F1 Placement Descriptions - Foundation

Employer information

You will be working in the Brunel building, one of Europe’s leading hospitals and will be at the centre of the redeveloped Southmead Hospital Bristol site, serving a community of over 500,000 people.

The Brunel building is home to almost all of our specialist teams formerly based at Frenchay Hospital and in the old Southmead buildings. These include regional centres such as Neurosurgery, Renal (Kidney), Orthopaedics, Plastics and Adult Burns plus, the Emergency Department (A&E).

The Southmead Hospital Bristol site also includes our outstanding maternity department and neonatal intensive care unit (NICU), the brand new Bristol Breast Care Centre, clinical research teams and Severn Pathology.

In addition the Trust is in the process of applying for Foundation Trust status.

Psychiatry and GP Placements

North Bristol NHS Foundation Trust, will remain your employer during your psychiatry or GP placement.

Psychiatry placements are with Avon and Wiltshire Mental Health Partnership NHS Trust (AWP), a significant provider of specialist mental health services to adults and older people in: Bath and North East Somerset (BANES), Bristol, North Somerset, South Gloucestershire, Wiltshire and Swindon.

They provide specialist drug and alcohol services and specialist and secure mental health services including prison mental health services, to people living across a wider area.

Increasingly AWP provide treatment and care in people’s own homes and other community settings, reflecting the preferences of our service users. AWPs community services are supported by high quality inpatient services that provide short term assessment, treatment and care.

F1 Placement Descriptions

Information on the placements that make up the F1 rotations at North Bristol NHS Trust. Click on the specialty to learn more.

F1 Acute internal medicine

Placement	F1 Acute internal medicine, AMU Southmead Hospital
The department	Acute Medicine
The type of work to expect and learning opportunities	To ensure that your documentation in the medical notes is thorough, accurate and legible Patients under Acute Medicine will have daily Consultant or Registrar ward rounds with Consultant support providing plenty of learning opportunities. You will also have the opportunity to conduct ward rounds on your own with senior support available as necessary. Much of your time will be spent liaising with other specialties, including radiology, to ensure that each patient’s care is managed smoothly. Sometimes there is a rapid turnover of patients. There are ample opportunities therefore to develop skills in safe and efficient handover, particularly with regards to discharge documentation. From time to time you will have the opportunity to assess and manage acutely unwell patients on the ward under appropriate supervision Supervised procedures (lumbar puncture, paracentesis), New patient clerking when on call, High dependency patient management including BiPAP, Discharge planning experience, handover.
Where the placement is based	AMU, Gate 31, Level 0, Brunel building, Southmead hospital.
Clinical Supervisor(s) for the placement	Drs John Ho, Madhu Wickremaratchi, Sam Patel, Kiaran Flanagan, Ishita Dasgupta, Louise Powter, Nigel Lane, Ella Chaudhuri, Fran Neuberger.
Main duties of the placement	To ensure the safe clinical management of each patient under your care (with senior support) To carry out jobs from the ward round and liaise with other specialties (including radiology) as necessary To ensure discharge documentation is complete and accurate To review patients when asked to by nursing staff
Typical working pattern in this placement	Normal weekday 08:00hrs – 16:00hrs 08:00 Morning meeting 09:30 Morning Board Round 14:30 Short Stay Medicine Board Round 16:00 End of day and handover Teaching in Acute Medicine every Monday 13:30 – 14:30hrs Monthly Clinical Governance meetings Foundation teaching as per timetable. On call days, nights and weekends as per on call rota.

It is important to note that this description is a typical example of your placement and may be subject to change.

F1 Cardiology

Placement	F1 Cardiology Southmead Hospital
The department	The department of cardiology has 6 Consultant Cardiologists. There is a catheter laboratory where diagnostic angiography, angioplasty and pacing procedures are carried out. We have a cardiac investigations unit for non-invasive tests such as echocardiography, ECG monitoring, exercise stress testing, CT coronary angiography and myocardial perfusion imaging.
The type of work to expect and learning opportunities	All Foundation Doctors in hospital posts will generally be ward based during the ‘normal’ working day and expected to deliver the daily medical care of all the patients on their ward irrespective of specialty. Whilst on-call in the acute admissions unit, the F1 will be involved with the generic clerking of patients being admitted and the ongoing care of the patients in the unit. The overall educational objectives of the F1 year are to provide the trainee with the knowledge, skills and attitudes to be able to: Take a history and examine a patient Formulate a differential diagnosis Prescribe safely Keep an accurate and relevant medical record Manage time and clinical priorities effectively Communicate effectively with patients, relatives and colleagues Use evidence, guidelines and audit to benefit patient care Act in a professional manner at all times Cope with ethical and legal issues which occur during the management of patients with general medical problems Educate patients effectively Become life-long learners and teachers.
Where the placement is based	Ward 27A Brunel building and occasional outliers on wards 7a and 7b, Southmead Hospital, Bristol
Clinical Supervisor(s) for the placement	Dr Shahid Aziz, Dr Andrew Skyrme Jones, Dr Paul Walker, Dr Phil Boreham, Dr Ben Farrow and Dr Mark Papouchado.
Main duties of the placement	The F1 doctor is responsible with other staff for the ward care of patients and the maintenance of the patient’s medical record. They are expected to attend the structured teaching programmes provided by the department and grand rounds.
Typical working pattern in this placement	Mainly ward based from 9am-5pm, apart from on-call duties.

It is important to note that this description is a typical example of your placement and may be subject to change.

F1 Dermatology

Placement	F1 Dermatology Southmead Hospital
The department	The Dermatology Department is within the Surgical Directorate. We work closely with Plastic Surgery to improve skin cancer patient pathways. Dermatology clinics are run in a dedicated area of outpatients in the Brunel building at Southmead Hospital and also run at Cossham Hospital, Kingswood. The work of the Dermatology Department includes: General Dermatology Clinics Skin Cancer Clinics and surgery Acute Ward Referrals Tele-dermatology Biologic clinic for Eczema Complex patient clinic (commissioned by UHBW) Nurse-led drug monitoring and inflammatory disease clinics Specialist Skin Cancer Multidisciplinary Meeting Undergraduate teaching There are close links with the Dermatology Centre at the Bristol Royal Infirmary (BRI), part of University Hospital Bristol and Weston NHS Foundation Trust (UHBW). Patients requiring complex biological treatments for psoriasis and patch testing are referred to the BRI for treatment. There are links with community specialist nurses for management of inflammatory skin disease. In addition, there is a Mohs’ micrographic surgery service supported by 3 part-time Mohs surgeons from UHBW. Our clinical team includes 4 Consultant Dermatologists, 1 Associate Specialist, 1 Specialty Doctor, 2 specialist nurses and 3 juniors employed at the trust.
The type of work to expect and learning opportunities	Our current junior team includes a one-year rotating dermatology trainee (NTN), a clinical fellow, and a GP doctor in training. The type of work is mainly outpatient based and includes outpatient clinics, minor procedures and reviewing inpatients referred via ‘careflow’ IT system at NBT. The post holder will see general dermatology and skin cancer patients in clinic. In addition, there will be opportunity to learn minor procedures and learn about sub-specialty areas of dermatology including complex eczema clinics, vulval dermatology, phototherapy, MOHS surgery, laser, and patients with complex needs. The junior team provide an ‘in hours on-call service’ for inpatient reviews using careflow. This is shared out using a ‘careflow rota’. Patient referrals are responded to via careflow and in person reviews. There is close links between Dermatologists across the city, time will also be allocated for the weekly regional combined clinic which is held at the BRI on Thursday afternoons. The post holder will be encouraged to be involved in a QIP project and case reports and to attend clinical governance which is bi-monthly.
Where the placement is based	Brunel Hospital Southmead and Cossham Hospital, Kingwood
Clinical Supervisor(s) for the placement	Dr Helen Audrain, Dr Daniel Keith, Dr Katherine Finucane
Main duties of the placement	The holder of this foundation post will be expected to participate in the oncall rota and see inpatient referrals as well as carry out skin biopsies. Basic surgical training will be provided early on. Senior review is readily available, often on the same day. The post holder will see clinic patients from consultants list and will not have their own clinics. Admin and education time will be allocated to the post holder.
Typical working pattern in this placement	9am-5pm Monday – Friday Monday 9.30am - 10am – On-call planning meeting Thursday 2pm – 5pm – regional education and virtual combined clinic 2^nd Thursday of the month - Departmental meeting

It is important to note that this description is a typical example of your placement and may be subject to change.

