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Hospital Trust

North Middlesex Hospital

The North Middlesex Hospital is a District General Hospital in Edmonton, serving communities in Enfield, Haringey, Barnet, Waltham Forest and beyond. It began life as a workhouse in 1840 and an infirmary was added in 1907. The modern hospital was built in 2010 with a new diagnostic centre, 5 inpatient wards, 8 operating theatres, a spacious outpatients and an A & E department. The North Mid has had some challenges recently, and the current CQC rating overall is “requires improvement”. An updated investigation by the CQC published in December 2016 praised the organisation for demonstrating improvements for patients across the board. The A&E department went from “inadequate” to “requires improvement.” The Royal Free is providing support for ongoing improvements, with the Chief Exec acting as accountable officer on an interim basis.

NMid

Consultant speciality interests

  • Dr B Jayaraman – Interstitial lung disease
  • Dr S Lozewicz – Tuberculosis (also does Allergy at Barts)
  • Dr H Makker – lung cancer, sleep apnoea (also does Sleep at UCLH)
  • Dr Z Mangera – lung cancer
  • Dr IK Moonsie – COPD, NIV
  • Dr B Sheinman – Allergy/asthma, FOB + EBUS
  • Dr C Valerio – pleural disease

Meetings

  • Weekly attendance at Lung cancer MDT/Radiology meeting
  • Infrequent attendance at clinical meeting/journal club
  • Rare attendance at M&M
  • Hospital Grand Rounds
  • Opportunity to attend ILD meeting

Bronchoscopy

  • Previously mixed experience in Bronchoscopy – recently much improved access with good training.
  • Two protected bronchoscopy list per week (shared between 2 registrars)
  • EBUS is present in the hospital and is now much more accessible
  • Suitable for ST3/4/5

Clinics

  • Previously only 1 clinic a week but now 2 TB/General clinics per week.

Typical week

There are 2 registrar clinics per week and 2 bronch/EBUS lists. Recent trainees tell us that the amount of ward work is more limited to other hospitals. This is partly because the Consultants are usually happy to have just an FY1 or SHO with them on ward rounds, and will encourage you to prioritise referrals.A busy AMU provides plenty of referrals and these take up a large amount of time: usually between 1 to 6 referrals per day, however the consultants also support with these, especially if stretched.  The intensive care unit run the NIV service meaning frustratingly poor access for respiratory trainees.

Procedures (estimated per year done by each Resp SpR)

  • Chest drains: 5-10
  • NIV initiation: 5-10

Pleural USS

  • New Consultants are level 2 trained and there is now a dedicated pleural service to go along with the departmental machine.

NIV

  • NIV is undertaken on the HDU adjacent to the Intensive care unit

GIM

  • Busy GIM on calls but since it is done in random days rather than blocks it doesn’t feel too hectic. 2 registrars (one for ward, one for take) on call including night shifts. Gaps in rota can mean this is not always the case however.

Teaching

  • Observed undergraduate teaching (lots of students around and opportunities to teach)
  • Observed postgraduate teaching (eg CMT)

Management/leadership

  • Rota and teaching organisation
  • Opportunities to engage with management
  • Junior doctor forum

Specialist training opportunities

  • There are plenty of other clinics including allergy, ILD (monthly), cough clinic, lung cancer which you are always welcome to join.
  • The Respiratory Physiology department is fantastic and offers a huge range of investigations including Bronchial challenge, CPET, fit to fly, amongst others. A great opportunity to get hands-on experience with lung function and be taught by some very knowledgeable staff…

Research

  • No clear opportunities. Many QIP opportunities.

Stage of training best suited to this rotation

  • Previously felt to be more suitable for ST4-6, but recent changes to the job structure, with increased levels of supervision, and a dedicated pleural service mean that recent ST3s recommend this post in early training

 Recent trainee comments:

“Can be intense, but good opportunities for slightly more senior trainees.”

“Interesting pathology, nice Consultants who have listened to feedback and made changes for benefit of trainees. I really enjoyed my time at North Mid.” 

About drlj

Respiratory Registrar in North East London

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