South Yorkshire Programme.

This is currently a 4 year training programme leading to a CCT in GU medicine, and is based at the Royal Hallamshire Hospital in Sheffield. Opportunities may arise for placements within the surrounding District General Hospitals GUM clinics and surrounding sexual health service venues in future.

The Department

The GUM training programme is embedded within the Sexual Health Sheffield (SHS), the integrated sexual service currently based within a purpose-built with design input at all stages from GUM staff and opened in November 2007. Accommodation here is across 3 floors and incorporates separate male and female clinical areas, an inhouse laboratory, an HIV suite, office accommodation & seminar room, and a clinical psychology unit. In addition, SHS delivers some services out of the Central Health Clinic based in the centre of town, and youth services at.the Firth Park clinic. Sexual health promotion services are also incorporated within the SHS team.

There is dedicated office space with individual computer access for registrars.

GU medicine together with the Regional Infectious Diseases & Tropical Medicine unit constitute the Directorate of Communicable Diseases, part of the Specialised Medicine division of the Royal Hallamshire Hospital. Close clinical and training links exist with the ID unit and HIV outpatient care is provided by both arms, with common ward accommodation, & certain teaching sessions and oncall provision, although the patient groups remain distinct and responsibility for inpatient HIV care lies with the ID team.

Currently the Department remains within the Sheffield Teaching Hospitals NHS Trust and operates an appointment system with some flexibility for a walk-in service. Service provision may be subject to change dependent on future local and national commissioning arrangements.

Principal HIV Treatment centre; Sheffield Teaching Hospitals is the designated HIV treatment centre for the South Yorkshire area, the central hub of a managed regional HIV network.

Staffing

There are currently 11 Consultants in GU medicine and 1 Consultant in Contraception and Reproductive Healthcare working in the unit under the clinical leadership for Sexual health of Dr Claire Dewsnap, the majority of whom also have clinical duties within the surrounding districts of Barnsley, Rotherham, Chesterfield and Doncaster & Bassetlaw.

There are 2 Specialty Doctors in Sexual Health attached to the unit.

There are 6 numbered training posts in GU medicine at ST3 level for Specialty registrars. In addition, we have one F2 trainee, two GP training posts at ST1/2 level, and two Core Medical Training posts again at ST1/2 in the unit, which rotate every 4 – 6 months.

The unit also has one Nurse Consultant in Health Advising, trained Clinical Nurse Specialists in HIV, and a large cohort of Nurse practitioners working in clinic, along with a dedicated Health Advisor team.

Training Programme

The 4 year training programme incorporates all aspects of the training curriculum, with around 70% of the working week dedicated to direct patient care, providing the experiential learning opportunities fundamental to GUM training. The Training programme Director is Dr Gillian Dilke-Wing. Additional experience is also provided by attachments to allied units such as gynaecology, dermatology, microbiology, urology, infectious diseases etc

Training in HIV is provided throughout all 4 years of training, both inpatient and outpatient, with registrars conducting their own clinics under the supervision of consultant staff. In addition, the registrars manage the routine day-to-day care for HIV inpatients with daily wardround, and twice weekly teaching rounds.

The middle grade oncall is about to change, the proposed arrangement is for routine oncall provision to be removed from working patterns for GU Registrars, with experience for acutely and chronically ill HIV patients provided as 3 -4 month attachments within the Sheffield ID unit. During these attachments there is likely to be an oncall commitment, which will be on a 1 in 9 or less basis. First oncall ward cover is provided by Foundation and ST1/2 trainees.

There are undergraduates from Sheffield medical school regularly attached to the Department, and registrars are involved in their clinical teaching, along with the postgraduate training of other staff attached to clinic or at postgraduate training programmes.

Trainees are encouraged to pursue research activity during their time here.

 

Regular formal educational sessions provided currently include:

       Weekly postgraduate lunchtime seminars in GUM;

       Twice weekly ID lunchtime seminars;

       Monthly Directorate AIDS discussion groups;

       Monthly journal club;

       Weekly HIV MDT meetings;

       Weekly early morning HIV teaching sessions with ID doctors;

       Weekly hospital Grand Rounds;

       Twice yearly regional GUM/HIV meetings (under review);

       Three times yearly regional HIV network meetings;

       Four regional SpR training days, shared with the Leeds and East Midalnds training programmes;

       Weekly all-staff Departmental training sessions.

The Challenges/Developments

Recruitment; due to uncertainty over the availability and nature of Consultant posts , it has become increasingly difficult to maintain 100% occupancy of all registrar posts, and so gaps in the training programme can occur.

Less-than-fulltime trainees; as women become the larger part of the workforce, more and more trainees wish to undertake less-than-full-time training; this is supported within our unit, and currently 3 of our 6 NTNs are occupied by LTFT registrars.

General medical oncall; currently the GUM registrars are employed on a 1 in 9 oncall basis for GUM and ID; in addition they provide a contribution to the bleep-carrying rota to provide emergency medical resuscitation for the Royal Hallamshire Hospital site up until 7.00pm, along with other specialised medicine registrars. This site does not provide a general medical take. The future contribution by GUM registrars to medical cover following the withdrawal of oncall is uncertain, but is less likely to involve a routine contribution to out-of-hours rotas thereafter.

Integration; the integration of GUM and contraceptive services has facilitated greater experience in and simplified access to training in all aspects of contraceptive practice, facilitating the DRSRH examination.   

Shape of training; as a physicianly specialty, GU medicine is likely to engage with the Shape of Training proposals in line with other medical specialties, which will result in curricular changes to incorporate the required additional general medical training.

Regional training programme; the Yorkshire & Humber Deanery presently has two training programmes, one based in South Yorkshire (Sheffield) and one in West and East Yorkshire (Leeds and York), each with a designated training programme lead. The programmes share a Specialty training Committee and some training events or assessments, but there are no current moves to amalgamate the programmes further.

Entry Criteria

The route of entry to Specialist Training in GUM is by open competition, the minimum entry requirements are MRCP (UK) or equivalent and fulfilling the other essential person specification criteria.

Recruitment to the Specialty is co-ordinated by the JRCPTB office, and follows a national single centre model. Further details are available from the ST3 recruitment website.

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