Respiratory medicine

Respiratory medicine ARCP

Curriculum - Respiratory medicine training (2010, with 2014 amendments)

Curriculum - Respiratory medicine training (2022)

JRCPTB Specialty Overview and Recruitment - http://www.st3recruitment.org.uk/specialties/respiratory-medicine

Mersey

Training Programme Director

Dr Jenny Marlow

Email: jenny.marlow@sthk.nhs.uk

Dr Nicola Hunt

Email: nicola.hunt2@sthk.nhs.uk

St Helen's and Knowsley Teaching Hospitals NHS Trust
Whiston Hospital
Warrington Road
Prescot
L35 5DR

Compulsory Training Days

The Regional Respiratory Teaching programme is run jointly with the North-West and Mersey Deanery and is co-ordinated by Dr Nagarajan (Mersey) and Dr Bright-Thomas (NW).

The aim is to provide10 high quality away days per year on a range of respiratory topics. It includes an induction day with practical skills training. The training programme days aim to cover all major areas of the respiratory curriculum. The teaching day venues vary and may take place in specialist centres to utilise the expertise available.

Trainees are encouraged to attend the British Thoracic Society Summer and Winter meetings. Trainees are also encouraged to attend specialist training courses run by the British Thoracic Society and are also expected to attend National and International (at least 1 during the training programme) meetings.

In addition, there is a General/Acute internal medicine education programme which runs across 5 days a year.

Attendance at 70% of the training days is expected and is reported to Programme Directors to form part of the ARCP process. It is the trainee’s responsibility to ensure that adequate notice is given locally to cover clinical commitments on the teaching days. The TPD controls a budget for study leave and guidance on this is provided on the deanery website.

Trainees are required to keep a training record. The specialist training committee assesses the progress of trainees annually using the ARCP process.

Other important dates

North Western

Training Programme Director

Dr Michelle MacDougall

Email: michelle.macdougall@nca.nhs.uk

Salford Royal Hospital

Northern Care Alliance NHS Group

Stott Lane

Salford

M6 8HD

About the specialty

Respiratory medicine is the specialty involves diseases and disorders of the lungs, pleura, pulmonary vasculature and ventilation. These may occur as part of a systemic disease or are localised to the thorax. The range of conditions is very varied and includes asthma and COPD, lung cancer, infections (e.g. pneumonia and tuberculosis), bronchiectasis, pulmonary fibrosis, transplantation, cystic fibrosis, sleep and ventilatory disorders, occupational respiratory disease and pulmonary embolism.

Respiratory physicians look after in-patients and outpatients, usually with general medical as well as specialty patients. In recent years a number have moved into primary care settings to concentrate on care of long-term respiratory conditions.

Respiratory physicians are skilled at the interpretation of lung function tests, flexible bronchoscopy, pleural procedures and thoracic radiology interpretation.

Respiratory physicians work as part of a multidisciplinary team with specialist nurses, physiotherapists, and clinical physiologists. They also have close working relationships with radiologists, pathologists, thoracic surgeons, critical care physicians, oncologists, and palliative care physicians.

Respiratory medicine has a strong academic base in the North West and Mersey. National Institute of Health Research Clinical Research Facilities exist at University Hospital South Manchester (UHSM) and Liverpool University Hospital Foundation Trust (Royal site - Phase 1 MHRA accredited). There are research opportunities in many different areas including infection, asthma, allergy, cough, lung cancer, cystic fibrosis, COPD, ILD and global. Academic respiratory posts for trainees also exist at Liverpool Heart and Chest Hospital in cystic fibrosis. Posts will be linked in with the local Higher Education Institutions such as Liverpool School of Tropical Medicine, Universities of Manchester or Liverpool.

Research is varied and ranges across clinical, social science, laboratory based or epidemiological projects. We encourage all trainees to develop a research interest and by the time they gain their CCST/CCT many will have higher academic qualifications (MD or PhD). We have a good track record of successful Fellowship, Clinical Lecturer and Senior Clinical Lecturer posts.

The range of clinical work is very varied and interesting. Most physicians will be involved in acute general medical on call and have a responsibility for the care of these patients. They will also have specialist patients who may be admitted on take, be referred to clinic by general practitioners or by other hospital doctors. Many respiratory clinicians also work substantively in Intensive Care, Palliative Care or Acute Medicine.

Many physicians will have developed a subspecialty interest and may run a sub specialist service. Clinical commitments will usually be split fairly evenly between in-patient and out-patient work. Patients vary with their problems from acute self-limiting illness, rapidly or slowly progressive terminal disease to chronic disease processes requiring long term care. Skills are required in the care of critically ill patients in critical care settings and at the other extreme terminally ill patients requiring palliative care. There are also increasing opportunities to work across primary and secondary care, for example in the organisation of COPD services.

Teaching of undergraduates is an increasingly important and enjoyable part of the job. There are many opportunities for research and audit.

