SOUTH TRENT GASTROENTEROLOGY
TRAINING SCHEME FOR
SPECIALIST TRAINEES
The Digestive Diseases Centre
Leicester
CONTENTS:
1.
2.
3.
4.
5.
6.
7.
8.
9.
General Description of the Scheme
General Medicine
Gastroenterology: "core" experience and skills; special options
Research
Formal Training Schedule
Appraisal
Individual Units and Trainers
Terms and Conditions of Service
Further Details
South Trent Training Scheme in Gastroenterology
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1.
GENERAL DESCRIPTION OF THE SCHEME
The aim of the scheme is for trainees to obtain a CCT in both general internal
medicine (acute) and gastroenterology.
The scheme will rotate trainees between either of 3 District General Hospitals
(Derby, Kettering, or Peterborough) and 2 of the 3 Leicester Teaching Hospitals
(Leicester General and Leicester Royal Infirmary). Each trainee will spend five 12month periods, each at one of the five training units, with the aim of providing dual
training in both GIM (acute) and Gastroenterology. It is envisaged that there will be 2
parallel arms to the scheme.
Entry to the scheme will be at ST3 (except during MMC transition when it may be at
a higher level). The total duration of the scheme is 5 years (following on from core
medical training [CMT] and assuming entry at ST3).
For trainees recruited to ST3 of the scheme, training will usually commence at either
Peterborough or Kettering. The middle 3 years will usually be in Leicester. The final
year will be either at the Leicester Royal Infirmary or at Derby City Hospital. For
those recruited during MMC transition into ST4 or above, initial placement will
depend both on trainee choice, previous experience, training needs and availability.
The trainer (or educational supervisor) for each post on the scheme will be one of
the consultant gastroenterologists with whom the trainee will agree a weekly
program to include the training features set out in section 7 of this document. Each
post will include a half day a week for education/research and protected time for the
monthly training half days.
Rotation date will be 1st October each year. Each trainee's needs and preferences
will be considered in deciding which post he/she will rotate to for the year. Normally,
if a trainee takes a year out for research (strongly encouraged), the
consultant/trainer to whom he/she is responsible will need to find a locum for the
clinical post for the year (normally a "LAT" - locum appointment for training).
SUMMARY OF TRAINING SCHEME
YEAR 1
Peterborough (1 post)
or
Kettering (3 posts)
YEARS 2 – 4
YEAR 5
Leicester General (4)
or
Derby City (1)
or
Leicester Royal (6)
Leicester Royal
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2.
GENERAL MEDICAL TRAINING
Each post provides experience of unselected acute general medical admissions and
care of both general medical inpatients and outpatients. The proportion of time
spent on GIM differs between the training units, with in general more time being
required in the District General Hospital posts in years 1 and 5. However, in all units,
trainees will be able to satisfy training requirements such that they can achieve
Level 2 competency in GIM (acute) as required by the GIM curriculum for those in
dual training. The JCHMT requires that at least the first and last years of SpR
training contain a substantial GIM commitment.
3.
GASTROENTEROLOGY
All areas of diagnosis and management of gastroenterological and hepatological
conditions will be covered in accordance with the National Curriculum. Training will
be provided in basic diagnostic and advanced therapeutic Endoscopy; with the
opportunity to learn ultrasound, ERCP or oesophageal manometry/pH studies
should the trainee have a desire to do so. Each trainee will be exposed to a
minimum of 6 months Hepatology with the possibility of further exposure. There is
also the opportunity to be exposed to specialised nutrition training.
4.
RESEARCH
The Diegestive Disease Centre encompasses all the relevant sites in the training
programme (see www.digestivediseases.org)
All trainees are strongly encouraged to take one or two years (the latter if a higher
degree such as MD is desired) during the scheme for full-time clinical or laboratory
research. Those interested may have areas they wish to research or may develop
interests during the scheme. The special and research interests of trainers are
indicated below, and any will be pleased to discuss further any proposals and
opportunities.
Professor Janusz Jankowski has a Visiting Professorship at Oxford University and
has a particular interest in the factors which create mucosal metaplasia and
dysplasia in the gastrointestinal tract. In particular there is an active program
assessing the role of chronic inflammation on stem cells in vivo and in vitro. There
are many opportunities for research from basic science projects in the laboratory,
translational research, phase II studies using novel therapies and finally phase III
trial work in endoscopy. Researchers will be given very close support for funding
applications and personalised supervision for experimental planning and execution.
The unit has very strong links with Cancer Research UK, London and Oxford
University. Research attachments there are possible. An Honorary Clinical
Lectureship can be granted depending on the individual candidates experience.
The Unit has published in prestigious journals including Lancet, Gastroenterology,
Cancer Research and The Journal of the National Cancer Institute. In addition we
are well funded with over 2 million pounds in in funding from Cancer Research UK,
Medical Research Council and National Cancer Research Institute.
