr Graham Davies, Prof Waseem Qasim, Dr Claire Booth, Dr Winnie Ip, Dr Maaike Kusters BMT: Dr Giovanna Lucchini, Prof Persis Amrolia, Dr Kanchan Rao, Dr Robert Chiesa, Prof Paul Veys
- Supervisor(s): Dr Delane Shingadia, Dr Alasdair Bamford, Dr Austen Worth, Dr Kanchan Rao, Dr Claire Booth, Dr Louis Grandjean
Clinical Training Responsibilities: For inpatient work, approximately 65% of time is spent in Immunology/Infectious Diseases, and 35% in BMT. There is considerable overlap in duties between these two areas. • In immunology and infectious diseases the trainee will assist in the care of in-patients and day-cases, including planning of admission, investigations and follow-up. • Attendance at 2 consultant-led ward rounds per week, and 1 out-patient clinic (when staffing allows). • Close involvement with in-patient consultation service for other departments throughout the hospital. • Attendance at weekly radiology and fortnightly histopathology meetings • As one of the inpatient registrars for BMT patients the trainee will work alongside Haematology trainees. Generally this will include predominantly looking after patients with genetic disorders, (mainly primary immunodeficiency) undergoing BMT while the Haematology SpR will look after haematological disorders. There will be some cross cover in this arrangement. This will give excellent experience in managing severely immunocompromised patients. • Attendance at regular departmental clinical, academic meetings as well as a formal timetabled teaching programme covering the 3 subspecialties.
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Workload/Rota Arrangements/Example Timetable: Currently a 13 week cycle including day shifts Monday to Friday, 7 night duty shifts (one block of 3 and one of 4 nights), approximately 1 evening shift per week and two weekends per cycle. This rota is EWTD compliant
Non-Clinical Training Responsibilities (expectations of research/audit/teaching): The ST will be encouraged to take part in the unit’s research activities which include molecular immunology, gene therapy, vaccination, and inflammation. • The ST will be expected to take part in a departmental audit project which may take the form of a service review or treatment protocol • The ST will be involved in supervising and teaching less experienced members of the multidisciplinary team and in regular departmental meetings and seminars. • Training is available in computer literacy, database management and statistics
Further Training Opportunities: Experience with a wide range of rare immunodeficiency disorders • Experience of infections in children who are immunocompromised for a wide variety of reasons and unusual infections in immunocompetent children. • Experience in paediatric bone marrow transplantation, gene therapy and thymic transplant for immunodeficiency • Attendance at inter-departmental teaching programme and opportunity to do the MSc in Clinical paediatrics • Opportunity to complete laboratory placements in Immunology, Bacteriology and Virology lab. • Extensive experience with HIV disease, including attendance of the family clinic. • Training and involvement in antimicrobial stewardship programme • Opportunity to obtain relevant practical competencies including bone marrow aspirate, skin biopsy, lumbar puncture, bone marrow harvest, mantoux.
Any further Information: The placement at Great Ormond is designed to provide training according to the UK GMC/RCPCH Paediatric Infectious Disease syllabus and curriculum relevant to immunology, bone marrow transplant and infectious diseases. Tertiary allergy training is not available at GOSH and therefore placement here is complementary to allergy training received in other centres included in the rotation.
Contact details for Unit: Telephone: ID: PA Infectious diseases Department 02078138504
IMM: PA Immunology Department 02078298834 E-mail: ID: [email protected]
IMM: [email protected] Curriculum: Each sub-specialty Grid Programme covers the RCPCH Progress Curriculum, as specified on the RCPCH website: https://www.rcpch.ac.uk/education-careers/careers-paediatrics/sub-specialties
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Sub-specialty: Paediatric allergy, immunology and infectious diseases
Base Unit: St. Marys Hospital
Deaneries involved: London
Outline of Programme
This post will form part of a 2 or 3 year, London-based training programme for those wishing to achieve CCT in paediatric immunology, infectious diseases and allergy.
Departmental Information
- Demographics
St Marys has:
• Paediatric Infectious Diseases (Grand Union Ward, total 12 beds)
• General Paediatrics (Great Western Ward – total capacity 20/24 beds)
• Ambulatory Paediatrics – Paediatric Short Stay Unit (PSSU)
• Paediatric Assessment Unit (PAU)
• Paediatric Haematology including bone marrow transplant (Grand Union Ward, Paediatric Haematology Day Unit)
• Paediatric Intensive Care Unit (PICU) (16 beds, with additional 2 HDU beds)
• Neonatal care unit, Winnicott Baby Unit (22 cots: 10 ITU/HDU, 12 SCBU)
The ID team also has a very large consult workload supporting other specialities at St Marys as well as local regional district general hospitals. They also work closely with the microbiology department to provide and develop antimicrobial stewardship within the trust. There is a large HIV family clinic held twice weekly, a growing adolescent HIV Service with weekly clinics, as well as specialist clinics in viral hepatitis, congenital infections, Kawasaki disease, general ID, primary immunodeficiency and TB. Approximately 20 bone marrow transplants are performed for haematological conditions per annum.
- Team
Dr Hermione Lyall, Consultant in Paediatric Infectious Diseases and Clinical Lead
Dr Liz Whittaker, Clinical Lecturer/Consultant in Paediatric Infectious Diseases
Professor Mike Levin, Professor of Paediatric Infectious Diseases
Professor Simon Kroll, Professor of Paediatrics & Molecular Infectious Diseases
Dr Gareth Tudor-Williams, Reader in Paediatric Infectious Diseases
Professor Beate Kampmann, Clinical Scientist, Paediatric Infectious Diseases
Dr Jethro Herberg, Clinical Lecturer/Consultant in Paediatric Infectious Diseases
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Dr Aubrey Cunnington, Clinical Lecturer/Consultant in Paediatric Infectious Diseases
Dr Shunmay Yeung, Consultant in Paediatric Infectious Diseases
Dr Caroline Foster, Consultant in Paediatric Infectious Diseases
Dr James Seddon, Clinical Lecturer/Consultant in Paediatric Infectious Diseases
Dr Helen Cox, Consultant in Paediatric Allergy
Dr Bob Boyle, Senior Lecturer in Paediatric Allergy
Dr Claudia Gore, Consultant in Paediatric Allergy and Immunology
Dr Sharon Hall, Consultant in Paediatric Allergy
Professor Adnan Custovic, Professor in Paediatric Allergy
Dr Parviz Habibi, Consultant Paediatrician with an interest in Respiratory and Sleep Medicine
Dr Marta Vazquez -Ortiz, Consultant in Paediatric Allergy
Dr. Maeve Kelleher, Consultant in Paediatric Allergy
Dr. Paul Turner, Senior Clinical Lecturer in Paediatric Allergy and Immunology
Dr. Costas Kotsapas, Locum Consultant in Paediatric Allergy
- Supervisor(s)
Dr Hermione Lyall, Dr. Jethro Herberg, Dr. Liz Whittaker, Dr. Aubrey Cunnington, Dr. Gareth Tudor-Williams, Dr Sharon Hall, Dr Claudia Gore, Dr Marta Vazquez-Ortiz
Clinical Training Responsibilities
Paediatric Infectious Diseases (ID) SPR - The inpatient Ward (Grand Union) has specialised facilities for managing children with severe infections. The SPR is expected to maintain excellent communication with referring hospitals and primary care regarding inpatients. The SPR is expected to participate in the antibiotic stewardship programme. There is also the opportunity to be part of the BMT team and learn about complex infections in this highly immunocompromised population. The ward registrar also carries the Paediatric ID pager which takes consults for management advice across all areas of paediatrics within the Trust including our Haematology/BMT service, NICU, PICU and external calls for referrals or advice, with support from the attending Paediatric ID consultant. Day case patients are also referred from other hospitals for support with management and review.