F1 Gastroenterology

Placement	F1 Gastroenterology Southmead Hospital
The department	The Dept of Gastroenterology comprises 6 Consultant Gastroenterologists. There are interests in Inflammatory bowel disease, advanced nutrition, small bowel, obscure GI bleeding & hepatobiliary. All general gastroenterology is represented. The department serves the local population of Bristol, South Gloucestershire and North Somerset.
The type of work to expect and learning opportunities	All F1 Doctors will be ward based during the ‘normal’ working day and expected to deliver the daily medical care of all the patients on their ward. Whilst on call for GIM the F1 will be involved with the generic clerking of patients being admitted, presentation to the on call consultant, initiation of their investigations & management and hand over to the next on call or ward based team. The overall educational objectives of the F1 year are to provide the trainee with the knowledge, skills and attitudes to be able to: Take a history and examine a patient Identify and synthesise problems Prescribe safely Keep an accurate and relevant medical record Manage time and clinical priorities effectively Communicate effectively with patients, relatives and colleagues Use evidence, guidelines and audit to benefit patient care Act in a professional manner at all times Cope with ethical and legal issues which occur during the management of patients with general medical problems Educate patients effectively Become life-long learners and teachers.
Where the placement is based	Wards in Brunel building, Southmead Hospital, Bristol
Clinical Supervisor(s) for the placement	Dr Robert Przemioslo, Dr Abid Mohsini, Dr Talal Valliani, Dr Melanie Lockett, Dr Peter Marden, Dr Ana Terlevich.
Main duties of the placement	The F1 doctor is responsible with other staff for the ward care of patients and the maintenance of the patient’s medical record. They are expected to attend the teaching programmes provided by the Trust and department. The doctor will be responsible for such other specific clinical duties as allocated by consultants including performing other duties in occasional emergencies and unforeseen circumstances.
Typical working pattern in this placement	Daily: Ward round 1700 Handover Tues: 10.00 GI X-ray meeting 11:00 GI Histology/ Journal club 12:00 IBD MDT Fri: 12.15 Grand round On call requirements: 1 in 9 days and 1 in 18 nights.

It is important to note that this description is a typical example of your placement and may be subject to change.

F1 General Psychiatry (General Adult Inpatient)

Placement	F1 - General Adult Inpatient Psychiatry
The department	Oakwood ward is a mixed sex, acute admission ward with rapid throughput. It is based in Southmead Hospital, Bristol.
The type of work to expect and learning opportunities	General Adult inpatient psychiatry. The F1 doctor will be ward based during the ‘normal’ working day, providing first-line assessment of all inpatients for both physical and psychiatric disorders. The overall educational objectives are to provide the trainee with the knowledge, skills and attitudes to be able to: - Take a history and examine a patient with particular emphasis on mental state examination - Formulate a diagnosis and management plan - Manage clinical problems independently and seek advice where appropriate - Prescribe safely with particular emphasis on psychotropic drugs - Keep accurate and relevant medical records - Manage time and clinical priorities effectively - Communicate effectively with patients, relatives and colleagues - Practice evidence based medicine and use local guidelines in place for the treatment of older adults in the mental health setting - Act in a professional manner at all times - Cope with ethical and legal issues with particular reference to the Mental Health Act and Mental Capacity Act - Manage psychiatric emergencies on call spanning forensic, adult of working age and older adult specialties - Teach medical students formally and informally - Work in a multi-disciplinary setting with particular emphasis on the care planning approach - Gain experience of risk management and become confident in making decisions associated with risk in the psychiatric setting
Where the placement is based	Southmead Hospital, Bristol on Oakwood ward
Clinical Supervisor(s) for the placement	Dr Jacek Kolsut
Main duties of the placement	Trainees will support the day to day administration of admissions and discharges of patients and the coordination of aspects of care while patients are on the ward. The case mix is of psychosis, mood disorders, anxiety disorders and personality disorders with occasional organic problems. You will not be expected to assess patients detained under S 136 of the MHA. Trainees are well supported, with consultant or senior trainee ward rounds three times a week and weekly supervision with Dr Kolsut. Assessment of Medically Ill Patients: Guidance for Foundation trainees. As a Foundation doctor, you may be called on to assess patients who are medically unfit either in the psychiatry in-patient units or possibly in the community. It is important to be aware that psychiatric hospitals do not have facilities to support patients with serious physical health problems and you are not in a position working in these settings to facilitate urgent investigation, or initiate immediate and complex treatment such as IV support, catheterisation. In many respects the support available may even be less than in a standard community setting as there is a lack of access to GP level medical advice. In the event that a patient needs more immediate and complex physical assessment, it is advisable to discuss with a senior psychiatry colleague and it is generally necessary to have these individuals seen in the nearest A&E department. It would of course be helpful if a patient was referred, to discuss the case with the casualty team, while the transfer is being organised. This would normally require an ambulance, which the in-patient team would generally organise. As a Foundation doctor working in psychiatry, you would not normally be expected to initiate complex physical treatments. If you are uncertain about appropriate physical care of an individual, you should always discuss this issue with a senior psychiatry colleague, who may be the local core/advanced trainee in your unit or your consultant or the consultant on-call. It may be useful to contact the specialist team in the general hospital for advice, but where a complex decision is being made this should always be shared with senior colleagues in the psychiatric team, who will be responsible for the treatment while the patient is in a psychiatric hospital. Note that discussion of the physical problems with a more senior psychiatric colleague is not generally to get expert medical advice (bearing in mind that as the psychiatric specialists become more senior their physical medicine skills tend to become out of date), but to bring the concerns to their attention so they can advise on the need to contact local acute medical/surgical services and how best to do this. There is an academic meeting on Tuesday afternoon (journal club and case presentation).
Typical working pattern in this placement*	Monday to Friday 9am to 5pm. *F1 psychiatry trainees will be rostered for twilight and weekend acute medical/surgical on call activity at Southmead Hospital. This will be ~ a 1:12 on call with specific restrictions- i.e. weekend only days to allow Monday work to continue and weekday only twilight shifts 5pm-10pm to allow next day working. This should minimize impact on core psychiatry posts but provide an excellent opportunity for trainees to develop and maintain their acute care skills during psychiatry placements.
Employer information	North Bristol Trust, seconded to Avon and Wiltshire Partnership (AWP) Mental Health NHS Trust.

It is important to note that this description is a typical example of your placement and may be subject to change.

F1 General psychiatry (Neuropsychiatry/ Crisis team)

