Mersey

Training Programme Directors

Dr Claire Cullen

Email: claire.cullen@aintree.nhs.uk

 

Dr Olivia Bennett

Email: olivia.bennett@nhs.net  

The Mersey Deanery rotational training scheme is flexible in that it offers training and experience which can lead to the award of a Certificate of Completion of Training, CCT in Geriatric Medicine and Level 2 competence in General Internal Medicine. Training takes 5 years. Each hospital placement during the scheme lasts for one year. The exact hospital to which the Specialist/Specialty registrar rotate to during the scheme can vary depending on the needs and wishes of the SpR/StR and the posts available. Rotation is decided each year after review of progress/ARCP with the Programme Director and the Post Graduate Dean. Rotation date is November. The scheme offers a wide variety of posts, each offering different special interests within the fields of Geriatric and General Medicine and related sub specialities.

 

Rotational Training Programme

Traditional Geriatric experience in acute rehabilitation, outpatient and day hospital settings are widely available. Special interests within Geriatric Medicine including Stroke care, Orthogeriatrics, Psychogeriatric liaison, Continence management and Intermediate Care are offered in most of the participating hospitals. One year of the scheme may be spent in a research post with the approval of the Speciality Training Advisor, the Post Graduate Dean and JRCPTB/GMC. The posts available in the Mersey Regional Training programme scheme in Geriatric Medicine and General Medicine are listed below:

 

Sub-speciality training opportunities are listed in the boxes, please note that in some hospitals there are several posts which offer different training opportunities. It is usually possible to request which Consultants you want to work for by contacting the STEC representative for the hospital. SpRs are usually placed in a District General Hospital during their first year and a District General Hospital in their final year. For Specialist Registrars at least 2 years of GIM are needed for accreditation in GIM plus one year of age related acute work. For Specialty Registrar there is no time restriction for gaining Level 2 competence in GIM.

 

Rotational Training Programme - Geriatric Medicine

Hospital	Rotational Information
Royal Liverpool and Broadgreen University Hospitals	8 NHS posts Subspecialty Training Orthogeriatrics, Old Age Psychiatry, Intermediate Care, Continence, Palliative Care, Parkinson's, Stroke, Vascular Rehabilitation Management. SpRs rotate through 4 posts in a year so can experience various subspecialties.
University Hospital Aintree	6 posts (5 + 1 stroke post) Subspecialty Training Stroke, Orthogeriatrics, Metabolic bone disease, Falls, Psychogeriatrics, CCU/Cardiology, ITU, Palliative Care Training Opportunities to be negotiated with STEC Representative
Arrowe Park Hospital	5 posts Subspecialty training Stroke (2 posts) All posts: Orthogeriatrics Old Age Psychiatry Continence Movement Disorders Intermediate and Community Care Palliative Care
Whiston/St. Helens Hospital	5 posts Subspecialty training Palliative Care Orthogeriatrics except Osteoporosis clinics Old Age Psychiatry (Liaison to be arranged elsewhere) Stroke Continence Movement Disorders
Countess of Chester Hospital	1 post Subspecialty training Palliative Care Intermediate/Community Care Stroke Cardiology Orthogeriatrics
Leighton Hospital	1 post Subspecialty training Palliative Care Orthogeriatrics Stroke (TIA clinics) Gastroenterology
Macclesfield Hospital	1 post Subspecialty training Parkinson's Intermediate and Community Care
Southport and Ormskirk Hospital	1 post Subspecialty Training Stroke Parkinson's Disease Intermediate Care Orthogeriatrics Service Development
North Cheshire Hospitals Trust	3 Posts Subspecialty Training Stroke Orthogeriatrics Falls Intermediate Care Movement Disorder Old Age Psychiatry

Each individual should aim to have at least 8 weeks experience at equivalent of 1 session per week in each of the major subspecialty areas of: Stroke care, Orthogeriatrics, Palliative Care, and Old Age Psychiatry. There should also be training in Continence Assessment and Management. Community Care training will depend on SpRs previous experience but should include a minimum of 24 sessions of experience.

 

View and print the Specialist Registrar Training Progress Review Form.

 

MRAB Academic Portfolio

Please download the MRAB Academic Portfolio in Geriatric Medicine information pack

 

Community Care

The aim of the program is to provide you with an understanding of Community and Intermediate care. Service provision differs widely in different areas, so you should spread your training over the 5 years to enable you to get a feel for this diversity and areas of common working as well as being able to evaluate what you feel are there strengths and weakness. Those of you wanting a more detailed knowledge of intermediate / community work may want to approach one of the "community geriatricians" for advice.

 

“Seeing and learning” session

There are 10 essential half-day sessions required as a minimum. Additionally you should try to attend a further 10 half-day sessions during your training dependant on your needs and local availability. All Trusts will have a range of possibilities for experiencing intermediate / community work and information for each trust should be available from your supervising consultant. After each half day session the trainee should complete a feedback form and keep this with their training record. The feedback form will summarise the service seen, including a reflection on the medical input into the service and a brief review of the evidence for that type of service where appropriate.

