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Royal Brompton and Harefield NHS Foundation Trust
Job Profile
Junior Clinical Fellow in Cardiothoracic Surgery
Harefield Hospital
Page
Description of the Trust
2–8
Job Description for Surgery
9 – 13
Job Description for Cardiology
14 – 19
Job Description for Transplant
20 – 23
Conditions of Service
24 – 27
Appendix one
26 – 27
1
Royal Brompton & Harefield NHS Foundation Trust
A System of Care
Royal Brompton & Harefield NHS Foundation Trust is an internationally renowned centre for
heart and lung services. Our brand identity is strong and clear: delivering the best clinical
care and the best research for patients with heart and lung disease.
Heart and Lung diseases are the world’s biggest killers and our experts care for patients who
come from across the UK and overseas, not only from our local areas.
Our integrated approach to caring for patients from the womb, through childhood,
adolescence and into adulthood and old age has been replicated around the world and has
gained the Trust an international reputation as a leader in heart and lung diagnosis,
treatment, and research.
Research programmes play a vital role at both our hospitals. This is because the most
talented medical experts are rarely content with using tried and tested methods to treat
their patients. The opportunity to influence the course of modern medicine by developing
new treatments is a prospect that attracts them to specialist centres, where research
opportunities are a fundamental part of delivering patient care. As well as travelling
internationally to lecture and share their knowledge, our clinicians hold prominent positions
on influential boards, committees, institutions and professional associations.
Our closest academic partners are the National Heart and Lung Institute in the Faculty of
Medicine Imperial College London and, the Harefield Heart Science Centre. Through our
clinical research studies we also have active collaborations with hospital and universities
across the UK, most notably with Liverpool Heart and Chest Hospital in the Joint Institute for
Cardiovascular Medicine and Science. This partnership also reflects the Trust’s desire to
develop partnerships outside its usual geographical boundaries.
Over the years our experts have been responsible for several major medical breakthroughs –
discovering the genetic mutations responsible for the heart condition dilated
cardiomyopathy, founding the largest centre for the development of new treatments for
cystic fibrosis in Europe and pioneering heart surgery for newborn infants.
Our hospitals do not operate in a vacuum; fully integrated networks of care exist with
partner organisations and many of our clinicians have joint appointments with neighbouring
trusts.
Our experts promote the principle of ‘shared care’ through an expanding system of
consultant-delivered outreach clinics, at which they see patients at over 30 hospitals across
the South East, covering Essex, Sussex, Surrey, Hertfordshire, and Middlesex. This system
allows patients to benefit from specialist expertise in their local environment, with inpatient
care at our hospitals as needed.
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1.0 Trust mission, values and approach.
The Trust’s mission is to be the UK’s leading specialist centre for heart and lung disease. We
will achieve this mission through a strategy of focused growth in aspects of heart and lung
treatment, such as congenital heart disease, arrhythmia, heart failure and advanced lung
diseases.
Our Approach
 The continual development of leading edge services through clinical refinement and
research
 The effective and efficient delivery of core specialist treatment
 The transition of appropriate routine services to other centres to release capacity for
new interventions
Remaining an autonomous specialist organisation is central to preserving and building our
strong clinical and organisational record. However we are equally convinced of the
importance of effective partnerships particularly with major academic bodies to ensure a
continuing pipeline of innovations to develop future treatments.
Our Values
At the core of any organisation are its values; belief systems that are reflected in thought
and behaviour.
We have three core patient- facing values and four others that support them.
Our three core values are:



We Care
We believe our patients deserve the best possible specialist treatment for their
heart and lung condition in a clean, safe place.
We respect
We believe that patients should be treated with respect, dignity and courtesy and
they should be well informed and involved in decisions about their care.
We are inclusive
We believe in making sure that our specialist services can be used by everyone who
needs them, and we will act on any comments and suggestions that can help us
improve the care we offer.
And the following values support us in achieving them:


We believe in our staff
We believe our staff should feel valued and proud of their work and know that we
will attract and keep the best people by understanding and supporting them.
We are responsible
We believe in being open about where our money goes, and in making our hospitals
environmentally sustainable.
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

We discover
We believe it is our duty to find and develop new treatments for heart and lung
disease, both for today’s patients and for future generations.
We share our knowledge
We believe in sharing what we know through teaching, so that what we learn can
help patients everywhere.
1.1 Performance and achievements in 2014/2015
Our experts in 2014/15:
Carried out more than
174,000 outpatient,
diagnostic and imaging
appointments and saw
35,706 inpatients
Scored over 98 per cent from
patients in the NHS England
Friends and Family Test
Achieved a world first by
implanting a Tendyne
transcatheter mitral valve
system to treat mitral
regurgitation (a leaking
mitral heart valve)
Performed 2,899 angiograms
and 2,344 coronary
angioplasties
Fitted 3,395 pacemakers and
implantable cardioverter
defibrillators (ICDs)
Pioneered homecare
support to shorten the
length of time patients need
to stay in hospital
Recommended by 92 per
cent of staff in the NHS
England Family & Friends
Test
Performed 708 paediatric
cardiac procedures and
admitted 2,546 children with
heart and lung conditions
Conducted 8,473
appointments with
paediatric (under 16 years of
age) cardiology and
respiratory outpatients
Carried out 6,169 inpatient
and 8,986 outpatient CT
scans
Performed 18,445
echocardiograms at Royal
Brompton Hospital and
13,191 at Harefield Hospital
Helped nearly 1,000 cystic
fibrosis (CF) patients
Recruited 3,149 patients into
more than 175 research
studies
Achieved the 18-week NHS
standard referral time for
admitted patients every
month between April 2014
and March 2015
Achieved the 18-week NHS
standard referral time for
non-admitted patients every
month between April 2014
and March 2015
1.2 Range of Services
The Trust provides first-rate clinical services and exceptional research output.
We have an outstanding Research and Development pedigree; with over 500 active research
projects across 10 R&D programmes. Every one of these programmes has been consistently
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given the top rating by the NHS R&D Directorate. The table below illustrates the interrelationship between our R&D activity and clinical services.
Several of our clinical services have been formally designated as national services by the
Department of Health: Heart and Lung transplantation, Ventricular Assist Devices (LVAD),
Pulmonary Hypertension and Primary Ciliary Dyskinesia.
1.3
Research Programmes
Congenital Heart Disease

