Geriatric Medicine

Rotation Information

Trainees will spend some time in Oxford and the remainder of their training across the other different hospitals. Rotations will be decided annually according to the trainee’s educational requirements. It is envisaged that all trainees will spend some time specifically in general internal medicine either exclusively or as part of their geriatric medicine attachment. The majority of the curriculum is covered at all Trusts.
As a small deanery we know our trainees well, and encourage each to develop their own interest. We are supportive of flexible trainees, aiming to pair them wherever possible to improve both service and training. It is possible to live in one place for the whole training programme, commuting to each Trust.

Trusts

John Radcliffe, Oxford
http://www.ouh.nhs.uk/

The Horton Hospital, Banbury
http://www.ouh.nhs.uk/

Local Community Hospitals

Stoke Mandeville, Aylesbury
http://www.buckshealthcare.nhs.uk/

Wycombe Hospital, High Wycombe
http://www.buckshealthcare.nhs.uk/

Royal Berkshire Hospital, Reading
http://www.royalberkshire.nhs.uk/

Trust Information

There are twelve posts based in Oxford:

– Two posts in acute general medicine, undertaken with a Geriatrician. These posts often involve door to discharge care of patients, including input to ITU.
– Two posts in the Acute Geriatric Wards; these trainees also input to the EMU (admission avoidance) units and specialty clinics and have opportunities to work with the liaison psychiatry team.
– One Orthogeriatric post with opportunities to attend osteoporosis clinics and complete higher level training.
– One Stroke post, in an 18-bedded Acute Stroke Unit; this trainee also attends weekly regional neuroradiology and stroke educational meetings
– Two community posts based in Abingdon and Witney Community Hospitals, where the medical staffing is from Geriatricians. These trainees will input to the locality EMU (admission avoidance) units, and have opportunities to spend time in care homes and with the falls service.
– One Day Hospital post with extensive clinic experience (Multi-disciplinary, General Geriatric, Rapid Assessment, TIA, Falls, Movement Disorders and Memory Clinics).
– One interface posts, allowing experience in the developing area of interface Geriatrics, along with time in a surgical liaison role (where the new peri-operative curriculum will be covered.)
– Two posts at the Horton Hospital, working in General Medicine and General Geriatrics, one post with an emphasis on community experience.

Trainees (apart from those at the Horton and in General Medicine) participate in the Thrombolysis and Geratology on-call rota. More senior trainees have an opportunity to participate in the locality admission avoidance unit rota. Trainees are encouraged to develop their research, governance and management portfolios whilst they are with us. Senior SpRs are encouraged to ‘act up’ before completing their CCT.

Geriatricians in Oxford have an active role in teaching and training Oxford University Medical Students, and trainees are encouraged to get involved. There is an opportunity to develop teaching ability with the Oxford Learning Institute.

There are many research groups working in Oxford, and there are links with several leading to Out of Programme Research opportunities for a number of trainees. Oxford Geriatricians are at the forefront of clinical work in many areas, and we have appointed four new consultants in the last year. It is an exciting and dynamic place to work

Stoke Mandeville Hospital, Aylesbury
Wycombe General Hospital, High Wycombe

Buckinghamshire Healthcare NHS Trust has recently undergone a major reconfiguration that has opened new avenues for training in acute geriatrics, day assessment, ambulatory care and community geriatrics.

Acute Medicine for Older People services are offered out of Stoke Mandeville Hospital which hosts the only A&E, with an acute unselected medical take. There are two MfOP teams with four MfOP Consultants and four trainees.

During their attachment they have the following opportunities:
– Acute Medicine for older people in-patient work
– Acute medical on calls
– Day Hospital
– Neurology clinics
– MfOP Clinics
– PD clinic
– Orthogeriatrics
– Medical Unit Day Assessment Service for a next day assessment of frail older pts. The unit also offers other services such as transfusions, day procedures, lumbar punctures etc.
– Geriatric Liaison Service to provide CGA at the front door
– Old Age Psychiatry, Palliative Care, ITU and Incontinence attachments

Stroke services are based at Wycombe. There is an 8 bedded HASU and 22 bedded ASU. There are two SpRs based in Wycombe. They do their on calls for Stroke (including Thrombolysis) there. The take at Wycombe is for cardiac & Stroke patients only. There is a Cardiac & Stroke Receiving Area (CSRU) run by the two specialties. These two SpRs also get an opportunity to see pts on MuDAS and a Step-Down rehabilitation ward.

There is a newly appointed community & interface geriatrician, with responsibility for 40 beds in Amersham Community hospital. Community training for the SpRs will be incorporated into the timetable soon.

There are six posts in Reading, each lasting six months, during which time the trainees will also take part in the acute general medicine rota. Working within a multidisciplinary team, the trainees will achieve core competencies in Geriatric medicine .There will be an opportunity to consolidate subspecialty experience in Falls, Orthogeriatrics, Movement disorders, Surgical Liaison, Interface and Community Geriatrics, Dementia care, Palliative care and Incontinence management. Trainees will gain experience in Comprehensive Geriatric Assessment by reviewing frail older patients attending the RACOP (Rapid Access Clinic for Older People)

There are two academic Professors within the department. Professor Margot Gosney works part time in the University of Reading and is the Head of School of Medicine at Health Education Thames Valley. She has a research interest in Cancer of older people as well as nutrition.

Professor David Oliver was the outgoing National Clinical Director for Older People and now works part time for the King’s Fund and is president elect of the British Geriatrics Society.

It is envisaged that all trainees working in Reading will undertake research of a sufficient standard to be presented nationally and published in peer reviewed journals

The posts are:

– Burghfield – where trainees will develop skills in General Geriatric Medicine,Rapid Access Clinics, Falls Clinics, General Geriatric Outpatients, continence and GIM
Mortimer – where trainees will have develop skills in General Geriatric Medicine, Rapid Access Clinics, Parkinson ’s disease by attending the Multidisciplinary Movement Disorders Clinic for older people, General Geriatric Outpatients and GIM
– Emmer Green – where trainees will develop skills in General Geriatric Medicine, Rapid Access Clinics and Specialist Dementia Care. They will also have an opportunity to work with the Older People’s Mental Health Liaison team, attend the Dementia Steering group meetings, Rapid Access clinics and GIM
– Orthogeriatrics – where trainees will develop skills in Preoperative assessments in Hip fractures and Care of older patients with Fragility fractures, Osteoporosis management and discharge planning , Rapid Access Clinics and GIM Interface and Community Geriatrics – where trainees will develop skills in doing General Geriatric Medicine, Rapid Access Clinics and GIM
– Surgical Liaison/Oncology – where trainees will be able to apply CGA to two new areas, have experience in oncology and old age, palliative medicine, end of life decision making and surgical liaison. They will be able to apply geriatric medicine principles to optimise older patients for surgery and cancer treatment. They will gain experience in the coordination of cancer care including liaison with the voluntary sector.