Much of the clinical work of the department is outpatient based so trainees during their time with the ID unit are encouraged to gain experience of outpatient management of ID patients including the weekly multi-disciplinary HIV clinics, TB clinic, inflammation clinics, hepatitis clinics, general infectious diseases and congenital infection clinics. The registrar is also encouraged to attend an allergy clinic weekly. In-patients are managed on Grand Union Ward by one SpR and two ST2-3s.
There is a full program of post graduate education. The SpR is encouraged to attend and contribute to this programme. It includes weekly Paediatric ID/PICU combined teaching rounds, antimicrobial stewardship rounds, ID Journal Club, Paediatric Grand Rounds, Hospital Grand Rounds, and twice weekly multi-professional clinical meetings with adult ID, microbiology, virology and infection control teams for the Trust.
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Allergy SPR Attendance at 2 allergy, 1 asthma clinic and 1 complex allergic disease clinic per week. Supervision of allergy nurses undertaking food challenges, drug challenges, allergen immunotherapy, monoclonal antibody treatment of allergic disease, intradermal skin testing. Inpatient and Accident and Emergency department referrals for allergic problems. Opportunity to attend specialist allergy/gastroenterology, allergy/dermatology, allergy/ENT, allergy/chest and transition clinics at St. Mary's Hospital. Active participation in undergraduate and postgraduate allergy education programmes including intercalated BSc, Allergy MSc and undergraduate medical curriculum. Active participation in allergy translational research studies.
Take part in 1 in 16 general and speciality paediatric rota
Workload / Rota Arrangements / Example Timetable
Hours per week: <48 hours
Rotas: One in six evenings and one in eight day time weekends with two registrars on site.
One in eighteen nights, in 3 and 4 night blocks
Non Clinical Training Responsibilities (expectations of research / audit / teaching)
Both the allergy team and the infectious diseases teams are heavily engaged in academic research in Imperial College. The section of paediatric infectious diseases is part of the Imperial College Department of Medicine focuses on HIV management and transitional care, mechanisms and treatment of sepsis, management of viral hepatitis, biology and diagnosis and management of tuberculosis and mechanisms and management of Kawaski's and toxin mediated diseases.
The Allergy team is bedded in the National Heart and Lung Institute at Imperial College and research focuses on food allergy and asthma. Both teams have close collaborations with other groups in college including respiratory medicine, public health and engineering. Furthermore, there are very close global links with the London School of Hygiene and Tropical Medicine
The registrar will be encouraged and supervised in research projects relevant to their interests and training needs.
Further training opportunities
Experience in paediatric Bone Marrow transplantation
Opportunity to complete laboratory placements in microbiology and virology
Very active research collaborations in invasive infections, immune response to infectious diseases, TB, HIV and Malaria.
Contact details for unit
PA Joan Farrell [email protected]
Curriculum
Each sub-specialty grid programme covers the RCPCH curriculum as specified on the RCPCH website: http://www.rcpch.ac.uk/training-examinations-professional-development/quality-training/curriculum/curriculum
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Sub-specialty: Paediatric Infectious Diseases, Immunology Base Unit: St. George’s University Hospital Deaneries involved: London
Outline of Programme: This post is part of the London based training programme in paediatric infectious diseases, immunology, and allergy. The program aims to achieve a CCT in paediatric immunology, infectious diseases and allergy.
Departmental Information: Demographics: The Paediatric Department provides a comprehensive level of services at district (secondary) level and specialist (tertiary) level. These include Paediatric Surgery, Neonatal Medicine and Surgery, Infectious Diseases, Haematology, Oncology Neurology, Endocrinology and Gastroenterology. There are close links with the Paediatric Oncology Unit at the Royal Marsden Hospital, Sutton with whom we currently operate a joint Primary Treatment Centre. Paediatric Inpatients The PID ward, Pinckney Ward, has 11 cubicles and 4 beds and is shared between Paediatric ID and Oncology (PTC and POSCU). Paediatric Outpatient Parenteral Antibiotic Therapy (POPAT) is available and day attenders for more complex work up attend the ward. Frederic Hewitt Ward is the main paediatric medical inpatient facility with 5 cubicles and 12 beds. Nicholls Ward has 6 cubicles and 12 beds predominantly for children’s surgery, neuro-surgery and neurology / neurosciences. There is a 6 bedded Paediatric Assessment Unit in the emergency department. Jungle Ward is the day case unit. The Paediatric Intensive Care and High Dependency has up to 12 beds Accident and Emergency Department St Georges Hospital is a designated Trauma Centre for South West Thames. The department sees over 32,000 children a year. Neonatal Unit The Neonatal intensive care unit (Level 3) with neonatal surgery and is one of the 3 lead centres for South London. The unit currently has 12 intensive care cots, 13 high dependency and 18 special care cots. Paediatric Infectious Diseases is a well-established specialty, with a large throughput of patients including children with HIV and other immunodeficiencies. PID team has a very large consult workload, support for specialities from Neurosurgery to paediatric, orthopaedic and spinal surgery. We have a close relationship with the microbiology department including combined PICU and NNU rounds. Additional training can be organized, weekly bench rounds to longer periods working in the microbiology department. We have a longstanding antimicrobial/antifungal stewardship service within paediatrics and in the trust. Weekly HIV clinic including twice monthly adolescent “one stop shop” evening clinics. As one of the 3 Hubs, we lead regular telephone conferences with the centres in our HIV network (Sheffield, Newcastle, Leeds, Leicester, Bristol and Southamphton). Monthly resistance meetings combined with the adult team. A monthly congenital infection clinic, 4 PID/TB clinics and 3 Immunology/vaccine clinics per months. Annual admissions to Pinckney ward around 600 per year, with a further 600 day ward attenders/year.
