West Midlands Hospitals Training Summary

Birmingham Heartlands and Solihull NHS Trust (Heartlands Site)

Number of registrars: 3 (+1 flexible trainee 80% currently)
Number of geriatric medicine consultants: 6

Core specialty training opportunities:
Stroke medicine, Psychiatry, Orthogeriatrics, Day Hospital, General rehabilitation, Continence training.

General medicine commitment:
1 in 8 with prospective cover shared by three registrars. (3 and 4 night shifts)
One third of the placement spent supervising a general medicine firm.

Pros:
Supportive consultants, good exposure to geriatric core specialties,
Less general medicine than many placements.

Cons:
Busy though infrequent general medicine on-calls

Summary:
A typical big Birmingham teaching hospital where a wide range of core specialties are available but with the flipside being a heavy general medicine commitment. Heartlands Hospital has the heaviest medical on-call (in numbers of patients) of any Birmingham Hospital. Whether you count this as a ‘pro’ or a ‘con’ depends on your interest in general medicine. Probably suits trainees at any stage of their rotation.

Sandwell and West Birmingham NHS Trust: City Hospital Site

Number of registrars: 2
Number of geriatric medicine consultants: 4 + 1 (including a dedicated intermediate care physician)

Core specialty training opportunities:
Dr Ritch / Head of Dept: Parkinson Disease and rehabilitation
Dr Simons : Orthogeriatrics / Falls / Day Hospital
Dr Sarkar : Orthogeriatrics / Falls / Heart failure / Day Hospital
Dr Kausar : Stroke and rehabilitation
Dr Hutchinson : Intermediate care

General medicine commitment:
On call: 1 in 11 (will be better soon) but currently band 2B with prospective cover

Pros:
Own office with personal computer
You do not carry the RMO bleep
Very good junior staff
Good ITU and cardiology support
Day hospital
Effective medical staffing department
Supportive consultants
On-site gym (I think this is a con not a pro but that’s just me)
Good access to City Centre and Broad St.
Good parking

Cons:
Extremely busy but challenging on calls and you also cover referrals from other specialties
A week of night shifts about every 2 months
A 3 day weekend day on call i.e. Fri - Sun
MAU is not as highly developed as in some hospitals
Medical care now ward based

Summary:
Once again the big Birmingham hospitals show their advantages; good, wide ranging experience in both general and geriatric medicine as well as their disadvantage; hugely busy on-calls with little time to think. You would miss out if one of these larger hospitals was not on your rotation somewhere, I’ll leave it to you to decide when, as it would probably suit an SpR not about to embark on the MSc or start a family etc. Interesting to note that City Hospital gets credit for a couple of things that few other hospitals ever do: Medical staffing and parking. Both much more important than they might seem at first.

George Elliot Hospital: Nuneaton

Number of registrars: 1
Number of geriatric medicine consultants: 0.6 (2 vacant posts)

Core specialty training opportunities:
None

General medicine commitment:
1 in 5 with no prospective cover (1 in 10 week ends)
No nights on-call

Pros:
Friendly staff
No difficulties in arranging study / annual leave
Good for general internal medicine training
No nights

Cons:
Band 2B
SpR supervises FY2 on call
Clerking patients whilst on-call
Little opportunity to do individual post take round
Can be difficult to attend post take with consultant

Summary:
This seems to be a hospital which is ideal for someone in their first year of SpR training. Useful to learn how to be a registrar first and worry about your specialty in your next three placements. Clearly there are some concerns with the current lack of geriatricians currently in post. I have no knowledge whether this is an ongoing or short term problem. The attraction of no nights, if this continues, could clearly suit you at a particular time in your training.

Good Hope Hospital: Sutton Coldfield

Consultants:
Elizabeth Smith: General, geriatric medicine and stroke
Rafik Henry: General, geriatric medicine and stroke
Sandie Ballantyne: Intermediate care and Parkinson's disease
Helen Chamberlain: Intermediate care and falls
Shah Vaquas: General rehabilitation and orthogeriatrics
Jamil Atiea: Diabetes and General Rehabilitation

All of the consultants are very nice and supportive, in fact all the medical consultants in Good Hope are very approachable and treat their registrars very well.

During the on-calls they treat you a senior member of the team. You get to lead the post take ward round especially after the night on-call and they make sure you leave on time. A week of nights is not too bad when you leave on time at 9 am each day.

On-call commitment:
1 in 12 week of nights
1 in 12 Friday weekends
1 in about every 2 or 3 weeks week day

During the day takes there are 2 SHOs, a house officer and a clinical nurse specialist who will bleep you when she finished clerking a patient.

You are mostly supervising the team and taking referrals from the surgical specialties.

During the night on-call there is a HO and SHO, you get to sleep most nights for at least 4 hours.

You start the post take ward round at 7 am and the consultant joins in at 8 am and you leave 9 am.