Placement	F1 Neuropsychiatry/ Crisis team Southmead Hospital.
The department	Split post between in-patient Neuropsychiatry and community crisis Team. Neuropsychiatry (Mon-Wed) 3 days of the post will be based with Dr Dane Rayment Consultant Neuropsychiatrist (and named Clinical Supervisor) working at the Rosa Burden Centre for Neuropsychiatry within the Neurosciences Directorate. It has a multidisciplinary team consisting of 2x Consultant Neuropsychiatrists, a Consultant Neurologist and 2 Specialty Doctors in Psychiatry, working alongside occupational and physiotherapists, and inpatient nursing staff (both general and mental health nursing). The service provides community and inpatient assessment and treatment of patients with an overlap of neurological and psychiatric symptoms as well as neurological sleep disorders. The inpatient unit has 12 beds, 2 of which are for polysomnography studies, and 4 are neurology patients (you do not have clinical responsibility for these). The department also provides Neuropsychiatry input for patients on medical/surgical wards alongside the mental health liaison team. Crisis Team (Thu-Fri) This community post is based with Dr Syed Husain Consultant Psychiatrist, working with the North Bristol Crisis Team. It has a multidisciplinary team consisting of a consultant, core trainee, F1 doctor (this post), experienced nurses, a psychotherapist, occupational therapist, social worker, support workers and a non-medical prescriber who are able to offer a range of therapeutic interventions. The crisis team supports and empowers community patients who require intensive support in the community and are at risk of being admitted to hospital. The team works very closely with North Bristol community mental health teams, Bristol Place of Safety, Mental Health Liaison Teams, and GP surgeries including Student Mental Health Services that supports Bristol university students. We work closely with our local inpatient wards and provide a Facilitated Early Discharge role for the wards.
The type of work to expect and learning opportunities	Neuropsychiatry The unique appeal of this post is the opportunity for specialist training relating to specific neuropsychiatric conditions. Examples include psychiatric symptoms of neurological conditions such as epilepsy, brain tumours, and Parkinson’s disease; functional neurological disorders; dissociative seizures, sleep disorders. This post also offers experience in common conditions such as depression, anxiety, psychosis and personality disorders. The F1 doctor will be ward based during the ‘normal’ working day, providing first-line, but clinically supervised assessment of all inpatients for both physical and psychiatric disorders. There is a weekly MDT ward round. The doctor can also be involved in neuropsychiatry liaison assessments on other hospital wards with close support and supervision. There will be opportunities to observe other outpatient clinic assessments if desired, but the F1 will not be asked to independently assess patients in clinic. There are lots of learning opportunities including neurology and psychiatry postgraduate programmes, and the weekly grand round. Dr Rayment will provide clinical supervision, and is full time at Southmead, usually in the Burden Centre, and is happy to be consulted at any time. There is 24/7 neuropsychiatric on call consultant cover. Crisis Team The F1 will have the opportunity to assess and treat patients presenting with an urgent risk, usually related to an acute mental disorder. Typically this disorder will be of psychosis, mania or depression and the risk behaviour will be of suicide, significant self neglect or harm to others through violence and aggression. The doctor will learn how to engage patients who have limited insight into their disorder. Other conditions will also be seen eg personality disorders and anxiety states, and patients will be of both adult and older adult ages. Appointments will take place predominantly in their own homes, but also at the team base for those willing to attend. Risk assessment and management is an essential part of the job. The F1 doctor will participate in twice daily handovers and weekly acute review. The overall educational objectives are to provide the trainee with the knowledge, skills and attitudes to be able to: meetings (formulation and care planning). All patient contact will be supervised. The doctor will also be able to observe S135 warrant executions in the community and S136 Mental Health Act assessments at the Place of Safety or Accident and Emergency. There will be consultant supervision and Dr Husain is full time at Southmead Hospital. The overall educational objectives are to provide the trainee with the knowledge, skills and attitudes to be able to: Take a history and examine a patient with particular emphasis on mental state examination Formulate a diagnosis and management plan Manage clinical problems independently and seek advice where appropriate Prescribe safely with particular emphasis on psychotropic drugs and their potential interactions in people with concomitant physical health problems Keep accurate and relevant medical records Manage time and clinical priorities effectively Communicate effectively with patients, relatives and colleagues Practice evidence based medicine and use local guidelines in place Act in a professional manner at all times Cope with ethical and legal issues with particular reference to the Mental Health Act and Mental Capacity Act Teach medical students formally and informally Work in a multi-disciplinary setting Gain experience of risk management and become confident in making decisions associated with risk Developing skills in building rapport and a therapeutic relationship Also on the Southmead site are other Psychiatry Advanced and Core Trainees, GPVTS and Foundation trainees on Psychiatry placements, and the post holder would be part of a supportive group of trainee doctors. If the trainee is interested in other aspects of psychiatry, we would aim to support their enthusiasm.
Where the placement is based	The Rosa Burden Centre for Neuropsychiatry, Southmead Hospital, Bristol and Gloucester House, Southmead Hospital, Bristol (Crisis Team)
Clinical Supervisor(s) for the placement	Dr Dane Rayment, Consultant Neuropsychiatrist
Main duties of the placement	Neuropsychiatry The F1’s main responsibility will be responsible for admitting, clerking, reviewing, writing the discharge summaries and TTO’s for the 8 inpatients, some of whom will have complex physical co-morbidity and liaison with other medical teams will be necessary. Attending the weekly ward round on Tuesday a.m. is essential and the F1 takes the main responsibility for documenting the MDT discussion in the medical notes and following up on ward jobs. Cover for this will be provided by the specialty doctor. Though patients may have comorbid physical health problems, and we benefit from the medical expertise of our foundation doctors, we are not a specialist unit for the investigation and treatment of acute physical illness. F1’s would not be expected to manage such conditions independently, and discussions with nursing staff, senior colleagues and medical colleagues may be needed to decide on the appropriate management of patients with unstable or deteriorating physical health conditions. Crisis Team The F1 doctor will be assessing new referrals, which is always done jointly with a senior member of staff. If not taken onto the Crisis Team caseload, then signposting advice to other services will be given. The doctor will also be responsible for reviewing those patients who are taken onto the caseload, particularly those that have medical needs. Diagnosis and treatment will be done under supervision of Dr Husain, as will prescribing of medication. It is not expected they manage the physical health needs of patients as this is generally left to the GP, but occasionally some intervention may be required eg urgent blood taking.
Typical working pattern in this placement	Monday to Friday, 9am to 5pm. (Neuropsychiatry Mon-Wed, Crisis Team (Thu-Fri). No on-call, but some trainees do out of hours acute surgical on calls in addition to their regular working hours. Foundation training is on Tuesday pm at Southmead Hospital. For the first F1 of the year there is an induction week prior to the starting date that consists of half the time at central induction at NBT and half the time shadowing the CT3/ Staff Grade/ F1 at the Neuropsychiatry inpatient unit.
Employer information	Your employer will be North Bristol NHS Foundation Trust, seconded to Avon and Wiltshire Partnership (AWP) Mental Health NHS Trust for the split post which will be with the Crisis Team.

It is important to note that this description is a typical example of your placement and may be subject to change.

F1 General Psychiatry (Liaison)

Placement	F1 Liaison Psychiatry, Southmead Hospital
The department	This post is based with the NBT Mental Health Liaison Team at Southmead Hospital, Bristol. Our team offers mental health input for in the NBT inpatient population at Southmead Hospital. We see people from 16yrs upwards and are subdivided into two teams – - The Emergency Zone team, covering the Emergency Department and Acute Medical Unit. It operates a 7am-10pm service, seven days of the week. - The Inpatient Liaison teams. The F1 doctor will be placed with the Inpatient team. It covers all inpatient wards and operates 9am-5pm, Monday to Friday. The two parts of our team have separate referral pathways and allocation/triage meetings but staff are rotated between the teams on a regular basis, as well as meet regularly for Multi-disciplinary team meetings.
The type of work to expect and learning opportunities	Liaison Psychiatry is an ideal learning environment for the Foundation doctor. It enables the bridging of biomedical learning with bio-psycho-social care, whilst retaining links with allied medical specialties and colleagues within the acute hospital setting. The post will enable the Foundation doctor to gain skills, knowledge and attitudes needed to assess and manage common psychiatric presentations seen in non-psychiatric settings. The foundation doctor will gain experience in: Carrying out specialist assessment informing diagnosis, treatment and management of existing or suspected new mental disorder in patients referred to the team. Assisting in acute hospital in-patient care planning meetings in more complex scenarios, and signposting people with mental health problems and their carers to appropriate community services on discharge. Providing training and education for acute trust colleagues of common mental health problems, with the aim to equip staff with the necessary knowledge and skills to improve the detection and day-to-day management of all people with mental health problems, challenging the negative attitudes of staff towards people with mental disorders. Providing seamless transfer of patients and optimum interfaces between the acute trusts/mental health services based upon rapid electronic and telephone contact between community teams, hospital staff and the liaison service. The nature of the work involves frequently linking patients with community teams, primary care, non-statutory and social services for aftercare. Working across the interface of mental health and the acute hospital will encourage the Foundation Doctor in the development of excellent inter-personal and communication skills, helping collaborative working. The trainee will be based at Donal Early house where they will have access to desk space and computer. There is administrative support Monday-Friday. Educational Supervision will be provided weekly, in addition there will be access to daily clinical supervision by senior healthcare practitioners. There is a weekly psychiatry academic program and regular MHLT MDT. Trainees will be timetabled to attend their Foundation Programme teaching. There is access on site to the library facilities in the Learning and Research Centre. The Foundation doctor will operate within Southmead Hospital during the ‘normal’ working day, providing first-line assessment of inpatients referred to the Liaison service. The overall educational objectives are to provide the trainee with the knowledge, skills and attitudes to be able to: - Take a history and examine a patient with particular emphasis on mental state examination - Formulate a diagnosis and management plan - Manage clinical problems independently and seek advice where appropriate - Prescribe safely with particular emphasis on psychotropic drugs and their potential interactions in people with concomitant physical health problems - Keep accurate and relevant medical records - Manage time and clinical priorities effectively - Communicate effectively with patients, relatives and colleagues - Practice evidence-based medicine, including the use of local guidelines - Act in a professional manner at all times - Cope with ethical and legal issues with particular reference to the Mental Health Act and Mental Capacity Act - Teach medical students formally and informally - Work in a multi-disciplinary setting - Gain experience of risk management and become confident in making decisions associated with risk in the acute hospital setting
Where the placement is based	The team is based at Donal Early House, Southmead Hospital. Clinical duties will be within Southmead Hospital, North Bristol NHS Trust.
Clinical Supervisor(s) for the placement	Dr Sophie Kellman, Consultant Psychiatrist
Main duties of the placement	Your duties will include: Assessment and Management of hospital inpatients who are referred to the Mental Health Liaison Team. To provide a timely response to referrals and efficient communication of assessments/ interventions to the relevant community teams/ referrer using either NBT or AWP Trust’s clinical IT systems. In addition to seeing patients on wards (history-taking, investigation, diagnosis, and management), you will practice preventative medicine, promoting health education, and work closely with other health professionals. To participate in the Audit and Quality Improvement activities of the department. To attend daily team supervision and regular MHLT MDT meetings. Attendance at regular psychiatry academic program and Foundation training. Assessment of Medically Ill Patients: Guidance from Severn Deanery School of Psychiatry for all Foundation doctors working in psychiatry As a Foundation doctor, you may be called on to assess patients who are medically unfit either in the psychiatry in-patient units or possibly in the community. It is important to be aware that psychiatric hospitals do not have facilities to support patients with serious physical health problems and you are not in a position working in these settings to facilitate urgent investigation, or initiate immediate and complex treatment such as IV support, catheterisation. In many respects the support available may even be less than in a standard community setting as there is a lack of access to GP level medical advice. In the event that a patient needs more immediate and complex physical assessment, it is advisable to discuss with a senior psychiatry colleague and it is generally necessary to have these individuals seen in the nearest A&E department. It would of course be helpful if a patient was referred, to discuss the case with the casualty team, while the transfer is being organised. This would normally require an ambulance, which the in-patient team would generally organise. As a Foundation doctor working in psychiatry, you would not normally be expected to initiate complex physical treatments. If you are uncertain about appropriate physical care of an individual, you should always discuss this issue with a senior psychiatry colleague, who may be the local core/advanced trainee in your unit or your consultant or the consultant on-call. It may be useful to contact the specialist team in the general hospital for advice, but where a complex decision is being made this should always be shared with senior colleagues in the psychiatric team, who will be responsible for the treatment while the patient is in a psychiatric hospital. Note that discussion of the physical problems with a more senior psychiatric colleague is not generally to get expert medical advice (bearing in mind that as the psychiatric specialists become more senior their physical medicine skills tend to become out of date), but to bring the concerns to their attention so they can advise on the need to contact local acute medical/surgical services and how best to do this. Foundation training is on Tuesday pm at Southmead Hospital.
Typical working pattern in this placement*	Monday to Friday, 9am to 5pm. F1 psychiatry trainees will be rostered for twilight and weekend acute medical/surgical on call activity at Southmead Hospital. This will be ~ a 1:12 on call with specific restrictions- i.e., weekend only days to allow Monday work to continue and weekday only twilight shifts 5pm-10pm to allow next day working. This should minimize impact on core psychiatry posts but provide an excellent opportunity for trainees to develop and maintain their acute care skills during psychiatry placements.
Employer information	North Bristol Trust, seconded to Avon and Wiltshire Partnership (AWP) Mental Health NHS Trust.

