Scottish Medical Training

GMC Reference: SES/389

 

Training in Clinical Pharmacology and Therapeutics (CPT) in Scotland is focused on three academic centres (Dundee, Edinburgh and Glasgow), all of which have international reputations for excellence. CPT training posts become available for an individual centre, which leads on training, but some trainees will wish to visit another Scottish centre to gain subspecialty expertise that is not available in their own.

CPT is a strong academic specialty in Scotland, with trainees encouraged to pursue a higher degree. Trainees are also encouraged to consider subspecialty training: in one or more of hypertension, stroke medicine, clinical trials, pharmacoepidemiology, pharmacovigilance and clinical toxicology. All centres have a strong research pedigree in hypertension and cardiovascular science, often matched with expertise in other areas (see below). Many Scottish Clinical pharmacologists lead on local and regional Drug & Therapeutics Committees, run Scottish Pharmacovigilance centres and are involved in the Scottish Medicines Consortium (SMC), its UK equivalent, NICE, and in committees of the UK medicines regulator, MHRA. They also play leading roles in various other national committees, such as in the British Pharmacological Society, British and Irish Hypertension Society, Royal College of Physicians (Edinburgh & London) and Faculty of Pharmaceutical Medicine.

Trainees are encouraged to join our specialist society, the British Pharmacological Society, and to attend its meetings, which include a strong educational component and dedicated trainee sessions. There are also annual Caledonian Society for CPT meetings, rotating between centres. In addition, there are opportunities to visit Drug & Therapeutics Committees, the SMC, MHRA and NICE, alongside broad medical education provided by the RCPE and RCPSG. Generally, CPT plays a major role in health technology assessment (HTA) and medicines management, and trainees are encouraged to gain experience in these areas.

Medical experience may be either in one of the core teaching hospitals or an associated DGH. Precise placements will depend on the location of the programme, the experience and situation of the trainee, and the availability of CPT trainers.

 

Dundee: contact Prof Isla Mackenzie, i.s.mackenzie@dundee.ac.uk

Dundee is a major CPT centre. The University of Dundee was ranked as the ‘most influential scientific research institution in pharmaceuticals (2006-2016)’ worldwide in the 2017 State of Innovation Report. Dundee has expertise in cardiovascular, stroke and respiratory medicine, clinical trials and pharmacoepidemiology. There are 6 clinical academic CPT consultants, and one CPT trainee post. The trainee will work alongside clinical research fellows and trainees from related specialties. Liaison with CPT trainees at other   UK centres will be encouraged. The Medicines Monitoring Unit (MEMO Research; https://www.memoresearch.com/) and Hypertension Research Centre (HRC) is based at Ninewells Hospital and has close links and collaborations with GPs, university and NHS centres across the UK and Europe. It is one of the most successful clinical trial centres in the UK. Dundee has an international reputation in data science, pharmacogenomics and precision medicine and is part of the Scotland HDR-UK and FARR Scotland collaborations. CPT and GIM training will take place in Perth Royal Infirmary and Ninewells Hospital, Dundee which has an Acute Medical Unit, general medicine/specialty wards and outpatient services including a cardiovascular risk clinic.

Members of the team specializing in CPT include:

• Prof Isla Mackenzie, Deputy Director of MEMO Research and HRC, clinical trialist, pharmacoepidemiologist, general and cardiovascular physician.
• Prof Chim Lang, Head of Division of Molecular and Clinical Medicine, clinical trialist, translational cardiologist.
• Prof Thomas MacDonald, clinical trialist, Director of MEMO Research and HRC, pharmacoepidemiologist, general and cardiovascular physician.
• Prof Brian Lipworth, Director of Scottish Centre for Respiratory Research, allergist/clinical pulmonologist.
• Prof Jacob George, National Clinical Lead for SMC, cardiovascular physician.
• Dr Alex Doney, pharmacogenomics, personalized medicine, clinical trials, stroke/cardiovascular/general physician

 

Edinburgh: contact Prof James Dear (james.dear@ed.ac.uk)

Edinburgh has a major heritage of pharmacology and toxicology, including Sir Robert Christison in the 19^th century and Sir Derrick Dunlop in the 20^th; celebrating its 250^th anniversary in 2018.  There is expertise in cardiovascular and renal medicine, stroke medicine, clinical trials at all stages, and clinical toxicology. There are 4 academic and 4 NHS consultants, and usually 2-3 trainees. The Edinburgh Unit of the Poisons Information Service (http://www.edinburghclinicaltoxicology.org) is based at the Royal Infirmary of Edinburgh (RIE), linked closely with liaison psychiatry and the Scottish Liver Transplant Unit. The academic unit, Pharmacology Therapeutics and Toxicology (PTT), is based in the BHF Centre of Research Excellence (https://www.cvs.ed.ac.uk) in the Queen’s Medical Research Institute on the RIE site. A (European Hypertension Society) Centre of Research Excellence for Hypertension is based at the Western General Hospital (https://www.bloodpressureclinic.ed.ac.uk) as is the Clinical Pharmacology Unit’s University Clinical Research Centre, which complements other Clinical Research Facilities across the city. Individual members include:

 

• Prof David Webb, hypertension researcher, clinical trialist, Scottish CPT TPD, past President of the BPS, and Vice-Chair of MHRA. 
• Prof Simon Maxwell, international prescribing education leader and originator of the UK’s PSA (https://prescribingsafetyassessment.ac.uk) 
• Prof Michael Eddleston directs the Centre for Pesticide Suicide Prevention, works globally in clinical toxicology, and advises WHO in the field. 
• Prof James Dear has international expertise in biomarker validation and is involved in early phase clinical trials in clinical toxicology. 
• Dr Euan Sandilands, Director, Edinburgh Unit, National Poisons Information Service, runs TOXBASE and is RIE undergraduate education lead. 
• Dr Iain MacIntyre, dual trained (CPT and nephrology), using NHS Research Scotland sessions to do clinical trials in hypertension and renal disease 
• Dr Emma Morrison leads on Medicines Management, chairs the local NHS Formulary Committee and is a member of the BPS Clinical Committee. 

