Clinical Genetics - Mersey


Merseyside & Cheshire Regional Genetics Service

Specialty Registrar Training Programme (ST3-ST6)

 

Clinical Genetics

Clinical genetics comes under the umbrella term of medical genetics, comprising the clinical department and the genetics laboratory. Genetics and genomic medicine is rapidly evolving. Whether your professional interests lie with the intricacies of genomic basic science or applied research, the detail of genomic variant interpretation, the excitement of treatment trials or the big picture aspects of service development, change and innovation, there will be an area of genomic medicine that suits you.

Liverpool Women’s Foundation Trust hosts the Merseyside and Cheshire Regional Genetics Service (RGS); this is a comprehensive genetics service for a population of approximately 2.8 million people across Merseyside, Cheshire and the Isle of Man. The service has strong links with many clinical and academic departments across the city and beyond.

 

Ethos of Department

The departmental ethos is strongly aligned to the goal of the Trust as a whole - to provide excellent healthcare for families in a safe, friendly and caring environment.  We are proud to push the boundaries of healthcare for our patients and their families and we continue to influence national and international research and development in these fields. 

This is a dynamic and thriving department with a heavily partnership-based approach to genomic medicine; we believe in working with our colleagues in laboratory medicine, acute and mainstream medical and surgical specialties and with colleagues in academia to provide truly excellent healthcare across the city of Liverpool and beyond. Our regional service footprint includes one of Europe’s largest specialist neurological trusts and one of the UK’s largest tertiary cardiothoracic trusts. We also have strong links with Liverpool Health Partners, Liverpool Clinical Laboratories, the University of Liverpool and the North West Coast Academic Health Science Network.
 
Who’s who in the Cheshire & Merseyside Clinical Genetics Service
 

Consultants

Dr Lynn Greenhalgh

  • Cancer Lead
  • Paediatrics and Cancer
  • Ormskirk paediatric clinic monthly
  • 100,000 Genomes Project Rare Disease Lead for North West Coast Genomic Medicine Centre

Dr Emma McCann

  • Clinical Director of Clinical Genetics
  • Paediatrics, Cancer, Adult
  • Craniofacial co-lead
  • Chester mixed clinics weekly

Dr Astrid Weber

  • Research Lead
  • Paediatrics, Cancer, Adult, MEN
  • Craniofacial co-lead
  • Warrington paediatric clinic monthly

Dr Ian Ellis

  • Senior Lecturer and Honorary Consultant
  • Undergraduate teaching
  • Paediatrics, Adult and Cancer

Dr Victoria McKay

  • Cardiovascular genetics lead
  • St Cath’s paediatric clinics fortnightly
  • 100,000 Genomes Project GMC Lead for Liverpool Heart & Chest
  • Training Lead for Clinical Genetics

Dr Jenny Higgs

  • Neurogenetics lead
  • Crewe paediatric clinic monthly
  • 100,000 Genomes Project GMC Lead for the Walton Centre

Dr Natalie Canham

  • Fetal and prenatal genetics lead

  

Training in Clinical Genetics

Entry to the specialty is at ST3 level. Completion of Foundation year competencies and of those in core medical training (CMT1 and 2) or level 1 paediatrics is essential. A broad range of experience in acute general medicine and/or paediatrics with exposure to unselected medical take is essential. MRCP, MRCPCH or equivalent are essential.

 

The training programme in clinical genetics is four years (subject to satisfactory ARCPs), of which at least three years must be clinical training during which experience will be gained in all aspects of clinical genetics. The programme incorporates training in laboratory and theoretical genetics, genetic counselling and ethical issues, mathematical genetics and the use of genetic databases.

 

The formal working hours are 9am to 5pm. STs do not undertake on call duties and no banding allowance applies to this post

 

LTFT Training

Those trainees training less than fulltime (LTFT) will participate in the same rotational programme as full-time trainees with sessions allocated on a pro-rata basis. The training programme will be extended with modules repeated to ensure that training experience equivalent to that of full-time trainees is obtained.

 

Facilities

Trainees share purpose built offices with their own telephones and PCs with internet access. Genetic databases are available for use by trainees, together with other computer programmes such as Excel, PowerPoint and Word. Secretarial support is provided to each trainee by a specified Personal Assistant within the department.

 

Reference books and journals are available within the genetics department library and a wider selection can be ordered through the main Trust library. The main library has 10 desk top PCs for quiet working with 24 hour access. 

 

Overview of Clinical Training Programme

 

Year 1 (ST3) – Introduction to Clinical Genetics

Dysmorphology and paediatric genetics

Cancer genetics introduction

Introduce ward/urgent referrals (starting November/month 3 of ST3)

Introduce your peripheral clinic

Lab attachment (1 month – keep 1 general clinic per week + peripherals)

Introduce 2nd general clinic per month (to max. of 10 clinics per month for 1.0WTE trainee)

 

Year 2 (ST4) – Sub-specialty Genetics

Neurogenetics and neuropsychiatric genetics

Huntington’s

Cardiac genetics

General adult genetics

Metabolic Attachment (2 weeks, in Manchester)

 

Year 3 (ST5) – Special Interest or Research Year

One general genetics clinic per week + peripheral clinics

Specialist interest clinics could include:

  • Dilated cardiomyopathy joint clinic
  • Joint polyposis clinic
  • Craniofacial clinics
  • Metabolic clinics

or any other clinics related to your developing area of interest.

