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Foundation Year placement information

Medical Directorate

The medical directorate consist of 8 consultants in acute medicine who cover a range of specialities: Diabetes / Endocrinology, Cardiology, Respiratory Medicine, Gastroenterology, Oncology, Care of the Elderly, Rheumatology and Nephrology. Each consultant has a ward where the majority of their patients are. The foundation doctors work in a team based structure, attached to one of the consultants. There are also core medical trainees within the medical directorate from HENW, as well as SAS doctors (staff and associate specialists).

There will be opportunities to attend out-patient clinics and some placements will have a community facing element (where half a day a week will be spent in the community). There will be opportunities to undertake audits and Quality Improvement projects as well as do presentations. There are regular educational meetings throughout the week including journal club, radiology meetings and grand round meetings.

General Surgery/Urology

There are 2 in-patient surgical wards (male and female) as well as a day procedure ward. Currently there are 4 general surgical consultants (with interests in colo-rectal, vascular and breast), a urology consultant, ENT consultant, Maxillo-facial consultant and 2 Ophthalmology consultants. Foundation doctors will be attached to 1-2 consultant teams, but should have chance to learn and develop skills in all of these areas e.g. when providing cross cover for teams or when on call. There are weekly educational events including the grand round on a Wednesday morning where a review of all surgical in-patients occurs and a weekly surgical teaching session. There may be opportunities to attend theatre and out-patient clinics, as well as undertake quality improvement work.

Ear, Nose and Throat Surgery ('ENT')

The ENT rotation includes time in the ENT outpatient department with the consultant ENT surgeon (Mr Richard Hogg), time in ENT theatres and on-call duties on the general surgery rota.

When not employed in fixed ENT duties during the week there is a service commitment to help fellow Foundation doctors in General Surgery when they are short-handed.

Orthopaedics/Trauma

There are 4 consultant orthopaedic surgeons and 2 orthopaedic wards (one for trauma and one for elective admissions). Foundation doctors are expected to undertake the ward work, as well as have opportunities to attend fracture clinic and out-patient clinics (where there will be chance to see new and review patients under consultant supervision). In theatre there are 2 ultra clean air theatres for orthopaedic procedures. There are elective and trauma operating sessions daily with opportunities to assist with hip/knee replacements, spinal surgery, fracture fixations and other procedures.

Emergency Department

All Foundation doctors will rotate through the Emergency Department during their F2 year. The department is relatively small and friendly seeing about 27,500 new patients and 6,000 follow-ups per annum, with about one fifth being children. There is 1 Consultant, 2 Associate Specialists, 9 SAS doctors plus 4 F2 doctors working in the department. The nursing staff comprises a ward manager, 6 Team leaders, approximately 25 Registered nurses plus Health Care Assistants and receptionists.

The F2 doctors are very much a part of the team and as such are expected to see their own patients and make management decisions accordingly. F2s are fully supervised and supported by more senior doctors at all times. At present, they do not work night shifts. Shifts comprise early, late and weekend shifts. Although the workload is generally higher than other departments and the shifts are longer, there is plenty of free time provided for other activities.

There is a regular weekly teaching programme within the department for F2 doctors on a Wednesday afternoon, and we strongly promote attendance at the generic Foundation programme on a Thursday afternoon. The F2 doctors are involved in this teaching and will give several presentations during the attachment. Participation in audit is strongly encouraged, and there are several audit topics in progress at any one time. We would also be very happy to assist with any research ideas. The caseload is extremely varied, and F2 doctors will be seeing a mixture of major and minor patients. Noble’s Hospital is an accredited Trauma Unit and part of the Cheshire and Mersey Major Trauma Network. For a small Island, we do see a very high proportion of major trauma, particularly during the TT and MGP (Manx Festival of Motorcycling) fortnights, and the F2 doctors form an invaluable part of the trauma team and gain good experience of major trauma management. An ATLS course is run locally and F2 doctors are given priority for booking places on these courses.

Leave is covered on a reliever week system. Taster weeks in other specialities are encouraged and in the past, these attachments have involved Radiology, Ophthalmology, ENT, General Practice, Orthopaedic and General Surgery.