It is important to note that this description is a typical example of your placement and may be subject to change.

F1 General psychiatry (Perinatal and Liaison)

Placement	F1 – Inpatient Perinatal Psychiatry/Liaison Psychiatry, Southmead Hospital
The department	This is a split post, three days based with the Mother and Baby Unit (with Dr. Karl Scheeres) and two days based in the NBT Mental Health Liaison Team (with Dr Sophie Kellman). Both are located on the Southmead Hospital site. The New Horizon Mother and Baby Unit (MBU) is part of AWP Mental Health Trust. The MBU is situated at Southmead Hospital. The service provides inpatient care for women with serious mental illness who require admission in the late stages of pregnancy, and for women and their babies where a psychiatric admission is required during the first postpartum year. The Liaison Service offers mental health input for in the NBT inpatient population at Southmead Hospital. They see people from 16yrs upwards and are subdivided into two teams – the Emergency Zone and Inpatient Liaison teams. The F1 doctor will be placed with the Inpatient team.
The type of work to expect and learning opportunities	The post will provide experience in the care of women with severe perinatal mental illness, where the F1 doctor will be ward based during the working day, providing the first line medical cover to the 4 inpatients on the MBU. The Liaison aspect of the post will enable the Foundation doctor to gain skills, knowledge and attitudes needed to assess and manage common psychiatric presentations seen in non-psychiatric settings. Liaison Psychiatry is an ideal learning environment for the Foundation doctor. It enables the bridging of biomedical learning with bio-psycho-social care, whilst retaining links with allied medical specialties and colleagues within the acute hospital setting. The overall educational objectives of this post are to provide the trainee with the knowledge, skills and attitudes to be able to: Take a history and examine patients with particular emphasis on mental state examination. To gain confidence in physically examining and managing the physical health of pregnant and postpartum women. To gain confidence and experience in managing clinical problems independently, seeking advice where appropriate. Prescribe safely psychotropic and physical health drugs, being aware of: - their side effects and potential risks particularly in pregnant or breastfeeding women. - potential interactions in people with concomitant physical health problems. Keep accurate and relevant medical records. Manage time and clinical priorities effectively. Communicate effectively with patients, relatives and colleagues. Practice evidence-based medicine, including the use of local guidelines. Act in a professional manner at all times. Consider the ethical and legal issues with particular reference to the Mental Health Act and Mental Capacity Act. Teach medical students formally and informally. Work in a multi-disciplinary setting as part of a multidisciplinary team. Gain experience and confidence in risk management, with particular consideration of: - risk to the baby (MBU). - making decisions associated with risk in the acute hospital setting. The MBU also provides the opportunity to learn about the importance of the mother-infant relationship and gain confidence in managing common physical health problems in infants (with appropriate support).
Where the placement is based	- New Horizon Mother and Baby Unit - Donal Early House At Southmead Hospital, Bristol.
Clinical Supervisor(s) for the placement	Dr Karl Scheeres, Consultant Psychiatrist Dr Sophie Kellman, Consultant Psychiatrist
Main duties of the placement	Mother and Baby Unit (MBU) The F1 will be responsible for admitting, clerking, reviewing and facilitating the discharge of MBU inpatients. They will participate in the weekly ward round and management round. Participation in mental health assessments and psychological treatments This post offers many possibilities to take part in psychiatric assessment on the MBU. The doctor will have opportunities to observe how mothers interact with their infants and the impact of maternal mental illness on this interaction. Working with different teams and health professionals, and seeking advice and support There will be opportunities for working with nursing staff, occupational therapy, psychology and nursery nurses. Also on the Southmead site are Psychiatry Higher and Core Trainees, GPVTS and Foundation trainees on Psychiatry placements, and the post holder would be part of a supportive group of trainee doctors. Consultant and Staff Grade are experienced and enthusiastic trainers. The Foundation doctor will be expected to attend weekly supervision meetings. Medical Care of women and infants on the MBU Postpartum women can occasionally become seriously physically unwell and it is important to be able to recognise this and arrange for transfer to the general hospital where required. It is also important to recognise if an infant is acutely unwell and be able to seek advice from paediatric services / arrange transfer where appropriate. The nursing staff on the MBU are very experienced and will be able to advise the F1 in this. Liaison Psychiatry Your duties will include: Assessment and Management of hospital inpatients who are referred to the Mental Health Liaison Team. To provide a timely response to referrals and efficient communication of assessments/ interventions to the relevant community teams/ referrer using either NBT or AWP Trust’s clinical IT systems. In addition to seeing patients on wards (history-taking, investigation, diagnosis, and management), you will practice preventative medicine, promoting health education, and work closely with other health professionals. To participate in the Audit and Quality Improvement activities of the department. To attend daily team supervision and regular MHLT MDT meetings. Attendance at regular psychiatry academic program and Foundation training. Assessment of Medically Ill Patients: Guidance from Severn Deanery School of Psychiatry for all Foundation doctors working in psychiatry As a Foundation doctor, you may be called on to assess patients who are medically unfit either in the psychiatry in-patient units or possibly in the community. It is important to be aware that psychiatric hospitals do not have facilities to support patients with serious physical health problems and you are not in a position working in these settings to facilitate urgent investigation, or initiate immediate and complex treatment such as IV support, catheterisation. In many respects the support available may even be less than in a standard community setting as there is a lack of access to GP level medical advice. In the event that a patient needs more immediate and complex physical assessment, it is advisable to discuss with a senior psychiatry colleague and it is generally necessary to have these individuals seen in the nearest A&E department. It would of course be helpful if a patient was referred, to discuss the case with the casualty team, while the transfer is being organised. This would normally require an ambulance, which the in-patient team would generally organise. As a Foundation doctor working in psychiatry, you would not normally be expected to initiate complex physical treatments. If you are uncertain about appropriate physical care of an individual, you should always discuss this issue with a senior psychiatry colleague, who may be the local core/advanced trainee in your unit or your consultant or the consultant on-call. It may be useful to contact the specialist team in the general hospital for advice, but where a complex decision is being made this should always be shared with senior colleagues in the psychiatric team, who will be responsible for the treatment while the patient is in a psychiatric hospital. Note that discussion of the physical problems with a more senior psychiatric colleague is not generally to get expert medical advice (bearing in mind that as the psychiatric specialists become more senior their physical medicine skills tend to become out of date), but to bring the concerns to their attention so they can advise on the need to contact local acute medical/surgical services and how best to do this. Foundation training is on Tuesday pm at Southmead Hospital.
Typical working pattern in this placement	The role is Monday to Friday, 9am to 5pm. The post will be split as follows: - Monday/Friday – Mental Health Liaison Team, Donal Early House. - Tuesday/Wednesday/Thursday – New Horizons Mother and Baby Unit. F1 psychiatry trainees will be rostered for twilight and weekend acute medical/surgical on call activity at Southmead Hospital. This will be ~ a 1:12 on call with specific restrictions- i.e. weekend only days to allow Monday work to continue and weekday only twilight shifts 5pm-10pm to allow next day working. This should minimize impact on core psychiatry posts but provide an excellent opportunity for trainees to develop and maintain their acute care skills during psychiatry placements.
Employer information	North Bristol Trust, seconded to Avon and Wiltshire Partnership (AWP) Mental Health NHS Trust.

