Academic Clinical Fellowship in Rheumatology Description of ACF Programme: Title: Rheumatology Duration: 3 years Lead NHS Hospital/Trust and contact details: Southampton Universities Hospitals Trust Contact: Professor Elaine Dennison, MRC Lifecourse Epidemiology Unit, Tremona Rd, Southampton SO16 6YD email: emd@mrc.soton.ac.uk tel 02380 777624 Research Institution in which training will take place: MRC Lifecourse Epidemiology Unit, University of Southampton; Wessex Rheumatology Rotation Arrangements for protected research time: A dedicated research period of 9 months will be incorporated into the training programme. Research Objectives: 1. To undertake the equivalent of 3 years full time specialist training in Rheumatology in an accredited post in the Wessex Rotation. 2. To undertake generic research methods training through a programme run by the Southampton Clinical Academic Training Scheme (SoCATS). 3. To gain relevant training and experience in research design, methods and data interpretation. 4. To pilot a research project (clinical or laboratory-based) or perform a systematic review in order to generate preliminary data for development of a proposal for a doctoral fellowship. 5. To submit a competitive application for a doctoral fellowship to the NIHR, MRC, Wellcome Trust.
Description of research component of programme (up to 500 words): This post offers a unique opportunity to work with an established, internationally recognised, clinical trial programme investigating the influence of nutritional and behavioural modification during pregnancy on offspring bone mass and body composition. This comprises 2 randomised, placebo-controlled, double-blind investigations: Firstly the MAVIDOS Maternal Vitamin D Osteoporosis Study, an RCT of vitamin D supplementation during pregnancy in which the offspring are currently assessed by DXA at birth and 4 years. The successful candidate would undertake state of the art MicroCT measurements (Scanco Xtreme CT) of bone microarchitecture at the tibia and radius, and measures of bone mass and body composition by DXA, in the children at 6-8 years old and relate this to 1) Maternal randomisation group (maternal vitamin D supplementation 1000 IU daily or placebo from 14 weeks gestation till delivery); 2) postnatal diet (focused on calcium and vitamin D intake) and physical activity (assessed by accelerometry cross-sectionally and at 4 years; and 3) tracking of bone development by DXA from birth to 6-8 years. Secondly, the SPRING study (Southampton Pregnancy Intervention for the Next Generation), will randomise pregnant women in early gestation in a factorial design to vitamin D/ placebo and a conversation-based diet-lifestyle intervention/usual care. This highly innovative study, based on the MRC Complex Interventions Framework, investigates whether a conversation-based intervention in pregnancy can alter diet/behaviour and compliance with supplementation. Outcomes assessed include offspring body composition/ bone mass by DXA at birth, duration of breast-feeding, and maternal diet/ physical activity and psychological/ control measures. The successful candidate would have the opportunity to undertake analyses using this dataset, and gain experience of qualitative assessments that would complement the quantitative analyses using both studies. Description of clinical component of programme (up to 500 words): Training programmes in Rheumatology alone are provided by posts in Christchurch, Poole, Portsmouth, Southampton and Winchester; rotations are established according to individual training needs and rotate through the regional centres on an annual basis. There is a region-wide syllabus and minimum standards of education agreed by all Trusts within the rotation with the aim of providing training on all aspects of the specialty curriculum. All posts within the training programme are recognised for postgraduate training by the Postgraduate Medical Education Training
Board (PMETB) in accordance with their standards for training. Study leave is granted in accordance with Deanery/Trust policy and are subject to the maintenance of the service. All posts have a service element; there will be minor variations in different hospitals, but the following covers the majority of duties: 1. Supervise, monitor and assist the House Officer (F1) in the day-to-day management of in-patients in posts with an attached F1. 2. Liaise between nurses, F1 and F2 Doctors, patients, relatives and senior medical staff. 3. Attend and participate in ward rounds as timetabled. 4. Attend outpatient clinics. 5. Take part in rostered emergency work. 6. Dictate discharge summaries. 7. Study for higher examination and maintain continued professional development. 8. Attend local educational and multidisciplinary sessions and regional training days. 9. Undertake audit at various times throughout the rotations. 10. Teach medical students as directed. 11. Co-operate with members of the personnel department when monitoring hours of work and other personnel issues. 12. Attend induction in each hospital or new department. 13. Comply with all local policies including dress code, annual and study leave. Specific support provided to trainee The trainee will be allocated an Academic Rheumatologist as an Educational Supervisor who will ensure that academic training requirements are delivered in parallel with clinical competencies. Regular meetings will ensure that the 9 month dedicated research period is pre-planned, allowing sufficient pilot data to inform a competitive fellowship application. As a trainee on the Wessex Rheumatology Rotation, the successful applicant will participate in the educational supervision, clinical supervision and peer mentorship programmes.
