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Training programme

The Respiratory curriculum (2010) is a long document, but it is essential trainees are familiar with its’ content. It lists the knowledge, skills and behaviours expected of a Respiratory trainee; provides an indication of the learning methods in use; and details the assessment methods in place. It also provides an indication of what can be expected to be covered in the structured training programme, and what sub-speciality experience is required to cover all of the required knowledge. The syllabus spells out exactly what knowledge, skills and behaviours trainees are required to demonstrate to CCT, and may be useful to structure revision for the SCE. In order to help you navigate the requirements for successful CCT we have provided some focused advice on several areas of the curriculum:

Trainees who joined the training programme between 01/08/07 and 03/08/10 folowed the 2007 version of the Respiratory Curriculum and the 2007 Generic Curriculum. Everyone should now be on the 2010 Respiratory Curriculum which includes GIM.

General

  • Inpatients: 12 months minimum at a DGH and 12 months minimum at a tertiary centre
  • Outpatients: including secondary and tertiary care. It is recommended that trainees attend on average 2 outpatient clinics a week and see 6 new patients and 12 follow-ups a week (clearly this will vary across placements and time periods but clinics should not be so busy as to compromise the training experience. In particular, it is essential that there is sufficient time allowed for adequate discussion of the cases seen by the trainee with the supervising consultant. Indicative times would be to allow 30 minutes for a new patient and 15 minutes for a follow up case.)
  • ICU: a minimum of 60 whole working days in Intensive Care Medicine (ideally full time appointment, including on calls)
  • WPBAs (see the ARCP decision aid for a breakdown of expected progress each year)
    • A minimum of 6 miniCex/CbD per year of training (we suggest you aim for more)
    • At least 2 MSFs (1 near the start of training ie ST3 or 4, and 1 near the end ie ST6)
    • 7 Bronchoscopy DOPS (in addition to the log of all Bronchoscopies completed (see ARCP and PAYE information)
    • At least 1 satisfactory Chest drain DOPS in both ST3 and ST4
    • 1 NIV DOPS in ST3

Specialist areas

There are areas in Respiratory Medicine practice in which some trainees may receive insufficient exposure in their main training units due to local arrangements for the care of certain categories of patients. It may be necessary for them to attend an approved course (for instance, a BTS course, with an end-of-course assessment) or have a secondment to a specialised unit, local or distant, to complete their training experience (see FAQs). These areas include:

  • Tuberculosis/opportunist mycobacterial disease (easily covered in usual rotations)
  • Cystic fibrosis (may need to be specially arranged if not at Royal London – see FAQs)
  • HIV/AIDS (may need to be specially arranged if not at Royal Free)
  • Respiratory allergy and immunology (available at Homerton and Royal London)
  • Occupational and environmental lung disease (will need to be specially arranged eg at NHLI, Imperial – see FAQs)
  • Genetic and developmental lung disorders
  • Pulmonary hypertension (will need to be specially arranged eg at Royal Free)
  • Transplantation (will need to be specially arranged – see FAQs)
  • Respiratory disease in the transition from adolescence to adulthood (for example, cystic fibrosis, difficult asthma, neuromuscular disease) and in pregnancy
  • Domiciliary NIV (should be covered in usual rotations as available at several sites eg Royal Free)

All trainees will have to demonstrate, before they receive their CCT, that they have appropriate experience in all these areas. In some very specialised areas this appropriate experience may comprise evidence of attending lectures or seminars, together with attending, in a supernumerary capacity, a number of ward-rounds and/or out-patient clinics dealing with the care of a particular group of patients.

Procedures

All procedures required of a Respiratory/GIM trainee are listed in section 10 of the curriculum. Trainees must complete DOPS but also keep a logbook of procedures (specifically bronchoscopy and pleural procedures: see ARCP and PAYE for links to example templates). Specific requirements include:

  • Bronchoscopy: competence at diagnostic bronchoscopy by end of ST4. The bronch logbook must include pathology results of biopsies taken.
  • Pleural Ultrasound: Level 1 competence (sign off) by end of ST5 (see FAQs)
  • Pleural aspiration: competent by end of ST3 with DOPS evidence
  • Chest drain: competent by end of ST3 with DOPS evidence
  • NIV: competent by end of ST3 with DOPS evidence
  • Spirometry: competent by end of ST3
  • Lung function interpretation: competent by end of ST4

Radiology

  • CXR interpretation: competent by end of ST3
  • CTPA/HRCT interpretation: competent by end of ST4

Study Leave

In order to acquire the necessary skills and knowledge required to CCT it is recommended that each trainee has the equivalent of 30 working days per annum to be used exclusively for educational purposes. The equivalent of one half day per week (15 free days per year) should be for a Structured Training Programme. At least 10 of the 15 days should be in Respiratory Medicine. Two of these 10 days may be used for authorised and confirmed attendance at recognised national/international meetings (such as BTS, ERS and ATS). The remainder, a minimum of 8 days per year, must be used to attend the regional Structured Training Programme, a regular, rolling programme of educational activities that should cover the entire Respiratory Medicine curriculum, usually over a period of 2-3 years, before being repeated. Attendance at 70% of the structured training programme days is required for each year ST3-5. In ST6 some of this time can be replaced with appropriate alternative educational activities. If you are having problems getting study leave approved get in touch with a trainee rep and/or Angshu. 

For a list of upcoming training days see the Calendar, which you can synch with your own iCal or Google calendar (see About page for links). This includes NET training days, Pan-London Respiratory training days and GIM training days.

For highlights of previous training days see the “Training Day” tab on the menu above.

Additional GIM CPD can be gained through various courses and seminars. We’re lucky that in London there are several options right on our doorstep:

Indicative Trainee Job Plan
Whilst the formal Structured Training Programme is designed to provide much of the knowledge required for expert practice in Respiratory Medicine, a large proportion of training is ‘on-the-job.’ An indicative job plan for a trainee in Respiratory Medicine, as suggested by the Respiratory Curriculum, is as follows:

  • Two consultant-led ward rounds per week
  • One trainee-led ward round per week
  • Two outpatient clinics per week
  • One practical procedures session (usually, but not exclusively, bronchoscopy) per week
  • Appropriate protected time for essential educational activities should be agreed between the trainer and trainee

It is emphasised that the above is intended only as a guide to the general job plan for the average post. It is not expected that this should be rigidly adhered to in all circumstances. If you are concerned that your job plan is not providing appropriate training experience please speak to your educational supervisor or the TPD, Dr Angshu Bhowmik.

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