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Brief Description of Hospital Posts
Written by Dr Tracey Collins   

Accident & Emergency

Ashford & St Peters Hospitals NHS Trust is an acute Trust and the A&E Department deals with all kinds of trauma and emergency cases, Paediatric A&E is also included in the Department.


General Medicine and Care of the Elderly

The GP Specialist Rotation includes placements in Cardiology, Gastroenterology, Endocrine, Respiratory Medicine, Haematology and Care of the Elderly. The trainee participates in the medical on call rota therefore broadening their experience of different medical specialties. There is weekly medical teaching by Consultants covering all medical specialties.


Paediatrics

Paediatrics is part of the Children's Services Directorate which includes Paediatrics, the Neonatal Unit and Child & Adolescent Mental Health Service. The Paediatric ward (Ash Ward) has 25 acute beds. Oak Ward is used for day surgery and for children who attend for investigations such as allergy or other tests. There is a busy Children's A&E Department which is open 24 hours a day and staffed by experienced paediatric trained nurses and an Associate Specialist. We also have outreach outpatient clinics at Ashford, Woking, Walton and Weybridge.

Paediatrics has a shift system and is also EWT compliant for 2009. All specialty grades get the chance to rotate to cover different shifts. The main duties of the job involve:
  • Four week rotation in the community with the opportunity to learn different aspects of primary/community care (this is in the process of being reviewed).
          
  • Long shift allowing them to take part in the morning and evening handovers, ward round with the consultants/registrars.
          
  • Review of patients in the ward.
          
  • Cover A&E when on the A&E shift.
          
  • Cover Oak Ward and review day attendees for different investigations/treatments.
          
  • Participation in Journal Club/Ward rounds.
          
  • Regular assessments (BWA) and formal appointments with their Clinical Supervisors to discuss issues of mutual interest.
          
  • Chance to attend OPD with Consultants (this is not formalised yet).

Obstetrics and Gynaecology

The trainee will be exposed to gynaecological problems presenting to A&E, Clinic and also within the ward. They will also have exposure to the EPU (early pregnancy unit), labour and postnatal wards and antenatal clinics. They will participate in the on call rota which includes labour ward duty and gynae on call duty. There is weekly teaching.


Orthogeriatrics

This job is based within Trauma and Orthopaedics, but also has input from Dr Dhakam Consultant in Care of the Elderly. In addition to Orthopaedic ward and clinic work, trainees also have the opportunity to attend teaching ward rounds and clinics in order to learn more about managing the elderly surgical patient pre and post op.


Adult Psychiatry

This job is based at the Abraham Cowley Unit which is on the St Peter's site. The trainee will have the opportunity to assess and look after psychiatric patients on the wards, to work with the Community Mental Health Teams and also to liaise with A&E about patients presenting with acute psychiatric problems. There is a weekly journal club and involvement in a Balint group to enhance their group skills and CBT knowledge.


Drug and Alcohol

This job is based with the Windmill Team, the community drug and alcohol service covering the north west of Surrey and an inpatient detoxification and rehabilitation unit covering the whole County. The Trainee will admit patients, thus learning the assessment process for drug and alcohol clients and the detoxification regimes. They will also participate in a group, to enhance their group skills and CBT knowledge and attend the team meeting to improve their understanding of engagement issues and the interface with GPs and specialist services. This job is an Innovative Training Post.


Psychogeriatrics

This job is based at the Abraham Cowley Unit and Woking Community Hospital. It includes ward work looking after acutely ill psychogeriatric patients and community care. It also includes clinic work including the memory clinic, and MDT meetings with the whole team. The trainee will therefore have a sound training is psychiatric presentation in the elderly, diagnosing and treating dementia and liaising with GPs. This is an Innovative Training Post.


Palliative Care

This job is based at Sam Beare Hospice, Weybridge and Woking Hospice. Both Hospices have ten inpatient beds, a day Hospice which has ten patients three days a week and also a community team covering 200 patients. The job involves ward work and a teaching ward round, MDT meetings with the Macmillan nurses and clerking admissions. This job gives the trainee an excellent grounding in palliative care, what community facilities are available to patients and also liaison with GPs. It includes weekly teaching. This is an Innovative Training Post.


Genitourinary Medicine

This is based at the Blanche Heriot Unit on St Peter's site. During their time in this post the trainee will take part in:
  1. GUM clinic work involving taking a sexual history and appropriate screening tests for men and women. Understanding and undertaking testing for HIV with the knowledge of the implications and ability to educate the patient.
          
