Introduction
University Hospitals Bristol NHS Foundation Trust (Formerly United Bristol Healthcare NHS Trust) is a busy acute teaching trust that is one of the largest providers of Core Medical Training within the Severn Deanery.

Core medical training is provided at Bristol Royal Infirmary (a 550 bedded hospital situated in the heart of Bristol) with some trainees also rotating through Weston General Hospital (a large DGH in Weston Super Mare) and the Bristol Haematology and Oncology Centre.

Clinical placements

 

Currently Core Medical Training occurs over 2 years, each year comprises of three 4 month rotations. Rotations are fixed within a year but there is the opportunity to tailor the second year to an individual's particular training needs. The following specialties are covered.

Cardiology BRI has a regional tertiary referral cardiology unit that is due to relocate to a purpose built on-site cardiothoracic centre in 2009. The service provides 24 hour angioplasty for the south west and has clinical and research interests in wide range of cardiac disease. The cardiology dept work closely with the regional cardiothoracic service and the adult congenital heart disease service. Full range of diagnostic services including angiography cardiac MRI etc etc The 8 consultant cardiologists take part in a specialty take on a daily basis. Core medical trainees duties include covering the 2 cardiology ward and 8 bedded coronary care unit. When on call CMTs take part in the acute medical rota and have additional responsibility for their own firms take.

Care of the Elderly

Trainees rotate within the geriatric department to experience acute geriatrics, general medical wards and rehabilitation medicine. There are 7 geriatric consultants and 9 wards including the Bristol General Hospital. There is an excellent acute geriatric admissions unit which accepts patients direct from ED and the community. There is a daily consultant ward round and great experience in the initial assessment and management of complex medical patients with multiple comorbidities. This provides a great learning and teaching environment. Also on the unit is the one stop TIA clinic and acute stroke unit to gain experience in stroke management. Trainees will then rotate to general geriatric wards which include many specialist interests; orthogeriatrics, syncope, movement disorders and diabetes. There is then a placement at the Bristol General hospital to experience rehabilitation medicine. Once a week there is a morbidity and mortality meeting and journal club with lunch provided and an opportunity to do presentations. There is also a weekly xray meeting to discuss any interesting radiology with the presence of a neuroradiologist from North Bristol.

Diabetes and Endocrionology

 

The D and E service includes an academic unit with an interest in neuroendocrinology. There are 2 NHS and 3 University consultants who share responsibility for inpatients on 2 wards. Trainees are ward based and have opportunities to attend outpatient clinics which includes a post-clinic educational de-brief with the relevant consultant staff. There are specialist clinics for thyroid and diabetes related eye disease and diabetes in pregnancy. Trainees take part in the acute medical take. There is also a once weekly departmental teaching session where difficult cases are presented and discussed. 

 

The gastroenterology department consists of 1 academic and 2 NHS consultants who have expertise in the care of a wide range of luminal GI disease. Specialist research clinical interest in IBD, enteral and parenteral nutrition, and infectious diarrhoea. Consultants rotate responsibility for in-patients on 1 ward. There is a large recently refurbished endoscopy unit which allows trainees to observe the full range of diagnostic and therapeutic GI endoscopy. There is a departmental educational meeting , MDT histopathology and radiology meetings and a journal club.

 
The haematology department based at the separate Bristol Haematology and Oncology centre are a regional service providing a full range of care for patients with haematological disease including, malignancy blood cell dyscrasias and disorders of coagulation. They are responsible for over 20 in-patient beds and run a bone marrow transplant service in conjunction with colleagues a t the Bristol Children’s Hospital. Trainees are responsible for in-patients, and help staff the Avon haematology day units which is a 24 hour walk in service for patients. The post offers opportunities to develop practical skills such as bone marrow aspiration and the insertion of various types of central venous access. There are opportunities to attend specialist and general outpatient clinics and to gain experience in the laboratory based aspects of haematology. There is weekly departmental teaching as well as case presentation and journal club. During this attachment CMTs do not take part in the acute medical take but out of hours are responsible for inpatients and direct admissions to the BHOC (including oncology and bone marrow transplant unit)

 
Hepatology

There are 3 hepatology consultants at the BRI who look after the full range of liver disease, with specialist interests in viral hepatitis, metabolic and alcohol related liver disease, hepatocellular cancer, iron overload and portal hypertension. There is a 23 bedded in-patient ward that includes 4 higher dependency beds for the care of decompensated liver disease as well as patients with significant upper GI haemorrhage. There is an active research and audit interest in liver cancer, hepatitis C, alcoholic hepatitis and hepatic encephalopathy and many trainees have the opportunity to present projects at local and national meetings.

