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Hospital Trust

Homerton University Hospital

Homerton University Hospital is a district general hospital providing hospital and community services to the people of Hackney, the City of London and beyond. It was one of the first Foundation Trusts and remains financially viable. It provides specialist care in obstetrics, neonatology, foetal medicine, fertility, laparoscopic surgery, bariatric surgery, asthma and allergy treatments, HIV and neuro-rehabilitation. The hospital has over 450 inpatient beds, and the A&E sees over 120,000 patients per year. The latest CQC rating was “good” with urgent and A&E services rated “outstanding“.

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The beauty of Hackney

 Consultant speciality interests

  • Dr Raj Rajakulasingam: asthma, allergy and immunotherapy
  • Prof Graham Bothamley: TB, cough, research
  • Dr Angshu Bhowmik: lung cancer diagnostics (EBUS), community/integrated care, management and leadership
  • Dr Agbetile – sleep and ventilation

Meetings

  • Weekly regional lung cancer MDT at Barts, attended by SpR
  • Weekly local diagnostic MDT (x-ray meeting)
  • Weekly clinical meeting/journal club (presentations by SpRs and juniors)
  • M&M meetings every 4 months (juniors with SpR supervision)
  • Weekly hospital Grand Round (with free lunch)
  • Monthly departmental management meetings for SpRs at the end of training

Bronchoscopy

  • Weekly all day bronchoscopy/EBUS list 1 SpR with 1 Consultant
  • Plenty of opportunity for bronchoscopy experience, and you can expect to become independant at EBUS for the easier to access nodes (St7 and 4)
  • Perhaps not ideal for an ST3 due to the need to be competent in the basics of bronchoscopy before moving onto EBUS, but good for ST4+
  • Great learning environment for procedural skills as plenty of time and supportive and patient trainer

Clinics

  • Weekly lung cancer/general clinic (AB)
  • Weekly General clinic (mainly TB/sarcoid/general) (GHB)
  • Weekly asthma/allergy clinic (RKR)
  • Occasional cover for additional TB clinic (GHB)
  • Opportunity to attend sleep clinics (AB)

Typical week

Monday: Consultant ward round am, and ward work/referrals/admin pm.
Tuesday: Lung cancer MDT am then ward round or referrals. Lung cancer clinic pm (AB).
Wednesday: EBUS/Bronchoscopy all day with Radiology meeting at lunchtime.
Thursday: Gen Resp Clinic (GHB). Possible consultant ward round. Referrals, elective pleural procedures pm.
Friday: Asthma/Allergy clinic am (RKR). Ward work/referrals/admin pm.

There are two SpRs so when both are there one or two clinics each. When one is on call/on leave all responsibility on one SpR (it is rare that both are in at the same time). The SpRs see all referrals and this can involve staying late to see them all in a timely manner. There are plenty of options to triage elsewhere, the MDT, X-ray meeting, TB nurses for TB screening, lung cancer nurse etc. If you are already level 1 US competent, expect to be kept busy! Radiology will do no pleural procedures once they find out you are competent. Luckily the juniors and CTs are keen to learn. Although officially there is not fixed leave, in reality there are limited periods when it is possible to take leave so plan ahead and negotiate. Swapping out of the on call block is nearly impossible but swapping weekends can be done.

Procedures (estimated per year done by each Resp SpR)

  • Chest drains: 20-25
  • Abrams biopsies: 5-10
  • NIV initiation: 20-25

Pleural USS

  • Dedicated Resp department portable USS machine available 24/7
  • No level 2 trained Consultant, but Radiology consultant is supportive. Have to make special effort, but it is possible to get Level 1 signed off

GIM

  • 4 week block every 3 months is spent on the Acute Care Unit running the take. Consists of weekends, nights and long days with appropriate compensatory days off. It works well concentrated in blocks as you do not have any Respiratory responsibility during this time. Takes are not too busy – days average 12 admissions (1 early SHO, 2 late SHOs clerking), nights average 8 (1 ward FY1 and 1 clerking SHO). There are not many arrests on the wards. Manageable but with enough experience to easily cover GIM curriculum requirements.

Teaching

  • Simulation facilities (which can be accessed by you)
  • Observed undergraduate teaching
  • Contribution to PACES teaching
  • Opportunity to be undergraduate OSCE examiner

Management/leadership

  • Junior doctor rep on Local Negotiating Committee

Specialist training opportunities

  • EBUS – become competent
  • Cough – attend the specialist clinic
  • TB – plenty of cases, including drug resistant TB, extrapulmonary and complex cases (in and outpatients)
  • Allergy – get experience in specialist investigation such as skin prick testing and challenge testing, and use of novel therapies such as immunotherapy
  • Integrated care – go on a visit with the ACERs team to COPD patients in the community
  • Pulmonary rehab – talk to the ACERs physio and volunteer to give a patient education session (then get them to fill in a teaching observation)
  • Palliative care – attend St Joseph’s Hospice Breathing Space clinic for pharmacological and non-pharmacological interventions for breathlessness and advance care planning

Research

  • GHB active in research – has PhD students and sometimes visiting fellows
  • Opportunities for projects related to Consultant specialist interests

Stage of training best suited to this rotation

  • ST4+

 Recent trainee comments:

“Good access to excellent COPD and lung function services. Nice mix of clinics. Perfect for ST4 or ST5 (more EBUS than normal bronchoscopy)”

“Homerton is a great place for an ST4. There is plenty of good general and specialist Resp work, and GIM is not too intense. There is enough independence but with good support. The department is cohesive with a good relationship with specialist nurse/physio teams and Resp physiologists. I would highly recommend Homerton.”

 “Excellent place for any stage. Lots of exposure to TB and asthma specialist services. I learnt a lot there in a friendly hospital environment.”

About drlj

Respiratory Registrar in North East London

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