Academic Clinical Fellowship in Anaesthesia

Overview of the programme

This Academic Clinical Fellowship (ACF) in Anaesthesia is designed to be a component of the NIHR integrated academic training pathway for clinical academics. The post will provide the best candidates with the training and research opportunities to become the future clinical academic leaders of our specialities. We have successfully hosted 4 generations of Anaesthetic ACFs in the region and our first “graduates” are now embarked on Wellcome Trust / MRC funded PhD studies.

The Bristol School of Anaesthesia & Intensive Care Medicine was established in 1996. One of the 12 Postgraduate Schools in Severn  it runs comprehensive training programmes in both Anaesthesia and ICM. As of August 2014 there are 167 trainees in the School, of whom 36 are core anaesthesia trainees, 17 are on the ICM CCT programme (most but not all ‘dualling’ with Anaesthesia) and a further 15 are on course for Joint CCT in Anaesthesia and ICM. The trainees are based in 8 hospitals across the Severn region. The hospitals in the School include: University Hospitals Bristol (including Bristol Royal Infirmary, Bristol Royal Hospital for Children, St Michael’s Hospital, Bristol Eye and Dental Hospitals), Southmead Hospital Bristol, Royal United Hospital Bath, Cheltenham General Hospital, Gloucestershire Royal Hospital, Great Western Hospital Swindon, Weston General Hospital and Yeovil District Hospital. The Bristol School of Anaesthesia & ICM aims to provide high quality clinical training in anaesthesia, intensive care and pain medicine and the success rate of our trainees in FRCA, FFICM and FFPMRCA examinations is well above the national average. For further details see http://www.anaesthesia.severndeanery.nhs.uk/

The successful candidate at interview will be offered an appointment at either CT1 or ST3 / ST4 level to the Bristol School of Anaesthesia & ICM. ST3 applicants who do not hold an NTN will need to be assessed and interviewed through the appropriate national specialty selection process to demonstrate that they reach threshold of appointability (they do not need to rank high enough to have received a post in the LETB). Applicants who already have an NTN in the specialty do not need to participate in national recruitment.

They will have a clinical programme that is constructed to ensure that they obtain the common core competencies required for progression with their clinical training in the most efficient and effective manner. They will be supernumerary within the rotation to protect their research time and facilitate the progression of their clinical training. They will be based for the three-year period of their ACF within the Bristol hospitals (in the case of ST3/4 trainees) or on the Yeovil/Southmead rotation for CT trainees.

During their second year, and subject to achieving the required clinical competencies (including passing the Primary / Final FRCA where applicable), they will undertake a programme of research. This research project will be undertaken during a six-month block of 100% protected time. This will be both preceded and followed by protected ’day release’ research time (one day per week) to initiate and complete the research project and prepare applications for further research. The fellow will have an identified academic mentor as well as research project supervisor. They will be encouraged to attend the clinical research methods training courses run by the University as well as attending project specific training courses.

The research project will be done in collaboration with a co-ordinated network of active researchers at the University of Bristol. This offers unique research opportunities in both basic and translational medical science in the areas of pain, cardio-respiratory control, cardiac sciences and other fields related to anaesthetic and critical care sciences. These projects will typically be linked to the activity of research groups in the School of Physiology & Pharmacology or the Bristol Heart Institute but we are flexible to align the interest of trainees with appropriate research groups. The specifics of the research project will be arranged by the trainee during a ‘milk-round’ phase during the first year of the programme. The preliminary work towards initiating the project will be undertaken using the protected ‘day release’ research time and will be expected to be well underway by the end of the first year. A formal assessment of the research plan will be made at a meeting of the trainee’s mentor, academic programme director and supervisor prior to commencement of the research block to ensure that the project is on track.

During the final year of the post the successful applicant will be supported to compete for a PhD studentship from NIHR / MRC / Wellcome Trust / BHF or other funders allowing them to pursue a three year research project that will build upon the work done during the ACF. We have an excellent track record of obtaining funding from such sources and extensive experience of grant applications. The individuals completing this ACF training programme are expected to become the academic and specialty leaders of the future, with strong career prospects and unique expertise.