- Team: Dr Katja Doerholt, Professor Paul Heath, Dr Simon Drysdale, Dr Laura Ferreras-Antolin, Dr Amaya Bustinduyi, Dr Kirsty LeDoare and Dr Shamez Ladhani.
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- Supervisor(s): Dr Katja Doerholt, Professor Paul Heath
Clinical Training Responsibilities: There are daily consultant ward rounds and three hours of joint id/microbiology clinical training each week as well as other infectious diseases collaborative consulting time. The management and care of complex inpatients and day ward attenders on Pinckney Ward will be a large part of the job. The trainee will also contribute towards the operational development of the inpatient service. We also admit many children with a fever returning from abroad with recent audits on Malaria, Typhoid etc. There is an active telephone, ward and outpatient consult service with general paediatric units across the region as well as other sub-specialties within the region. Patients are discussed with the consultant and the database will be maintained by the team. The busy Paediatric Infectious Diseases outpatient service, which provides consults on children with recurrent fever, TB and other complex infections. The trainee is expected to join regular clinics -paediatric ID, congenital infection, immunology, vaccine, HIV and TB clinics Review children under the paediatric Outpatient Parenteral Antimicrobial Therapy (POPAT) service. Active involvement in twice weekly paediatric and neonatal antimicrobial stewardship programme. There are also joint adult and paediatric infectious diseases and microbiology academic programmes on Friday lunchtimes. Join the paediatric infection control link team including hospital wide meetings and training of doctors/nurses.
Workload/Rota Arrangements/Example Timetable: The trainee will participate in the paediatric Medicine Middle Grade out of hours rota, covering long days during the week, weekends and night in a 1 in 10 rota. The on-call responsibilities include general paediatrics cover for other paediatric specialities and paediatric A&E. Timetable attached separately.
Non-Clinical Training Responsibilities (expectations of research/audit/teaching): We encourage the trainees to participate in and learn about research in ongoing studies involve inpatients on Pinckney, giving opportunity to widen their educational experience. Larger projects or audits leading to publication are encouraged and supported with a wide range of subjects available on the clinical but also the PIDRG (Paediatric Infectious Diseases Research Group). Teaching of students and more junior members of the team. Attendance at weekly PID MDT meeting with regular teaching covering the curriculum. Furthermore weekly microbiology meetings, weekly bench teaching in microbiology, weekly journal club in the PIDRG. We encourage attendance of regular Quality Improvement training at St. George’s University Hospital.
Further Training Opportunities: Through the oncology Primary Treatment Centre with the Royal Marsden at St. George’s exposure to complex post transplant patients and close working with Oncologist exposure to OI/IFD etc. Paediatric Fungal stewardship at St. George’s as well as at the Royal Marsden is an additional service provided.
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Close working relationship with our adult Infectious Diseases Colleagues allow for further exposure to MDR TB, complex HIV cases and an adult fungal stewardship round can also be attended. Specific Vaccine related clinics and further training is possible with 2 consultants part of the JCVI
Any further Information: St. George’s University Hospital provides training according to the UK GMC/RCPCH PID Syllabus. Through a wide range of specialities at St. George’s, the exposure to a multitude of complex infections/patients are available. No tertiary allergy service is available, however should the applicant be interested in joining allergy clinics, then this can be arranged.
Contact details for Unit: Telephone: 02087251683 Youne Ng PA PID St. George’s University Hospital E-mail: [email protected]
Curriculum: Each sub-specialty Grid Programme covers the RCPCH Progress Curriculum, as specified on the RCPCH website: https://www.rcpch.ac.uk/education-careers/careers-paediatrics/sub-specialties
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North East and North Cumbria
Hospital / Centre Placement Name
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Great North Childrens’ Hospital
Immunology and Infectious Diseases
36 AR Gennery [email protected] C Y
Additional Information As a training centre this programme based in Newcastle upon Tyne (Health education England North East and North Cumbria) can provide all the training required to successfully complete grid training in Immunology and Infectious diseases.
There is a range of information about working in the North East available on the HEE “MadeinHEENE” website: http://madeinheene.hee.nhs.uk/lead_employer_trust/policies
We would recommend discussion with the lead Prof Andy Gennery for more detailed exploration of what the programme has to offer. The programme includes a 1 week attachment in London relating to HIV work.
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Sub-specialty: Paediatric Immunology and Infectious Disease
Base Unit: Great North Children's Hospital, RVI, Newcastle upon Tyne Hospitals Foundation Trust
Deaneries involved: Health Education England North east and North Cumbria (Formerly Northern region)
Outline of Programme: This 3 year post, based at the Great North Childrens’ Hospital, is suitable for training in immunology, infectious diseases; the content of the programme can be slanted according to the trainee's particular interests.
Departmental Information: Demographics: Clinical service provides supra-regional paediatric immunology service to Northern Britain and Ireland via a paediatric immunology network. Team: 6 consultants in paediatric immunology and infectious diseases (4.8 WTE). 2 consultants in paediatric haematology / oncology / bone marrow transplantation. 1 part time consultant in bone marrow transplantation. 1 part time staff grade in bone marrow transplantation. 3 ST6-8 specialist trainees, 1 ST6-8 specialist trainee in paediatric oncology / bone marrow transplantation,1 FY2 Supervisor(s): Professor A R Gennery
Clinical Training Responsibilities: Assisting care of immunology and infectious diseases in-patients, out-patients and day cases, including planning admission, investigation and follow-up. -2 consultant led ward rounds per week and 1 out-patient. -Active participation in consult service. -Supervise management of tertiary and quaternary referrals. -Presentation of cases and participation in weekly clinical meetings. -Case discussions after each out-patient clinic. -Screening and treatment of childhood TB. -Diagnosis and management of rare primary immune deficiency. -Management of infection in the immunocompromised child. -Experience in care of paediatric bone marrow transplant patients. -Management of sepsis and complicated/unusual or deep-seated infections in regional patients. -Assessment of children with allergy and treatment including food challenge and de-sensitisation -Trainees will spend 1-2 weeks (depending on interest) in London to learn about management of HIV
Workload/Rota Arrangements/Example Timetable: The unit provides a supra-regional paediatric immunology service to Northern Britain & Ireland via a paediatric immunology network. The unit also manages children with severe and unusual infections both from Newcastle and across the Northern Region of England. There is a service for children with TB, tropical infections & HIV, as well as excellent collaboration with the adult infectious diseases & immunology departments. The unit runs a service for assessment & treatment of childhood allergies & systemic auto-immune disease. There is a twice weekly consult round for other sub-speciality paediatric departments within Newcastle and daily visits to PICU. Activity: 300 in-patients per year, 1000 new out-patient referrals, 2300 follow-up out-patient referrals. 400 day cases, 35-40 allogeneic bone marrow transplants, 300 consults per year. Rota: 1 week of nights covering all paediatric specialties every 8 weeks
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Non-Clinical Training Responsibilities (expectations of research/audit/teaching): Opportunity to take part in research. Audit projects related to service review or treatment protocols Opportunities to publish research, case series Supervise and teach FY2s and medical students. Training in database management and IT skills available
Further Training Opportunities: The programme and HEE NE broadly offer opportunities to gain training in Teaching skills via Masters programme in medical education, Management skills via HEE sponsored training courses up to masters standard, Personal development, Presentation skills/ critical analysis
Any further Information: We have strong links with other units in the UK, and additionally the North East has a developing global health link with the MRC unit in the Gambia.
