The Critical Care unit at Dumfries and Galloway Royal Infirmary is a 16 bedded combined Intensive Care and High dependency unit. The Critical Care Unit is well equipped, currently with ventilators to provide invasive and non-invasive ventilation; High flow oxygenation devices; Philips monitoring and electronic notes; ultrasound and echocardiography. Multi-modality renal support is used with excellent support from the renal unit.

The Critical Care Unit is staffed by six Critical Care Consultants on a ‘week at a time’ daytime rota. Out of hours consultant cover is provided by two on call consultants, one of which is always an Intensivist. The unit actively participates in audit and multi centre research From February 2024 our critical care unit will have a 24x7 junior/middle grade tier dedicated to the management of critical care patients.

The F2 working in critical care will be a fully active participant of this tier. Medical and surgical specialities have admission and discharge rights into the unit. Level 1 patients will remain under the care of the admitting medical/surgical consultant whilst the responsibility of care for Level 2/3 patients will be transferred to the care of a critical care consultant. The junior/middle tier will work with the named consultant to help deliver excellent care to critically ill patients.

Responsibilities of the FY2 doctor include:

• Receiving referrals from clinical teams
• Holding the arrest page.
• Admitting patients, including assisting with stabilisation
• Daily reviews and formulation of management plans
• Participation and presentation at the daily MDT
• Co-ordination of discharge of patients from the critical care unit
• Provision of out of hours cover

The post will involve spending an average of one day per week working with the microbiology team although these may be grouped as week-long attachments

Microbiology Component

A team of three Consultants provide the clinical Microbiology and Infection Control service for Primary and Secondary Care for the Dumfries and Galloway region. The FY2 doctor will work with the Microbiology team based in the Microbiology laboratory at Dumfries and Galloway Royal Infirmary.

Responsibilities of the FY2 doctor include:

• Participation in laboratory bench rounds
• Communication of significant results to clinical teams and liaison with Health Protection Team
•  Attendance and participation in Infection Team meetings

Preparation and participation in various infection MDTs

The training potential of this module is excellent.

F2 doctors will take responsibility for their own learning and will be expected to take advantage of training opportunities presented during their day-today work. Training periods will be allocated by rota.

During these clinical sessions focus will be made on achieving clinical competency in the areas set down in the Curriculum for the FY2 and will include:

• Airway management
• Breathing problems
• Circulation problems
• Treating pain
• Infection control
• The principles of medical ethics, practices of obtaining valid consent for procedures and the ethics of when to treat, when to withdraw treatment.

Practical experience will be expected to be gained in:

• Ultrasound guided vascular access including insertion of arterial and central venous catheters
• Lumbar Puncture
• Chest drain insertion

There will be opportunities for the F2 doctor to be attached to a consultant anaesthetist and spend time in theatre to gain experience in airway management and other aspects of anaesthetic management such as management of major fluid and blood loss and methods of post-operative pain management.

Microbiology Component

There will be ample opportunity for learning during the placement, both within the laboratory and through case discussion in wider clinical practice. 

Dedicated training time will be given to developing clinical competency in the areas specific to infection as set down in the Curriculum for the FY2. During the placement, concepts can be taught from a basic level onwards, therefore no prior experience of Microbiology is required. For experience in diagnosing and managing complex infection, the FY2 doctor will be linked with a Consultant. There will also be opportunities to shadow Consultants during infection control incidents/outbreaks.

Additional learning opportunities within the laboratory include:

• System specific/syndromic testing of specimens in the laboratory
• Laboratory identification of common pathogens
• Methods of antibiotic sensitivity testing Theory and practice of empirical and definitive antimicrobial choices for community and hospital acquired infection

Experience in management of acutely unwell patients whilst working in a highly supervised environment The Microbiology placement gives an opportunity to experience working in an Infection Specialty managing complex cases at the interface between the Microbiology laboratory and other specialties across the region.

This post will provide 2 hours per week of self-development time