Academic environment - Translational network

Steering group

Dr Tony Pickering MB ChB, PhD, FRCA (Academic programme lead) - Wellcome Trust Senior Clinical Fellow & Consultant in Anaesthesia
Professor David Wynick MB BS, PhD, FRCP - Professor of Molecular Medicine & Director of Research NBT/UHB
Professor Julian Paton PhD - Professorial Research Fellow
Dr Sanjoy Shah FRCP MD - Consultant in Intensive Care Medicine
Dr Ben Gibbison FRCA MD - Consultant in Cardiac Anaesthesia
Dr Ronelle Mouton FRCARSI, PhD - Consultant in Anaesthesia, North Bristol NHS Trust
Mr Nik Patel, MB BS, BSc, FRCS - Consultant Neurosurgeon, Frenchay, NBT
Mr Marcus Drake, BM BCh, DM, FRCS - Consultant Senior Lecturer in Urology, NBT
Dr Peter Brook, MB ChB, FRCA - Consultant Anaesthetist and Pain Clinician, StMH, UHB
Dr Jon Brooks, PhD - Senior Research Fellow, CRIC, University of Bristol.

This has grown out of a research base within the School of Physiology & Pharmacology in the School of Medical Sciences at the University of Bristol. Within this School there is a critical mass of researchers working within the fields of Pain and Autonomic neuroscience (extending beyond the core of investigators listed above; see http://www.bris.ac.uk/phys-pharm/) within the Umbrella of both Bristol Neuroscience and the Bristol Heart Institute. From this nucleus of research there has been a shift of focus over the past five years to test some of the hypotheses generated from the basic science research in the clinic, and indeed to reverse translate some clinical findings into basic science investigations.

In parallel with this movement of ideas towards clinical applicability has been the agglomeration of cross disciplinary research interactions making links between clinicians and scientists and a blurring of the once traditional boundaries between the two faculties. This has been richly productive in terms of publications, grant awards and the career development of trainee clinicians in particular (but also scientists). The fostering of academic clinical trainees at registrar level has been successful to date and this territory is fertile for integration into the NIHR academic training path. There is a broad spectrum of opportunities to foster research and to achieve this end we have founded a steering group to offer mentorship, supervision and oversight to clinical trainees undertaking research within this program.

Relevance of this network to the training of academic clinicians

The current emphasis on restoring academic clinical training to produce a cadre of clinician scientists capable of devising, implementing and assessing the next generation of therapies provides an opportunity and a challenge. The hypothecated funding stream provides the opportunity but the challenge is to provide suitable environments for research training especially for specialties, such as Anaesthesia and ICM, whose research capacity has dwindled. By cross-disciplinary interaction it is possible to re-invigorate the growth of clinical academia, by selecting the best trainees and then offering them a broad palate of options from which to select a research direction and appropriate supervisor/mentor. The facilities available to support collaborative research within Physiology and Pharmacology are outstanding (see http://www.bris.ac.uk/phys-pharm/research/) and the recent research assessment exercise ranked the School as one of the best in the country.

Clinical environment

The academic trainee will be appointed at either CT1 or ST3 / 4 level and the program will be flexed according to their training and academic needs.

Example rotation in Anaesthesia (ST3)

Trainees will participate in the clinical anaesthetic training rotations within the Bristol hospitals (Bristol Royal Infirmary, St Michael’s Hospital, Bristol Eye Hospital, Bristol Heart Institute and Bristol Royal Hospital for Children all at University Hospitals Bristol; Southmead Hospital, North Bristol Trust). This programme will be agreed with the programme director to provide the appropriate balance of specialty and sub-specialty training required to acquire clinical competencies in the most efficient and effective manner. The trainee will take part in the on call rota at each of these sites and will receive the appropriate pay-banding supplement from each Trust. They will be supernumerary within the rotation to protect their research time and facilitate the progression of their clinical training.

Trainee Level

Start Date

Length (mo)

Base

ST3

August 2016

12

UHB

ST3-4

August 2017

6

NBT

ST4

Feb 2018

6

Research project

ST5

August 2018

12

NBT/UHB

The focus of the first 18 months will be to obtain the key core competencies for intermediate level specialist training in line with the requirements of the Royal College of Anaesthetists (http://www.rcoa.ac.uk/index.asp?PageID=1479). This will include modular attachments in Obstetric, Cardiothoracic and Paediatric anaesthesia, Neuro, General duties, Pain Medicine and Intensive Care Medicine. The fellow will also be expected to obtain the final FRCA examination during these placements (allowing certification of completion of intermediate level training and a requirement for transition to ST5). In addition to the normal annual and study leave allocation the trainee will have protected research time during this period on a fixed day basis (usually Tuesdays) commencing after 9 months in post in the lead in to the research project.
The research project will be done during a 6 month block of protected research time. During the project the trainee will have the option to take part in the on call rota at either Trust on a flexible locum basis to maintain their clinical skills (while not disrupting their research activity).
In the final year the fellow will usually rotate back to NBT or UHB as appropriate. However, it may be possible to arrange subspecialty modules appropriate to the research interest of the fellow. They will continue to have day release to remain in contact with their research supervisor, complete their project, draft grant applications and submit publications.