Contact details for Unit: Telephone: Prof AR Gennery 0191 2336161 (Roz Scott 01912825234) E-mail: [email protected] ( [email protected] )
Professor AR Gennery, Clinical Resource Building, Block 2, Level 4, Great North Childrens’ Hospital, Queen Victoria Road, Newcastle upon Tyne. NE1 4LP Curriculum: Each sub-specialty Grid Programme covers the RCPCH Progress Curriculum, as specified on the RCPCH website: https://www.rcpch.ac.uk/education-careers/careers-paediatrics/sub-specialties
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North West
Hospital / Centre Placement Name
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Alder Hey Children’s NHS Foundation Trust
Paediatric infectious diseases and Immunology
24 David Porter
C Y
Additional Information Two - three [WTE] years of clinical training at Alder Hey Children’s Hospital, Liverpool with options for two 6 weeks secondments to gain further experience of paediatric HIV (Imperial, London) and severe primary immunodeficiency (Newcastle).
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Sub-specialty: Paediatric Infectious Diseases and Immunology (with emphasis on Infection) Base Unit: Alder Hey Children’s NHS Foundation Trust, Liverpool Deaneries involved: Health Education North West
Outline of Programme: Two-Three [WTE] years of clinical training in Alder Hey Children’s Hospital, Liverpool with the option of two six week secondments to gain further experience of paediatric HIV (Imperial, London) and severe primary immunodeficiency (Newcastle). Laboratory attachments in Microbiology, Virology and Immunology will also be available.
Departmental Information:
- Demographics: Alder Hey Children’s Hospital is the tertiary referral centre for children from Merseyside, Cheshire, parts of Cumbria & Lancashire, Shropshire, the Isle of Man and North Wales. A brand new award-winning, purpose built Hospital in the Park was opened in October 2015 providing modern customised facilities for children, families and staff. The hospital has over 300 beds and has an extensive range of subspecialties (including PICU, oncology, cardio-thoracic surgery, neonatal surgery, neurosurgery, craniofacial surgery, burns and plastic surgery) all on a single site, plus emergency & general paediatric and surgical care for the local population. The Paediatric Infectious Diseases and Immunology service (ID team) was established in 2005, and provides an outpatient and inpatient consulting service within the Trust and a daily bacteraemia ward round, together with a number of out-patient clinics and in-patient multi-disciplinary meetings (MDTs). The ID team has a very large consult workload supporting other specialities and is the Tertiary Referral Centre for infectious disease cases with complex diagnostic or management issues. The ID team also provide a tertiary service for tropical infectious disease in children and are one of four teams commissioned nationally to manage children with airborne High Consequence Infectious Diseases (HCID). The Team sees 1000 ward consults, 700 outpatients and 400 daycases/ ward attenders per year. There are regular Paediatric Infectious Diseases, Immunology, HIV, TB and Hepatitis clinics and joint clinics with Rheumatology. There are weekly MDT meetings with PICU, Cardiology, Oncology, Neonatal Surgery, Orthopaedics and Neurosurgery. The ID team also provide Antimicrobial Stewardship and Outpatient Parenteral Antibiotic Therapy (OPAT) services. The Team has long been involved in research in Infectious Disease with emphasis on sepsis/ Meningococcal Disease and has valued links with the Liverpool School of Tropical Medicine, Liverpool University, the department of Immunology at the Manchester Children’s Hospitals and adult services at the Royal Liverpool and Broadgreen University Hospitals NHS Trust.
- Team: Four Consultants/ 1 Professor in Paediatric Infectious Diseases and Immunology (3.4 WTE) - Two Consultants in Microbiology (1.4 WTE) - One Immunology/ Infectious Diseases Clinical Nurse Specialists (1.0 WTE) - Two Antimicrobial stewardship/ OPAT nurses (1.6 WTE) - Antimicrobial Pharmacist (1.0 WTE) - - Trainees - This post
- Supervisors: Dr David Porter/ Dr Andrew Riordan/ Dr Beatriz Larru
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Clinical Training Responsibilities: Assist in the care of infectious diseases and immunology in-patients, out-patients and day cases, including planning admission, investigation and follow-up. Attend 2 consultant-led ward rounds and 1 supervised out-patient clinic per week Able to attend consultant led clinics; including HIV, Immunodeficiency, Rheumatology, Hepatitis and TB. Participate in consult service by taking referrals from other departments throughout the hospital and external calls, with support from the attending Paediatric ID consultant. 8 week laboratory attachment, including virology and bacteriology.
Workload/Rota Arrangements/Example Timetable: The post is compliant with EWTD. The trainee will contribute to the out-of-hours acute general paediatric middle grade on call rota (1:9). Provisional Job Plan DAY
AM PM
MON Joint immunology clinic (bi-monthly)/ Bench round
Neurosurgical MDT Patient admin
TUE HIV Clinic/ Orthopaedic MDT PICU/HDU round WED ID clinic (TB clinic monthly) Respiratory X-ray meeting THU Training (Microbiology, Adult ID etc)
Neonatal Surgical/ Oncology MDTs Journal Club/ ID meeting Audit/research
FRI Hospital Grand Round ID & Immunology MDT meeting/ Bench round
PICU/HDU round
Non-Clinical Training Responsibilities (expectations of research/audit/teaching): Clinical audit Trainees are expected to complete at least 1 full audit/year and attend any critical incident meetings. Opportunities will be given for participation in clinical guideline development. Teaching appraising and assessing Trainees will be involved in supervising and teaching less experienced members of the multidisciplinary team Opportunities for formal and informal teaching of undergraduates and postgraduates include; Medical student teaching (history/ examination), STEP1&2 teaching. Research There is an active program of clinical research in Paediatric Infectious Diseases in Liverpool. Clinical infectious disease research includes studies of biomarkers in acute infections, Brain Infections and Pharmacology. Trainees are encouraged to become involved in a research project. Management Opportunities to be involved in management include attendance at Hospital Infection Prevention and Control Meetings and the Antimicrobial Prescribing Group.
