UCLH

Updated in Feb 2020

University College London Hospital was opened in 2005. Services offered at UCLH include accident & emergency, hyper-acute stroke unit, cancer care, critical care, endocrinology, general surgery, ophthalmology, dermatology, general medicine, general neurology, rheumatology, orthopaedics, paediatric & adolescents, and urology. The latest CQC rating was overall “good“.

The hospital has a growing focus on cancer care. The very beautiful Macmillan Cancer Centre just behind the acute hospital building opened in 2012 and there is ongoing building work with a new centre planned to open in 2020. 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 and both are the only respiratory SpRs in the hospital (although there are various other clinical fellows with other commitments).

Consultant speciality interests

• Dr Joanna Porter – ILD, autoimmune disease, cryobiopsy
• Prof Jerry Brown – Bronchiectasis, immune deficiency, pneumonia (Strep pneumoniae)
• Dr Helen Booth – TB, Bronchoscopy/EBUS, sarcoidosis, general medicine
• Prof Sam Janes – Lung cancer,Bronchoscopy/EBUS, stem cells
• Dr Neal Navani – Lung cancer, Bronchoscopy/EBUS, clinical trials
• Dr Fionnula Crummy – Sleep medicine
• Dr Himender Makker – Sleep medicine (also works at North Mid)
• Dr Christian Hasford – Allergy, complementary/integrated medicine, medically unexplained symptoms, acute medicine
• Dr Toby Hillman – pleural disease, acute medicine, leadership and management
• Dr Ricky Thakrar – lung cancer, interventional bronchoscopy
• Dr Ronan Astin – sleep medicine, neuromuscular respiratory disorders, research (also works at Lane Fox Unit)
• Dr Mel Heightman – ILD and community/integrated care

Typical week for SpRs

	Mon	Tue	Wed	Thu	Fri
AM	Gen Resp/ILD clinic (alt weeks)	Bronch list	Ward/ Referrals	Ward/ Referrals	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. Realistically, it is mainly covered by just 1 SpR while the other is on leave or their acute medical block.
• The day starts at 8 am and as there is no admin time due to the high clinic burden, trainees can end up staying late.
• You can feel a bit peripheral to the lung cancer service because the research fellows do a lot for the service. But the overall care is excellent and the MDT is an example of efficient, high quality practice that is worth seeing.
• Up to 5 clinics a week but now generally a maximum of 4 clinics a week.
• No respiratory on calls.

Other meetings:

• Weekly lunch time departmental teaching
• Mortality and morbidity meeting every 3 months
• Complex infection MDT
• ILD MDT

Bronchoscopy

• 1 bronchoscopy list per week supervised by a consultant
• The bronchoscopy set up is the best in London (according to a recent trainee) but unfortunately trainees find it difficult to get much experience of EBUS despite this hospital doing vast numbers.
• As a rotating trainee, there is generally only one list you can attend for EBUS and in that list you will not “drive”. “If you want a job that will train you to be independent in EBUS, go elsewhere.”
• The interventional lists are organised by Dr Neal Navani and Dr Ricky Thakrar and they have an interventional fellow who will be prioritised for hands on experience. “A great opportunity for trainees is to attend interventional lists if you make the effort which are really interesting and you can get a small amount of hands on experience.”

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 is a dedicated departmental USS machine
• Dr Toby Hillman is Level 2 trained and can support sign off 
• There are opportunities for trainees to perform medical talc pleurodesis and indwelling pleural catheter insertion.
• Trainees have not reported any pleural biopsy or medical thoracoscopy experience.

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

• Adequate acute NIV experience
• Comprehensive sleep service available here with overnight pulse oximetry, limited and complex polysomnography services available.

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

GIM

• 2 month acute medical block split into the weeks as detailed below with additional ward cover weekends.

	Mon	Tue	Wed	Thu	Fri	Sat	Sun
Week 1	8 am – 4 pm	8 am – 4 pm	8 am – 4 pm	8 am – 4 pm	8 am – 4 pm	OFF	OFF
Week 2	12 – 10 pm	12 – 10 pm	12 – 10 pm	12 – 10 pm	OFF	OFF	OFF
Week 3	Nights	Nights	Nights	Nights	OFF	OFF	OFF
Week 4	Normal day in Acute med	Normal day in Acute med	Normal day in Acute med	Normal day in Acute med	Normal day in Acute med	OFF	OFF
Week 5	OFF	OFF	OFF	OFF	Nights	Nights	Nights

• Although the take is not busy with approximately 30 patients in 24 hours (and the acute medicine consultants are friendly too), you do spend a third of your time doing acute medicine during which time you can’t take leave. This means 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.
• SpRs 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.

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

Whilst there are 2 SpRs, you are very often on your own doing Respiratory (as the other will be on GIM or on leave) covering a lot of clinics and ward referrals which means it is difficult to go to certain specialist training opportunities due to clashes.

There are also satellite transplant clinics which occur at UCLH, but again trainees do not find it easy to attend these.

• Specialist bronchoscopy – cryobiopsy and specialist interventional bronchoscopy
• Dr Hasford’s clinic at the Homeopathic hospital – recommended to attend as it provides a great learning experience
• COPD community clinics and MDTs
• Dr Crummy’s sleep clinic at Queens Square
• Complex lung infection in immunocompromised patients (Haemato-oncology) – significant exposure
• Lung function – full lung function tests and FeNO testing available (opportunity for experience with friendly physiologists)
• ILD – Plenty of opportunities for experience

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+

 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.”