Specialty training:
Acute Stroke in ward 8 (no thrombolysis) with Dr. Smith and Dr. Henry
Stroke Rehabilitation in stroke unit
Parkinson's disease with Dr. Ballantyne
Falls with Dr. Chamberlain
Intermediate care with Dr. Chamberlain and Dr. Ballantyne
Orthogeriatrics with Dr. Vaquas

There is also an opportunity to do psychogeriatrics or palliative care.
There is no incontinence training.
They are very good in accommodating your training needs.

Summary:
Big hospitals and large departments once again show their strength. Recent consultant appointments and expansion of the service has improved the training opportunities. The SpRs in post were clearly being treated as registrars rather than senior SHOs as should be the case in all placements but is often not. Would likely suit trainees of any experience from 1st to 5th year. There were few ‘cons’ described by those currently in post so either Good Hope is really good or the trainees are just really polite. We look forward to the review from the next rotation.

Hereford County Hospital

Consultants:
Dr Dalziel: Intermediate care and age care
Dr Byatt: General internal medicine and age care
Dr Jenkins: General internal medicine and stroke medicine
Dr Wales: General internal medicine and age care

Specialist registrars:
Two SpRs and one staff grade

Geriatric medicine training opportunities:
Particularly good for stroke as well as general and geriatric medicine
Continence
Rehabilitation

General medical training:
Equates to approximately a one in seven
Full shift
Week of nights

Pros:
Friendly
Good exposure to stroke medicine and intermediate care
Good general medical exposure

Cons:
Difficult to swap on calls
Over fifty miles traveling to attend Birmingham training days

Trainees’ other comments:
Small, friendly hospital in a beautiful part of the English countryside.
Plenty of rural activities, restaurants and pubs to explore.

Summary:
A typical smaller DGH with all the benefits and difficulties that brings. Often these smaller DGH placements would suit a registrar looking for a 1st or 2nd placement rather than someone approaching their CCT.

Royal Shrewsbury Hospital

Consultants: 2 full time and 2 part time.
Registrars: 1, may get a flexible trainee in future.

Geriatric medicine opportunities:
Stroke and general rehabilitation, day hospital, community hospital.

General medicine:
Good exposure to general medicine, 1:8 acute medicine on calls, full shift rota.
There are 8 registrars to support the whole hospital with week of night shifts and weekends which run from Friday to Sunday.

Pros:
Very supportive consultants
Smaller hospital with friendly staff
On-calls are not too onerous

Cons:
Difficult to swap on-calls due to few middle grade staff
Relative lack of junior staff in own firm

Summary:
Once again a typical smaller DGH with all the benefits and difficulties that brings. Often these smaller DGH placements would suit a registrar looking for a 1st or 2nd placement rather than someone approaching their CCT.

Russell’s Hall Hospital

Consultants:
Dr. Banerjee - Stroke and cardiovascular disease in the elderly
Dr. Mandal - Stroke and rehabilitation
Dr. Stellman - Rehabilitation, stroke but based at Wordesley Hospital

1 SpR and 1 clinical fellow

Geriatric medicine training:
Good for stroke, general, psychogeriatrics, palliative care and continence.
Rehabilitation potential extensive but currently on different site to main hospital

General Medicine training:
On call very busy - up to 70 + patients sometimes
On-call with week of nights (1 in 8)
3 MAU consultants

Pros:
Good general medicine exposure
Opportunity for interested SpRs to learn echocardiography including saline bubble ECHOs

Cons:
No orthogeriatric or falls service
Spread over 3 sites but will be coming together soon at RHH.
Lot of building work currently

Summary:
A mid-sized hospital which is currently in a state of flux whilst three sites become one. Great potential once all services are based at Russell’s Hall site due 2005/6. Meanwhile, it is strongly recommended that SpRs have their own car or other suitable transport. Corbett hospital is 5 miles from Russell’s Hall Hospital. Would probably suit a trainee nearer the beginning of their rotation rather than someone approaching their final year.

Sandwell and West Birmingham NHS Trust: Sandwell site

Geriatric medicine consultants: 4
Number of registrars: 2

Core specialty training opportunities:
Stroke medicine, Orthogeriatrics, Parkinson Disease.
Community Medicine and Rehabilitation at Rowley Regis Hospital.
Psychogeriatric placements available if needed.

General medicine commitment:
1 in 11 with prospective cover

Pros:
Very friendly place with very supportive geriatricians (trained locally)
You can get time off for MSc or writing papers or personal work.
Ward based system.

Cons:
None

Summary:
To those who have only worked in large cumbersome teaching hospitals, which without doubt have their role in training, Sandwell Hospital will introduce you to the advantages of smaller DGHs. Friendly hospital with excellent staff and there are still many opportunities to learn some of the core geriatric medicine specialties to fill up your RITA folder. The general medicine on-call commitment has recently fallen to that specified above, turning this placement from one perhaps more suitable for a 1st or 2nd year SpR to one that will suit all trainees.