Example rotation in Anaesthesia (CT1)

Trainees will participate in the clinical anaesthetic training rotations within region that is likely to include time at Yeovil General and Southmead Hospital or Royal United Hospital, Bath. This programme will be agreed with the programme director to provide the appropriate balance of training required to acquire clinical competencies in the most efficient and effective manner. The trainee will take part in the on call rota at each of these sites and will receive the appropriate pay-banding supplement from each Trust.

Trainee Level

Start Date

Length (mo)

Base

CT1

August 2016

12

Yeovil

CT2

August 2016

6

NBT or Bath

CT2

Feb 2017

6

Research project

CT3

August 2018

12

NBT and/or Bath

The focus of the first 18 months will be to obtain the key core competencies for basic level specialist training in line with the requirements of the Royal College of Anaesthetists in line with the CCT in Anaesthetics [2010 Curriculum]. The fellow will be expected to obtain the Primary FRCA examination during these placements. In addition to the normal annual and study leave allocation the trainee will have protected research time during this period on a fixed day basis (usually Tuesdays) commencing after 12 months in post in the lead in to the research project.

The research project will be done during a 6 month block of protected research time. During the project the trainee will have the option to take part in the on call rota on a flexible locum basis to maintain their clinical skills (while not disrupting their research activity).
In the final year the fellow will usually rotate to NBT or RUH as appropriate. They will continue to have day release to remain in contact with their research supervisor, complete their project, draft grant applications and submit publications.

Partnerships

The programme will involve clinical and academic interactions between the anaesthetic departments in the two acute hospital trusts (UHB and NBT), with clinical academics located in both Trusts and also with scientists in the School of Physiology & Pharmacology at the University of Bristol. There are established links between all of these establishments with clinical academics in the programme working at all of these sites.

Academic and clinical training

The protected academic time in the first fifteen months of the programme will ensure that the trainee gains foundation skills in research methodology and, with supervision, can begin to apply these to the development of a research project. The designated academic training days will access the University’s generic academic training programme supplemented by training in specific aspects relevant to the chosen project (e.g. ICH-GCP courses, statistical methods and/or Home Office module training). They will also be encouraged to attend the programme of talks and seminars timetabled on Tuesday lunchtimes where internationally renowned speakers jostle for position with undergraduate students.
The clinical training will include regional pre- and post-fellowship study days, local departmental educational meeting programs and access to the medical simulation centre courses (both as a trainee and tutor) which is a particular strength in Anaesthesia/ICM in the region.

Support for higher degree training programme application

Within the research network there is considerable expertise in making research grant applications in general and a track record of success with PhD studentship and fellowship programs. This expert mentorship will be available to the fellow to provide guidance on grantsmanship, advice on project design and subsequent training in interview technique. Additionally support is available from the University RED department particularly in the identification of opportunities, the costing of applications and linking of proposals to currently topical research themes.

Protected time for research

The fellow will be supernumerary throughout their anaesthetic rotations thus they will be guaranteed to be freed from clinical duties to spend a minimum of 25% of their time on research activity. This 9 month period of research time will be divided, as previously described, into a six month research block. The remaining three months will be allocated as a fixed academic day (every Tuesday) starting when the fellow is 9-12 months into their programme and continuing throughout the clinical attachment thereafter.

Milestones

Clinical milestones:

Before initiating the research project the fellow will have to be able to demonstrate at their ARCP that they have achieved satisfactory clinical competencies (and to have passed their FRCA examination where appropriate). In the event of a failure to achieve these minimum standards, the research project will be delayed and the trainee’s suitability for continuing on the academic programme will be reassessed.