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Trainees will be given opportunities to work locally in Leicester on clinical research or
depending on the individual’s track record translational and basic science
opportunities at his laboratories at the University of Oxford.
The University is committed to producing research and teaching of the highest
quality, to promoting undergraduate and postgraduate studies through campus
based and distance-learning programmes and to developing close collaboration with
the local and regional community. Links also exist between the South Trent scheme
and Adelaide Australia. In the future, trainees may have the opportunity to spend
time in Adelaide as part of their training.
Dr John de Caestecker has clinical and research interests in upper GI motility
disorders, gastro-oesophageal reflux and Barrett’s oesophagus. He is responsible
for the GI function laboratory and would be keen to encourage/support any
interested trainees in project development related to any of the above topics.
5.
FORMAL TEACHING SCHEDULE
There is a regional training day rotating between Leicester, Nottingham or Sheffield
three times a year. This covers a syllabus which is determined by a regional GI
program working party and trainers as well as trainees are expected to attend.
There is also a monthly South Trent half day trainees' meeting with a different,
symptom-oriented syllabus and a more informal format. The latter meeting will be
chaired in rotation (rolling half day, usually in the last week of the month except in
months with a Trent regional study day) by a different trainer from Leicester,
Peterborough, Kettering or Derby. The trainer will decide the venue and designate a
trainee to be responsible for organising the meeting. The topics and format of the
meeting will vary; these will be decided in advance at a meeting of trainees and the
director of GI training for South Trent.
There is a separate GIM teaching program organised by the Director of Training in
GIM whilst trainees are in Leicester.
6.
APPRAISAL
A logbook will be made available to each trainee in which conditions experienced
and techniques/practical procedures carried out will be recorded. This is a logbook
provided by the JCHMT and will normally form the basis for reviewing experience
attained and further training needs. Trainees will also be assessed by mini-clinical
evaluation exercise (mini-CEX), directly observed procedural skills (DOPS) and 360
degree appraisal.
Each trainee will be appraised yearly by interview with the Postgraduate Dean for
South Trent (or his representative), together with the director of the South Trent
training scheme. There usually will be one or more of the other trainers in
attendance as well as a representative from another deanery. The interview will be
based on a report from the relevant trainer, the JCHMT logbook and competency
based assessments and will aim to assess progress and future training needs.
Where deficiencies are identified, corrective measures will be suggested and
implemented. The penultimate assessments will be designed towards deciding
whether the requirements have been met in GIM and Gastroenterology to
recommend the award of a CCT. The PYA in Gastroenterology will be carried out
on a regional basis once a year, and the PYA in G(I)M will be organised locally.
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7.
THE INDIVIDUAL UNITS AND TRAINERS
UNIVERSITY HOSPITALS OF LEICESTER NHS TRUST
a).
LEICESTER TEACHING HOSPITALS
Leicestershire Health Authority covers a population of 875,000 served by 3
teaching hospitals based in the city and a number of community hospitals based
around the county. Gastroenterology is based primarily at the Leicester General
Hospital and Leicester Royal Infirmary.
JAG (Joint Advisory Group) Endoscopy courses are run in Leicester and it is
recognised as one of three Aspirant Centres that runs courses in conjunction with
the National and Regional Training Centres.
i).
LEICESTER GENERAL HOSPITAL
Gastroenterologists:
Dr J F Mayberry
Dr S Shah
Dr J S de Caestecker
Dr R Robinson
This large acute teaching hospital has a complement of 950 beds. Professorial
departments of Nephrology and Elderly Care Medicine are on site. Training is
available in the full range of gastrointestinal disorders, including specific training in
upper GI endoscopy, colonoscopy, ERCP, and all therapeutic endoscopy. All of the
consultants partake in general acute medical admissions.
There are 5 colorectal surgeons and two hepatobiliary surgeons who compliment
the medical gastroenterology services. Close working relationships between
physicians and surgeons allow for joint training in ERCPs and PEG insertion. This
takes place in a modern multi-room endoscopy suite with X ray screening facilities in
the nearby X ray department plus CCTV to a seminar room on the day case unit for
postgraduate teaching purposes. More than 6000 endoscopic procedures a year are
undertaken. There is a dedicated GI radiologist (Dr R Verma) and 1 GI/liver
histopathologist (Dr R Harrison, with 2 others having a major interest).
In addition, this is a major centre for GI research. Achievements include an annual
output of more than 20 publications and major grants from the ICRF/MRC, the
British Digestive Foundation and NACC, together with other research bodies. During
the last 5 years, the main commitment has been to epidemiological studies.
Weekly timetable:
There are 4 posts available with Drs Mayberry / Shah / De Caestecker / Robinson.
The work schedules for the posts are similar, but the exact timetable will depend on
the experience and needs of the trainee.