It is important to note that this description is a typical example of your placement and may be subject to change.

F1 General Surgery (Breast Surgery)

Placement	F1 Breast Surgery
The department	Breast Surgery, North Bristol NHS Trust
The type of work to expect and learning opportunities	Exposure to breast surgery from benign to cancer work.
Where the placement is based	Southmead Hospital, Bristol
Clinical Supervisor(s) for the placement	We have a number of consultants who are trained to be Clinical Supervisors including: Miss Mullan, Miss Ainsworth, Miss Dash, Miss Govindarajula and Professor Potter.
Main duties of the placement	The role of an FY1 would be to attend New patient clinics Follow up clinics MDM Monthly audit and M &M Assist in breast theatre, learning basic surgical skills such as suturing and removing breast lumps. Possible opportunity to assist the breast surgeons in breast reconstructions and gain exposure to oncoplastic breast work See emergency breast patients between 0900-1630 Exposure to family history/genetics There would also be the chance to see how a breast service works, and spend time with the CNSs and breast radiology (including breast screening). If the FY1 was interested, we have an active research department, and there are possible research projects to be involved with.
Typical working pattern in this placement	0830- 1700 (to be confirmed) No on call or out of hours work for the breast service

It is important to note that this description is a typical example of your placement and may be subject to change.

F1 General surgery (Colorectal)

Placement	F1 General surgery, Colorectal Southmead Hospital
The department	The Dept of general surgery comprises 19 consultant surgeons including 6 Colorectal surgeons, All colorectal consultants take in part in the acute General surgery on-call. There are interests in benign and malignant colorectal diseases, colorectal laparoscopic surgery, inflammatory bowel disease and pelvic floor surgery. The department covers part of Bristol, North Somerset and South Gloucestershire with a catchment population of 500,000.
The type of work to expect and learning opportunities	F1 Doctors in hospital posts will generally be team based during the ‘normal’ working day and expected to deliver the daily medical care of all surgical patients irrespective of specialty. Whilst on-call the F1 will be involved with the generic clerking of patients being admitted and the ongoing care of the patients in the unit. The overall educational objectives of the F1 year are to provide the trainee with the knowledge, skills and attitudes to be able to: Take a history and examine a patient Identify and synthesise problems Prescribe safely Keep an accurate and relevant medical record Manage time and clinical priorities effectively Communicate effectively with patients, relatives and colleagues Use evidence, guidelines and audit to benefit patient care Act in a professional manner at all times Cope with ethical and legal issues which occur during the management of patients with general medical problems Educate patients effectively Become life-long learners and teachers.
Where the placement is based	Brunel building, Southmead Hospital, Bristol
Clinical Supervisor(s) for the placement	Mr A Roe, Miss A Lyons, Miss A Pullyblank, Mr A Dixon, Miss C Burt, Miss K McCarthy, Mr T Roe
Main duties of the placement	The F1 doctor is responsible with other staff for the team care of patients and the maintenance of the patient’s medical record. They will also take responsibility for problems arising in surgical patients on the ward. They will have the opportunity to attend theatres, They are expected to attend the teaching program provided by the department. The doctor will be responsible for such other specific clinical duties as allocated by consultants including performing other duties in occasional emergencies and unforeseen circumstances.
Typical working pattern in this placement	Daily: 0800 Ward round 1700 Handover 2030 handover ( on-call) Tues am: Upper GI grand round On call requirements: Full shift 1:13 nights, long days, twilight shifts, on-call weekends and ward cover weekends.

It is important to note that this description is a typical example of your placement and may be subject to change.

F1 General Surgery (Endocrine Transplant)

Placement	F1 General surgery (Endocrine Transplant) Southmead Hospital
The department	The Dept of general surgery comprises 19 consultant surgeons including 3 general and transplant surgeons. The general and transplant surgeons take in part in the acute transplant surgery on-call with 3 vascular and transplant surgeons. There are interests in laparoscopic surgery, living kidney donor transplant, vascular access, endocrine and bariatric surgery. The department covers part of Bristol, North Somerset and South Gloucestershire with a catchment population of 500,000. The catchment area for renal transplantation is 2,000,000. The department performs about 100 adult transplants a year.
The type of work to expect and learning opportunities	F1 Doctors in hospital posts will generally be team based during the ‘normal’ working day and expected to deliver the daily medical care of all surgical patients irrespective of specialty. Whilst on-call the F1 will be involved with the generic clerking of surgery patients being admitted and the ongoing care of the patients in the unit. The overall educational objectives of the F1 year are to provide the trainee with the knowledge, skills and attitudes to be able to: Take a history and examine a patient Identify and synthesise problems Prescribe safely Keep an accurate and relevant medical record Manage time and clinical priorities effectively Communicate effectively with patients, relatives and colleagues Use evidence, guidelines and audit to benefit patient care Act in a professional manner at all times Cope with ethical and legal issues which occur during the management of patients with general medical problems Educate patients effectively Become life-long learners and teachers.
Where the placement is based	Wards in Brunel building, Southmead Hospital, Bristol
Clinical Supervisor(s) for the placement	Mr N Kadi, Mr J Morgan, Ms A Edwards
Main duties of the placement	The F1 doctor is responsible with other staff for the team care of patients and the maintenance of the patient’s medical record. They will have opportunity to work with the consultants in theatres and outpatients clinics, and also take responsibility for problems arising in surgical patients on the ward. They are expected to attend the teaching program provided by the department. The doctor will be responsible for such other specific clinical duties as allocated by consultants including performing other duties in occasional emergencies and unforeseen circumstances.
Typical working pattern in this placement	8 am daily ward round On call full shift 1:13 Weekdays 0800-2100 1 in 13 Twilight shifts 1600-2400 1 in 13 Sat 0800 – 2100 1 in 13 Sun 0800 – 2100 1 in 13 On call handover at 2030

It is important to note that this description is a typical example of your placement and may be subject to change.

F1 General Surgery (Upper GI)

Placement	F1 General surgery (Upper GI) Southmead Hospital
The department	The Dept of general surgery comprises 19 consultant surgeons including 4 upper GI surgeons; the upper GI surgeons take in part in the acute general surgery on-call. There are interests in benign upper GI, gallstones surgery, anti-reflux surgery and bariatric surgery. The department covers part of Bristol, North Somerset and South Gloucestershire with a catchment population of 500,000.
The type of work to expect and learning opportunities	F1 Doctors in hospital posts will generally be team based during the ‘normal’ working day and expected to deliver the daily medical care of all surgical patients irrespective of specialty. Whilst on-call the F1 will be involved with the generic clerking of patients being admitted and the ongoing care of the patients in the unit. The overall educational objectives of the F1 year are to provide the trainee with the knowledge, skills and attitudes to be able to: Take a history and examine a patient Identify and synthesise problems Prescribe safely Keep an accurate and relevant medical record Manage time and clinical priorities effectively Communicate effectively with patients, relatives and colleagues Use evidence, guidelines and audit to benefit patient care Act in a professional manner at all times Cope with ethical and legal issues which occur during the management of patients with general medical problems Educate patients effectively Become life-long learners and teachers.
Where the placement is based	Brunel building, Southmead Hospital, Bristol
Clinical Supervisor(s) for the placement	Mr C Wong, Mr J Hewes, Mr A Osbourne, Miss S Norton, Mr D Saunders and Mr Nitin Arvind
Main duties of the placement	The F1 doctor is responsible with other staff for the team care of patients and the maintenance of the patient’s medical record. They will have opportunity to work with the consultants in theatres and outpatients clinics, and also take responsibility for problems arising in surgical patients on the ward. They are expected to attend the teaching program provided by the department. The doctor will be responsible for such other specific clinical duties as allocated by consultants including performing other duties in occasional emergencies and unforeseen circumstances.
Typical working pattern in this placement	Daily: 0800 Ward round 1700 Handover 2030 handover ( on-call) Tues am: Upper GI grand round On call requirements: Full shift 1:13 nights, long days, twilight shifts, on-call weekends and ward cover weekends.

It is important to note that this description is a typical example of your placement and may be subject to change.

