Scottish Medical Training

Why choose this programme?

The Respiratory training programme in the North of Scotland offers comprehensive clinical training in a very busy but efficient & supportive atmosphere, based in Aberdeen Royal Infirmary (ARI) and Raigmore Hospital, Inverness. We value our trainees & have high expectations of them but recognise that we need to work hard to provide high quality training. With a complement of around 900 beds, ARI is a major tertiary referral centre for the North and North East of Scotland, Orkney & Shetland and provides a complete range of medical and surgical specialities, described below.

The Respiratory Unit is in the Emergency Care Centre adjacent to the Medical HDU. The medical school and Institute of Medical Science are also on site and trainees will have the opportunity to pursue teaching and research interests. Training also occurs, typically for 2 years, in Inverness at Raigmore Hospital, which is a large district general hospital, with an established and well respected 30 bed Respiratory Unit. There are opportunities to pursue interests in quality improvement, medical education and respiratory research.

Specialty Information

ABERDEEN ROYAL INFIRMARY

Facilities and training opportunities

Our unit provides comprehensive facilities for patients with Respiratory disorders in the Grampian region and also provides a service for those from the islands of Orkney and Shetland (total population approximately 570,000, 610,000 including Orkney & Shetland). Currently we have 9 Respiratory consultants in Aberdeen and 4 in Inverness.

In patient activity

In Aberdeen we have 30 in-patient beds, admitting approximately 2,500 patients annually. Patients are admitted via ED, the acute medical assessment unit or directly from chest clinic. We have a 24-hour physiotherapy led acute non-invasive ventilation service treating approximately 180 patients per year, with both bi-level and continuous pressure support. We also have thoracic ultrasound and transcutaneous CO2 monitoring. We have extensive sub-speciality nursing support, detailed below.

Out patient activity

We have one of the largest Chest Clinics in the UK, with approximately 10,000 attendances each year of which over 2,500 are new outpatient referrals. Within the Chest Clinic are more specialised weekly clinics in: • Adult Cystic Fibrosis. • Sleep Medicine • Interstitial Lung Disease • Tuberculosis • Airways Disease • Bronchiectasis • Pleural Service

Pleural service is provided by three consultants (Dr. Chetty,Dr Alluri and Dr.Thomson. A Weekly consultant led  Pleural clinic where USS guided diagnostic and therapeutic (including IPC) procedures are carried out.

Cystic Fibrosis service is run by three consultants (Dr. Dempsey, Dr. Srivastava and Dr. Thomson) and supported by various health care professionals such as CF nurses, Diabetologist, Specialist Physiotherapist, Specialist CF Pharmacist and a psychologist.

We also have regular all-day peripheral clinics held at least twice each month at local hospitals in Peterhead, Banff and Elgin.

Specialist services

Lung Cancer

There are approximately 350 new diagnoses of lung cancer in Grampian each year. There is a well-established local multidisciplinary team including respiratory medicine, oncology, radiotherapy, thoracic surgery, pathology, radiology and cytology. The unit has consistently achieved targets for referral over many years, and a higher proportion of Grampian patients receive active treatment for lung cancer than elsewhere in Scotland. Patients are regularly recruited into multicentre trials. Lung cancer survival in Grampian exceeds the Scottish average.

Bronchoscopy

There are 2 weekly Bronchoscopy sessions (Tuesday pm and Thursday pm) with modern facilities including endobronchial ultrasound. Approximately 600 procedures are performed each year. The bronchoscopy service is supported by a specialist nurse, administration support and physician’s associates.

Interstitial Lung Diseases

Three consultants (Dr Dempsey, Scott and Alluri) run ILD clinics each week, and we hold a monthly multidisciplinary ILD conference to discuss difficult cases. We receive input form the pathology team, including Prof Keith Kerr, who is on the UK ILD panel. There are 2 consultant radiologists with a particular interest in thoracic imaging and 3 thoracic surgeons on site. We are currently involved in ongoing multicentre ILD trials, have a research nurse and have recently published in this field. We also have a physiotherapy led ambulatory oxygen assessment service for our ILD patients. There is an ILD specialist nurse.