2-3 endoscopy/colonoscopy lists per week

ERCP training for selected trainees (usually ST3 or above)
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
2-3 gastroenterology
IBD/coeliac/PEG clinics

1-2 consultant ward rounds per week
OP
clinics
per
week,
including
specialist
(The timetable is in the process of change which may give added training
opportunity).
Other activities:

Histology meetings

Endoscopy audit meetings quarterly

A joint medical/surgical GI meeting every 2nd week (plans for a weekly
meeting)
 Weekly HPB MDT meeting is held on this site
 Weekly postgraduate meeting (Thursday lunchtime)
 Monthly Tuesday morning DDC meeting at LRI (including external speakers
and audit)

Options:

Abdominal ultrasonography and guided liver biopsy (Dr Y Rees, Consultant
Radiologist).

Inflammatory bowel disease (Dr Mayberry or Dr Robinson)

Oesophageal functions tests (Dr de Caestecker)
On call commitments:
1 in 12 full shift
Special Interests:

Oesophageal disease, especially oesophageal motility disorders, non cardiac
chest pain and gastro-oesophageal reflux disease. Oesophageal manometry
and ano-rectal physiology is performed at Glenfield (Dr de Caestecker)

Epidemiological aspects of gastrointestinal disease, in particular inflammatory
bowel disease. Patient information and education programmes. (Dr
Mayberry)