Chronic Coronary Heart Disease and Atheroma
Failing Heart
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
Critical Care
Chronic Respiratory Failure


Lung Cancer
Severe Respiratory Disease


Occupational and Environmental Medicine
Chronic Suppurative Lung Disease


Clinical Services
Adult Congenital Heart Disease
Pulmonary Hypertension
Paediatric Respiratory
Paediatric Congenital Heart Disease
Foetal medicine
Primary Ciliary Dyskinesia
Acquired Heart Disease
Heart Failure
Heart & Lung Transplant
Critical Care relating to Heart and Lung
Chronic Obstructive Pulmonary Disease
Sleep Ventilation
Pulmonary Rehabilitation
Lung Volume Reduction
Lung and Upper GI cancer services
Interstitial Lung Disease
Acute Lung Injury
Asthma & Allergy
Occupational Lung Disease
Paediatric and Adult Cystic Fibrosis
Non – CF Bronchiectasis
Aspergillosis
Mycobacterial Infections
Organisation
The Trust Board is constituted as follows:
Non Executive Members
Executive Members
Chairman; Baroness Sally
Morgan
Chief Executive; Mr Bob Bell
Mr Andrew Vallance-Owen
Medical Director and Responsible Officer;
Dr Richard Grocott-Mason
Ms Lesley-Anne Alexander
Chief Operating Officer; Mr Robert Craig
Mr Neil Lerner
Associate Chief Executive – Finance; Mr Richard
Paterson
Ms Kate Owen
Director of Nursing, & Clinical Governance; Ms Joy
Godden
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Professor Kim Fox
Director of Service Development; Mr Nick Hunt
Mr Richard Jones
Mr Philip Dodd
Mr Luc Bardin
The Clinical Divisions are: Heart (RBH incorporating Cardiology Radiology and Cardiac
Surgery), Heart (HH incorporating Cardiology, Transplant, Radiology and Cardiac Surgery),
Lung (cross-site incorporating Respiratory Medicine, Radiology and Lung Surgery); and
Directorates of Paediatrics, Anaesthesia and Critical Care, Laboratory Medicine, Pharmacy
and Rehabilitation and Therapies.
Non-clinical directorates are: Human Resources, Finance, Patient Services, Estates &
Facilities, Communications and Public Affairs and Business Development & Commissioning.
1.4
Harefield Hospital Site
Harefield Hospital (HH) is a regional centre for cardiology and cardiothoracic surgery, and an
international centre for adult heart and heart-lung transplantation. It is one of a small
number of UK cardiac centres assisting in development of implantable mechanical
ventricular assist devices in the management of end-stage heart failure. It also provides a
primary intervention service for acute coronary syndromes to selected Trusts and the
London Ambulance Service, in outer West London and the Home Counties. It has
approximately 1,185 staff, 180 beds with 5 operating theatres, and 4 catheter laboratories.
1.5
Royal Brompton Hospital Site
The Royal Brompton Hospital (RBH) is a specialist cardiothoracic centre specialising in
diseases of the heart and lung, with services for adults (Cardiology, Cardiothoracic Surgery,
Radiology, and Thoracic Medicine) and Paediatrics. It has approximately 2,081 staff, 296
beds, 6 operating theatres, 5 catheter laboratories, a private patients’ ward and extensive
imaging facilities. The hospital has recently opened the Cardiovascular Biomedical Research
Unit (BRU) in partnership with Imperial College London. This facility offers a CMR scanner,
catheter lab and echocardiography suite for research purposes, as well as state of the art
genetic analysis facilities.
A Respiratory Biomedical Research Unit was opened on the RBH site in 2010 offering
extensive research facilities for lung disease. Following public consultation, it was agreed
that inpatient paediatric surgery and investigations should consolidate at the Royal
Brompton Hospital.
1.6
Clinical Governance and Quality
The Trust has an extensive programme of clinical governance and quality led by Mrs Joy
Godden, Director of Clinical Governance and Nursing and Dr Richard Grocott-Mason,
Medical Director. The programme is delivered through the organisation’s systems and
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processes for monitoring and improving services, including sections for:
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Clinical audit and information
Clinical risk management
Research and development office
Infection prevention and control
Patient feedback
Clinical Quality and Improvement
Consultant appraisals form an integral part of the process with each consultant undertaking
annual appraisal with their line manager. There is also a programme of mandatory training
undertaken by all staff.
1.7
Regulation
The Trust was assessed by the Care Quality Commission as meeting all of the essential
standards of quality and safety, which were inspected during 2012/13. The report of the
most recent inspection in June 2016 is awaited.
1.8
Research and Development
Research is a major activity at RBHFT. In pursuing its research role, it is closely likened with
its association with the National Heart and Lung Institute (NHLI) which is a constituent
division of Imperial College School of Medicine. At the last research assessment exercise,
the clinical research carried out jointly between the hospital and NHLI was awarded a 5*
rating (the highest possible rating, shared by only two other UK establishments). Consultant
staff at Royal Brompton and Harefield NHS Foundation Trust are normally granted honorary
status at Senior Lecturer level with the University of London through NHLI and Imperial
College.
Over recent years the Trust has opened two Biomedical research units, one Cardiac and one
Respiratory, in partnership with Imperial College.
The BRUs undertake pioneering research into heart regeneration, aiming to increase the
understanding of poor heart function in people living with cardiomyopathy, arrhythmia,