F1 Geriatric medicine

Placement	F1 Geriatric medicine
The department	Geriatric medicine is a large department encompassing nearly 200 beds within the Southmead site. There are 20 consultants with general geriatric interest, in addition to specialist areas of interest (including movement disorders, community and interface geriatric medicine, orthogeriatrics, syncope and stroke) The department runs a speciality acute take (frailty take) with referrals from the community direct to the admissions ward and from the Emergency Department. In addition, there is a programme of community geriatric medicine with a focus on the frailest patients in the community at nursing homes. This is multi-disciplinary and consultant led. Whilst the F2 doctor will not have a specific rota pattern going to nursing homes they are able to attend with the team on request.
The type of work to expect and learning opportunities	Excellent experience in general medicine and common presentations across a wide spectrum of body systems Specialist focus on frailty and management of frailty syndromes (falls, cognitive impairment, immobility, polypharmacy etc.) Multi-disciplinary working within healthcare teams both in the hospital and community Communication skills improvement with a particular focus on explaining complex inter-related multimorbidity and palliative care Attendance at clinics is available (movement disorder, rapid access community referral, surgical liaison) Weekly departmental teaching on Thursday afternoons Weekly departmental radiology meeting Monday lunchtime There is a 5-6 week “acute block” where the doctor will primarily be clerking patients. They will gain significant experience of common presentations and initial management of medical conditions. The overall educational objectives of the F1 year are to provide the doctor with the knowledge, skills and attitudes to be able to: Take a history and examine a patient Identify and synthesise problems Perform IV cannulation and other appropriate procedures Prescribe safely Keep accurate and relevant medical records Manage time and clinical priorities effectively Communicate effectively with patients, relatives and colleagues Supervise and provide support and guidance for F1 doctors Use evidence, guidelines and audit to benefit patient care Act in a professional manner at all times Cope with ethical and legal issues which occur during the management of patients with general medical problems Educate patients effectively Become life-long learners and teachers.
Where the placement is based	Either Acute Frailty Unit at Southmead Hospital or “complex care” wards 9A or 9B. Doctor will be emailed in advance of starting. Clinic sites are at Southmead and Cossham Hospitals.
Clinical Supervisor(s) for the placement	This will vary with each rotation and the doctor in training will be informed via email before starting placement. Dr Daniel Thornton is education lead.
Main duties of the placement	Participate in ward work and consultant led post-take ward rounds on either acute frailty unit or “complex care” wards 9A and 9B. Duties include reviewing patients and actioning any jobs (liaising with other specialities, requesting and reviewing investigations, communication with families, reviewing patients when asked by other healthcare professionals) A key aspect of the role is to communicate management and gain histories from family and friends. Clinic duties, if attending, are supernumerary During clerking shifts doctors will be expected to see patients that have been referred from the ED or community and make an initial differential diagnosis and management plan before being reviewed on the post-take ward round.
Typical working pattern in this placement	Monday to Friday 08.00-16.00 On call commitments will vary and there is an “acute block” of 5 or 6 weeks where the doctor will be clerking patients. This will include out of hours work, including nights.

It is important to note that this description is a typical example of your placement and may be subject to change.

F1 Infectious diseases

Placement	F1 Infectious diseases Southmead Hospital
The department	There are 6 Consultants in Infectious diseases, HIV & general medicine, 3 consultants in microbiology & ID, and 3 consultants in immunology & HIV. Junior staff include 1 FY1 doctor, 4-5 IMT/Clinical fellows, and two ID SpRs. Inpatients are based on a 32-bed ward with 6 additional isolation beds. We are responsible for the care of medical patients on the wards and ID & HIV outliers, including our patients on ITU.
The type of work to expect and learning opportunities	As an F1 in ID/ HIV, you will be expected to deliver the daily medical care for the inpatients on the wards. Inpatient Care You will often attend Consultant or Registrar ward rounds, although sometimes you will be expected to conduct your own ward round Typically each day you will be responsible for the care of 18 inpatients. ID & HIV medicine will give you the opportunity to manage a wide variety of infectious & tropical diseases, these are not rare, but you may not see more than one or 2 of the same condition in your 4 months with us. Sometimes patients have complicated and prolonged admissions, which will require careful discharge documentation, and telephone communication with GP. You will get the opportunity to learn about the management of HIV, including issues of confidentiality, disclosure, testing, new diagnoses, and long-term complications. You will also learn the management of TB in the context of HIV and non-HIV infected patients, PUO and fever on the returned traveller, including investigation of non-infectious differential diagnoses. Clerking You will have ample opportunity to assess and manage acutely unwell patients with a variety of conditions during your days on medical take. You will be expected to present these patients to the on call Consultant on the post take ward round. For all kinds of work, senior review (SHO, registrar or consultant) is readily available and should be easily accessible. HIV senior advice is available out of hours by contacting the on-call consultant through switchboard.
Where the placement is based	Brunel building, Southmead Hospital
Clinical Supervisor(s) for the placement	Dr Moran/Dr Heys/Dr Jenkins/ Dr Elsayed/Dr Gupta-Wright
Main duties of the placement	To ensure the safe clinical management of each patient under your care (with senior support) To carry out jobs from the ward round and liaise with other specialties as necessary To ensure handover and discharge documentation is complete and accurate To review patients when asked To ensure that your documentation in the medical notes is thorough, accurate and legible.
Typical working pattern in this placement	Mon – Fri 08:00-16:00 – ward based care Participation in the acute medical take

It is important to note that this description is a typical example of your placement and may be subject to change.

F1 Intensive care medicine

Placement	F1 Intensive care medicine (ITU) Southmead Hospital
The department	The Critical Care Unit based at Southmead Hospital consists of 48 beds allowing the individual to gain experience in managing a wide range of critically ill patients with particular emphasis on neuro-intensive care and trauma as well as general medical and surgical patients.
The type of work to expect and learning opportunities	Learning opportunities include but are not limited to: The recognition and immediate treatment of critically ill/injured patients The ongoing care of critically ill/injured patients through to discharge including wide experience of all aspects of intensive care, except post-cardiac surgery. This includes management of severe head injuries and other neurosurgical emergencies, major trauma patients, major surgical patients including burns and plastic surgical patients and medical patients Practical procedures under direct supervision according to their own individual needs and proficiency. Experience in advanced monitoring techniques, cardiovascular management, respiratory care including airway management and renal support.
Where the placement is based	Intensive Care Unit, Southmead Hospital
Clinical Supervisor(s) for the placement	Allocated on arrival, currently Dr Ben Walton
Main duties of the placement	Working as part of the Intensive Care multi-disciplinary team the individual will be involved in all aspects of patient care and administration
Typical working pattern in this placement	As per F1 working pattern, Monday – Thursday 0730-1730

It is important to note that this description is a typical example of your placement and may be subject to change.

F1 Renal medicine

Placement	F1 Renal medicine Southmead Hospital
The department	The department of renal medicine comprises 12 consultant nephrologists, all of whom participate in a specialist renal on call service. Renal medicine is a tertiary referral specialty. The department provides renal services to Bristol, South Gloucestershire, Bath and North East Somerset and Wiltshire. In addition it provides transplantation for Dorset, Gloucester and North Devon. The department provides a comprehensive renal replacement therapy programme to approx 1500 patients comprised of 600 patients on dialysis and 880 renal transplant recipients. The department performs about 100 adult transplants a year.
The type of work to expect and learning opportunities	All F1 doctors in renal medicine are ward based during the normal working day and provide the daily medical care of all patients in the renal unit under their Firm. There are two Firms of consultants providing inpatient care. There are learning opportunities on the 2-3 weekly consultant lead ward rounds, the X-ray meeting, in house renal tutorials, biopsy meetings and in the course of the job as there is a high level of support provided by the renal registrars. F1s will be involved in the care of patients with acute kidney injury, chronic dialysis patients, newly transplanted patients and acutely unwell immunosuppressed patients. They will also gain experience of managing patients with acute vasculitis and new presentations of nephrotic syndrome. There are no out of hours or on call duties, but during the day F1s may clerk in new admissions if they wish to do so.
Where the placement is based	The Richard Bright Renal Unit, Brunel building Southmead Hospital, Bristol, BS10 5NB
Clinical Supervisor(s) for the placement	Dr Chris Dudley, Professor Steven Harper, Dr Rommel Ravanan, Dr Karen Anderson, Dr Alison Armitage, Dr Helen Campbell, Dr Uday Udayaraj, Dr Simon Satchell, Dr James Bushnell, Dr Albert Power, Dr Alexandra Hodsman, Dr Fergus Caskey
Main duties of the placement	Together with the registrar for the respective inpatient firm and 3 F2/CMT1/CMT2 level doctors the F1 is responsible for the ward care of patients and the maintenance of the patient’s medical record for their Firm. As the F1 does not do out of hours work they play an important role in maintaining daily continuity of care. The F1 is also very important to the discharge process and liaison with the ward pharmacist and patients GPs. They are expected to attend the in house renal tutorials and attend the F1 teaching programme.
Typical working pattern in this placement	Daily 8.30 - 9 am handover from the night team. 9am board round. 9.30 onwards ward round 2pm Huddle at electronic white board with ward pharmacist and nurse in charge to discuss discharges. Normal Working Day 8.30am – 5.00pm Early Finish 2pm one day per week. Monday Consultant ward rounds,1-2pm x-ray meeting Tuesday 12-1 renal in house tutorial, 1-2 renal biopsy meeting (optional). Wednesday 12 noon multidisciplinary team meeting.

It is important to note that this description is a typical example of your placement and may be subject to change.