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Further Training Opportunities: Liaison with Adult services Including Adult TB, GUM, Infectious Diseases and Immunology services in Liverpool. Monthly HIV Pregnancy meeting (with Obstetrics, Adult GUM/ID) Network Meetings NW Paediatric Allergy, Immunology and Infectious Disease Network workshop. Research Links These are available via the Clinical Research Unit at Alder Hey, Liverpool School of Tropical Medicine and the Wellcome Trust Tropical Centre, Liverpool. Formal teaching on research ethics and research methodology is available on line and via the University of Liverpool.
Any further Information: Available from; Paediatric Infectious Diseases and Immunology Alder Hey Children’s NHS Foundation Trust, Liverpool L12 2AP.
Contact details for Unit: Telephone: 0151 228 4811 Ext 3989 E-mail: [email protected]
or [email protected] or [email protected]
Curriculum: Each sub-specialty Grid Programme covers the RCPCH Progress Curriculum, as specified on the RCPCH website: https://www.rcpch.ac.uk/education-careers/careers-paediatrics/sub-specialties
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Scotland West and North East
Hospital / Centre Placement Name
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Royal Hospital for Children, Glasgow
Immunology, infectious disease and allergy
C Y
Royal Hospital for Children and Young People, Edinburgh
Immunology, infectious disease and allergy
C Y
Additional Information This rotation involves two busy tertiary centres in central Scotland: Glasgow and Edinburgh
Each centre offers a broad clinical experience including:
• In patient management of patients with complex and severe infections and those with primary immunodeficiencies, and training in antimicrobial management
• Laboratory experience in microbiology and virology • MDT working including working with adult infectious disease and immunology services. • Out patient management of patients with immunodeficiency, including those pre and
post stem cell transplant, those with blood borne viruses, Tb, patients on long term antibiotics for complex infections and patients with severe allergy.
• Consult service for tertiary hospital, primary care and hospitals elsewhere
The teams in Glasgow and Edinburgh work very closely together and the experience and training complement each other.
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Sub-specialty: Paediatric Infectious Diseases and Immunology
Base Unit: Royal Hospital for Children, Glasgow, rotating to Royal Hospital for Sick Children Edinburgh
Deaneries involved: Scotland Deanery NES Outline of Programme: 36 months training in paediatric infectious diseases and immunology, (24 months if prior agreement of CSAC) Rotational post between Glasgow and Edinburgh.
Departmental Information Edinburgh:
- Demographics:
The RHC Glasgow is a comprehensive Children's Hospital serving the West of Scotland and features 244 paediatric beds. It is a teaching hospital of the Faculty of Medicine of the University of Glasgow. It is a new build facility opened in June 2015 with state of the art facilities and co-located with a regional maternity unit and comprehensive adult services at the Queen Elizabeth University Hospital. It provides care, not only for children resident within Greater Glasgow, but is also a tertiary referral centre for children from the West of Scotland. All paediatric medical and surgical subspecialties are represented in RCH and the hospital has 9 operating theatres. It provides national services in specialities including paediatric ECMO, cardiology, stem cell transplantation, renal dialysis and transplantation, complex airway surgery, and has been designated the national centre for burns, and a major trauma centre. It includes a 24 bedded intensive care unit providing the majority of paediatric intensive care for Scotland. The RHC is co-located with a regional maternity unit (including fetal medicine service) and NICU with 16 ICU cots, 14 HDU cots and 24 SCBU cots. Laboratory services located on the same campus include microbiology, immunology, haematology, biochemistry and genetics.
The Royal Hospital for Sick Children Edinburgh, is a tertiary teaching hospital for South East Scotland, serving East and South East Scotland. It is the national centre for complex spinal surgery and epilepsy surgery, in addition to having one of 2 PICUs for Scotland and specialist services for endocrinology, respiratory, gastroenterology, neurology and haematology and oncology. There are over 50,000 new presentations at the Emergency Department per year and over 6000 admissions.
The Royal Hospital for children and Young People (RHCYP) is now anticipated to open in early 2020. The new RHCYP will be a 240 bed state of the art hospital, co-located with the Royal Infirmary of Edinburgh, NCIU at Simpson Centre for Reproductive Health, and the Queen’s Medical Research Institute, hosting state of the art research and lab facilities and the department of neurosciences.
- Teams: GLASGOW: The paediatric infectious diseases and immunology department offers training in the diagnosis and management of both severe and/or unusual infections, the appropriate use of antimicrobials, the management of blood borne viruses in children and the recognition, diagnosis and management of primary immune deficiency and allergies. The clinical inpatient workload involves close liaison with microbiology and virology laboratory services managing infections largely in the patients of other services who frequently have complicating co-morbidities e.g. immunocompromise. Our out-patient workload involves a general infectious disease clinic as well as specialist clinics in HIV, Hepatitis and Tuberculosis as well as primary immune deficiency and allergy clinics. The service covers the West of Scotland and also supports patients across Scotland via the Scottish Paediatric and Adolescent Infection and Immunology Network (SPAIIN). The service also co-ordinates the paediatric Antimicrobial team (AMT) with pharmacy and microbiology which promotes the effective and safe use of antimicrobials
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within the hospital by offering advice and monitoring usage of antimicrobials and the development of antimicrobial guidance. The paediatric AMT has recently put in a business case for further development of antimicrobial stewardship rounds and the out-patient antimicrobial therapy service. The paediatric infectious diseases team also links to the perinatal BBV team based at the Princess Royal Maternity Hospital in Glasgow. The immunology service involves inpatient and outpatient care of children with primary immune deficiency, and provision of advice to other services in patients with secondary immune deficiency. The majority of stem cell transplants for primary immune deficiency for Scotland are performed in the transplant unit, under the transplant team with input from the immunology service, and advice from Newcastle to which centre complex cases are referred. There is a paediatric clinic and dedicated teenage and young adult clinic held jointly with adult immunology, and a stem cell transplant clinic held jointly with the transplant service. A national network clinic attended by clinicians from Scotland and Newcastle is held quarterly in either Glasgow or Edinburgh. The immunoglobulin replacement service is nurse led, supported by the medical team. A trainee would gain extensive clinical experience and be well supported within a small team of 4 consultants, rotating general paediatric trainees, 1 specialist nurse, 2 pharmacists ( 1 x AMT and 1 x national SPAIIN BBV pharmacist) and 2 administrative staff.
EDINBURGH: The paediatric infectious disease and immunology team consists of one full time paediatric ID and Immunology Consultant, one full time specialist nurse, Consultant microbiologist with expertise in paediatrics, and Consultant Virologist, and 2 admin staff. In addition to twice weekly infection meetings, the trainee would be also involved in regular meetings with AMT team and public health, and the (adult) Infection team. The Infection team has very close working relationships with all the teams within the hospital, including PICU, respiratory, neurology and the neurosurgical team and surgical specialities. There is a very close working relationship with the adult ID team, and the trainee will have the opportunity to join their weekly teaching sessions in addition to the monthly MDT TB meeting.
