UCLH

Updated in Nov 2023

University College London Hospitals comprises 7 sites around Bloomsbury. The Respiratory department is predominantly based at University College Hospital.

The Respiratory Department comprises 17 consultants. Dr Rónan Astin is the Clinical Lead. UCLH Respiratory is a tertiary ILD centre, a specialist Cancer and interventional bronchoscopy centre, a specialist neuromuscular ventilation centre, and have other specialist clinics in Complex Lung Infection, Asthma, Pleural disease, Unexplained Breathlessness, and Sleep medicine. We have just purchased a bronchoscopy robot which will be the first to be used in clinical practice in the UK.

UCLH is a centre for Cancer and Haematology care, quaternary Neurology, Women’s Health, General and Specialist Medicine, is a national centre for infectious diseases, and performs General, Orthopaedic, Urological and Thoracic surgery, with a large interventional radiology department. It also comprises Specialist ENT, Dental, Paediatric and critical care units. The latest CQC rating was overall “good“. Four of UCLH’s specialties ranked in the top 10 in the world for their fields in 2024. UCLH achieved the highest score of any acute/combined trust in England in the 2023 National Inpatient Survey

UCL medical school is just down the road, offering plenty of opportunities to get involved in Undergraduate teaching.

2 Respiratory trainees will be posted here (usually 1 year rotation) at each time. They are supported by an IMT3 and sometimes an Acute Medicine SpR. The ‘junior’ team comprises an IMT2, FY2, two FY1s and a Physician Associate. There is a large CNS team who support in many ways, including seeing some ward referrals.

Consultant speciality interests

• Prof Joanna Porter – ILD, autoimmune disease, cryobiopsy
• Prof Jeremy Brown – Complex Lung Infection including Bronchiectasis
• Prof David Lomas – Antitrypsin deficiency, the serpinopathies and chronic obstructive pulmonary disease
• Prof Sam Janes – Lung cancer, Bronchoscopy/EBUS, Head of UCL Div Medicine
• Dr Neal Navani – Lung cancer, Bronchoscopy/EBUS, clinical trials
• Dr Ricky Thakrar – Lung cancer, interventional bronchoscopy
• Dr Neelu Kumar – Cancer, Pleural
• Dr Reza Abdullah – Pleural, cancer
• Dr Toby Hillman – pleural disease, Long COVID
• Dr Fionnula Crummy – Sleep medicine
• Dr Himender Makker – Sleep medicine
• Dr Christian Hasford – Allergy, complementary/integrated medicine, medically unexplained symptoms, acute medicine
• Dr Rónan Astin – Ventilation medicine (incl neuromuscular respiratory disorders), Respiratory physiology, Unexplained Breathlessness
• Dr Melissa Heightman – ILD and community/integrated care, Long COVID
• Dr Kay Roy – Sarcoid, asthma, community/integrated care
• Dr Santino Capocci – Complex Lung infection, TB
• Dr Nobby Chakrabarti – General Respiratory, Research

Typical week for SpRs

	Mon	Tue	Wed	Thu	Fri
AM	Sarcoid/ILD clinic (alt weeks)	Bronch list	Ward/ Referrals	Bronch list	Complex infection clinic
Lunch	Lung cancer MDT
PM	Lung cancer clinic	Pleural list	New patient clinic	Sleep clinic	Ward/ Referrals

• The above timetable is shared between the 2 SpRs and IMT3. The rota was organised so that each week one SpR is on ‘clinics’ and the other on ‘referrals’. This affords admin time for the SpR on ‘clinic week’. This system is necessarily flexible to account for annual/study leave.
• There are no respiratory on calls.
• The day starts at 8 am with a Board round on the Respiratory Ward.
• The referrals activity is busy. There is a large volume of pleural inpatient work, and haematology/cancer referrals make up the bulk.
• The ward consultant is nominally responsible for overseeing referrals activity, but it is expected that subspecialty consultants support
• The Pleural consultants provide oversight for the inpatient pleural work, with a CNS supporting. There is a Pleural MDT every Tuesday, but consultants are happy to contacted through the week. There is an excellent Respiratory radiology team who can support with pleural procedures if needed.
• The Complex lung Infection team are happy to be contacted to discuss often complex patients. You will have exposure to rare and complex conditions, and are not expected to work independently.