Inflammatory Bowel Disease. (Dr Robinson)
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ii).
LEICESTER ROYAL INFIRMARY
Gastroenterologists:
Dr B J Rathbone
Dr J Stewart
Dr P Wurm
Prof J Jankowski
Dr A Grant (Hepatology)
Dr Delahooke (Hepatology)
This is an acute 1092 bedded teaching hospital with beds for all main specialities
and contains the only major Accident and Emergency Unit in the district. The Clinical
Sciences Block of the University of Leicester is situated in the Royal Infirmary site
and provides offices and research laboratories for the greater part of the University
Departments of Medicine, Surgery, Psychiatry, Obstetrics and Gynaecology,
Paediatrics, Community Health, Pathology, Pharmacology and Therapeutics.
The medical gastroenterology department is supported by 3 upper GI, two
hepatobiliary and 2 colorectal surgeons. There are two specialist gastrointestinal
radiologists and 2 histopathologists specialising in gut and liver pathology.
The Infirmary has a modern purpose-built endoscopy unit with up to date video
equipment carrying out all forms of diagnostic and therapeutic endoscopy. Nurse
endoscopists contribute to the service and carry out regular fibreoptic
sigmoidoscopies and upper GI endoscopies.
There are specialist liver and inflammatory bowel disease clinics.
Professor Jankowski has a major interest in Gastrointestinal Epithelial Biology and
has a well funded research programme. Trainees will be expected to take an active
role in research while working in the department.
Weekly timetable:
There are 6 posts available. The weekly timetable is similar for each post, though
the exact program would depend on the experience and needs of the trainee.

2 endoscopy/colonoscopy lists

ERCP lists (available to those showing interest and aptitude)

2 gastroenterology clinics

0.5 general medical clinic

2 consultant ward rounds
Other activities:

1 weekly GI radiology meeting – Monday Lunch time (1-2 pm)

1 weekly multidisciplinary clinical meeting – Alternate Tuesday & Thursday
(1-2 pm)

1 weekly general medical meeting – Friday Lunch time ( 1-2 pm)
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
Weekly UGI MDT meeting

Monthly Tuesday morning DDC meeting (including external speakers and
audit)
Options:

Viral hepatitis and HIV clinics (Drs. Grant/Delahooke/Wiselska)

Liver disease (Dr Grant/Dr Delahooke)


Nutrition (Dr Stewart)
Helicobacter pylori research techniques (Dr Rathbone)

Training in Advanced Chemoprevention (Professor J Jankowski &
Professor W Steward)
On call commitments:
1 in 11 full shift
Special interests:
Dr Rathbone has a special interest in H pylori, particularly in the field of 3rd
generation serology, pathogenicity and treatment.
Dr Stewart is interested in enteral/parenteral nutrition, audit, clinical governance and
legal medicine
Professor Jankowski has interests in Cancer Surveillance and Chemoprevention.
Dr Wurm is interested in advanced colonoscopic techniques
Drs Delahooke and Grant are interested in all aspects of liver disease
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b).
DERBY CITY HOSPITAL
Gastroenterologists:
Dr J G Freeman
Dr A T Cole
Dr A F Goddard
Dr Cunliffe
Dr Holmes
Dr Norton
Dr Austin
Dr Lai
This is one of two large Teaching Hospitals serving the population of South
Derbyshire (approximately 500,000); supporting a new undergraduate-entry medical
school. The hospital has 507 beds providing acute medical, surgical and obstetric
facilities. The District Renal Unit is based at Derby City General Hospital. There is a
12-bedded Planned Investigation Unit and a new Intensive Therapy Unit.
A Professorial Chair in Rehabilitation medicine was established in 1995, and in the
following year Chairs of Paediatrics and Obstetrics and Gynaecology were
established. There is a Chair of Medicine (Vascular Medicine) at the Derbyshire
Royal Infirmary. A Chair of Gastrointestinal Surgery is established at the Derby City
General Hospital. There is a large commitment to teaching medical students from
Nottingham University.
The Gastroenterology Department is an active and expanding unit offering training
in all upper GI and colonic endoscopy, together with ERCP and endoscopic
ultrasound. Training and experience in all forms of therapeutic endoscopy will be
provided. There is a particular interest in laser work, with referrals from the East and
West Midlands. The unit possesses an enteroscope for small bowel endoscopy for
which training is also available.
Drs Freeman, Austin and Lai has an active interest in hepatology including the care
of patients with advanced liver disease, hepatitis C and post liver transplant patients.
They are active contributors to the Trent Hepatitis C Research Network. Drs Cole,
Goddard, Norton and Holmes provide care for patients with inflammantory bowel
disease and nutritional problems.
Weekly timetable:

one colonoscopy list

one endoscopy/laser list

one ERCP list

three gastroenterology clinics

one or two consultant ward rounds

Clinical Nutrition Team Ward Round
Other activities:
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
one weekly GI radiology meeting

one weekly GI histology meeting

one weekly Grand Round

one audit meeting weekly

Medical/Surgical gastroenterology meeting twice a month

Journal Clubs & Derby Medical Society meetings
Options:

Advanced therapeutic endoscopy including laser treatment of tumours,
treatment of tumours with photodynamic therapy and argon beaming,
oesophageal stenting and enteroscopy

Advanced therapeutic ERCP

Management of advanced liver disease

Endoscopic ultrasound
On call commitments:
1 in 6 resident on call
Special interests:
There are special interests in laser treatment, hepatobiliary disease and
inflammatory bowel disease.
Current research in Derby relates to drug trials in ulcerative colitis, duodenal ulcers
and GORD; portal hypertension, alcoholic hepatitis, hepatorenal syndrome,
inoperable rectal cancer and aspects of laser.
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c).
KETTERING GENERAL HOSPITAL
Gastroenterologists:
Dr A P Chilton
Dr A Hussain
Dr A Steel
Kettering General Hospital (KGH) is a large DGH serving a population of 320 000. It
is estimated that this will have increased to 400 000 by the end of the decade. We
currently have 900 beds, 232 of which are medical. The GI unit is a productive
environment dealing with greater than 6000 new and follow up patients and caring
out over 6000 endoscopies per annum. KGH is a designated colorectal cancer
centre, and there is close collaboration with the GI surgeons.
The Endoscopy unit is JAG compliant.
We aim to provide broad and focused training in gastroenterology and general
medicine in a unit committed to the provision of high quality GI services. The SpR
responsibilities are for the day-to-day management of inpatients and for the on
going direct and planned support of patient care and junior doctor supervision.
Training will be focused on the needs of the individual and based on current
competencies and agreed objectives.
A wide range of endoscopic services is provided in a modern well-equipped unit with
three endoscopy theatres with plans for further expansion. Two nurse endoscopists
support the endoscopy services.
We also have a part time CNS in gastroenterology, providing the hepatitis C support
and managing complex ambulatory GI care.
Our objective is to equip trainees with the necessary tools to support them in their
development into independent GI specialist.
Weekly timetable:









2 endoscopy list (one training list)
2 GI clinics
0.5 GIM clinics
2 consultant WR
1 SPR WR
Medical student teaching
Flexible endoscopic backfill (dependant on competence)
Support of GI CNS in management of ambulatory care patients
Admin and research time
Additional Activities:



Weekly GI meeting (Tuesday 12.30-1.30)
Weekly MDT (wed 12.30-2.00)
Weekly academic half day (Friday 1.30-3.30) inc. grand rounds.
Options:


Instruction in therapeutic endoscopy (APC national training faculty member)
Service development
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


Managerial skills
Research and audit
Options will depend upon identified needs and educational prescription
On-Call:
1 in 11 full shift (may increase to 1:12)
Special Interests:




d).
Skills teaching and transference
Colorectal cancer risk and genetics
CRC screening
Patient satisfaction and embedding service quality
PETERBOROUGH DISTRICT HOSPITAL
Gastroenterologist:
Dr M W Dronfield
Dr P Nair
Dr M Ninkovic
This is a modern district general hospital of 642 beds which provides all acute
medical services for Peterborough district. The district has a total catchment area of
291,000.
There are three Consultant Gastroenterologists, Dr Dronfield, Dr Nair and Dr
Ninkovic. The duties of the post are partly those of general medicine, both
emergency inpatient and outpatient. There is also an extensive experience of
gastroenterology, including diagnostic and therapeutic endoscopy, and an
inflammatory bowel disease clinic. The registrar will be encouraged to acquire
experience in this clinic of long-term management of IBD.
There is a well-equipped endoscopy unit with good teaching facilities: registrars will
be taught basic endoscopy and colonoscopic skills, with opportunity also to learn
ERCP techniques.
Weekly timetable:

2 endoscopy lists

1 general gastroenterology clinic

1 inflammatory bowel disease clinic

1 general medical clinic - option to choose another speciality of trainee's
choice.

