Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
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. 2 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. 3 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 4 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 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 5 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 6 processes for monitoring and improving services, including sections for: 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 7 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. 8 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. 10 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 11 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 12 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. 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