The BRI is a regional centre offering innovative technologies such as TIPS, Fibroscan, RFA and TACE. Trainees will have an opportunity to familiarise themselves with all aspects of the care of patients with severe liver disease and major GI haemorrhage and improve their practical skills in central venous access, paracentesis and the assessment and management of the acutely unwell patient. There are also opportunities to attend outpatient clinics (including a liver transplant clinic) and therapeutic endoscopy sessions.

Weekly departmental teaching takes place on a Monday in conjunction with other GI colleagues and there are supplemental monthly teaching sessions on aspects of hepatology.

Oncology and Palliative Care Medicine

Also based at the BHOC, the onclology service provides specialist in and out patient care for the region. There is a large in-patient ward plus a chemotherapy day unit. The service provides chemo and radiotherapy to for patients with a wide range of malignancy with most consultants subs-specialising in particular areas of disease. There is an active research programme with many clinical trials on-going. CMT are responsible for inpatients in a large unit and this provides exposure to a wide range of oncological emergencies as well as close liaison with palliative care services. There are departmental teaching sessions and a journal club. There are opportunities to attend specialist MDT meetings. During this attachment CMTs do not take part in the acute medical take but out of hours are responsible for inpatients and direct admissions to the BHOC (including haematology and bone marrow transplant unit)

Respiratory Medicine

The respiratory medicine department encompasses a large number of inpatient beds, outpatient clinics and diagnostic services. There are 6 consultants with a range of specialised interests including a regional cystic fibrosis, tuberculosis and sleep service. There are 2 inpatient wards and a specialised cystic fibrosis unit. There is also a 5 bedded high dependency unit where patients receive non invasive ventilation which give trainees an opportunity to develop their skills in managing patients with severe respiratory compromise. There is an opportunity to attend outpatient clinics and bronchoscopy lists. There are weekly educational meetings including a large MDT meeting.   There is opportunity to learn and develop practical skills in chest drains insertions and thoracocenthesis.

Acute medicine at the BRI

There is a 19 bedded MAU department which admits on average 40 patients a day referred from general practice and the adjacent emergency department. Elderly patients are also directly admitted to a dedicated assessment unit. There are separate designated medical staff on the MAU 9 to 5 working alongside the on call medical team which comprises 1 consultant, 1 registrar, up to 3 medical trainees and 2 foundation year 1 trainees. There are 2 consultant led post take ward rounds daily which provide great learning and assessment opportunities. General practice direct admissions to the MAU are screened first by a resident experienced GP which helps prevent unnecessary admissions. There is also a MAU clinic, DVT clinic and TIA clinic providing services which accept direct referral from MAU and ED. The cardiological emergencies and admissions are seen by the oncall trainees with the support from a dedicated on call cardiology service and a separate cardiology post take ward round. There is a new acute stroke thrombolysis service and a 24 hour on call GI endoscopist. A typical on call rota is enclosed although this current working pattern is under review to ensure compliance to the new European working time directive and may change in the future.

Formal and Informal Teaching Opportunities Formal teaching out with the departmental teaching mentioned before includes a weekly grand round and designated CMT teaching. The grand round includes 2 presentations chaired by a member of the academic faculty and provides a forum for the discussion of interesting cases and updates on current and future practice relevant to specialist and general physician. Speakers include representatives out with the core medical specialities for example dermatology and rheumatology. The meeting is preceded by a lunch sponsored by the pharmaceutical companies. CMT teaching as recently been redesigned to cover the new GIM curriculum directly aimed at ST1 and ST2 CMT trainees but with one session a month also relevant to GP trainees. The timetable is enclosed for the next year. There are monthly clinical governance meetings which provide an opportunity for all consultants and trainees to meet and discuss specific governance issues and every 3 months there is a medical department mortality and morbidity meeting which includes nursing and managerial staff. As to be expected in a large teaching hospital there are many informal teaching sessions within each speciality and all trainees are expected to be actively involved in teaching their peers, medical students and other health care professionals.

 

There is a junior doctors website and very pro active junior doctor committee and doctors mess.