  2. Diagnosis and treatment of STIs.
          
  3. Joint working with health advisors to manage partner notification.
          
  4. Learn what can be managed in primary care and what should be referred to secondary care. Learning will involve management of those who do not wish to be referred to GUM Clinic.
          
  5. Share management with GUM Specialist Nurses and gain understanding of overlapping roles.
          
  6. Manage the treatment of HIV positive patients and develop ideas to improve the GP/Hospital HIV team interface.
          
  7. Attend Consultant led 'Vulval Problems' Clinic to gain experience in managing these in General Practice.
          
This is an Innovative Training Post.


Surgical Upper GI and Lower GI

These posts include ward work looking after patients with Upper and Lower GI problems, acute surgical on call, occasional theatre work, and the opportunity to attend specialist Breast, ENT and Vascular Clinics. This gives the trainee experience in diagnosing and managing surgical problems presenting from General Practice either acutely or chronically. There is weekly teaching and Consultant teaching ward rounds.


Dermatology

Common Conditions:
  • Acne and rosacea
  • Disorders of hair and nails
  • Drug eruptions
  • Eczema
  • Generalised pruritus
  • Infestations including scabies and head lice
  • Leg ulcers and lymphoedema
  • Less common skin conditions - Such as the bullous disorders, lichen planus, vitiligo, photosensitivity, pemphigus, pemphigoid, discoid lupus, granuloma annulare and lichen sclerosus.
  • Psoriasis
  • Skin infections (bacterial, viral and fungal)
  • Skin tumours (benign and malignant)
  • Urticaria and vasculitis

Symptoms:
  • Bruising or purpura
  • Hair loss
  • Itch (also known as pruritus)
  • Lumps in and under the skin
  • Nail disorders
  • Photosensitivity and the red face
  • Pigmented skin lesions
  • Rashes
  • Signs of infections of the skin

Emergencies:
  • Angioedema
  • Disseminated herpes simplex
  • Erythroderma
  • Meningococcal sepsis
  • Necrotising fasciitis
  • Pustular psoriasis
  • Severe nodulo-cystic acne
  • Stevens-Johnson syndrome
  • Toxic epidermal necrolysis

Specific Skills:
  • Ability to take specimens for mycology from skin, hair and nail
  • Basic interpretation of histology reports
  • Skin biopsy

ENT

Knowledge of specific clinical cases.


EMERGENCIES:
  • Foreign Bodies – How to remove and when not to try!
  • Epistaxis
  • Infections including suspected epiglottitis (when not to examine)

COMMON GP PRESENTATIONS:
  • Sore ear – Adult including Atypical e.g. TMJ problems - Child
  • Sore throat – Who to refer for tonsillectomy, When to use antibiotics.
  • Discharging Ears – Otitis externa, CSOM
  • Hearing Loss including wax management
  • Vertigo
  • Tinnitus
  • Nasal obstruction, polyps, allergy
  • Sinus problems
  • Facial pain

SPECIFIC CASES TO HIGHLIGHT:
  • Dysphagia
  • Foreign Bodies, Fishbone
  • Neck lumps
  • Hoarseness
  • Head and Neck Cancers

Appreciation of Roles of Others:
  • Audiologist

Specific Skills:
  • Use of diagnostic set
  • Epley’s manouevre
  • Audiogram interpretation
  • Micro-suction of auditory canal

Ophthalmology

Knowledge of specific clinical cases.


EMERGENCIES:
  • Red Eye – Assessment
    Urgency e.g. Suspected Acute Glaucoma
    Management – including Eye Infections (bacterial and viral)
  • Eye Trauma – Assessment and Treatment of Corneal Abrasions, Foreign Bodies in Eyes
  • Sudden Visual Loss

COMMON GP PRESENTATIONS:
  • Cataract
  • Glaucoma
  • Dry and Watery Eyes
  • Eyelid problems
  • Paediatric Eye Problems inc knowledge of developmental checks inc squints
  • Flashes and Floaters
  • Macular Degeneration – Wet and Dry
  • Links with Systemic Illness e.g. Diabetic Eye Disease

Appreciation of the roles of others:
  • Ophthalmologist including how register someone blind.
  • Optician inc some basic contact lens problem knowledge
  • Ophthalmic Optician
  • Hospital Eye Casualty
  • Optometrist

Specific Skills:
  • Fundoscopy
  • Assessment Eye Movements
  • Visual Field Assessment
  • Checking Visual Acuity
  • Everting Eyelids
  • Fluorescein Staining
  • Interpretation Results – Orthoptist and Optician Reports
Last Updated ( Tuesday, 13 September 2011 13:46 )