Specialty Trainees firms at the BEH

There are seven six-month ST 3-7 firms at the Bristol Eye Hospital:

  • Retina (3)
  • Oculoplastic and Adnexal
  • Corneal and Anterior segment
  • Glaucoma
  • Paediatric and Strabismus

ST3-7 trainees will have the opportunity to spend at least three years in the Bristol Eye Hospital in a combination of ST or ASTO positions.

The Training Programme Director will ensure that all subspecialty areas have been covered either in the BEH, or during an ST3-7 attachment to a peripheral unit.

ASTOs/TSCs

There are six 12 month ASTOs / TSCs available at the Bristol Eye Hospital;

  • Vitreo-retinal
  • Medical retina
  • Oculoplastics and Adnexal
  • Glaucoma
  • Paediatric and Strabismus
  • Corneal and Anterior segment

However it is only generally possible for 2 STs to be assigned to an ASTO / TSC post at any one time. These posts can be "booked" some years in advance via the training Program Director.

If more than one trainee wants to do a particular ASTO at the same time, there will be a competitive interview for this post.

Retina Firm

Consultants

  • Prof Andrew Dick (Uveitis/VR)
  • Miss Clare Bailey (MR)
  • Mr Richard Haynes (VR/MR)
  • Mr Mohammed Majid (MR/Uveitis/VR)
  • Mr Bradley Johnson (MR/Uveitis)
  • Mr Richard Markham (VR/Paeds)
  • Miss Abosse Cole (MR)

The retinal firm has three ST trainees in it.

All three STs work within the firm, but each job will be weighted towards one or other subretinal specialty (Vitreo-retinal, Medical Retinal or Uveitis). The job description is to work with all consultants on the firm (see above) so that a large team structure is reinforced, but each ST has an individual timetable weighted to a subretinal specialty. Ward work and ward rounds are shared (and cross covered) and covers the VR/MR/Uveitis admissions.

On the Retina firm we aim for a seamless delivery of service and training. The trainees will be exposed to training opportunities in Medical Ophthalmology including care of ocular inflammatory disease in regional clinics and also in the award wining joint monthly paediatric ophthalmology and uveitis clinic.

The experience will involve management of patients with a range of ocular inflammatory disease, the medical management including use of immunosuppression and biologics agents. There is also exposure to the surgical management of such cases including complex cataract surgery, biopsy and vitreoretinal procedures.

There is also responsibility for care of medical patients on ward; their investigation and management of complex inflammatory disease. This experience dove-tails with care of vitreoretinal disorders including retinal detachment, macular pathology, trauma and complex diabetic retinopathy, working closely with Vitreoretinal fellows/ASTO so that DOPS/ OSATS etc should be covered with various team members.

STs will develop considerable experience in the management of patients with diabetic retinopathy, undertaking photocoagulation treatment (Bristol Eye Hospital has PASCAL, argon and diode lasers). There is also ample exposure to other retinal vascular disorders as well as the management of AMD including anti-VEGF treatments. There is a large photographic department, with HRA as well as Imagenet systems, 3 OCT scanners and EPR.

Additionally, there are training opportunities in management and the liaison with PCTs for funding of therapies. The STs form part of the Clinical Research team involved in the many clinical trials running through the Clinical Research Unit at Bristol Eye Hospital. ICH-GCP training and exposure to the integral running of trials within the NHS is available. As such there will be ample opportunity for STs to develop their own research interests compatible with that of the unit to ensure success and support is given.

Oculoplastics and Adnexal Firm

Consultants

  • Mr Harrad
  • Mrs Herbert
  • Mr Salve

Trainees will be exposed to all aspects of oculoplastic, lacrimal and orbital surgery. They will gain experience of assessing patients with eyelid malposition, peri-ocular and orbital tumours, lacrimal problems, socket pathology and orbital pathology. They will have regular exposure to interpretation of neuroradiology imaging. In addition they will have opportunities for interaction with the ocular prosthetics service.

Surgical Training

The ASTO/Fellow has 3 supervised lists with each of the consultants and one oculoplastics list with experience of teaching and supervision of the ST.

The ST has two consultant supervised lists (one adnexal and one cataract list) and one oculoplastic/minor ops list supervised by the fellow.