- Supervisor(s): Glasgow: Educational Supervisor: Dr Conor Doherty Clinical Supervisors: Dr Conor Doherty, Dr Rosie Hague, Dr Louisa Pollock & Dr Chris Moxon Edinburgh: Dr Laura Jones, Educational supervisor. Clinical supervision with the acute medical team with oversight from Dr Jones.
Clinical Training Responsibilities: GLASGOW A trainee based in RHC Glasgow would be on call with a supervising consultant for paediatric Infectious Diseases and Immunology. This would involve ‘in hours’ referrals from both general and specialist paediatric teams within the hospital or queries regarding appropriate investigation or antimicrobial treatments. Referrals and queries would also come from primary care services throughout the West of Scotland and secondary paediatric services mainly in the West of Scotland but also nationally. Much of the trainees work would involve the daily review of the teams own patients as well as initial assessment and review of referrals from other teams. The on-call consultant generally leads the ward round on Mondays (p.m.), Thursday (a.m.) and Fridays (p.m.) and finish on PICU to discuss all of their patients jointly with microbiology. The trainee will lead the ward rounds on the intervening days. On Monday (a.m.) patients can be also be brought to the ambulatory unit for review if a recent discharge or undergoing further assessment or investigation as an out-patient. There is a weekly tuberculosis clinic on Wednesday (a.m.) which is co-ordinated by the paed respiratory and infectious diseases services. Wednesday (p.m.) also sees the teenage immunology (1st Wed of month), the general infectious diseases clinic (1400-1600) and paediatric HIV clinic (1600-1800) (2nd Wed of month), the
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paediatric immunology (3rd Wed of month) and the hepatitis (1400-1600) and then teenage HIV clinic (1600-1800) (4th Wed of month). The teenage HIV and immunology clinics are attended by adult GGC team members. There is also a 3 weekly IVIG clinic on the ambulatory unit as well as scheduled joint clinics with bone marrow transplant service. Thursday (a.m.) is the grand round for the team where all team members meet to review all inpatients and discuss out-patients. Team meetings (business, educational, AMT, hepatitis C treatment and BBV cohort reviews) are scheduled for lunchtime on Thursdays. Thursday afternoon and Friday morning allergy clinics offer further training opportunities as does the monthly drug allergy (principally antibiotic) testing session based on the day unit. Friday afternoon finishes with the ward round. The trainee will also contribute to out of hours service for medical paediatrics. This commitment includes presence in acute medical receiving, seeing and assessing children attending for medical paediatric opinion and contribution to the hospital at night rota (covering specialties including ID/Immunology, Cardiology, Respiratory, Neurology, Nephrology, Haem/Oncology and Gastroenterology and providing a medical consult service to all surgical specialities). EDINBURGH In patient responsibilities include caring for
• Ward and critical care in-patients with significant or severe infections and those with immunodeficiencies
• Organising and collating investigations for patients undergoing investigations of primary immunodeficiencies
• Consult service to other teams within and out-with RHSC during working hours – with Consultant supervision. This would include reviewing referrals from any team within RHSC, including A+E, for clinical advice regarding investigations, interpretation of infection or immunological results and antimicrobial advice, and taking phone calls regarding such advice from primary care and hospitals across South East Scotland (SES)
Outpatient responsibilities include attendance at
• Blood borne virus clinic – management of patients with perinatally acquired HIV, Hep C, Hep B, and management of pregnant women and infants exposed to infections in utero including syphilis and HIV
• Rapid access infection clinic – reviewing patients referred from A+E/ GP often returning travellers
• Immunology clinics – twice per month • Tb clinics – twice per month • General infection clinics – new patient referrals and follow up and ongoing management of
patients with complex infections • Review of post BMT patients – attending for review and or immunoglobulin therapy • Opportunities to also attend clinics in other relevant specialities when patients have multiple
co-morbidities, and the young person clinics for HIV – young adults with perinatally acquired HIV.
All clinics are supervised by paediatric ID consultant Skills The trainee would work towards independent in patient and out-patient review. As part of the rotation in Edinburgh the trainee would spend time in our laboratories gaining the appropriate lab skills required, mastering analysis and interpretation of results and would attend relevant teaching from the labs in this regard. The infection service in Edinburgh has established a laboratory “ boot camp” for adult microbiology and infection trainees which the paediatric trainee will also be able to attend.
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Workload/Rota Arrangements/Example Timetable: GLASGOW The trainee will be one of two registrars working with the ID service. The second trainee will usually be a General Paediatric trainee on specialty rotation. An example time table of ID service is as follows: Mon Tues Wed Thurs Fri am Inpatient
consults Ambulatory care
Registrar WR TB clinic ID grand round Paediatric grand round In patient consults Xray meeting
pm Consultant WR PICU MDT
Inpatient consults Research and audit time
ID/Imm Clinics: Teenage immunology (1st wed) General ID and HIV (2nd Wed) Hepatitis (3rd wed) Teenage HIV (4th Wed)
Allergy clinic Consultant WR PICU MDT
Senior trainees will also take part in the out of hours service for general paediatrics, shared by 24 trainees (1:6 rota). The hospital at night rota has two tiers, with most trainees working at ST7 and above contributing to the senior tier rota, and trainees at ST4-ST6 contributing to the second tier. Supervision is provided by a general paediatric consultant out of hours (presence on site of a medical consultant between 09:00 – 22:00). The proportion of time spent in daytime specialty is around 70% of total working hours, with the remaining 30% of hours contributing to the on call medical receiving / hospital at night rota. EDINBURGH The trainee would contribute to the hospital out of hours senior tier ST resident on call ( 1 in 12) rota. EWTD arrangements are strictly upheld with max 7 days consecutive working. An example of a typical week is demonstrated below: Mon Tues Wed Thur Friday AM Ward round
in patients/ Consults
BBV/ rapid access clinic
Immunology clinic alternate. AMT work alternate weeks
BBV clinic ID micro round
Ward round/ Consults/ MDTs/ clincial Meetings
Grand Round Consults XR meeting Adult ID teaching (WGH)
PM General ID clinic , OPD
Micro round Consults
Audit work TB clinic 1st and 3rd week
ST teaching
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Non-Clinical Training Responsibilities (expectations of research/audit/teaching): GLASGOW Trainees will be expected to complete regular audit projects. Over 24 months, trainees will be encouraged to design and implement at least one quality improvement intervention and re-audit to close the loop. Both the local AMT (and national SAPG - Scottish Antimicrobial Prescribing Group) and the national SPAIIN network would offer opportunities for audit. There is a monthly hospital-wide Paediatric Research and Audit meeting which trainees are encouraged to attend and present their work. Trainees will be expected to contribute to ongoing local research initiatives by assisting with clinical data collection or analysis as appropriate. The unit has more recently focused on paediatric hepatitis C intervention trials and has worked on commercial licensing trials through the Clinical Research Facility at QEUH. There are opportunities for trainees to link to local research institutes based within the University of Glasgow. A direct link is offered by Dr Chris Moxon who is a Senior Clinical Lecturer at the Wellcome Centre for Integrative Parasitology at the University of Glasgow. Dr Pollock is also developing collaboration with the MRC Virology Unit. Trainees will be encouraged to develop and implement their own research ideas, and supported to apply for a post-graduate research degree if appropriate. Trainees will be expected to participate in the Clinical Tutor programme for final year University of Glasgow medical students. Trainees will be encouraged to contribute to GPST2 and ST2 teaching programmes, and to assist with clinical and communications skills teaching for the MRCPCH. EDINBURGH Trainees will be expected to complete regular audit projects and relevant quality improvement projects. Attendance at Anti-microbial team meetings with projects related to this are encouraged. Both the AMT (and national SAPG - Scottish Antimicrobial Prescribing Group) and the national SPAIIN network offer additional opportunities for audit. There are regular paediatric research and audit meetings: trainees are encouraged to attend and present their work, in addition to at the weekly hospital grand rounds. There are opportunities for trainees to link to local research institutes based within Edinburgh, and teaching of medical students and paediatric trainees is encouraged, both on site at RHSC and within the University of Edinburgh.
