Scottish Medical Training

Training in paediatric cardiology is highly rewarding and stimulating. However, it is also motivationally demanding and frequently requires re-location within the United Kingdom, if not further afield. As such, candidates considering a career in paediatric cardiology should therefore not embark on this without careful reflection. The importance of seeking the advice of both consultants and those training in the field cannot be over-emphasised. This brief prospectus cannot provide a comprehensive account of all aspects of training in paediatric cardiology in Scotland. Potential candidates are therefore strongly advised to contact the Training Program Director (details below), who will be more than happy to discuss their aspirations

The Training Centre

The Scottish Paediatric Cardiac Service, based in Glasgow at the Royal Hospital for Children (RHC), provides the only training site for paediatric cardiology in Scotland and therefore draws on a catchment population of 5.2 million. The unit did not fall under the auspices of the original Safe and Sustainable review for NHS England, nor subsequent reviews considering the configuration of congenital cardiac services in the United Kingdom. However, it voluntarily underwent reviews in 2011 by the Safe and Sustainable body, and in 2013 by the Scottish government, as a benchmarking exercise to assure a high standard of care is delivered to children with heart disease.

In 2015 the Royal Hospital for Sick Children as it was previously known transferred all services to a bespoke, new children’s hospital nearby. Now known as the Royal Hospital for Children, it forms a part of the new Queen Elizabeth University Hospital, the largest single campus hospital complex in the UK. Thstand-alone children’s hospital was designed and built in accordance with contemporary best-practice guidelines, including IT capability and new models for patient care and movement throughout the hospital. All non-cardiac tertiary paediatric services are represented on site, including the largest neonatal unit and paediatric intensive care units in Scotland. The cardiac ward is a 14-bed dedicated unit adjacent to the intensive care unit, cardiac catheter laboratory and cardiac theatres, and connected across a walk-way to the neonatal unit. New MRI and CT scanners were installed prior to moving into the new hospital providing state of the art imaging. The catheterisation suite was built to satisfy all specifications and standards required for hybrid surgical cases.

The unit undertakes all paediatric cardiac surgery and intervention in Scotland, this being over 300 cardiac surgical procedures and over 220 catheter interventionsor electrophysiology cases annually. There is a highly developed paediatric ECMO service and an active research program in association with the Universities of Glasgow and Strathclyde. Cardiology patients are admitted to the neonatal and paediatric intensive care units, and to a dedicated cardiac care ward. The cardiac service is staffed by seven cardiologists and three congenital cardiac surgeons. The core cardiac team also includes 10 physiologists, five liaison nurses and three dedicated cardiac Advanced Nurse Practitioners (ANP). A seventh cardiologist based in Edinburgh maintains a predominantly outpatient-based service. Unit patient activity includes four and a half all-day operating sessions, two all-day catheterisation sessions, and weekly electrophysiology and pacing sessions. There are currently nine weekly outpatient sessions and at least two weekly fetal medicine clinics. An ANP-led pre-admission clinic is run weekly. Sub-specialty clinics in pulmonary hypertension, cardiac genetics and cardiomyopathy are held every several months, the first two in conjunction with a team from Great Ormond Street Hospital. Two adult congenital cardiologists provide the ACHD arm of the Scottish congenital cardiac service at the Golden Jubilee National Hospital, at which adult surgery and intervention are commissioned. A monthly transition clinic is held at RHC.

Training

Training in paediatric cardiology is via a national grid system, and is uncoupled from general paediatric and adult cardiology training schemes from which it can accept ST4 entrants. All areas of training required for the attainment of a CCT in paediatric cardiology are represented in Glasgow. The training posts are administered through the Scottish Deanery, West Region. The Trust adheres to the Deanery’s requirements for study leave and funding. Special interest training can be undertaken in most areas with the exclusion of transplant medicine and pulmonary hypertension, though it is routinely recommended that trainees aspire to also gaining experience in an additional centre(s) in the case of other areas of special interest.

All new acute neonatal referrals requiring early treatment and all children requiring surgery or intervention attend the service in Glasgow. There is therefore excellent training exposure and a rapid acquisition of skills available, compounded by the fact there are currently only two cardiology trainees simultaneously enrolled. This is important, as the five year training scheme consists of three years core training, during which all base competencies must be accrued, followed by two years of sub-specialty training. Core training can be tailored to afford trainees a chance to sample sub-specialty areas to help them chose an area for further training in the final two years.

Trainees in Glasgow take part in a 1:5 resident partial shift roster, overnight call being provided via the Hospital At Night team. This ensures no training opportunities are missed through taking compensatory rest following on call duties during the preceding night. Following a weekend on call a trainee is required to take the Monday off in according to European Working Time Directive regulations. It should be noted the Scottish Government has elected not to enforce the new junior doctor’s contract now implemented in England and Wales. Trainees are based throughout their training at RHC, with exposure to adult congenital cardiology provided at the Golden Jubilee National Hospital. The middle grade includes two ST1-7 general paediatric trainees and an FY2, with additional support from the three ANPs. A general paediatric trainee developing special expertise in paediatric cardiology is frequent attached to the service. There is office accommodation with computer access located within the ward both in a clinical hub area and in a dedicated office.

ST4-6 trainees are assigned to rotating weeks of ward duty, cardiac catheterisation and echocardiography, in collaboration where appropriate with the general paediatric trainees. Attendance at outpatients sessions supported by a consultant is built into every week. Trainee attendance at outreach clinics is not compulsory, though encouraged in the latter years of training. There is a highly active teaching program, consisting of weekly sessions facilitated by a cardiologist, weekly surgical teaching, twice monthly formal echocardiography teaching and twice monthly ECG teaching. A journal club is held on Fridays. Trainees are expected to participate in the teaching and supervision of  junior doctors and medical students, including lecturing. Participation in audit and research initiatives is required. Active contribution to the weekly joint cardiac conference is expected. This includes preparation of morbidity and mortality patients for discussion, as well as those for surgical referral. Trainees are enabled to attend the compulsory national training days. As trainees progress through the program they are expected to become involved in the running of the service at a greater than point-of-care level, with early exposure to management and clinical governance principles.

Greater Glasgow and Clyde, Yorkhill Campus.