F1 Respiratory medicine

Placement	F1 Respiratory medicine Southmead Hospital
The department	North Bristol Lung Centre, Respiratory Medicine
The type of work to expect and learning opportunities	The assessment and day to day management of patients with acute respiratory disorders. This includes over 30 different kinds of respiratory disorders ranging from COPD, asthma, pneumonia, lung cancer, pleural disease and alveolitis, through to managing acute respiratory failure with non-invasive ventilation, assessment of blood gases, and management of patients in the palliative/terminal stages of chronic respiratory disease. The North Bristol Lung Centre includes an active Academic Respiratory Research Unit especially in interstitial lung disease and pleural disease. It provides tertiary respiratory services: endobronchial ultrasound (EBUS) and autofluorescence bronchoscopy (AFB), pleural clinic including thoracoscopy and indwelling pleural catheter (IPC) insertion, interstitial lung disease; as well as one of the longest running pulmonary rehabilitation services in the UK and other specialist clinics including lung infection, bronchiectasis and complex airways disease. All Foundation Doctors in hospital posts will generally be ward based during the ‘normal’ working day and expected to deliver the daily medical care of all the patients on their ward irrespective of specialty. Whilst on-call in the acute admissions unit, the F1 will be involved with the generic clerking of patients being admitted and the ongoing care of the patients in the unit. The overall educational objectives of the F1 year are to provide the trainee with the knowledge, skills and attitudes to be able to: Take a history and examine a patient Formulate a differential diagnosis Identify and synthesise problems Recognise & manage acutely ill patients Contribute to the cardiac arrest team & get involved with DNAR decisions Perform practical procedures including pleural taps chest drains (under supervision) using pleural ultrasound Prescribe safely Keep an accurate and relevant medical record Manage time and clinical priorities effectively Communicate effectively with patients, relatives and colleagues Use evidence, guidelines and audit to benefit patient care Act in a professional manner at all times Cope with ethical and legal issues which occur during the management of patients with general medical problems Educate patients effectively Become life-long learners and teachers.
Where the placement is based	Level 4 Gate 27b, Brunel building, Southmead Hospital
Clinical Supervisor(s) for the placement	Dr James Calvert (Specialty & COPD Lead), Dr Martin Plummeridge (Lung Cancer & Lung Function Lead), Dr Andrew Medford (Education & EBUS Lead), Dr David Smith (Bronchiectasis & Pulmonary Rehab Lead), Dr Huzaifa Adamali (ILD Lead), Prof Nick Maskell (Pleural & Research Lead)
Main duties of the placement	Clerking and day to day assessment of patient’s progress with up to date neatly written entries in the notes detailing the patient’s progress and future intended plans and investigations. Liaison with senior members of the team, specifically the specialist registrar and consultant, specialist physiotherapist, dietician, pharmacist, occupational therapist, senior nurses, and palliative care team. There will be daily ward rounds (either consultant, SpR or CMT); full consultant ward rounds of all patients occur twice a week, once a week from the SpR, and otherwise with the CMTs.There is a daily morning board round Mon-Fri starting at 0900 (ready to start with complete patient list at 0900) which is mandatory. The F1 doctor is responsible with other staff for the ward care of patients and the maintenance of the patient’s medical record. They are expected to attend the teaching programmes provided by the Trust and Department (see below). NB: A number of the consultant ward rounds are also teaching rounds and there is often ample opportunity for ad hoc teaching around cases (if opportunity allows, it may be possible to visit some of the other areas in the respiratory dept but the ward is the priority). The doctor will be responsible for such other specific clinical duties as allocated by consultants including performing other duties in occasional emergencies and unforeseen circumstances.
Typical working pattern in this placement	Daily ward round to assess patient’s progress and keep the patient’s notes up to date with details of their progress and any important results and future plans. Typical working hours: 0845 (in readiness for board round)-1645. Mon: Board round 0900-0930. Ward round 0930-1200. Tues: Board round 0900-0930. Ward round 0930-1200. 1300-1500 (bimonthly Trust F1 teaching) Wed: Respiratory Grand Round 0830-0900 (mandatory). Board round 0900-930. Ward round 0930-1200. ILD MDT 1000-1115 (optional). Lung cancer MDT 1115-1230 (optional, when patients to discuss). Thurs: Board round 0900-0930. Ward round 0930-1200. Fri: Board Round 0900-0930. Ward round 0930-1200. Grand Round 1230-1330. Social MDT 1400-1430.

It is important to note that this description is a typical example of your placement and may be subject to change.

F1 Stroke medicine

Placement	F1 Stroke medicine Southmead Hospital
The department	Gate 7a in the Brunel Building has all our acute stroke beds. Gate 9a has patients further on in their stroke rehab pathway. Patients with a diagnosis of stroke (cerebral infarction or Haemorrhage) are admitted to the wards directly from ED. If due to bed pressures or other needs patients are on a different ward they are still reviewed by the stroke team. All patients who have had thrombolysis started in ED are transferred to the stroke unit unless they require ICU support. Supervised experience of seeing in patients is available throughout the patients stroke pathway. There will also be some other Neurology and sometimes medical patients on the wards. These patients remain under the admitting Neurology / Medical consultant.
The type of work to expect and learning opportunities (subject to change)	Board rounds – Mon- Fri at 9.00- 9. 30 (7a and 9a). Quick catch up of current issues and new admissions working closely with nursing and professions allied to medicine. Daily Consultant led Ward Rounds – There is a consultant led ward round every morning at 9.30 on 7a to see all new stroke admissions. There are other weekly or twice weekly consultant ward rounds of the other patients. There are daily opportunities for case based discussion (CBD) and evaluation of skills. (mini-CEX & DOPS). Opportunity to go to ED to be involved with the thrombolysis team. These patients may have clot retrieval which you can watch. Opportunities for skills training such a lumbar puncture, iv cannulation, ia puncture, NG insertion. Management of stroke related complications. Multi-Disciplinary Meeting (MDM) ~Every Week on 7a and 9a. The MDM documentation is recorded electronically and printed into the notes each week. A representative from all teams tries to be present so that all aspects of each patients care can be discussed. Action plans, discharge planning and estimated discharge dates (EDD) are agreed for each patient. The MDM is chaired by varying members of the team. Progress Meetings Patients with potentially complex discharge plans may require a progress meeting, so that the team can discuss with the patient, family and other carers the progress the patient has made so far, and set goals towards discharge planning. It is important to have the 1st meeting within 2 weeks of admission to hospital. You may be asked to give an overview of the patient’s medical condition and prognosis. Patients and their relatives may also approach you at separate times to discuss issues. The consultants are all happy to be involved in discussions (but need some warning). Supervised training in generic skills e.g. Breaking bad news. Prescribing and drugs management. Care planning meetings Led by the social worker to plan placement/ packages of care. Discharges Patients TTAs need to be written as soon as possible. Compliance aids (Dossett boxes etc) require at least 24 hours notice. It is important to ensure that secondary prevention is addressed as an inpatient, and patients are medically ready for discharge (investigations done, etc) in line with the expected discharge date. We do not provide routine follow up - only those with outstanding medical issues. All other patients should be directed to their GP. It is important that the discharge summary is explicit in any follow up requirements. Most Stroke inpatients will require therapy input (OT, PT, SLT etc) prior to discharge. Please check the notes for therapy discharge plans. The Multi-Disciplinary Team (MDT) One of the key points to remember on the unit is that we function as a team. You may frequently find that the therapists who work closely with the patients are often the best source of information about progress etc and can help your management of the patient. Equally, they may come to you for advice as to the best way to manage a patient. It is especially important to remember that patients may not be fit for discharge just because all their medical problems have been addressed. The team comes to a consensus on issues such as these, which are discussed regularly at the multi-disciplinary meeting (MDM). Foundation doctors weekly teaching/training session in stroke Tuesday 11:45 in addition to general foundation training (opportunity to teach). Neuro/Stroke X ray meeting weekly Wednesday. Thrombolysis meeting fortnightly with journal club alternating
Where the placement is based	Gate 7a and 9a in Brunel Building, Southmead Hospital
Clinical Supervisor(s) for the placement	The Consultants in Stroke are Dr Justin Pearson, Dr Rose Bosnell, Dr OIivera Martinovic, Dr Alvaro Cervera and Dr Phil Clatworthy. They are all involved in training Foundation Trainees. Dr Ian Ormerod is C/S for Foundation Trainees
Main duties of the placement	Patient care Medical notes entries Arranging appropriate investigations Managing acute ischaemic stroke including role of thrombolysis Management if ICH Managing complications of acute stroke Stroke secondary prevention Palliative care On call duties Joint meetings Involvement in communication with patients, their families, other doctors, members of the health care team in this hospital and at other hospitals (for repatriation)
Typical working pattern in this placement	Normal daytime ward cover 9am – 5pm Partial shift and general medical on call

It is important to note that this description is a typical example of your placement and may be subject to change.

