Royal Free Hospital

The Royal Free Hospital was the first hospital to provide free care and the only London hospital to stay open during the 19th-century cholera epidemics. Today the Royal Free Foundation Trust runs the Royal Free Hospital, Barnet and Chase Farm. Specialist services include cancer, neurosciences, HIV and liver, kidney and bone marrow transplantation, as well as haemophilia and amyloidosis. The Royal Free Hospital has approximately 800 beds and sees 85,000 patients in A&E per year. The latest CQC rating was “good” overall.

The Respiratory Job

Consultant speciality interests

• Dr James Goldring: Medical education/training, Pleural disorders, EBUS – now clinical lead
• Dr Paul Dilworth: Asthma, medical education/training
• Dr Marc Lipman: HIV
• Dr Swapna Mandal: Sleep medicine, ventilation
• Dr John Hurst: alpha1-antitrypsin deficiency, COPD, bronchiectasis
• Dr Dean Creer: Pleural disorders, EBUS, TB
• Dr Anant Patel: COPD, Pleural disorders, EBUS, lung cancer
• Dr Michael Beckles: acute respiratory problems, lung cancer, asbestos, sarcoidosis
• Dr Rama Vancheeswaran: COPD, ILD, integrated care

Meetings

• Monthly attendance at Lung cancer MDT
• Monthly attendance at Radiology meeting
• Weekly attendance at clinical meeting/journal club
• Rare attendance at M&M
• Hospital Grand Rounds + morning report
• Rare opportunity to attend ILD meeting

Bronchoscopy

• More than adequate experience in Bronchoscopy, which includes endobronchial biopsy
• Transbronchial biopsies rare
• EBUS is done in the hospital, but not by trainees at present
• Suitable for ST3/4
• Variable supervision/learning environment dependant on which Consultant is supervising the list. Opportunity for very good teaching, even for those who are experienced, with focus on safe sedation, best technique for BAL etc.
• Bronchoscopy simulator available in the hospital (but charge to access)

Clinics

• Weekly general respiratory clinic
• TB clinic every 2 weeks on average
• Sleep/ventilation clinic every 2 weeks on average
• Lung cancer clinic every 2 weeks on average
• ID/HIV clinic during HIV block

Typical week

There can be between 1 and 3 SpRs on the ward at any one time. There are ward rounds everyday for the two ward-based respiratory teams and the SpR is expected to lead ward care between the two Consultant ward rounds each week, which is not particularly arduous. There are potentially 5 clinics that need to be covered during the week, with 2 bronchoscopy lists and ad-hoc pleural procedures. The referral system is via a bleep system and it can be very variable how many referrals are required. SpRs see all referrals and some of these patients can be complex (due to the other speciality interests within the hospital eg ID, Renal, Transplant).

2016: trainees now have 5-6 sleep reports to complete each week during the respiratory block, under the supervision of Swapna. CPEX has also been introduced and is open to all trainees to attend (useful experience in interpretation for SCE).

Procedures (estimated per year done by each Resp SpR)

• Chest drains: 15-20
• Abrams biopsies: 1-5
• NIV initiation: 20-25
• Knee aspiration: 1-5
• Ascitic drain/top: 1-5
• Central line: 0
• Lumbar puncture: 5-10

Pleural USS

• There is a Level 2 Ultrasound trained Consultant who can sign off trainees for Level 1. There is good support for this process and trainees can expect to be signed off as Level 1 without any problems.
• There is a dedicated Respiratory Department machine

NIV

If you have information on the Resp SpR experience of NIV at Royal Free please get in touch. 

GIM

• Acute medicine comes in 6-8 week blocks with no Respiratory responsibilities during that time
• There are generally 2 of these blocks during the year
• Acute medicine is well supported and takes are manageable, and there are several specialties who have separate on calls.
• Other on calls (when not seconded to general medicine in a block) are speciality, and cover ID/HIV/Rheum/Resp.

Teaching

• Simulation facilities are available including a Bronchoscopy simulator (which can be accessed by you)
• Observed undergraduate teaching (lots of UCL students around and opportunities to teach)
• Observed postgraduate teaching (eg CMT)

Management/leadership

• Rota and teaching organisation
• Junior doctor forum
• Management course available

Specialist training opportunities

• There is an ILD MDT that happens once a month. This is attended by the Rheumatologists and rarely by the Respiratory SpRs – this is because of clinic commitments, which is a shame
• Pulmonary Hypertension service within the hospital – again trainees feel that it is shame that it is not part of the attachment. Study/annual leave would be required to attend clinics/lists
• 3 months covering HIV ward patients as part of the rotation
• Specialist alpha-1 clinic (but not formal part of rotation)
• TB is mainly ID-led, so limited contact. However there is a TB MDT which is well worth attending.

Research

• Marc Lipman and John Hurst are active in research and are often on the lookout for trainees to join them in standalone projects or fellowships. The Free is also a site for a number of pleural trials – speak to Dr James Goldring for more information.

Stage of training best suited to this rotation

• ST5-6 (less supervision, some complex patients)

 Recent trainee comments:

“Looking after some of the more complex patients e.g. haematology/renal/transplant patients with difficult respiratory infections is great experience.”

“The HIV placement is completely different to anything else on the rotation so is a real opportunity to learn.”

“The Free job is good, with a supportive Consultant body and good training. There is variable supervision, and with some complex patients it’s better suited to later on in the training programme. Being in Hampstead is not bad either!”