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Further Training Opportunities: GLASGOW There is a large adult BBV and tuberculosis service in Glasgow whose inpatient beds are based in the Queen Elizabeth University Hospital adjacent to the RCH. There is a weekly adult ID team meeting and monthly Tb MDTs as well as quarterly cohort reviews. The South Glasgow microbiology lab and the regional immunology laboratory is based on-site and adult immunology service works closely with the paediatric service. SPAIIN national teleclinics occur every 3 months and joint SPAIIN/Newcastle clinics occur x 4 per year. There is a Scotland wide ID community of practice which trainees would be expected to join and national training meetings for Scottish adult ID trainees which paediatric trainees are welcome to attend. Trainees would be expected to attend weekly Paediatric Grand Round and quarterly West of Scotland Child Protection Peer Review meetings. EDINBURGH There is excellent MDT working across Scotland for both paediatric infectious diseases and immunology and adult immunology. Attendance at national clinics would be encouraged, in addition to attendance at relevant tele clinics and teaching events. The close working relationship with adult ID services offer the opportunities for trainees to gain experience in the adult ID centre also, both inpatient and outpatient. Complex immunology transplants are not performed in either site but we have excellent links with Newcastle and anticipate that trainees could spend time there gaining experience.
Contact details for Unit: Telephone: 0141 201 0000 page 18418 ( Dr Conor Doherty) E-mail: [email protected] Telephone: 0131 536 0601 Bleep 9017 ( Dr Laura Jones) E-mail: [email protected]
Curriculum: Each sub-specialty Grid Programme covers the RCPCH Progress Curriculum, as specified on the RCPCH website: https://www.rcpch.ac.uk/education-careers/careers-paediatrics/sub-specialties
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Severn
Hospital / Centre Placement Name
Du
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(M
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ths)
Educational Supervisor (name and e-mail) These will be published unless you ask otherwise
Co
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ry (C)
or O
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Availab
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(Y
/N)
Bristol Children’s Hospital
Paediatric Infectious Disease
24-36 (fte)
Dr. Jolanta Bernatoniene, jolanta.bernatoniene@uhbristol .nhs.uk
C Y
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Subspecialty:
PAEDIATRIC INFECTIOUS DISEASE & IMMUNOLOGY
(NB. Immunology included in the training syllabus but the accreditation in Paediatric Infectious Disease only)
Base Unit: Bristol Royal Hospital for Children (BRHC)
Deaneries involved: SEVERN
Outline of Programme
The programme is based on the specialty specific competencies outlined in the Framework for Competencies for Level 3 training in Immunology, Infectious Diseases and Allergy (RCPCH progress PID Syllabus, August 2018; Revised PID Curriculum August 2016). All training is provided in Bristol and the trainee(s) will received two (WTE) years of clinical training in the paediatric infectious disease & immunology (PID), with opportunities for rotating through microbiology, virology and adult immunology departments and experience in other allied paediatric sub-specialties. The training will also offer the opportunity to combine clinical training with access to an active research programme in a high quality learning environment.
Departmental Information
- Demographics Bristol is the biggest specialist referral centre for the South West of England, a population of 5.5
million. The Paediatric Infectious Disease & Immunology services provide comprehensive services to the children with primary (inherited) immunodeficiency, acquired immunodeficiency including HIV, and children with severe and unusual infections in Bristol and the South West Region of England with occasional supra-regional referrals.
Approximately 500 children are seen a year in six PID outpatient clinics a month at BRHC and every 2-3 months in Bath, Exeter, Swindon, Taunton, Yeovil, Gloucester and Plymouth. Some children are seen as inpatient consultations. Children with disorders requiring bone marrow transplantation or gene therapy are jointly managed with Great Ormond Street Hospital in London. Children with antibody deficiencies requiring gammaglobulin replacement (currently 50 children) are reviewed in the clinic and most receive treatment at home.
Children exposed to or infected with HIV are managed to every extent possible in a family-orientated fashion. Currently 25 HIV positive children are managed through monthly half-day family clinic at BRHC while some are seen at the same outreach clinics as above. To prevent mother to child transmission of HIV, we also provide postnatal care, treatment and a nurse led follow up (for 2 years) of the babies born to HIV positive mothers in Bristol (15-20 babies per annum).
The TB incidence rate in Bristol is the highest in the South West region and currently is 19.2 per 100,000 population. Each year approximately 200 children are screened for latent or active TB infection in a twice monthly dedicated paediatric TB clinic which we run at BRHC.
In 2014, we have successfully introduced p-OPAT (paediatric outpatient parenteral antimicrobial therapy) at Bristol Children’s Hospital. The OPAT allows [patients who are
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medically stable and whose only reason for admission is the requirement for IV antibiotic therapy, to be treated in an outpatient setting. So far, 450 patients have been referred to the service and safely managed in their home environment with an infection cure rate of 99.2%.