 

Education/Training meetings

Provided through the Regional SpR training day programme including talks by a Community Geriatrician, General Practitioner with an Interest in Intermediate / Community Care and Social Services.

 

Personal Study

List of recommended reading:

• BGS compendium - policy statements - intermediate care - role of Geriatrician in the community both of which refer you to other relevant sections in the BGS compendium.
• BGS - developing intermediate care to support reform of emergency care services
• National Service Framework especially standard 3
• NSF for older people- intermediate care : moving forward DoH June 2002 - reviews the evidence base and give examples of good practice
• Implementation of the National Service Framework and Intermediate care seen from the Geriatricians and Older Peoples Perspective. A joint statement from age Concern and the British geriatrics society
• Elderly medicine - a training guide Rai and Mulley

 

Daily Practice

Understanding about community and intermediate care should be nurtured during your daily practice. Consideration of community/Intermediate care options are to some extent a part of all discharge planning.

 

Knowledge and Skills

Many of these are part of the core geriatric curriculum. The new knowledge/skill lies in the application of core knowledge within a low-tech environment within an interdisciplinary team. Know which services are available and which are appropriate.

 

Audit

We would encourage any SpR who was interested in doing an audit project to contact one of the Geriatricians with an interest in community work.

 

Continence Programme

The aim of this programme is to enable the future consultant in Geriatric Medicine to make a basic assessment of continence problems in a frail elderly patient and to access other sources of help. The trainee is not expected to become the local expert but should know who the experts are and what they might be able to offer. The programme can be extended for those who wish to develop a special interest.

 

The basic programme consists of a number of 'stand alone' sessions with practitioners in Merseyside.The SpRs will be expected to complete all 11 sessions and be able to demonstrate that they have been able to put their knowledge into practice.

 

After each session a trainee feedback sheet (Continence Training form) should be filled in. This form also serves to certify satisfactory completion.

 

Old Age Psychiatry Programme

This programme has two components – delirium and old age psychiatry. The curricula for both of these is enclosed. These include details of learning objectives, knowledge and skills to be acquired and methods of assessment.

 

Requirements for the training programme in delirium

• the trainee is expected to achieve the objectives of this training programme within the first two years of their specialist training.
• it is anticipated that experience and training in the management of delirium will be provided as part of core training in geriatric medicine.
• trainees can be supervised for this part of their training by either their educational or clinical supervisor.
• trainees are required to prepare a detailed account of three case histories with a comprehensive management plan in each case.
• trainees should arrange at least two meetings with their supervising consultant – the first at the beginning of the programme to identify knowledge base and discuss learning objectives, and the second at the end of the programme to reinforce new knowledge and skills using discussion of case histories and to complete a final assessment for the log book.

 

Requirements for the training programme in Old Age Psychiatry

• the first and last sessions of the programme will be by a consultant geriatrician where session details will be given and aims of the programme discussed.
• each trainee will also have a supervising old age psychiatrist whom they should meet at the beginning of the programme to discuss their training requirements and at the end of the programme to complete a final report.
• trainees are required to prepare three detailed case histories covering a range of mental health problems, other than delirium, which will be discussed with their supervising old age psychiatrist.
• the trainee is expected to attend at least one session of each of the following:trainees may feel they would benefit from more than one session of some or all of the above - it is the responsibility of the trainee to assess their training needs and arrange to attend any additional sessions.
  • outpatient clinic.
  • domiciliary visits.
  • day hospital.
  • community psychiatric nurse visits.
  • in-patient ward rounds.
  • liaison psychiatry.
• knowledge of the use of drugs used in the management of dementia is required - this can be achieved through attending memory clinics or general old age psychiatry clinics depending on the system in place in an individual area.
• training in liaison psychiatry should only take place in hospitals where this service is provided by senior staff.

 

After each subject a trainee feedback sheet (Old Age Psychiatry Training form) should be filled in. This form also serves to certify satisfactory completion.

Download the SpR Psychiatry Training form as a pdf file.

Download the Final Summary SpR Psychiatry Training form as a pdf file.

 