Academic milestones:

  • Identification of project topic and associated supervisor (by 6 months)
  • Completed necessary research protocol and obtained appropriate approvals, permissions and training certification (12-15 months)
  • Data acquisition and analysis completed by end of main project period.
  • Application for PhD/postdoctoral funding submitted to funding bodies by month 30.

Ensuring competencies

At each of the rotation placements the fellow will have an educational supervisor assigned with oversight by the local college tutor, as would be the case for any speciality trainee in anaesthesia. Their clinical progress will be monitored through workplace based assessments, review of training logbooks, completion of the school training record and through feedback from clinical colleagues. The fellow will have an annual academic ARCP which will include the presence of a clinical academic (not their supervisor). The clinical placements will be carefully organised by the training programme director to maximise the opportunities for acquiring competencies.

Mentoring/supervision arrangements

In addition to the usual clinical mentoring and supervision arrangements that are well established in the region the fellow will identify a research supervisor in the first six months of their entry to the programme. They will also choose an academic mentor who will track their progress through the programme and offer support and guidance. They will have regular meetings with their research supervisor and academic mentor facilitated by the protected weekly research day both before and after completion of the research block.

Infrastructure to support training

The specialty programmes for Anaesthesia and ICM are run by the respective programme directors Dr Tom Simpson (ST Anaesthesia), Jo Kerr (CT Anaesthesia) and Dr Anne Whaley (ICM) supported by the Head of School (Dr Ted Rees) and school manager (Mrs Julie Flowers). Each hospital has College Tutor(s) appointed by the Royal College of Anaesthetists to oversee all aspects of training in that hospital. Daily education and training is delivered by educational and clinical supervisors. Trainees choose a mentor who offers pastoral support alongside the support for training offered by the supervisors and tutors. The mentor scheme, annual assessments and study leave are organised by the school manager who is based in the Severn PGME. The school has lead on the development of educational supervision and mentoring at all levels of training and is confident of the systems and processes currently in place to ensure clinical progression. The Deanery leads on recruitment and hosts the school board meetings.

The fellow will have direct access to the excellent core facilities and infrastructure for research and training that exist within the School of Medical Sciences. They will be guaranteed office space, have a computer, access to library and University IT services and a designated budget to support travel and meeting expenses.

Programme management and administration

The academic training programme lead is Dr Tony Pickering based in the Anaesthetic Department at UHB and within the School of Physiology and Pharmacology at the University of Bristol. The ACF training programme will be managed through the office of the Head of School of Anaesthesia & ICM (Dr Ted Rees and Mrs Julie Flowers).

Ensuring the programme is trainee centred

The clinical component of the training has considerable flexibility. Thus the clinical training can be tailored by the trainee (with the support of the programme director) to focus on the aspects of training that are most relevant/useful at each stage of the programme (ST3/4 appointees). The competencies can be acquired relatively rapidly allowing time for the academic studies.

The research component is similarly flexible with a wide pool of potential supervisors and research areas and themes. The potential supervisors will provide a statement of research interests and outline a potentially suitable project. The fellow will be expected to choose their research area and will have time and support to design a research programme to match their interests. They will then have formalised discussions with the individual research PIs to identify a project that best matches their aspirations. By having a clearly identified clinical and research mentors as well as programme lead the trainee will be able to shape the fellowship to suit their aspirations.

Entrance / Exit from the programme

  • We aim to recruit to CT1 or ST3 level however there is sufficient flexibility in our programme that applications could also be considered at other intermediate level specialist training grades if they have a sufficiently strong academic pedigree. These trainees will be assessed against the core clinical standards expected for this grade and will be offered an appropriate specialty training programme in Anaesthesia. Their research programme will be personalised but in general will be structured in much the same way as for a CT1 /ST3 applicant.
  • Management of early exits from the programme

Should a trainee no longer want (or be able) to continue with an academic path then they will be considered for entry to the equivalent level within the clinical programme in region. However, this will depend upon the trainee having achieved satisfactory/appropriate clinical assessments and as such cannot be guaranteed.

Integration of the post within the Specialty Training Scheme

The academic clinical fellow will receive an equivalent specialist clinical training and achieve the competencies required at each time point. They will be selected and appointed according to the same clinical selection criteria with the additional academic markers of merit. They will have annual academic ARCP assessments to monitor progress. At each stage their progression will be dependent upon satisfactory assessments. However, the post will not be completely integrated within the clinical service programme and it will remain a supernumerary position ensuring that the research component can be protected at all times.