coronary heart disease and heart failure. The Cardiovascular BRU aims to be the leading
national and international laboratory for the discovery of genes involved in cardiovascular
disease and their use in diagnostic and therapeutic strategies. The BRUs offers cutting edge
genomics facilities, using state-of-the-art next generation DNA sequencing, in order to
directly focus on the genetic analysis of inherited heart and lung conditions.
At the beginning of 2013, the Research Management Committee established a Research
Awareness Working Group to take forward the Trust’s research strategic goals. The Working
Group brought together the Research Office, Biomedical Research Units, Research Nurses,
Communications, Patient and Pubic Involvement representatives and PALS to identify and
execute a time-limited action plan to raise research awareness. New awareness initiatives
complement research Patient and Public Involvement (PPI) events already being taken
forward by both the Biomedical Research Units (Cardiac and Respiratory). Both BRUs also
have patient advisory groups who contribute to BRU research activities by commenting on
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research proposals, advising researchers on recruitment and helping with public/patient
facing material such as information sheets. The BRUs are also planning to start evaluating
the impact of their PPI work during 2014.
The two Biomedical Research Units (BRUs) have recently been awarded five-year funding by
the National Institute for Health Research (NIHR). The grant of almost £20 million will allow
both the Cardiovascular and Respiratory BRUs to continue pioneering research into some of
the most complex heart and lung conditions. During the period July-September 2013, 5 new
grants were awarded totalling £657k. It should be noted that the two awards to Professor
Eric Alton (£543k in total) are a result of his successful bid to become the Director of the
NIHR Respiratory Rare Disease Translational Research Collaboration.
1.9
Imperial College London
The Royal Brompton and Harefield NHS Foundation Trust has established and maintained
close links with Imperial College, which was established in 1907 in London’s scientific and
cultural heartland in South Kensington, as a merger of the Royal College of Science, the City
and Guilds College and the Royal School of Mines. St Mary’s Hospital Medical School and
the National Heart and Lung Institute merged with the College in 1988 and 1995
respectively. Imperial College embodies and delivers world class scholarship, education and
research in Science, Engineering and Medicine, with particular regard to their application in
industry, commerce and healthcare. We foster interdisciplinary working internally and
collaborate widely externally. Consequently, a significant amount of Medical Staff employed
by Imperial College hold honorary contracts with the Royal Brompton Trust.
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JOB DESCRIPTION
Post:
Junior Clinical Fellow in Cardiothoracic Surgery
Location:
This is a bank assignment and the main base will be at
Harefield Hospital. The post holder may also be required to
work at our Royal Brompton site on an intermittent basis, or
more regularly in due course by mutual arrangement.
Additionally, the post holder may be required to work at any
of the trusts sites and any associated sites as required.
DUTIES OF THE POST
Aims and responsibilities of the post:
The junior post holders will rotate between the consultant firms and be fully involved in a
range of cardiothoracic work. In addition to providing immediate cover to patients in
cardiac recovery and on the general cardio-thoracic ward, the post holder will provide cover
for intensive care emergencies. Consultant cover will be available at all times.
Clinical Duties
1.
To take history, examine and record all findings of all patients admitted under the
Consultant’s care.
2.
Carry out and arrange all relevant investigations.
3.
To see and examine all patients under the care of the Consultant concerned, (ward
rounds include those in the Intensive Therapy Unit) ensuring communication is
maintained regarding the condition of any of their patients
4.
To assist when required in the operating theatre whilst participating in a one in six
theatre week.
5.
To attend and assist Outpatient clinics when required under the direction of the
consultant and to ensure that clinic letters are dictated promptly to fall in line with
the 18 week referral to treatment policy.
6.
To arrange for the transfer of patients to other hospitals or discharge home, and
including a discharge summary on patient’s transfer.
7.
To be responsible for the care of all cardiothoracic patients on the wards when
working the on-call duty during weekend and evenings under the direction of the on
call Senior Clinical Fellow (SpR).
8.
To perform minor surgical procedures such as chest aspiration, insertion of
intercostal tubes, etc. and if necessary under the supervision of a Registrar.
To dictate all urgent discharge summaries and ensure that these are forwarded to
the patient’s General Practitioner or hospital of transfer within 24 hours after the
patient is discharged and complete letters to General Practitioners.
9.
9
10
11.
12.
13.
14.
15.
16.
17.
To cross cover, in conjunction with other Junior Clinical Fellow (SHO) to ensure the
service is covered during periods of absence, annual or study leave and with the
guidance and supervision of the appropriate Senior Clinical Fellow (SpR).
To keep the Specialist Registrar and Consultant informed of any patient who is giving
cause for concern.
To communicate to a patient’s relative the progress of that patient.