There has been an expansion in the number of consultant posts in the country (including the North West and Mersey Region) over the last 10 years. To date none of the North West or Mersey trainees have encountered any difficulties in obtaining consultant positions, not just in the North West but also in other regions in a mixture of District General and Teaching Hospitals. A few trainees have taken up Consultant posts in Acute and Respiratory medicine. Almost all local trainees tend to choose to work in the North West or Mersey areas.

Would a career in respiratory medicine suit me?

The respiratory physician is one part of a multidisciplinary team and therefore must be a good team player, as well as on some occasions a leader and strategist. The work can be busy and requires a degree of flexibility.

Much of the work involves the care of severely acutely ill patients requiring emergency management and careful decision making.

Working in respiratory medicine requires a combination of knowledge and skills in several practical procedures which makes the role varied but can be demanding.

Good communications skills are essential to interact with colleagues, patients and relatives. Empathy and sensitivity are essential as patients may have life threatening conditions. Attention to detail and good diagnostic skills are an important part of being a good physician. Although the specialty can be hard work it is often very rewarding.

What does the training involve?

There is a national person specification available on the JRCPTB website for entry into higher medical training in respiratory medicine. Trainees will usually have completed 3 years of core medical training, have attained the relevant competencies and will have passed their ARCPs. This will usually be achieved during a rotation through a range of medical specialities. Experience during this time in respiratory medicine and critical care is desirable.

Trainees will need to be members of the Royal College of Physicians (MRCP UK or I) by the time they commence the ST4 year, so trainees should have MRCP PACES or have a date to sit it prior to entry into the ST4 year. Audit is an essential part of training. Research experience, a published case report or an audit on a respiratory topic will undoubtedly give candidates more to talk about at interview and help with shortlisting for ST4 posts.

Higher Respiratory Specialist Training in the North West and Mersey will lead to dual accreditation in Respiratory and General Internal Medicine. The usual training programme lasts for 4 years (ST4-ST7), in posts providing a mixture of general and specialist experience. Entrance into the ST4 position is via the national selection process (https://phstrecruitment.org.uk/). Trainees may take periods out of programme (OOP) training to pursue research projects. OOP training must be applied for at least 6 months in advance and adhere to the deanery guidelines with clear objectives provided. Any time accredited towards training should also be prospectively applied for through JRCPTB. To avoid gaps in the rotation there is a limit to the number of trainees allowed OOP at the same time so early application for OOP is strongly advised.

There are academic fellowship posts in respiratory medicine appointed to every year for a duration of 3 years and several trainees have been successful in gaining academic clinical lectureship posts. The SCE (Specialist Certificate Examination) is a mandatory examination for Respiratory trainees. It is recommended you sit the examination in your penultimate year of training i.e. ST6 or above.

There are 35 training posts in the North West Region. The trainees rotate between the regional centre (UHSM), inner city ‘teaching hospitals’ (Manchester Royal Infirmary, Salford Royal, North Manchester General) and a selection of teaching and district general hospitals (Stockport, Bolton, Preston, Bury, Oldham, East Lancashire, Blackpool, Barrow, Wigan, Tameside, Lancaster). The rotations occur every 12 months and trainees will have two DGH, one teaching hospital and one regional centre slot.

There are 24 training posts in the Mersey region. The trainees rotate between the regional central hospitals (LUFT and LHCH) and DGHs including Warrington, Whiston, Southport, Chester, Arrowe Park, Macclesfield and Leighton hospitals.

The programme provides training in all aspects of Respiratory Medicine and continued experience in General Internal Medicine. There are opportunities for trainees to develop specialist interest or expertise e.g. cystic fibrosis, transplantation, occupational respiratory disease, asthma and allergy, pleural procedures, critical care and interventional bronchoscopy.

Research is encouraged throughout the training programme. There are extensive facilities to support research at the North West lung Centre (UHSM) and Liverpool University Hospital Foundation Trust (LUFT).

Teaching is also strongly encouraged, and all trainees get the opportunity to complete module 1 of a PG Certificate in Medical education at Edge Hill University in ST4.

Leadership is recognised as an important attribute and all senior trainees have an opportunity to complete the Medical Leadership In Practice module run by Edge Hill University (or an equivalent course).

Where can I find out more?

Training Programme Director (North West)

Dr Mark Wilkinson

Email: mark.wilkinson1@mbht.nhs.uk

University Hospitals of Morecambe Bay NHS Foundation Trust
Royal Lancaster Infirmary
Ashton Road
Lancaster
LA1 4RP

Telephone 01524 65944

Training Programme Directors (Mersey)

Dr Jenny Marlow

Email: jenny.marlow@sthk.nhs.uk

Dr Nicola Hunt

Email: nicola.hunt22@sthk.nhs.uk

St Helen's and Knowsley Teaching Hospitals NHS Trust
Whiston Hospital
Warrington Road
Prescot
L35 5DR