Orthogeriatric Programme

Curriculum in Orthogeriatric for SpRs in Geriatric Medicine

Subject	Knowledge	Skills	Sessions
1. Falls.	Evidence-base for multifactorial risk assessment and interventions for fallers. Understand appropriate investigations for syncope.	Ability to carry out an adequate Falls Assessment (History, Examination, Investigation ordering). Understanding tilt test results. Ability to refer appropriately to interventions which may prevent further falls.	Ward work. Taught curriculum. Falls clinic attendance. Tilt-Test session.
2. Metabolic bone disorders.	Osteporosis. Osteomalacia. Paget’s disease. Function of osteoporosis clinic. Evidence base for different drug treatments for osteoporosis.	Ability to investigate osteoporosis. Apply osteoporotic drug regimens appropriately.	Osteoporosis clinics. Taught curriculum.
3. Anaesthetic Issues (hip fracture).	Nature of anaesthetic pre-operative assessment. Awareness of situations when surgical treatment may not be appropriate.	Medical assessment skills.	Orthogeriatric liaison. Taught curriculum.
4. Diagnosis, classification of treatment for hip fractures.	Fractured neck of femur. Intertrochanteric fractures. Sub-trochanteric fractures. Upper limb fractures including fractured humerus, Colles fracture, vertebral fractures.	Ability to diagnose and classify fractures based on X-ray appearances. Knowledge of specific complications of individual surgical and non-surgical interventions.	Orthogeriatric liaison. Orthogeriatric rehabilitation ward work. Taught curriculum.
5. Post operative care, (acute and rehabilitation), including usual post operative complications.	Acquire knowledge of skills and treatment options that each individual member of multi-disciplinary team can bring to the management of the patient with hip fracture.	Acute post surgery care. Ability to identify rehabilitation needs. Ability to provide an adequate management plan. Ability to assess progress of rehabilitation.	Orthogeriatric rehabilitation as part of weekly clinical timetable during attachment in Department of Geriatric Medicine. Mini-Cex –Running an MDT in an Orthogeriatric setting. Mini-Cex –Assessment of Orthopaedic patient with regard to suitability for rehabilitation.
6. Orthopaedic joint replacement assessment clinic.	What is joint replacement trying to achieve in terms of analgesia and function. For whom is this appropriate?	Identify and assess patients who might benefit from joint replacement (hip/knee).	Orthopaedic out-patient session(s) with Consultant Orthopaedic surgeon with special interest in joint replacement.
7. Orthotics and appliances.	Principle of orthotics and knowledge of appliances available.	Ability to identify the patients who might benefit from orthotics.	Orthotics department session.

 

After each subject a trainee feedback sheet (Orthogeriatric Training form) should be filled in. This form also serves to certify satisfactory completion.

 

Stroke Programme

The table below is a list knowledge and skills to contribute to a comprehensive service for patients with acute stroke and chronic stroke related disability in the hospital and the community.

Object	Subject Matter	Learning Experiences	Evidence of Competence
To provide the trainee with the knowledge and skills to contribute to a comprehensive service for patients with acute stroke and chronic stroke related disability in the hospital and the community.	Knowledge Epidemiology of stroke Classification schemes for acute stroke (eg. OCSP) Acute stroke management Basis of primary and secondary prevention measures Complications of stroke Different rehabilitation models in hospital and community Ethical and legal issues relating to patients with severe disability Skills Clinical assessment of stroke type and severity in the acute situation Planning appropriate management according to the stroke type Management of dysphagia and malnutrition Management of spasticity and post-stroke pain Leadership of multidisciplinary rehabilitation team. Provision of palliative care as required. Attitudes To involve patient and carers in treatment decisions and goal settings. To work closely with other relevant specialists and value the opinion of members of the multidisciplinary team	Working on an acute stroke unit and a stroke rehabilitation unit or a combined unit [6 months] Outpatient experience in a neurovascular clinic under the supervision of specialist stroke physician [6 months experience] Outpatient experience in a stroke follow-up clinic to facilitate post- discharge care of stroke patients in collaboration with multidisciplinary team and various agencies in the community [6 months experience] Be part of stroke thrombolysis team and gain experience in fast tracking acute stroke patients. Should be able to coordinate rapid but thorough assessment and direct rest of the team to enable prompt and safe thrombolysis [3 months experience] Participate as a member and leader of multidisciplinary stroke team in setting goals and coordinating rehabilitation of stroke patients [6 months experience] Personal study including the Royal College guidelines for stroke management and all clinical trials relevant to stroke care (journals, internet and textbooks) Formal teaching including departmental teaching programmes, regional study days and national stroke conferences Note: formal stroke sub-CCT can be achieved by undertaking optional one year of additional training	Satisfactory training and assessment records.

 

Falls Programme

Please view the Falls Programme For Geriatric Medicine Trainees In Mersey Deanery document

 

Palliative Medicine

The aim of this training is to provide the trainee with the knowledge, skills and attitudes to deliver good care to dying patients and involves liaison with different members of the palliative care team in different settings. The trainee will be required to write up cases of patients they have been involved with to discuss with their palliative care supervisor. They will be required to fill in an assessment of the value of the attachment.

 

The training is available for SPRs in years 2 or 4 of their geriatric medicine training or STRs between ST4 and ST6. It is available in Liverpool, Wirral, Southport, Whiston and Aintree.

 

There are 3 elements to the training:

 

The first element will be made up of 10 sessions of lectures in the form of an induction day, 6 sessions of communication related topics specific to palliative care, and a one day exit session; This will run over the course of one year and may be open to other trainees besides those in geriatric medicine.

 

The second element will be hospital based sessions consisting of ward rounds, multidisciplinary team meetings, case conferences and inpatient referrals.

 

The final element will be hospice based and will include attendance at multidisciplinary team meetings and ward based sessions with palliative care nurses in the community, hospice based outpatient clinic and inpatient and day care hospice based session.

 

Contact name: Dr Julie Langton