To be available for emergency calls to ITU and other parts of the hospital, if required
i.e. for cardiac arrest.
To participate in research projects which may already be in progress.
To participate in lecturing to other staff if required, e.g. nurses and physiotherapists.
To accept that occasional emergencies and unforeseen circumstances may occur,
and to respond to the needs of the service when they arise.
To participate in the Medical Audit Programme on a monthly basis and update PATS
data entry.
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PERSON SPECIFICATION
Job Title:
Junior Clinical Fellow in Cardiothoracic Surgery
Department:
Surgery
Date:
February 2017
D/E
Assessed by
QUALIFICATIONS
• MBBS or equivalent medical qualification
• Full GMC with licence to practise
E
E
A/I
A/I
E
A/I
E
E
E
E
E
E
E
E
A/I/R
A/I/R
A/I/R
A/I/R
A/I/R
A/I/R
A/I/R
A/I/R
E
A/I/R
E
A/I/R
E
E
A
A/I/R
E
A
E/D
A/I/R
ELIGIBILITY
• Evidence of achievement of Foundation competencies in line with GMC
standards/Good Medical Practice including:
• Good clinical care
• Maintaining good medical practice
• Good relationships and communication with patients
• Good working relationships with colleagues
• Good teaching and training
• Professional behaviour and probity
• Delivery of good acute clinical care
• Eligibility to work in the UK
FITNESS TO PRACTISE
• Is up to date and fit to practice safely
HEALTH
• Meets professional health requirements (in line with GMC standards/Good
Medical Practice)
CAREER PROGRESSION
• Ability to provide complete details of employment history
• relevant experience (at SHO level) in surgery (not including Foundation modules)
APPLICATION COMPLETION
• ALL sections of application form FULLY completed according to written
guidelines
CLINICAL SKILLS
• Technical Knowledge & Clinical Expertise: Capacity to apply sound clinical
knowledge & judgment & prioritise clinical need. Demonstrates appropriate
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technical competence & evidence of development of excellent diagnostic skills &
judgement
• Validated logbook documentation of surgical exposure to date
E/D
A/I
E
A/I
E
A/I
D
A/I
D
D
A/I
A/I
E
A/I/R
E
A/I/R
E
A/I/R
E
A/I/R
E
E
A/I/R
A/I/R
E
A/I/R
E
A/I
E
A/I
ACADEMIC / RESEARCH SKILLS
• Research Skills: Demonstrates understanding of the basic principles of audit,
clinical risk management & evidence-based practice. Understanding of research
basic research principles, methodology & ethics, with potential to contribute to
research
• Teaching: Evidence of contributing to teaching & learning of others
• Evidence of relevant academic & research achievements, e.g. degrees, prizes,
awards, distinctions, publications, presentations, other achievements
• Evidence of active participation in audit
• Evidence of participation in risk management and/or clinical/laboratory research
PERSONAL SKILLS
• Judgement under Pressure: Capacity to operate effectively under pressure &
remain objective in highly emotive/pressurised situations. Awareness of own
limitations & when to ask for help
• Communication Skills: Capacity to communicate effectively & sensitively with
others, able to discuss treatment options with patients in a way they can
understand
• Problem Solving: Capacity to think beyond the obvious, with analytical and
flexible mind. Capacity to bring a range of approaches to problem solving
• Situation Awareness: Capacity to monitor and anticipate situations that may
change rapidly
• Decision Making: Demonstrates effective judgement and decision-making skills
• Leadership & Team Involvement: Capacity to work effectively in a multidisciplinary team & demonstrate leadership when appropriate. Capacity to
establish good working relations with others
• Organisation & Planning: Capacity to manage time and prioritise workload,
balance urgent & important demands, follows instructions. Understands
importance & impact of information systems
PROBITY
• Professional Integrity: Takes responsibility for own actions, demonstrates
respect for the rights of all. Demonstrates awareness of ethical principles, safety,
confidentiality & consent. Awareness of importance of being the patients’
advocate, clinical governance & responsibilities of an NHS employee
COMMITMENT TO SPECIALTY
• Learning & Development: Shows realistic insight into cardiothoracic surgery and
the demands of a surgical lifestyle. Demonstrates knowledge of training
programme & commitment to own development. Shows critical & enquiring
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approach to knowledge acquisition, commitment to self-directed learning &
reflective/analytical approach to practice
• Extracurricular activities / achievements relevant to cardiothoracic surgery
Key: E = Essential D = Desirable A = Application I = Interview R = References
13
D
A/I
JOB DESCRIPTION
Post
Junior Clinical Fellow (CT1-2 level) in Cardiology
Location
This is a bank assignment and the main base will be at Harefield Hospital. The post holder
may also be required to work at our Royal Brompton site on an intermittent basis, or more
regularly in due course by mutual arrangement. Additionally, the post holder may be
required to work at any of the trusts sites and any associated sites as required.
Aims and Responsibilities of the post:
The appointee is expected to undertake the admission and day to day care of cardiology
patients. This includes a number of patients admitted for short term investigation and also
patients requiring longer term treatment. Emergency cases are admitted daily incorporating
all aspects of tertiary centre cardiology.
Main Duties and Responsibilities
The appointee is expected to attend regular cardiac clinics and ward rounds.