Surgical experience and exposure includes: Correction of lid malposition (adult and paediatric), Surgical management of periocular tumours, orbital surgery including decompression, DCR and complex lacrimal surgery, enucleation/evisceration and socket reconstruction.

Clinics

Both trainees will attend the Thursday am Orbital inflammation/Thyroid Eye Disease/Adnexal clinic. This starts with an MDT organised by the fellow where patients are discussed with the endocrinologist and scans are reviewed and discussed with the neuroradiologist. This is followed by a journal club where trainees take it in turn to present.

In addition the ST attends an additional oculoplastic/motility clinic, a paediatric/genetic clinic with Miss Churchill, and a general/motility clinic.

The ASTO/fellow has two additional supervised specialist clinics (oculoplastic and orbital), and one post-op/follow-up clinic with opportunities to review their own post-ops.

Research, Teaching and Audit

Trainees will have an active role in the adnexal component of the teaching programme, developing their presentation skills. The CIRTED Trial (Bristol arm) actively recruits patients and trainees are involved in this. The ASTO/Fellow has an active role in assessing patients within the research clinic. There are ample opportunities for research and audit.

Glaucoma Firm

Consultants

  • Mr Jeremy Diamond
  • Mr John Sparrow
  • Mr Michael Greaney

This busy firm covers most forms of glaucoma medicine and surgery, works in conjunction with other ophthalmic subspecialities, and oversees the work of the large in-house optometrist run shared glaucoma care service.

Surgical Experience

  • Specialty Trainee; (two lists)
  • One MG cataract list - straightforward and complex cataract cases under supervision. Case numbers as competence permits.
  • One JD glaucoma (with Fellow).
  • Mr Greaney ASTO / Fellow
  • One Glaucoma list - complex glaucoma surgery under supervision with a view to enabling such cases unsupervised.
  • One unsupervised list - straightforward and complex cataract and glaucoma surgery as competence permits Mr Diamond / Mr Sparrow Fellow
  • One glaucoma list (with Consultant and Registrar). Complex glaucoma including paediatric glaucoma surgery and tube-shunt surgery.
  • One unsupervised glaucoma operating list

Research opportunities: these are generally opportunistic and self directed. Involvement in audit is encouraged.

Corneal/Anterior Segment Firm

Consultants

  • Mr Stuart D Cook
  • Mr Derek M Tole
  • Mr Philip Jaycock (from summer 2010)

The firm covers the whole range of anterior segment medicine and surgery. Currently both trainees attend the specialist Cornea clinics on Tues morning (SDC) and Wed afternoon (DMT). The ASTO/Fellow participates in the Friday morning Immunosuppression clinic which is part of the Regional Ocular Inflammatory Service. Both trainees take part in the primary care/ A&E service.

Surgical Experience

Specialty Trainee; (two lists) SDC fast track cataract list (eight cases/list) this includes complex cataracts. The trainee will learn to manage these cases under supervision and the skills required to manage the list. The trainee will be able to do as much of the list as competence permits.

SDC anterior segment list. Participation in the range of anterior segment surgery.

ASTO/Fellow; (three lists) DMT and SDC anterior segment lists. Participation in the range of anterior segment surgery. The ASTO /Fellow has an additional alternate week unsupervised list.

Research opportunities: - these can be opportunistic and self directed; there are opportunities to participate in research through the UK Transplant database.

Mr P Jaycock returns to BEH in 2010. This will enhance our ability to provide training in laser and refractive surgery and other innovative anterior segment treatments.

Paediatric and Strabismus firm

Consultants

  • Mr Richard Harrad (adult motility and paediatric oculoplastics)
  • Mr Richard Markham (paediatric cataract and strabismus)
  • Miss Cathy Williams (ROP neuro-developmental paediatrics)
  • Miss Amanda Churchill (Genetics and paediatric strabismus)

This firm offers experience in both paediatric and adult strabismus, including the use of botulinum toxin in the management of strabismus. There is the opportunity to be involved with the screening of premature infants at risk of developing retinopathy of prematurity and to observe treatment of threshold ROP.

Bristol provides a paediatric cataract service and a Regional Ocular Genetics service and trainees on this firm will be involved with these clinics.