  

Glasgow: contact Dr Linsay McCallum, linsay.mccallum@ggc.scot.nhs.uk

Glasgow’s pharmacology heritage includes Nobel Laureate Sir James Black who developed propranolol and cimetidine.  Glasgow’s Clinical Pharmacology trainees benefit from close involvement with the local highly active clinical research institutes (Cancer Sciences (https://www.gla.ac.uk/schools/cancersciences/), Cardiovascular and Metabolic Health (https://www.gla.ac.uk/schools/cardiovascularmetabolic/) and Infection and Immunology (https://www.gla.ac.uk/schools/infectionimmunity/ ) co-located with their clinical training base. Ample opportunities exist to take time out of programme with a view to completion of a higher degree. Comprehensive training is provided in all aspects of clinical pharmacology with many opportunities to develop specialty interests within this broad discipline through participation in the University of Glasgow’s postgraduate taught Masters programme in Clinical Pharmacology (www.gla.ac.uk/postgraduate/taught/clinicalpharmacology), and through engagement with undergraduate and postgraduate medical education, regulatory matters and clinical trials. Glasgow University’s Clinical Innovation Zone at the Queen Elizabeth University Hospital (QEUH) campus is now Scotland’s focal point for the implementation of precision medicine, with the Stratified Medicine Scotland Innovation Centre (SMS-IC) located there (https://www.gla.ac.uk/research/beacons/precisionmedicine/ ). This offers unique opportunities for CPT trainees to obtain training in integrating genomic, imaging and information technologies, health economic assessments, regulatory perspectives and clinical trials for precision medicine.

Individual members include

• Prof Sandosh Padmanabhan, Cardiovascular Genomics, Hypertension, Clinical Trials, Precision Medicine
• Prof Matthew Walters, Head of School (Medicine, Dentistry and Nursing), Stroke medicine, Clinical Trials
• Prof Jesse Dawson, Stroke Medicine, NHS Research Scotland lead for stroke research, Clinical trials.
• Prof Gerard McKay, Diabetes, Prescribing, Clinical Trials.
• Dr Scott Muir, Hypertension, Stroke Medicine, Clinical Trials, Chair- Area Drugs and Therapeutics Committee, Vice Chair - Scottish Medicine Consortium.
• Dr Craig Harrow, Stroke Medicine, Clinical Trials
• Dr Linsay McCallum, Hypertension, Clinical Trials
• Dr Andrea Llano, Diabetes, Hypertension

 

CPT training is provided as a well-integrated Scottish programme, with excellent interaction and collaboration between centres, ensuring optimal access to the range of subspecialty experience available. Placements in Scotland are managed by the South East Deanery based in Edinburgh.

CPT has an outstanding academic track record and allows flexibility to pursue clinically-relevant, medicines-focused research and integrate it with clinical practice. Opportunities range from lab to clinically based research, clinical trials, drug safety (clinical toxicology, pharmacovigilance and pharmacoepidemiology) and data science (big data).

There are many opportunities for educational activities in the three teaching centres. Audit projects are encouraged, as is completing a full audit cycle

Of all the medical specialties, CPT probably offers trainees the widest range of post-CCT job opportunities. Normally training is conducted in association with a general medical or acute medical programme.

Job opportunities after training exist in many areas including in research, teaching, clinical medicine and clinical toxicology within the NHS, academic university careers, with drug regulatory authorities and in the pharmaceutical industry. Further careers can be moulded around trainee’s interests and this is unusual in most other medical specialties.

Most training programmes will include a component of acute or general medicine interspersed with more academic-based activities. The precise nature of these will vary, dependent on the local opportunities and the interests of the trainee. In addition, trainees become familiar with how to prescribe, advise on the use of drugs within the NHS, and are often involved in local drug and therapeutics committees.

 

Training is delivered across:

Glasgow Royal Infirmary, Ninewells Hospital, Dundee, Royal Alexandra Hospital, Paisley , Royal Infirmary of Edinburgh, The Queen Elizabeth University Hospital Glasgow , Western General Hospital, Edinburgh

NHS Greater Glasgow & Clyde, NHS Lothian, NHS Tayside

Programme Type	Deanery based or National: National
Administration office	West of Scotland
Lead Dean / Director	Professor Adam Hill
Responsible Associate Postgraduate Dean or Assistant Director (GP)	Dr Jane Rimer
Specialty or Sub-specialty	Specialty or Sub-specialty: Specialty
Date of GMC recent approval	August 2010
Associated Royal College - Faculty	Joint Royal Colleges of Physicians Training Board (web site)
Curriculum and Associated Assessment System	http://www.gmc-uk.org/education/postgraduate/clinical_pharmacology_and_therapeutics.asp
Programme Administrator:	Named Programme Administrator: Sarah McNeil Address: NHS Education for Scotland, Third Floor, 2 Central Quay, 89 Hydepark Street, Glasgow, G3 8BW Tel: Email: Sarah.McNeil@nhs.scot
Programme Director	Programme Director Name: Prof Gerard McKay Address: Glasgow Royal Infirmary Castle Street Glasgow Tel: 0141-451-5367 Email: Gerard.McKay@ggc.scot.nhs.uk
Quality of Training	Quality Management