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
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Some experience may be gained in all aspects of non-invasive cardiac
investigations and in addition, some experience in assisting at cardiac
catheters may be obtained
Some experience in procedural techniques including central line insertion,
pleural taps and ascetic taps maybe obtained.
He/she is expected to maintain good professional liaison with colleagues,
nursing, para-medical and administrative staff.
The rota is a partial shift working pattern which may be subject to change.
Additionally there is resident night cover at SHO level.
A cardiac arrest bleep is always carried by the SHO on call, local resuscitation
training will be provided and completion of the ALS course supported
SHO’s are expected to provide cover for the absence of their colleagues
during annual and study leave.
Emergency management of all acute cardiac conditions.
Attendance and case presentations at MDTs.
Communication with primary and secondary care teams to plan safe and
appropriate patient discharge will be a key role.
Clinical audit.
Rota
The European Working Time Directive (EWTD) has set a minimum requirement for working
hours, rest periods and annual leave. Junior doctors should not work over 48 hours a week.
(over a 26 week reference period). This is a requirement under UK as well as European law.
14
Objectives of the training programme
The objective of this training programme is to provide the Fellow with advanced knowledge
and clinical experience in delivering a broad spectrum of critical care including:




Management of single and multiple organ failure secondary to
cardiovascular intervention.
Advanced techniques in ventilation including protective lung strategies and
management ALI/ARDS, differential ventilation and prone ventilation.
Management of patients post thoracic organ transplant
Advanced haemodynamic monitoring including pulmonary artery flotation
catheters and non-invasive cardiac output monitoring.
In addition the Fellow could acquire experience in:







Postoperative peri-operative management of complex cardiothoracic
surgical patients.
Transoesophageal and transthoracic echocardiography and critical care
ultrasound techniques.
Intra-aortic counter-pulsation therapy, invasive and non-invasive cardiac
output monitoring techniques and pacing.
Non-invasive ventilation.
Contribution to a clinical or basic science research project during their
appointment.
Contribution to an audit project
Competency –based training at the Harefield SIM centre
Clinical experience
TOE training
 Basic and advanced peri-operative and critical care echocardiography education
 Initial training will focus on basic principles (physics, standard views for examination,
Doppler principle and quantification etc),
 Training sessions on the Heartworks TOE simulator
 Further training may include sponsorship for attendance at a recognised external
advanced training course.
Access to in house 3D echo cardiac training is currently being developed
Critical Care Ultrasound
 Vascular access ultrasound
 Chest and pleural space ultrasound
 FEEL/FATE focussed ultrasound
Transplant experience
 Contribution to retrieval, donor TOE and other transplant relating working groups
 Monthly morbidity and mortality audit meeting
15


Education through attendance and participation in the Departmental Education
Programme.
Option to participate in assessment and retrieval of donor hearts and lungs
Research experience
 The Department actively supports research. The post holder will be encouraged to
develop and undertake a research project, which may be undertaken in
collaboration with the Heart Science Centre (Imperial College).
 There will be an initial assessment at the commencement of the post to assess
individual aims and objectives.
 Suitable time will be made available within the weekly timetable to participate in
appropriate research and clinical audit on discussion with the educational
supervisor.
The aim of the fellowship position is to enable the Fellow, by the end of twelve months:
 To function independently as an SHO to cover Cardio respiratory/Tx ITU
 To have gained clinical experience in cardiothoracic medicine relevant to higher
medical training
 Take part in the non-airway management on call rota for ITU
Expected outcomes



Be able to clinically assess, stabilise and manage sick patients requiring advanced
cardiothoracic support
Have a sound knowledge of ventilation, mechanical circulatory support (IABP, VAD –
peripheral and central, ECMO) and nitric oxide.
Practical skills to include
o Line insertion (arterial, central venous, vas cath)
o Chest drain insertion using seldinger technique
o Ultrasound
o ECHO – TTE and TOE
16
PERSON SPECIFICATION
Job Title:
Junior Clinical Fellow (CT1-2 level) Cardiology
Department:
Cardiology
Date:
February 2017
CRITERIA
D/E
Assessed by
E
D
A/I
A/I
E
E
A/I
A/I
E
E
E
E
E
E
E
E
A/I
A/I
A/I
A/I
A/I
A/I
A/I
Up to date and fit to practice safely
E
A/I/R
Meets professional health requirements (in line with GMC standards/Good
Medical Practice)
E
A/I
E
D
A/I
E
A
QUALIFICATIONS


MRCP 1
MRCP (PACES)
ELIGIBILITY










Eligible for full or limited registration with the GMC at time of appointment
Evidence of achievement of Foundation competencies by time of appointment
in line with GMC standards/Good Medical Practice including:
Good clinical care
Maintaining good medical practice
Good relationships and communication with patients
Good working relationships with colleagues
Good teaching and training
Professional behaviour and probity
Delivery of good acute clinical care
Eligibility to work in the UK
FITNESS TO PRACTISE

HEALTH

CAREER PROGRESSION

Ability to provide complete details of employment history At least 6 months’
experience (at SHO level) in Cardiology (not including Foundation modules)
APPLICATION COMPLETION

ALL sections of application form FULLY completed according to written
guidelines
EXPERIENCE
17