We have recently set up weekly Antimicrobial Stewardship Programme at BRHC in line with national and international recommendations to improve the appropriateness of antibiotic prescribing and reduce rising antimicrobial resistance long term. It involves regular reviews of antibiotic prescriptions through weekly ward rounds which are usually attended by one of PID consultant and an antimicrobial stewardship pharmacist,
- Team The care of the children and their families is multi-disciplinary. The trainee(s) will work alongside
Four consultants, three full time clinical nurse specialists, two full time secretaries, a part-time dietician (0.1WTE) and a part-time clinical psychologist (0.1WTE). PID/Immunology service works in close collaboration with other professionals including adult HIV and Immunology teams, Microbiology, Mycology and Virology colleagues as well as a number of paediatric medical specialties at BRHC. Therefore, the proposed training programme will offer a comprehensive paediatric infectious disease & immunology training package with broad opportunities for experience in related tertiary services.
- Supervisor(s) Dr Jolanta Bernatoniene, Dr Marion Roderick, Dr Stefania Vergnano and Professor Adam Finn
Clinical Training Responsibilities
The trainee(s) have an active role in inpatient and outpatient evaluation under consultant supervision.
Inpatient consultancy work, which goes on throughout the week, is facilitated by formal weekly ward rounds at the neonatal intensive care unit at St Michael’s Hospital and at BRHC both conducted jointly with colleagues in microbiology and virology. The trainee(s) are involved in the management of patients in weekly outpatient clinics in Bristol such as TB, OPAT, HIV, young people transition, joint immunology/rheumatology, immunisation or immunology clinics, e.g. arranging immunological investigations and supervision of immunoglobulin therapy, and the consultation service. They have supervised involvement in multidisciplinary management of HIV-positive children and their families, and investigation and long term management of patients with primary/secondary immunodeficiencies. They are expected to attend regular weekly Antimicrobial Stewardship rounds. Occasional participation at regional shared care clinics is encouraged.
Trainees will have a number of opportunities to provide telephone advice concerning infectious diseases, immunology and immunisation-related issues throughout the week both within and outside UHBristol to colleagues in the community and in other Trusts in the region. Related to this, an immunisation query hotline (24 hour turn round) has been established for Bristol health professionals to contact for advice and trainees with a PID interest participate in this rota, with consultant cover.
Workload / Rota Arrangements / Example Timetable
BRHC training posts are compliant with EWTD. The trainee(s) cover the PID service 9am-5pm. There is no overnight or weekend on call commitment for the PID service. However, the trainee(s)
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contribute to the out-of-hours acute general paediatric middle grade rota within the context of the requirements for daytime sub-speciality training experience. Nursing staff are experienced and supportive.
Weekly Timetable Example
Day Regular Clinical Activities Further details
Monday 9:00 – 13:00 Monday 14:00 – 17:00
Microbiology handover, NICU, PICU Ward rounds Inpatient reviews TB clinic x1 month HIV clinic x1/month Immunology clinic am x1/month Immunisation clinic pm x1/month Joint immunology/rheumatology clinic x6/year
Inpatient reviews & management of the children with infectious diseases; telephone advise within/outside the Trust with support from attending ID Consultant Supervised/Consultant led clinics
Tuesday 9:00 – 13:00 Tuesday 14:00 – 17:00 Tuesday 14:00 – 17:00
PID clinics x2/month Regional PID clinics every 2-3 months Antimicrobial Stewardship Ward round
As above Bath, Swindon, Exeter, Plymouth, Gloucester, Taunton, Yeovil Review of antimicrobial prescription at BRHC
Wednesday 9:00 – 13:00 Wednesday 14:00 – 17:00
Inpatient reviews Microbiology/ID journal club Antimicrobial Stewardship Ward round
Responsible for coordinating/presenting literature review, case presentations, etc Review of antimicrobial prescription at BRHC
Thursday 9:00 – 13:00 Thursday 14:00 – 17:00
Joint PID ward round with microbiology/virology colleagues OPAT service provision HIV TC with St George’s team x4/year Admin/Research/Clinical Governance Activities
Inpatient reviews & management of the children with infectious diseases; telephone advise within/outside the Trust with support from attending ID Consultant The trainee will be encouraged to participate in R&D activities The trainee will be expected to conduct 1 audit per year
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Friday 9:00 – 13:00 Friday 13:00 – 14:00 Friday 14:00 – 17:00
Weekly MDT meetings (TB, HIV, Immunology & Clinical Governance) Oncology round Weekly Grand Round TB clinic x1/month Immunology clinic x1/month Admin
Inpatient reviews & management of the children with infectious diseases; telephone advise within/outside the Trust with support from attending ID Consultant Supervised/Consultant Led clinics
NB.
- The trainee will have a 6 week laboratory attachment in virology and bacteriology labs, and 2 weeks in the immunology lab.
- On call cover for general paediatrics/ED/ speciality wards: 1:9 - There is no overnight or weekend on call commitment for the PID service.
Non Clinical Training Responsibilities (expectations of research / audit / teaching)
Trainees are expected to develop their role in the academic teaching undergraduate and postgraduate programmes and to perform two audits. The formal teaching programme includes regular departmental academic meetings and consultant-led teaching sessions. This supplements the educational value of clinical meetings – weekly MDT/HIV/TB/Immunology/OPAT/Clinical Governance, 6 monthly joint meetings with HIV adult colleagues, 3 monthly teleconferences with our supraregional centres in London. Weekly hospital grand rounds. The Education Centre accommodates several Trust departments, including Post Graduate Medical education, the Clinical Skills Centre, Resuscitation Services and the Learning Resources Centre. It also offers a range of training facilities for both formal lectures and group work.
Trainees will be expected to attend at least 75% of available national training meetings in the sub-specialty and encouraged to join & attend respective national/international host organisations.
Bristol is leading international centre for health research and education and has a considerable reputation for innovation research and development. It hosts the NIHR Western clinical Research network, which provides administrative, managerial and infrastructural support for clinical research and trials in children. The trainees are encouraged to participate actively in internal and external research projects which address local, national and international healthcare needs. The PID service is linked to an active research programme in infectious diseases epidemiology, human mucosal immunology and clinical trials of vaccines and antimicrobials.
Further training opportunities
The trainees are encouraged to look for an area where the service requires leadership in development or innovation and to attend business meetings. The trainees will complete 6 week attachments in microbiology and virology and at least 2 weeks in the clinical immunology lab. Additional training and experience in other supraregional centres (eg GOSH, St Georges) will also be encouraged as deemed necessary on annual review and according to the trainees’ specific interests.
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Contact details for unit
Dr. Jolanta Bernatoniene, Lead Clinician 0117 342 0174
Professor Adam Finn, Honorary Consultant in Paediatric Infectious Diseases & Immunology
0117 342 0172
Dr Marin Roderick, Consultant in Paediatric Infectious Disease & Immunology
0117 3427716
Dr Stefania Vergnano, Consultant in Paediatric Infectious Disease & Immunology
0117 3427716
Curriculum
Each subspecialty grid programme covers the RCPCH curriculum as specified on the RCPCH website: https://www.rcpch.ac.uk/education/training/curriculum