Other meetings:

• Weekly lunch time departmental teaching (Friday)
• Mortality and morbidity meeting every month
• Radiology MDT weekly Tuesday 1-2pm
• Pleural MDT weekly Tuesday 12-1pm
• Complex infection MDT Tuesday 2-3pm alternate weeks
• ILD MDT Tuesdays 2-3pm alternate Tuesdays
• Hyperinflation MDT (monthly Thursday AM)

Bronchoscopy

The Bronchoscopy service specialises in advanced diagnostic and therapeutic bronchoscopy, performing more than 1000 procedures each year across 8 lists per week. Procedures undertaken at UCLH:

• Endobronchial ultrasound and transbronchial needle aspiration
• Navigation bronchoscopy with advanced imaging techniques
• Robotic bronchoscopy
• Flexible video bronchoscopy
• Autofluorescence bronchoscopy
• Airway stenting
• Rigid bronchoscopy
• Laser resection, other thermal, and cryo-ablation techniques
• Bronchoplasty for non-malignant strictures
• Brachytherapy

Consultants (Lung Cancer & Bronchoscopy): Professor Janes, Dr Navani, Dr Thakrar, Dr Abdullah, and Dr Kumar

Specialist Training: There are two dedicated supervised lists per week for registrars to attend with the opportunity to be trained in EBUS, flexible bronchoscopy, and pleural procedures. The expectation is that each trainee should perform at least 30 procedures during a 6 month rotation. Simulation training can also be arranged on a bespoke EBUS phantom – any trainee interested should discuss this with Dr Thakrar at the start of their rotation.

Advanced Interventional Bronchoscopy is performed by Professor Janes, Dr Navani, and Dr Thakrar. Specialist trainees can also gain exposure to these procedures. Any trainee specifically interested in a career in lung cancer and bronchoscopy should aim to meet with Dr Thakrar at the start of their rotation to arrange a more bespoke training programme and discuss research opportunities. Any patients across the training network with airway obstruction or those needing robotic bronchoscopy can be referred directly to Dr Thakrar (ricky.thakrar@nhs.net).

Estimated number of bronchoscopic procedures in 6 months per trainee: 1 – 10 (with 0 endobronchial/transbronchial biopsies)

Estimated number of EBUS/TBNA in 6 months per trainee: 21 – 30

Pleural USS

There are great opportunities for training in pleural procedures, and thoracic ultrasound. Trainees should meet with the Pleural consultants early in rotation to discuss their training needs so that appropriate experience and support can be arranged. Dr Toby Hillman is level 2 accredited and can train, and sign off trainees for thoracic ultrasound.

There is a weekly procedures list in theatres that provides opportunity for IPC insertion and removal experience.

Inpatient pleural work is frequent, with close support from Consultants available on a daily basis. Procedures on the wards will include chest drain insertion, therapeutic and diagnostic aspiration, talc pleurodesis, and intrapleural fibrinolysis.

There are currently no routine pleural biopsy training opportunities, nor medical thoracoscopy, but service development includes aims to support these in the future.

There is a dedicated handheld ultrasound for SpR use (Butterfly) for mobile examinations. There are larger pleural ultrasound machines available on wards, the acute medical unit, ED, and in the outpatient department.

Consultants: Dr Toby Hillman, Dr Reza Abdullah

Estimated number of thoracic US in 6 months per trainee: 31 – 40

Estimated number of pleural aspirations in 6 months per trainee: 11 – 20

Estimated number of chest drain insertions in 6 months per trainee: 21 – 30

NIV/Sleep

The UCH Respiratory Sleep service sees a range of sleep presentations and manages patients with OSA. There are 4 consultant clinics per week and a weekly dedicated supervised Registrar list.

The inpatient ventilation work is currently predominately performed on AMU, with initiation experience gained on acute medicine shifts. Patients do receive NIV under Respiratory medicine, including those who are more complex or are slow to wean. Service development aims include bringing acute NIV under Respiratory medicine. However, Dr Rónan Astin is Trust NIV lead and is eager to support trainees in developing NIV skills and knowledge. Trainees should meet with him early in rotation to discuss their training needs.

Dr Astin also leads the Ventilation service at the Neuromuscular complex Care Centre at the Hospitals for Neurology and Neurosurgery (‘Queen Square’) managing a large cohort of complex neuromuscular patients receiving NIV. Whilst Registrars are not timetables to attend his clinics, he is happy to have trainees in clinic. Any trainee interested in a career in Ventilation medicine should aim to meet with Dr Astin early in rotation to discuss opportunities in training and resear

Estimated number of adequate involvement in management/initiation of NIV in 6 months per trainee: 11 – 20

Estimated number of NIV cases in 6 months per trainee: 11 – 20

Physiology

UCLH has a large respiratory physiology service with laboratories at UCH and Queen Square. There are learning opportunities in all standard respiratory physiology techniques including hypoxic challenge testing, bronchoprovocation and Forced Oscillometry technique (FOT).

There are CPET lists twice per week, under the supervision of Dr Astin. Trainees are not timetabled to attend physiology sessions but any trainee that would like to should approach Dr Astin to identify opportunities.