Airways

Two consultants (Dr D Miller and Dr J Miller) run an airways clinic each month. There is specialist nurse, pulmonary function and clinical psychologist support at this clinic. Exhaled NO and serum prednisolone levels are available as is bronchial challenge testing.

Bronchiectasis

Monthly bronchiectasis clinics with respiratory physiotherapy support are run by Dr Dempsey.

Tuberculosis

In Grampian there are approximately 50 new cases of TB every year and in addition there are approximately 25 patients found to have environmental mycobacterial infection. A monthly TB clinic is run by Dr Brittain-Long (Infectious Diseases Consultant) together with Respiratory Consultant (Dr Fitch) and the TB specialist nurses. Additional clinics are occasionally held to review patients with suspected “latent” TB found through immigrant screening.

Pulmonary function

The Pulmonary Function laboratory within ARI provides a range of physiological services, including plethysmography (2 body boxes), bronchial challenge testing, fitness to fly assessment, FeNO, skin prick allergy testing and a cardiopulmonary exercise testing service is in development.

Thoracic surgery

There is a busy Cardiothoracic Surgical Unit within ARI. Mr Hardy Remmen, Mr Mohammed Khalil and Mr Keith Buchan undertake thoracic surgery. We have rapid access to video-assisted thoracic lung surgical procedures and rigid bronchoscopy.

Pulmonary vascular disease

The Scottish Pulmonary Vascular Disease Unit now visit 3 monthly intervals and provide a satellite clinic for patients with pulmonary hypertension, at which our trainees can participate.

Radiology

We have a full range of imaging available including conventional CT, spiral CT, MR, isotope scanning and on-site PET. Two of our radiologists (Dr Gomersall and Prof Denison) have a major interest in thoracic imaging, including stent placement.

ITU support

We have a large ITU with 19 beds, with a full range of services, including extracorporeal membrane oxygenation (ECMO) for which the team have a Platinum Award. Our senior trainees rotate through ITU for a minimum of 3 months and the option of further training in ITU is possible.

Sleep Service

There is a well established Sleep Service run by Dr Fitch. Currently there are over 2000 patients established on CPAP, and the sleep clinic receives upwards of 600 new referrals per year, with specialist nurse support. Patients needing NIV home ventilatory support for kyphoscoliosis, neuromuscular disease etc (currently over 120) are also seen through this service.

Specialist Nurse / Physiotherapy support

We have Specialist Nurses for Lung Cancer, Lung Cancer investigation, Adult Cystic Fibrosis, Tuberculosis Control, Sleep Medicine (run together with pulmonary function technicians), Respiratory Support Service for patients with airways disease, oxygen service run by senior physiotherapists and respiratory nurses. We also have a “Hospital at Night” service.

The Respiratory Unit has a considerable reputation in clinical research. A number of trainees have been supported through out of programme opportunities to gain qualifications and experience in medical education.

Our trainees have the opportunity to take time out of programme for research and educational, opportunities including: • Studies into the role of eosinophils and their products in the pathogenesis of Asthma • Studies into the early life origins of Asthma and Allergy • The natural history of wheezing syndromes: particularly factors affecting decline in lung function including perinatal factors, childhood diagnostic category and diet • Studies into outcome measures for Asthma particularly quality of life • Major involvement in National / MRC etc studies into the chemotherapy and other management of Lung Cancer • Interstitial lung disease (currently we are the only Scottish centre recruiting into multicentre ILD trials) • Developmental research into whether the plethysmogram from a pulse oximeter can be used to record respiratory rate • Studies into the value of inhaled mannitol in the management of patients with bronchiectasis • Clinical trials of newer biological agents in the management of severe persistent asthma • Clinical trials in COPD and asthma including trials of oral theophylline in COPD exacerbations and high dose ICS in reducing severity of asthma exacerbations.

Teaching & training Multi-disciplinary meetings

Weekly Departmental meetings are held (Thursday lunchtimes), covering the full range of Respiratory diseases. We also hold sub-speciality meetings in lung cancer, interstitial lung disease, cystic fibrosis, and thoracic pathology. Our medical school is on site and weekly “Grand Rounds” are held in a state of the art teaching facility every Wednesday lunchtime. There is weekly teaching organised by and for doctors on Wednesday afternoons on the respiratory unit in addition to the national respiratory ST training programme.