University Hospital Birmingham: Selly Oak Site

Consultants:
Dr. Main - Geriatric medicine, fraility
Dr. Dunstan - Geriatric medicine, Parkinson's disease, continuing care
Dr. Goodman- Geriatric medicine, orthogeriatrics, clinical lead
Dr. Turnbull - Geriatric medicine, intermediate care, medical education
Dr. Treml - Geriatric medicine, orthogeriatrics, falls
Dr. Sims - Geriatric medicine, stroke
Dr. Tandon - Geriatric medicine, orthogeriatrics

4 SpRs (including the Irish exchange programme SpR from Corke as agreed with Jed Rowe)

Main site is Selly Oak Hospital plus an average of 2 sessions in a community hospital; either Moseley Hall or West Heath (divided between the 4 SpRs)

Geriatric medicine training opportunities:
General rehab, stroke, orthogeriatrics, falls, palliative and continuing care (in the Sheldon Unit), and old age psychiatry (through attachment at the Queen Elizabeth Psychiatric Hospital)

General medicine:
On-call 1 in 12 full shift (on average) plus weekend as second on SpR every couple of months

Pros:
A lot of exposure to geriatric medicine, involvement in community hospitals is not available in many other attachments, consultants are all are very supportive

Cons:
Very busy medical take but has improved due to the appointment of 2 new acute medical SpRs

Summary:
A large Birmingham Hospital with all the benefits and hard work that brings. A particular attraction will always be the community hospital, a luxury unavailable in most centres. Centrally located, a good all round placement and likely to suit new and experienced trainees, though it may be slightly better suited to someone at the end of their training.

University Hospital of North Staffordshire

Consultants
Professor Crome (Head of Academic department, and specialty is Dementia)
Dr Christine Roffe (stroke)
Dr Barnabas Panayiotou (General Geriatrics and Community rehab)
Dr Patel (Parkinson's disease)
Dr Murugasu (falls)
Dr Browne (general geriatrics and some orthogeriatrics)
Dr Amit Arora (stroke)
Dr Vreeburg (stroke)
and 2 locum consultants

Specialist registrars
Should be 5 with a 6th planned - currently only 4 in post

Core training:
Psycho-geriatrics placements/memory clinic
Continence (urology / gynecology clinics)
Stroke acute and rehab
Community hospitals - rehabilitation, intermediate care, respite, continuing care
Opportunities for domiciliary visits
MSc - well supported both practically and financially
Potential for primary care placement

Trainees’ comments:
What is especially good is the training you get in Stroke medicine with Dr Roffe when you work at the stroke unit, and looking after patients in the rehabilitation ward at Bucknall hospital. Also the involvement in active stroke research in IST3 trial, PROFESS study, COSSACS study, CLOTS study, and oxygen studies in stroke. The department here is active in terms of encouraging registrars to write and publish articles.

There is also excellent training in Dementia when you do the memory clinic with Professor Crome as well as looking after his patients in a nearby continuing care hospital Bradwell hospital.

Cons:
Very busy medical on calls
15 SpRs on rota but covers 2 day shifts + 1 night, i.e essentially 1:5(incl w/e)
Nights split into Monday-Thursday and Friday-Saturday
Location of Stoke for attending training days or other activities

A word of caution is that you may be allocated to one of the other consultant geriatricians and not end up working for Dr. Roffe or Prof. Crome, if that is what you want. So clarify your requirement at the beginning, unless you wish to stay in Stoke for two placements when you can do Stroke and Dementia with Dr. Roffe and Prof. Crome, as well as working with the other consultants in your second placement.

Summary:
Stoke is excellent especially for stroke medicine, dementia and research due to the presence of a large academic department. Due to the size of the hospital the general medicine commitment is heavy and the location of Stoke an hour to the North of the Birmingham training days may put some trainees off.

Warwick Hospital

Consultant:
Dr Joseph Ngeh the Stroke Physician is a very modern stroke consultant. There is an active Stroke Unit which follows a very strict Evidence Based Medicine protocol.

Stroke Unit:
Weekly CT-Scan and MRI training forall staff who work in the Stroke Unit. This is very useful as you are trained in the interpretation of the scans. A new neuroradiologist has been appointed who has a keen interest in teaching.

There is ample opportunity to do audits in stroke medicine and also research. You are more than welcome to get involved in the management aspect of running this unit which probably will help you as a Consultant.

Pros:
Ample time to do your research or MSc.
The on-call is adequately busy and you can function as a proper registrar. If you are in the final year then the post-take round can be your show. The consultants are very rationale and respect your views.
Clinics they are not rushed and you get enough time to sort things out.
Rota is 12 hour shift and nights are not busy. You manage to get a good 4-5 hours sleep.
Sub-speciality training in cardiology and diabetes is available.
Continence and palliative care placements are educational.

Cons:
Annual leave has become prospective cover but since there are not enough SPRs it is not very easy to organise.
Few specialist clinics.

Summary:
Warwick sounds excellent for budding stroke physicians thanks to Dr. Ngeh’s enthusiasm. Otherwise Warwick hospital is a reasonably typical DGH but there are many training opportunities in core geriatric medicine specialties for those who wish them. Night shifts certainly seem less busy than many other hospitals. Would likely suit registrars of any experience, though may suit a final year SpR who is keen to train with stroke medicine as their major interest.

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