F1 Trauma and orthopaedic surgery

Placement	F1 Trauma and orthopaedic surgery
The department	The Muskuloskeletal Directorate manages the elective and trauma orthopaedic services based at the Brunel Building, Sothmead Hospital. The Avon Orthopaedic Centre (AOC) is a centre of excellence in the South West and consultant sub-specialist interests include shoulder & elbow, hip, knee, foot & ankle as well as spinal surgery. Southmead Hospital is a Level 1 Trauma Centre and also provides the regional pelvic fracture and acetabular reconstruction service. 13 Consultants participate in the Acute Trauma on-call rota in a team based system (Teams A-D = Mon –Thurs). There is an additional Spinal on-call rota. Consultant led fracture clinics & trauma operating lists are run 365 days per year. There are combined ortho-plastics lists 3 days per week and follow-up fracture clinics mon-thurs. The department works closely with our affiliated Ortho-Geriatricians and the Plastics and Neuro-surgery departments. There are well established trauma and elective research teams who are busy coordinating numerous research projects and overseeing audit activity. There is a trauma coordinator, specialist hip fracture and spinal surgery nurses.
The type of work to expect and learning opportunities	F1 Doctors will attend the morning Trauma meeting and then be ward based during the ‘normal’ working day, expected to deliver the daily medical care of all the patients on their allocated ward. Whilst in the T&O attachment the F1s will be involved with the clerking of patients being admitted and the ongoing care of the patients in the unit. F1’s are encouraged to take opportunities to attend theater and clinic. The overall educational objectives of the F1 year are to provide the trainee with the knowledge, skills and attitudes to be able to: Take a history and examine a patient Identify and synthesise problems Prescribe safely Keep an accurate and relevant medical record Manage time and clinical priorities effectively Communicate effectively with patients, relatives and colleagues Use evidence, guidelines and audit to benefit patient care Act in a professional manner at all times Cope with ethical and legal issues which occur during the management of patients with general medical problems Educate patients effectively Become life-long learners and teachers.
Where the placement is based	Brunel building, Southmead Hospital, Bristol
Clinical Supervisor(s) for the placement	Mr IN Packham; Mr JCJ Webb; Mr SJ Eastaugh-Waring; Mr TJ Chesser; Mr IW Nelson, Mr JR Robinson
Main duties of the placement	Attend the daily morning trauma meeting. F1’s will be involved in the day-to-day ward care of patients and be responsible for contemporaneous medical note keeping during daily business ward rounds and weekly consultant ward rounds (especially post-take). They will participate in orthopaedic ward rounds as well as join the Consultant Ortho-Geriatricians on their weekly ward-rounds and liaise with the specialist nurses as required. Whilst on call the F1 doctor will work closely with the F2,CT and SpR trainees in assessing, admitting and managing acute cases presenting to the Emergency Department or Fracture Clinic. They will have the opportunity to shadow a consultant or registrar in new & follow up fracture clinics and they are strongly encouraged to attend either the main trauma list or day case list to assist a wide variety of cases and be taught some basic surgical skills such as suturing, metalwork removal, insertion of a screw or fixation of a fracture. Each F1 should arrange a session with the technicians in the Plaster Room and they will have the opportunity to partake in or undertake an Audit project the results of which they will present to the Department. They will be expected to present their team’s M&M data at the end of their 4-month attachment. They are expected to attend the structured teaching program provided by the department and the Trust. The doctor will be responsible for such other specific clinical duties as allocated by consultants including performing other duties in occasional emergencies and unforeseen circumstances.
Typical working pattern in this placement (subject to change in the new hospital building)	Daily: 0800 daily trauma xray meeting 0900 ward round 1200/1700/2000 Handover On call 1 in 5 Mon: Am fracture clinic Pm ward work Tues: 1300-1400 F1 formal teaching Weds: Am ward work Pm main theatre Thurs: Am Day case theatre Pm ward work Fri: 0800-0900 weekly departmental teaching/clinical governance meeting 1000 Orthogeriatric ward round

It is important to note that this description is a typical example of your placement and may be subject to change.

F1 Urology

Placement	F1 Urology Southmead Hospital
The department	Urology
The type of work to expect and learning opportunities	Ward work, preoperative preparation, postoperative care, clinic consultations, attendance at operating lists. Ward-based and interactive teaching
Where the placement is based	Urology, Southmead Hospital
Clinical Supervisor(s) for the placement	Urology consultants
Main duties of the placement	Ward work, preoperative preparation, postoperative care, clinic consultations, attendance at operating lists.
Typical working pattern in this placement	Daily schedule, with long days to cover dedicated urology on call rota

It is important to note that this description is a typical example of your placement and may be subject to change.

F1 Vascular Surgery

Placement	F1 Vascular surgery Southmead Hospital
The department	The Major Arterial Centre (MAC) at North Bristol Trust provides specialist vascular services for the populations of Bristol, South Gloucestershire, North Somerset, Bath and North East Somerset and parts of Wiltshire (1.3 million people) and a Complex endovascular service for the South West (population 3.5 million people). The Vascular Surgery team comprises 11 consultant vascular surgeons, 6 vascular interventional radiologists, 3 specialist nurses, ward nurses and a specialist amputee rehabilitation team. The junior medical team comprises 1 post CST fellow, 4 registrars, 4 core trainees (2 of whom are unbanded fellows), 1 F2 and 3 F1s. The vascular surgeons and interventional radiologists provide 24/7 emergency vascular care and three consultants contribute to the renal transplant on-call. There are interests in open vascular surgery (aortic, carotid, peripheral), endovascular procedures (thoracic, abdominal, peripheral), diabetic foot care, living kidney donor transplant, and vascular access surgery. The MAC is the hub for the Bristol Bath Weston Vascular Network that has a dedicated network coordinator (Joanna Pawlowska) and dedicated network MDT (Wednesday mornings). Clinical governance arrangements include reporting of outcomes for arterial surgery to the National Vascular Registry (NVR) which are available on NHS Choices.
The type of work to expect and learning opportunities	The F1/2 doctors in this hospital post will be team based; during the ‘normal’ working day (08:15-17:00) with the vascular team and out of hours on call with the general surgery team, who also provide out of hours’ vascular cover. The day time role is ward based (Gate 33b) on a 32 bed dedicated vascular ward. There is a daily consultant ward round and support from a core trainee or fellow on the ward, a registrar ‘baton’ bleep holder and twice weekly care of the elderly consultant ward round. Whilst on-call the F1 will be involved with the generic clerking of general surgery and vascular patients being admitted and the ongoing care of the patients in the unit. The overall educational objectives of the F1 year are to provide the trainee with the knowledge, skills and attitudes to be able to: Take a history and examine a patient Identify and synthesise problems Prescribe safely Keep an accurate and relevant medical record Manage time and clinical priorities effectively Communicate effectively with patients, relatives and colleagues Use evidence, guidelines and audit to benefit patient care Act in a professional manner at all times Cope with ethical and legal issues which occur during the management of patients with general medical problems Educate patients effectively Become life-long learners and teachers.
Where the placement is based	Gate 33b & Gate 26b Brunel building, Southmead Hospital, Bristol
Clinical Supervisor(s) for the placement	Mr D Mitchell (Governance Lead), Mr A Baker, Mr W Neary, Mr M Brooks (Clinical Lead), Miss R Winterbourne (Education Lead), Mr P Lamont, Professor F Smith, Mr J Budd, Mr M Pai, Mr P Bevis and Mr A Weale,
Main duties of the placement	The F1 doctor is responsible with the other members of the multi-disciplinary vascular team for the care of patients and the maintenance of the patient’s medical record. Central to this role are patient education and the handover of care when patients leave hospital as most have a long term condition. They will have opportunity to work with the consultants in theatres and outpatients clinics (each Tuesday afternoon there is a dedicated teaching clinic), and also take responsibility for problems arising in patients on the ward. They are expected to attend the teaching program provided by the department. The doctor will be responsible for such other specific clinical duties as allocated by consultants including performing other duties in occasional emergencies and unforeseen circumstances.
Typical working pattern in this placement	Vascular Surgery Daily: 08:15 MDT Board Round (Ward 33b) 08:30-11.30 Consultant Ward Round 11:30-15:30 Ward Jobs/Discharges 15:30-16:30 Chase investigations 16:30-17:00 Board round & Handover There will be patients to clerk from daily vascular ‘hot clinic’ and interventional radiology. Mon: 12:00-13:00 Complex discharge MDM Tue: 13:00-16:30 Teaching clinic Wed: 08:15-10:30 Network MDT Meeting 11:15-12:30 1 in 5 M&M Meeting Fri: 12:00-12:30 Complications report General & Vascular Surgery On Call On call full shift 1:13 Weekdays 0800-2100 1 in 13 Twilight shifts 1600-2400 1 in 13 Sat 0800 – 2100 1 in 13 Sun 0800 – 2100 1 in 13 On call handover at 2030

It is important to note that this description is a typical example of your placement and may be subject to change.

This page was last updated March 3rd 2020 (4 years ago)