Informal teaching experience
Formal teaching experience
E
D
A/I
A/I
E
A/I
D
A/I
E
A/I
E
A/I
D
A/I
D
D
A/I
A/I
KNOWLEDGE


Knowledge of the basic educational principles and their applications within
clinical settings
Good understanding of current issues and challenges within medical education
CLINICAL SKILLS

Technical Knowledge & Clinical Expertise: Capacity to apply sound clinical
knowledge & judgment & prioritise clinical need. Demonstrates appropriate
technical competence & evidence of development of excellent diagnostic skills
& judgement
ACADEMIC / RESEARCH SKILLS




Research Skills: Demonstrates understanding of the basic principles of audit,
clinical risk management & evidence-based practice. Understanding of
research basic research principles, methodology & ethics, with potential to
contribute to research
Evidence of relevant academic & research achievements, e.g. degrees, prizes,
awards, distinctions, publications, presentations, other achievements
Evidence of active participation in audit
Evidence of participation in risk management and/or clinical/laboratory
research
PERSONAL SKILLS










.
Judgement under Pressure: Capacity to operate effectively under pressure &
remain objective in highly emotive/pressurised situations. Awareness of own
limitations & when to ask for help
Communication Skills: Capacity to communicate effectively & sensitively with
others, able to discuss treatment options with patients in a way they can
understand
Problem Solving: Capacity to think beyond the obvious, with analytical and
flexible mind. Capacity to bring a range of approaches to problem solving
Situation Awareness: Capacity to monitor and anticipate situations that may
change rapidly
Decision Making: Demonstrates effective judgement and decision-making skills
Organisation & Planning: Capacity to manage time and prioritise workload,
balance urgent & important demands, follows instructions.
Enthusiasm for medical education and training
Teaching and training skills
Critical appraisal skills
Presentation or papers.
18
E
A/I/R
E
A/I/R
E
A/I/R
E
E
A/I/R
A/I/R
E
A/I/R
E
D
D
A/I/R
A/I/R
A/I/R
D
D
A/I/R
A/I/R
E
A/I/R
PROBITY