One current F2 doctor describes A&E as;

'a well-organised, well-supported, happy department'.'

Women, Children and Outpatients Directorate

Paediatrics

Welcome to paediatrics. This is a relaxed and friendly area with regular teaching and supportive consultants, and close working with community nurses, health visitors, pre-school and child and adolescent mental health (CAMHS) professionals. Enjoy your time with us!

As an F2 in paediatrics your duties begin with the ward round at 8.30am where we discuss the medical cases that are looked after by each consultant. Usually each case will be presented starting with the initial referral, by whom they were referred and why, after which there will be a brief description of the history. You should use this as an opportunity to present cases that you have clerked when you have been on call.

The main aims for this placement are to be able to:

  • be comfortable taking a history from a child
  • perform Venepuncture on a young child and a baby
  • perform a heel prick to obtain bloods from a baby
  • perform a baby check when supervised
  • examine a neonate in SCBU
  • safely prescribe for a young child and neonate
  • calculate fluid requirements
  • enjoy yourself

Department of Social Care's Mental Health Service (Psychiatry)

The Mental Health Service provides a range of services for people of all ages in the Isle of Man who are experiencing mental health problems and in some circumstances, care, treatment and interventions from secondary care mental health services may be required.

The Care Programme Approach ('CPA') is a way of organising care for people with mental health problems. From 2011 the key principles of CPA are being extended to all recipients of the Mental Health Service. This means that there is now a requirement that every service user open to the Mental Health Service will have an individual care plan and risk management plan, which they have been involved in developing, and which is based on a thorough assessment of their health and social care needs.

Anaesthesia

A four month placement in anaesthesia offers exposure to patient care on the 6 bedded intensive care unit under the supervision of a consultant anaesthetist, and ample opportunity to develop basic and advanced airway skills and cannulation skills. Noble's hospital has 6 operating theatres offering exposure to anaesthesia for general surgery, orthopaedic, ENT, dental, urology, breast surgery and trauma anaesthesia. The anaesthetic department comprises 12 consultant and 3 staff grade anaesthetists. Regular exposure to chronic pain clinics and preassessment clinics is also available.

The anaesthetic department plays a very active role in teaching and training junior doctors both locally and nationally.

Palliative medicine

We offer an F1 placement in a Specialist Palliative Care Unit within a multidisciplinary Hospice organisation. This rotation would suit anyone seeking experience in palliative care as a prelude to a career in palliative medicine or simply as an excellent environment to acquire foundation competencies.

The World Health Organisation defines palliative care as 'the active total care of patients whose disease is not responsive to curative treatment. Control of pain and other holistic symptoms is paramount. The goal of palliative care is achievement of the best quality of life for patients and their families.'

Main duties of the placement include:

  • holistic specialist palliative care assessments and therapeutic interventions of patients
  • liaising with other professionals and lay carers in the interests of the patient.
  • providing medical support and advice for all clinical staff/clinical services of the Hospice
  • undertaking practical clinical procedures including catheterisation, intravenous cannulisation, phlebotomy and removal of pacemakers

Learning opportunities include:

  • history taking and cinical examination
  • communication skills
  • multidisciplinary team working
  • decision making and clinical reasoning
  • disease process and management of symptoms
  • therapeutics and safe prescribing
  • rehabilitation
  • end of life care
  • social and family relationships
  • the doctor-patient relationship
  • ethics
  • religion and spirituality

General Practice

The F2 placements in General Practice are a new development – Palatine and Peel Practices offering places at present.

We provide well supervised contact (designated GP) with the full range of General Practice patients, including acute presentations, follow up of patients through an episode of illness and its investigation, and chronic disease care (diabetes, COPD etc). The F2 doctor takes part in the management of acutely ill patients on a daily basis through the Peel practice triage process.

You will experience how General Practitioners co-ordinate patient care and interact with community and secondary care. Additional hospice experience and training is offered.

Whatever your future career aims, your time in General Practice will give valuable insights into clinical care, how patients present with their illness and the context within which they have to deal with these illnesses.

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