Milestones and timing of achievement of academic and clinical competencies The following milestones will be achieved Year 1 1 Initial clinical training in Rheumatology and will be assessed using the national measures (Directly Observed Procedural Skills, mini Clinical Evaluation Exercise, Multi-source Feedback, Case-Based Discussions, etc.) and by quarterly meetings with the educational supervisor 2 Attendance at autumn introductory course provided by University of Southampton Postgraduate School of Medicine 3 Identification of research question to be addressed in pilot study or systematic review through an iterative process of discussion and planning with the academic supervisor(s) 4 Identification of specific learning needs for the project and appropriate courses and identification of ongoing projects with which to become involved 5 Obtaining ethical committee and NHS Research & Development approval for exploratory project as appropriate and initial generation of pilot data 6 Attendance at relevant internal and external training courses and attendance at annual national/international conferences of relevance to the project Year 2 1 Continuing clinical training in Rheumatology, with the relevant competency based assessments (DOPS and minicex) and the knowledge-based assessments & commence dedicated research time toward end of year 2 Continued work to identify project and/or data collection for pilot study as appropriate 3 Attendance at relevant internal and external training courses and attendance/presentation of data at annual national/international conferences of relevance to the project 4 Preparation and submission of clinical research fellowship application to external funding agencies
Year 3 1 Continuation of Rheumatology component of clinical training & complete dedicated research time 2 Data collection and presentation at national/international conference(s) 3 Write up and submission of pilot research project, and/or other research for publication as appropriate 4 Preparation for research training fellowship interview How post links in to the NIHR approved Research Training Programme at your locality: It is envisaged that a successful fellowship application will lead to a further three years in fulltime clinical research, culminating in a PhD. There would then, subject to a successful application, be a natural progression to a NIHR Clinical Lecturer position within the Faculty of Medicine. This path is now well established within this programme, with Dr Nicholas Harvey and subsequently Dr Zoe Cole successfully progressing from PhD fellowship to NIHR Clinical Lecturer. Trainee centredness: The training will be centred on the trainee s own needs, identified early during the first year, and by dedicated supervision during the post. The fellowship will be tailored towards achievement of successful external funding. Quality assurance of the programme: The research methods training will be provided through the established Postgraduate School/Clinical Academic Training Scheme at the University of Southampton Faculty of Medicine. The academic supervisors have completed the postgraduate research supervision training provided by the University.
Mentoring Arrangements: The University of Southampton has a formal training structure for PhD students and supervisors including logbooks meetings, training courses and other activity, regular reports and yearly assessments. The Academic Supervisor will maintain regular contact throughout the entire ACF programme and will meet with the ACF individually weekly both within the 9 month Academic Attachment and during the externally funded period of doctoral research. Additionally, trainees are encouraged to bring other issues as needed between formal meetings either in person or by phone call or e-mail. At the supervisory meetings, progress is reviewed, results discussed, further research and manuscripts/presentations are planned, and any other ground is covered as required. Particularly from mid fellowship onwards, this might include further training needs and career progression. MRC mentoring policies are followed, together with, for those trainees who are successful in obtaining a doctoral fellowship, the option of participation in the national mentorship scheme administrated by the Academy of Medical Sciences. Academic Lead (University) for the IAT Programme: Professor Eugene Healy Professor of Dermatology University of Southampton Southampton General Hospital Southampton SO16 6YD Tel 023 8077 7222 E.Healy@soton.ac.uk Academic Supervisor (University) Details: Professor Cyrus Cooper Professor Elaine Dennison Dr Nicholas Harvey
Education Supervisor (Trust) Details: As above; other accredited supervisors from Wessex rotation Clinical Supervisor(s) Details: As above; other accredited supervisors from Wessex rotation Deanery Programme Training Director Details: Dr J Ledingham Deanery Programme Manager Details: Ms Elizabeth Martin Confirmation that ACF posts attract an NTN(a): This post will attract a NTN