Professional Integrity: Takes responsibility for own actions, demonstrates
respect for the rights of all. Demonstrates awareness of ethical principles,
safety, confidentiality & consent. Awareness of importance of being the
patients’ advocate, clinical governance & responsibilities of an NHS employee
Key: E = Essential D = Desirable A = Application I = Interview R = References
19
JOB DESCRIPTION
Post:
Junior Clinical Fellow (CT1-3 level) in Cardiothoracic Medicine incorporating Medical
Simulation and Education
Location:
This is a bank assignment and the main base will be at Harefield Hospital. The post holder
may also be required to work at our Royal Brompton site on an intermittent basis, or more
regularly in due course by mutual arrangement. Additionally, the post holder may be
required to work at any of the trusts sites and any associated sites as required.
Educational Duties of both Posts - Medical Simulation and Education
This is a fixed term post for 6 months in the first instance, extendable by mutual consent for
those interested in developing a career in cardiothoracic medicine and an interest in medical
simulation and education. The trainee would be expected to have two days a week
dedicated to staff training and medical simulation projects, with three days a week clinical
service commitment to either the cardiology or the transplant medicine services with a 1 in
6 on-call commitment.
The aim of the fellowship position is to enable the Fellow, by the end of twelve months:
 To function independently as a medical simulation and education instructor.
 To have gained clinical experience in cardiothoracic medicine relevant to higher
medical training
 To have developed an understanding of how simulation training can be used to
reduce clinical risk.
Harefield Hospital STaR Centre www.rbht.nhs.uk/healthprofessionals/education/star-centre
Medical education in the clinical setting is ad-hoc in nature, relying on random exposure to a
variety of healthcare problems. Currently, in order to gain experience and become
independent health care professionals, doctors and nurses manage patients with close
supervision from senior staff.
Medical simulation allows the use of high fidelity human patient simulators where real time
evolving clinical situations can be simulated and managed by the appropriate health-care
team. Scenarios can be replayed at will and no actual patient harm can occur, thus allowing
less experienced health care professionals the opportunity to lead in the management of
cases. As well as concrete experience of common medical conditions, medical simulation
can provide exposure to important rare and potentially life threatening conditions.
As well as the specific clinical skills and knowledge required to manage a simulated case, the
impact of individual and team behaviours on the effective management of medical crises can
be explored, facilitated by video assisted debriefing of the scenarios. The debrief is an
20
essential part of the educational experience, facilitating constructive critique and reflection
on the management of the case.
Clinical Duties and Responsibilities – Junior Clinical Fellow in Transplant Post
The Transplant trainees work includes pre-operative assessment of patients with cardiac
respiratory disease who are referred for transplantation. Trainees are involved in the
medical management of patients both before and after transplant in the Intensive Care Unit
and on the general ward. The post provides experience in the management of acute
cardiovascular and respiratory problems together with the management of
immunosuppression and it’s complications including the treatment of opportunistic
infections. There is the opportunity to gain experience with renal replacement therapy.
The Heart Failure service deals with the medical care of patients with heart failure,
assessment for transplantation and alternative therapies such as mechanical circulatory
support with left ventricular assist devices
Transplant medical staff must be familiar with the medical condition of all in-patients within
the unit and take part in ward rounds with the Registrars and Consultants as appropriate. It
is important to ensure good communications with Medical colleagues in other departments
particularly Cardiology and Anaesthesia and with paramedical personnel. The inpatients’
records must be kept up to date. Any significant deterioration in a patient’s condition must
be reported to one of the Transplant Consultants.
The medical team are responsible for maintaining close links with the patients referring
hospitals and GPs including the arrangement of satisfactory follow-up for patients following
discharge since the majority of patients undergo “shared care” with their referring hospital
and family physician.
They are also responsible for keeping the patients notes up to date and the prompt
compilation of discharge summaries and out patients letters. They are also responsible for
keeping the referring physician informed about the progress of patients who undergo
prolonged hospitalisation. The family doctor must be contacted promptly in the event of a
patient’s death.
The transplant unit and the hospital have an active Postgraduate Teaching Programme. The
transplant SHOs are expected to attend these meetings and take an active part in them
including the presentation of clinical cases.
In addition, the unit has its own Medical Audit Programme and all junior medical staff are
required to participate in the audit process.
There may be opportunities for a suitable candidate to become involved in one of the ongoing research projects within the unit.
The on-call rota is a full shift system shared with the Core Medical Trainees working in
Cardiology.
21
Clinical Duties and Responsibilities – Junior Clinical Fellow in Cardiology Post
The appointee is expected to undertake the admission and day to day care of cardiology
patients. This includes a number of patients admitted for short term investigation and also
patients requiring longer term treatment. Emergency cases are regularly admitted and
there are a number of cases requiring assessment for cardiac or heart/lung transplantation.
The appointee is expected to attend regular cardiac clinics and appropriate ward rounds.
Some experience may be gained in all aspects of non-invasive cardiac investigations and
supervision at a regular exercise testing session is expected. In addition, some experience in
assisting at cardiac catheters and insertion of pacemakers may be obtained.
He/she is expected to maintain good professional liaison with colleagues, nursing, paramedical and administrative staff.
The rota is a partial shift working pattern which may be subject to change. Additionally there
is resident on-call cover at SHO level.
A cardiac arrest bleep is always carried by the SHO on call.
SHO’s are expected to provide cover for the absence of their colleagues during annual and
study leave
Educational opportunities
There are weekly clinical meetings in Cardiology and Transplant medicine with educational
opportunities including: weekly interventional cardiology meeting, weekly imaging meeting
and a weekly joint cardiology and cardiothoracic surgery meeting, all held at Harefield
Hospital. In addition there is one protected, consultant teaching seminar per week. There
are compulsory monthly audit, morbidity and mortality meetings for all staff. We have a
state of the art simulation centre where all trainees will be encouraged to develop clinical
and practical skills including procedural and emergency scenarios.
Expected outcomes
The successful candidate will be provided with training in the use of simulation equipment
and will be encouraged to develop their teaching skills. They will be expected to identify
through critical incident review with the risk management team where simulation education
may improve patient safety for the future. The position will involve developing educational
programmes incorporating medical simulation. The Fellow will be expected to maintain a
learning portfolio reflecting upon their progress through the fellowship.
22
PERSON SPECIFICATION
Job Title:
Junior Clinical Fellow (CT1-3 level) in Cardiothoracic Medicine incorporating
Medical Simulation and Education
Department:
Transplant
Date:
February 2017
CRITERIA
D/E
Assessed by
Full registration with GMC
E
A
MRCP Part 1
E
A
MRCP
D
A
Informal teaching experience
E
A/I
Formal teaching experience
D
A/I
Current NHS Experience
D
A/I
Knowledge of the basic educational principles and their applications within clinical
settings
E
A/I
Good understanding of current issues and challenges within medical education
D
A/I
Teaching and training
D
A/I/R
Critical appraisal skills
D
A/I/R
Presentation or papers
D
A/I/R