2 consultant ward rounds
Other activities

weekly X-ray meeting
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
weekly grand round

weekly pathology meeting

weekly medical dept meeting

weekly MDT meetings
On call commitments:
1 in 6 resident on call
Research
There is a well-endowed research fund; trainees are encouraged and supported in
developing research interests. Two sessions are available for research activities.
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8.
TERMS AND CONDITIONS OF SERVICE
The appointment is subject to the Terms and Conditions of Hospital Medical and
Dental Staff (England and Wales) as amended from time to time and also other
such policies and procedures as may be agreed.
The successful candidate as part of the South Trent Training Programme will be
contracted by the individual Trusts at which he/she will work. As a consequence
he/she is expected to be aware of local policies and procedures and take note of the
standing orders and financial instructions of those authorities.
Salary
The Specialist Registrar salary scale is at present £27,483 per annum rising by
annual increments to a maximum of £41,733 per annum in accordance with current
nationally agreed salary scales.
Medical Examination/Clearance
The appointment is subject to medical fitness and the appointee may be required to
undergo a medical examination and chest x-ray.
Potential applicants should be aware of the Department of Health and GMC/GDC
requirements with regard to HIV/AIDS and Hepatitis viruses.
Study Leave
Study leave is granted in accordance with the recommended allowance subject to
the maintenance of the service and to prior approval by Consultant, Leave Coordinator and the Study Leave Committee.
Study leave is defined as leave taken to attend a formal course of study designed to
further the employees career and to enable the employee to obtain his/her
professional qualification or gain necessary expertise in order to carry out his/her
job. Where ever possible employees should attend courses organised within Trent.
Annual Leave
Specialist Registrars on the 1st and 2nd incremental points of the payscale shall be
entitled to leave at the rate of five weeks a year. Specialist registrars on the 3rd or
higher incremental point of the pay scale shall be entitled to leave at the rate of six
weeks a year.
Residence
This is a non-resident post. However, the appointee is required to be resident when
on-call and an on-call room will be made available to him/her at the hospital.
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Accommodation
Accommodation may be available and enquires should be directed to the
Accommodation Officer at the appropriate hospital.
Removal Expenses
Hospitals on the South Trent Rotation operate their own policies for the
reimbursement of relocation expenses.
You Should not commit yourself to any expenditure in connection with relocation
before first obtaining advice and approval from the Medical Staffing Department at
your administering Trust. Otherwise you may incur costs which you are unable to
reclaim.
Termination of Employment
Specialist Registrars are required to give a minimum of three months notice of
termination of their employment, only in exceptional circumstances will less than
three months be allowed.
Health and Safety
Participating Trusts recognise their duties under the Health and Safety at Work Act
1974 to ensure, as far as it is reasonably practical, the Health, Safety and Welfare
at Work of all its employees and in addition the business of the Trusts shall be
conducted so as to ensure that patients, their relatives, contractors, voluntary
workers, visitors and members of the public having access to the Trust premises
and the facilities are not exposed to risk to their health and safety.
All medical and dental staff under contract will be expected to comply with all
appropriate District and Trust Health and Safety policies. Arrangements will be
made for the successful candidate to have access to the appropriate policies.
9.
FURTHER DETAILS
Further details may be obtained from :Dr J Stewart
Training Programme Director/Consultant Gastroenterologist
University Hospitals of Leicester NHS Trust
Leicester Royal Infirmary
Leicester
LE1 5WW
Tel: (0116) 2586480
August 2006
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