GIM

	Mon	Tue	Wed	Thu	Fri	Sat	Sun
Week 1	Resp	Resp	Resp	Resp	OFF	Ward cover 8.30am – 6pm	Ward cover 8.30am – 6pm
Week 2	Resp	Resp	Resp	Resp	Resp	OFF	OFF
Week 3	SDEC 8.30am – 9.30pm	SDEC 8.30am – 9.30pm	OFF	OFF	SDEC 8.30am – 9.30pm	SDEC 8.30am – 9.30pm	SDEC 8.30am – 9.30pm
Week 4	OFF	OFF	SDEC 8.30am – 9.30pm	SDEC 8.30am – 9.30pm	OFF	OFF	OFF
Week 5	Nights 9pm – 9am	Nights 9pm – 9am	Nights 9pm – 9am	Nights 9pm – 9am	OFF	OFF	OFF
Week 6 – 8	Resp	Resp	Resp	Resp	Resp	OFF	OFF
Week 9	Resp	Resp	OFF	OFF	Nights 9pm – 9am	Nights 9pm – 9am	Nights 9pm – 9am
Week 10	OFF	OFF	Resp	Resp	Resp	OFF	OFF

• The respiratory trainees share a line on the acute medicine rolling rota. There are 11 slots on the rota, meaning that the respiratory NTNs effectively do a 1 in 22 rota if sharing the line between 2 trainees. 
• Each acute medicine block includes 7 SDEC day shifts (8:30am – 9:30pm; split over 2 consecutive weeks), 7 nights (9pm – 9am; split over 2 weeks) and a ward cover weekend (8:30 – 6pm). 
• Each SpR will do the acute medicine block only once every 6 months (see above schedule).
• The take has become busier in recent years and includes 30 – 50 referrals per day. For each shift, the SpR is paired with an IMT3. The SpR and IMT3 often alternate duties between taking referrals from ED and covering the inpatient wards.
• SpRs and IMT3 will manage 1 – 3 clerking SHOs and 1 F1 in one shift.
• Trainees have reported having to manage a cardiac arrest in every other shift. 
• The acute medicine department is generally very friendly, and GIM experience has been rated “excellent” by trainees.
• Previously, SpRs spent a third of their time doing acute medicine during which time they couldn’t take leave. This meant all annual and study leave has to be taken on respiratory – a problem when trying to make the most of all the potential educational opportunities. We have therefore negotiated a reduced acute medicine commitment – 50% of the previous commitment.
• Trainees have reported having to manage a cardiac arrest in every other shift.

GIM experience has been rated “excellent” by trainees.

Teaching

• There are many UCL medical students around with plenty of opportunities to get involved in formal and informal teaching in Respiratory and GIM.
• There is usually a PACES course run for CMTs which you can also get involved in.

Management/leadership

• Trainees can participate in the shadowing scheme of the senior leadership/chief executive
• Opportunity for the chief registrar role
• Trainees are also invited to the departmental management meetings

Quality improvement

• Trainees are involved in BTS Audits
• QIP opportunities are always available.

Specialist training opportunities

• Specialist bronchoscopy – cryobiopsy and specialist interventional bronchoscopy
• ILD – Plenty of opportunities for experience
• Complex lung infection in immunocompromised patients (Haemato-oncology) – significant exposure
• Unexplained Breathlessness and Exercise Intolerance service– including CPET
• Specialist Ventilation clinics (Queen Square)
• Dr Hasford’s clinic at the Homeopathic hospital – recommended to attend as it provides a great learning experience
• TB clinic (Whittington)
• COPD community clinics and MDTs
• Lung function – Full lung function tests, Bronchial challenge, hypoxic challenge, FeNO, FOT, CPET, (opportunity for experience with friendly physiologists)

Trainees have reported inadequate experience in TB, CF, occupational/genetic/developmental lung disease, palliative care in respiratory, pulmonary rehabilitation and pulmonary hypertension.

Research

• Many Consultants in the department are active in research and always looking for interested SpRs to contribute to projects and apply for OOPR. Have a look at our research pages for more information.

Stage of training best suited to this rotation

• ST5+

Comments from Dr Rónan Astin on behalf of the Consultant body

• Whist we are proud of the care our department delivers, we are aware that the SpR job has been challenging at times. We are eager to improve this experience and have made changes in order to provide greater training opportunities. Such changes include increasing the number of SpR bronchoscopy lists, reducing the acute on call commitment by 50%, formalising outpatient clinic supervision, increasing the junior work force (adding a physician associate, FY2 and IMT3), and providing increased subspecialty consultant supervision. We want trainees to enjoy their time with us, and gain valuable experience in a supportive environment.

 Recent trainee comments:

“Overall, this has the potential to be a really good job but you need to be proactive to get the most from it. Many have felt frustrated that they did a lot of general respiratory medicine during their time at this specialist centre.“

“Great GIM experience. Exceptional clinical resp experience in outpatients but work load far too heavy.”

“UCLH is an excellent job. I enjoyed it and learnt a lot there and would recommend it highly. There is a wide range of subspecialist interests, very friendly and supportive consultants, and a medical take that isn’t too busy. However, you need to push and stand your ground to take advantage of everything that’s on offer.”

“This job can be particularly busy because they have not in general cancelled commitments regardless of the number of registrars on the wards. This may be changing but there is still lots of service provision which is a barrier to making the most of the opportunities present at UCLH.”