 

Time could also be used to develop a clinical or basic science research interest or to generate pilot data before major projects or OOPR.

 

You also need to strongly consider taking SCE Medical Genetics examination in ST5 (if not on OOPR)

 

Final Year 4 (ST6)

Unselected patients from all areas of clinical genetics

Maximum of 10 clinics per month for WTE trainee

Make post-CCT plans for further research posts, fellowships or consultant posts

 

Further consolidation of sub-specialty genetics to include some of the following:

  • Eye genetics clinic
  • Genetics of deafness – audiology clinic
  • Dermatology clinic to include skin biopsy list
  • Renal genetics clinic
  • Turner’s syndrome clinic
  • Disorders of sexual differentiation
  • NF1 clinic

 

You will also need to complete the current mandatory courses as determined by HENW.

 

Could also consider overseas experience in either developing country or to gain more insight into a specific area of clinical genetics.

 

Overview of Individual Training Programmes Based on Prior Experience

 

Paediatric Background

  • More familial with paediatric medicine, including examining neonates and children
  • Used to environment of paediatric and neonatal intensive care
  • Familial with some aspects of dysmorphology
  • Less confident with cancer genetics
  • Little or no recent exposure to adult-onset conditions
  • Little or no experience of adult neuro-genetics and conditions such as Huntington’s

 

  • Start with dysmorphology and paediatrics
  • May be confident to start seeing ward referrals independently sooner than colleagues from an adult background

 

Adult Background

  • May be more confident with cancer genetics
  • Often recent exposure to acute and adult-onset conditions
  • May have varied experience of adult neuro-genetics and conditions like Huntington’s

 

  • Not familial with paediatric medicine, including examining neonates and children
  • Not used to environment of paediatric or neonatal intensive care
  • May have little or no experience with any aspects of dysmorphology

 

  • Start with general adult
  • Add in cancer after further teaching
  • May be less confident to start seeing ward referrals independently than colleagues from paediatric background

 

General Monthly Commitments and Expectations of Trainees

Example Trainee Monthly Timetable:


Monday
Tuesday Wednesday Thursday Friday
Week 1 AM General Clinic Clinical team Meeting ICC MDT (LHCH)
Week 1 PM StR Lunchtime Teaching General Clinic Teaching Liverpool / Manchester
Week 2 AM General Clinic Peripheral Clinic

Skeletal Dysplasias MDT (AHCH)

Fetal Path MDT (AHCH)

Week 2 PM StR Lunchtime Teaching General Clinic

Departmental Meeting

Case discussions and MDTs

Week 3 AM General Clinic Neurogenetics MDT (AHCH / LWH) Peripheral Clinic
Week 3 PM StR Lunchtime Teaching General Clinic

Departmental Meeting

Case discussions and MDTs

Week 4 Am General Clinic
Week 4 PM StR Lunchtime Teaching General Clinic

Departmental Meeting

Case discussions and MDTs


Other Educational Opportunities during Training

Courses and training requirements will change frequently. Please keep up-to-date with all information on the Mersey Deanery and Health Education North West websites and discuss potential training opportunities with your

 

Mandatory courses

(as per deanery, please check website https://www.nwpgmd.nhs.uk/welcome)

 

Medical leadership and Management, Edge Hill University (free for final year registrars, multiple cohorts per year but will need to book in advance)

 

Other Courses and Training Events

It is intended that trainees will have access to as many courses as their study budget allows and assuming clinics have appropriate cover. Clinics can be cancelled for study leave events as long as 6 weeks’ notice is given. More than one trainee can attend the same event as long as clinic commitments are covered/cancelled, as we appreciate that some courses are only held once every two years and there may only be one opportunity to attend during training.

 

Attendance at other events such as conferences, and symposia is encouraged, but study leave to attend should be discussed with your educational supervisor well in advance. For every conference but especially in more senior years, trainees are encouraged to submit abstracts, posters and presentations to conferences.

 

Audit and Teaching

Trainees are expected to participate in local, regional and national opportunities for audit, quality improvement projects and teaching. Trainees are encouraged to submit work for presentation at local, national and international meetings.

 

Dedicated Teaching Time

Trainees have regular teaching sessions within the department, in local specialist Trusts and with other genetics trainees within Health Education North West. Current teaching sessions include:

  1. Weekly Clinical Genetics referrals and medical case discussion meeting (LWH)
  2. Weekly Clinical Genetics prenatal and all team case discussion meeting (LWH)
  3. Monthly X-ray Genetics MDT meeting (AHH)
  4. Monthly Fetal Pathology MDT meeting (AHH)
  5. Monthly Neurogenetics MDT meeting (AHH)
  6. Monthly StR teaching programme (joint with Manchester)

 

All the information above is available to download as a booklet by clicking this link