Palliative Medicine
The Posts and the Training Programme
The posts are designed to provide a comprehensive, four year higher training programme to equip individuals to become consultants in Palliative Medicine working in a variety of clinical settings. The rotation offers experience of palliative medicine practised in several hospices (Wakefield Hospice; St Gemma’s and Wheatfields Hospice, Leeds; Manorlands Hospice, Oxenhope; Marie Curie Centre, Bradford and St Catherine’s Hospice, Scarborough) and with hospital palliative care teams (Leeds Teaching Hospital Trust with bases at Leeds General Infirmary and St James University Hospital; Airedale hospital, Keighley, Bradford Royal Infirmary, Bradford; York District General, York) throughout the Yorkshire Deanery. Specialist registrars on the rotation can expect to work in Leeds, Bradford, Wakefield and Scarborough at some point in their training.
Experience of specialist pain management, medical oncology and clinical oncology are part of the core training programme. Additional experience in relevant related specialities such as liaison psychiatry, rehabilitation medicine and paediatric oncology is also available as appropriate. Training opportunities are tailored to the needs of individual specialist registrars as far as possible, based on regular appraisals and annual assessments by the Yorkshire Regional Palliative Medicine Training Committee.
Higher training posts in Palliative Medicine were first created in Yorkshire in 1991 with pump-priming from Macmillan Cancer Relief. Since that time the programme has grown to include 12 full time posts with 9 flexible trainees currently. This has allowed the development of excellent opportunities for joint clinical weekly meetings, for regular journal club, joint audit and research projects and the regional learning group. Links between palliative care, chronic pain relief and oncology services are strong.
Duties of the Trainee
Timetables and individual responsibilities will differ from unit to unit and will be negotiated with each trainee according to their training needs at the time. Throughout the training programme the registrar will be expected to provide a high level of clinical care for their patients and take increasing responsibility for supervision of junior staff and for clinical decisions under the guidance of consultants. He/she will have increasing involvement with teaching of medical students, nurses, junior doctors and other professionals over the four years.
It is the responsibility of each trainee to make good use of their protected study and research time. Tutorials will be provided by arrangement with educational supervisors. The trainee will attend local and national research and education meetings and attend a management course when appropriate.
ST3-6 doctors will provide out of hours cover for the different hospice units throughout the four-year rotation. The frequency of on-call varies between hospices but will be no more than a 1 in 5 rota including prospective cover. There may be some training placements that do not require the trainee to provide on-call cover. This means there will be periods when the trainee does not provide on call. A minimum of three months notice will be given of changes in the on-call base unit so that trainees can anticipate variations in on-call pay. Trainees should note the travel time requirements for on-call duties for the individual hospice units.
Supervision, Appraisals and Assessments
Educational supervisors are nominated for each part of the training programme. Developmental appraisals occur every 2-3 months during each rotational attachment. Trainees may also choose a mentor from the list of supervising consultants for informal discussions and career guidance.
The purpose of the annual assessment by members of the training committee and the postgraduate dean is to measure progress against criteria based on the curriculum as laid out in the training handbook. Trainees must meet these standards in order to proceed from year to year and ultimately achieve a certificate of completion of training (CCT).
Study Leave
The purpose of study leave is to enhance clinical education and training. It can be used to attend courses, acquire specialist skills or develop the necessary theoretical knowledge base. Specialist registrars receive either day release with pay and expenses for the equivalent of one day a week during University terms or leave with pay and expenses within a maximum calculation of 30 days in the year (the year for this purpose being counted from 1st October). For Palliative Medicine specialist registrars this is distributed between a half-day session each Wednesday morning and individual days at conferences and courses.
Each financial year (April to March), trainees will be allocated a notional study leave budget by the specialty study leave advisor (SSLA).
This represents the maximum costs for study leave in that year and any surplus cannot be carried over to the next leave year. Study leave is approved by the trainee’s educational supervisor and SSLA and will meet clearly defined educational objectives.
Research
Trainees are encouraged to be involved in research projects. Currently, there is an active trainee research group, which meets one Wednesday each month. Within the region there are a number of industry-sponsored and in-house research projects.
Trainees wishing to gain a higher degree can be allowed to retain their
national training number for up to three years, but only one year can count towards the award of a CCT. A research supervisor is necessary to help guide research and provide advice on funding and obtaining grants.