Excellent networking abilities
E
A/R
Enthusiasm for medical education and training
E
A/R
Good communication skills
E
A/R
Qualifications / Training
Experience
Knowledge
Skills and Abilities
Other
Key: E = Essential D = Desirable A = Application I = Interview R = References
23
Conditions of Service
The post is covered by the Terms and Conditions of Service of Hospital Medical and Dental
Staff (England and Wales 2003), the salary will be paid at the appropriate Medical and
Dental pay scale, subject to previous NHS Service.
A London Weighting allowance is payable.
Additional Information
Confidentiality
During the course of your employment you may have access to, see or hear
information of a confidential nature and you are required not to disclose such
information, particularly that relating to patients and staff.
Data Protection
In order to comply with the Data Protection Act 1998 you must not at any time use
personal data held by the Trust for any unauthorised purpose or disclose such as
data to a third party. You must not make any disclosure to any unauthorised person
or use any confidential information relating to the business affairs of the Trust,
unless expressly authorised to do so by the Trust.
Health and safety
You must co-operate with management in discharging its responsibilities under the
Health and Safety at Work Act 1974 and take reasonable health and safety of
yourself and others and ensure the agreed safety procedures are carried out to
maintain a safe environment for patients, employees and visitors.
Diversity
You are at all times required to carry out your responsibilities with due regard to the
Trust’s diversity policy and to ensure that staff receive equal treatment throughout
their employment with the Trust.
Risk management
All staff have a responsibility to report all clinical and non-clinical accidents or
incidents promptly and, when requested, to co-operate with any investigation
undertaken.
Conflict of interests
You may not without the consent of the Trust engage in any outside employment.
In accordance with the Trust’s conflict of interest policy, you must declare to your
manager all private interests, which could potentially result in personal gain as a
consequence of your employment in the Trust. Interests that might appear to be in
conflict should also be declared to your manager.
In addition, the NHS Code of Conduct and Standards of Business Conduct for NHS
Staff (HSG 93/5) requires you to declare all situations where you or a close relative
or associate has a controlling interest in a business (such as a private company,
public organisation or other NHS voluntary organisation) or in any activity which
24
may compete for any NHS contracts to supply goods or services to the Trust. You
must therefore register such interests with the Trust, either on appointment or
subsequently whenever such interests are gained. You should not engage in such
interests without the written consent of the Trust, which will not be unreasonably
withheld. It is your responsibility to ensure that you are not placed in a position that
may give rise to a conflict between your private interest and your NHS duties.
Code of Conduct for Professionally Qualified Staff
All staff are required to work in accordance with their professional group’s code of
conduct (e.g. NMC, GMC, DoH Code of Conduct for Senior Managers).
Criminal Records Bureau
Any applicant who is short-listed for this post will be asked to complete a disclosure
form as the post-holder will be required to have contact with vulnerable adults or
persons under the age of 18. The successful candidate will be subject to a criminal
record check from the Criminal Records Bureau prior to the appointment being
confirmed. The disclosure will include details of cautions, reprimands, and final
warnings, as well as convictions if applicable.
To abide by the Trust’s no-smoking policy
Note:
The above description is not exhaustive, and may be altered to meet the changing needs of
the post and of the directorate. The post holder will be expected to be flexible and to cooperate in accordance with the changing requirements of the directorate and of the Trust.
25
Appendix One
HEALTH CLEARANCE
Applicants invited for interview will be asked to complete a medical questionnaire for
submission to the Trust’s Occupational Health Service.
NB: Medical Staff who will be undertaking clinical work will be required to provide
written Proof of hepatitis B immunisation and antibody status, BCG and rubella
immunisations. In the absence of such evidence the post holder will not be placed
on the payroll or undertake clinical work until the evidence is produced to the
satisfaction of the Trust.
The Trust requires that any doctor or dentist who directs the use of x-rays for procedures
such as cardiac catherisation, pacemaker insertions, orthopaedic procedures, etc, in patient
investigations or administers radioisotopes to patients possesses a certificate as proof of
training in accordance with the “Ionising Radiation (Protection of Persons undergoing
Medical Examination or Treatment) Regulations 1988”, and submits a copy of their
certificate to the Medical Staffing Department. Courses to allow Trust medical staff to
obtain the certificate are available through the Department of Medical Physics, Churchill.
CLINICAL GOVERNANCE
The post-holder will participate in the clinical audit, clinical effectiveness, risk management,
quality improvement and any other clinical governance activities as required by the Trust,
Health Authorities, and external accrediting bodies.
PERSONAL AND PROFESSIONAL DEVELOPMENT
The post-holder will be required to keep himself/herself fully up-to-date with their relevant
area of practice. Professional or study leave will be granted at the discretion of the Trust, in
line with the prevailing Terms and Conditions of Service, to support appropriate study,
postgraduate training activities, relevant CME courses and other appropriate personal
development needs.
MANAGEMENT
The post-holder will be required to work within the Trust’s management policies and
procedures, both statutory and internal, accepting that the resources available to the Trust
are finite and that all changes in clinical practice or workload, or developments requiring
additional resources must have prior agreement With the Trust. He /She will undertake the
administrative duties associated with the care of his/her patients, and the running of his/her
clinical department under the direction of the Clinical Director.
GENERAL
The post-holder will assume a continuing responsibility for the care of patients in his/her
charge and the proper functioning of his/her department.
26
IMPORTANT GENERAL NOTE
The post-holder must take responsible care of his/her own health and safety and any other
personnel who may be affected by his/her omission. Trust policies and regulations must be
followed at all times.
INDEMNITY
Under NHS Indemnity, the Trust will take direct responsibility for costs and damages arising
from medical negligence where it (as employer) is vicariously liable for the acts and
omissions of its medical and dental staff.
Where junior medical staff are involved in the care of private patients in an NHS hospital,
they would normally be doing so as part of their contract. It is advisable that junior doctors
who are involved in work outside his/her employment should have medical defence cover.
This includes Category 2 work, i.e. reports for insurance companies, cremation fees.
All staff will commit to:
 Act with honesty and integrity at all times
 Demonstrate respect for others and value diversity
 Focus on the patient and internal and external customer at all times
 Make an active contribution to developing the service
 Learn from and share experience and knowledge
 Keep others informed of issues of importance and relevance
 Consciously review mistakes and successes to improve performance
 Act as ambassadors for their directorate and the Trust
 Be aware of the impact of their own behaviour on others
 Be discreet and aware of issues requiring confidentiality

In addition, all managers and supervisors will:
 Value and recognise the ideas and contributions of all team members
 Coach individuals and teams to perform to the best of their ability
 Delegate work to develop individuals in their roles and realise their potential
 Give ongoing feedback on performance, and effectively manage poor performance
 Provide support and guidance to all team members
 Encourage their team to achieve work/personal life balance
 Actively listen to comments/challenges and respond constructively
 Lead by example, setting high standards
 Ensure that there are sufficient resources for their team and rebalance priorities
accordingly
 Provide a safe working environment
27