IBD Clinical Fellow

Job overview

This is an exciting post for 12 months aimed at a senior Gastroenterology trainee or accredited specialist wishing to garner further specialist experience in Inflammatory Bowel Disease (IBD) delivery in a large teaching hospital Gastrointestinal unit. A core component of this post is the delivery of lower GI endoscopy (diagnostic colonoscopy), with a particular focus on IBD assessment and surveillance. The post also comes with the opportunity to participate in clinical research and clinical trials, with time set aside within the job plan to enable this to occur

Main duties of the job

The IBD Team has strong links to the Royal Colorectal Team, as well as the Alder Hey Children’s Hospital Paediatric Gastroenterology Team and Liverpool Women’s Hospital Obstetric Team.

There will be an opportunity to undertake clinic work in aspects of the service to meet the needs of the department and the learning needs of the successful applicant.

There are a variety of different facets to the IBD service.

• General IBD clinics
• IBD MDT and radiology (APEX)/histology MDTs
• Similarly, Radiology (APEX) MDT
• Endoscopy
• Transition clinic
• Obstetric Clinic
• Clinical Governance, Directorate and Mortality and Morbidity
• Educational meetings
• Opportunities will be available to gain all relevant CPD points
• Research/Audit/Quality Improvement (QI)
• Patient initiatives

Below is an example of a current time-table but this will be flexible and aimed to meet the fellows needs.

Detailed job description and main responsibilities

The IBD team at the Royal Liverpool Hospital consists of:

Dr Violeta Razanskaite – Consultant Luminal Gastroenterologist and IBD Lead

Dr Paul Collins - Consultant Luminal Gastroenterologist

Dr Edmund Derbyshire - Consultant Luminal Gastroenterologist

Dr Joseph Fiske - Consultant Luminal Gastroenterologist

Dr Alan Steel - Consultant Luminal Gastroenterologist

Dr Doug Penman, Consultant Luminal Gastroenterologist

Dr Thomas Conley - Consultant Luminal Gastroenterologist

5 IBD specialist nurses

4 IBD Research nurses

2 IBD Pharmacists

1 Clinical psychologist

1 Dietician

1 IBD Administrator

6 Specialist Registrars

The IBD Team has strong links to the Royal Colorectal Team, as well as the Alder Hey Children’s Hospital Paediatric Gastroenterology Team and Liverpool Women’s Hospital Obstetric Team.

There will be an opportunity to undertake clinic work in aspects of the service to meet the needs of the department and the learning needs of the successful applicant.

There are a variety of different facets to the IBD service.

General IBD clinics

This is an essential part of IBD service as the main IBD clinics run on a Tuesday and Friday and occur either virtually (telephone) or face to face.  A successful applicant will be expected to work in both clinics and see unselected patients and discuss and escalate any concerns to the IBD consultant and/or nurses within the Team.

Patients from these clinics can be discussed in IBD MDT on a Friday, Radiology (APEX) MDT on a Monday or Histology MDT (once a month) on a Monday afternoon.

IBD MDT and radiology (APEX)/histology MDTs

These MDT are essential to the learning and development of a successful applicant.  IBD MDT occurs every Friday morning and is an important opportunity to discuss complex and challenging cases but also learn about the latest advances and uncertainties in IBD patients. Attendance is mandatory and presentation of cases and implementation of MDT plans is essential.

Similarly, Radiology (APEX) MDT is a mandatory part of the applicants’ duties – so to present and learn from the multiple cases that are presented related to IBD (plus general luminal gastroenterology and hepatology) at this meeting by IBD physicians, nurses, colorectal surgeons and radiologists.

Finally, Histology MDT is a highly recommended opportunity to discuss and learn about histological uncertainties related to IBD.  Attendance is mandatory if presenting cases.

Endoscopy

The applicant is expected to deliver at least 2 lower endoscopy lists per week at the Royal Liverpool or Broadgreen sites. Full JAG colonoscopy accreditation is a mandatory requirement for this post. Exposure to IBD endoscopy including chromoendoscopy for dysplasia, pouchoscopy, capsule endoscopy, and stricture dilatation will be facilitated depending on experience and interests of the candidate.

Transition clinic

The Royal Liverpool hosts the North West of England only dedicated transition service for patients with chronic GI conditions moving from paediatric to adult care, of which IBD patients are the largest majority.  This challenging and complex group of patients need additional support to integrate into adult services and gain confidence and independence from guardians, and hopefully good IBD control and management skills.  Transition clinic runs weekly (for follow up patients), with new patient clinics occurring monthly with the Alder Hey Children’s Hospital paediatric team.  A successful applicant should be encouraged to attend clinics as frequently as other service delivery allows to experience working alongside IBD Nurses, psychologists and paediatric team members.

Obstetric Clinic

Managing IBD and pregnancy can be challenging and so the Royal Liverpool IBD team run a joint clinic every month at the Liverpool Women’s Hospital.  A successful applicant should be encouraged to attend clinics as frequently as other service delivery allows to experience working alongside Obstetricians, midwifes and IBD Nurses.

Joint surgical clinic

Management of patients with perianal Crohn’s disease and complications of ileoanal pouch is an important skill for any IBD physician. A successful applicant will be encouraged to attend monthly clinics as frequently as other service delivery allows to experience working alongside Colorectal surgeons, stoma nurses and pouch nurse specialists.

Clinical Governance, Directorate and Mortality and Morbidity meetings

There is an expectation that a successful applicant will participate in all departmental meetings and all aspects of clinical governance, including departmental/service audits and QI projects.

Educational meetings

Many of the MDTs listed above have educational content and key learning points which a successful applicant should seek to learn from.   In addition, as the main teaching hospital in the region we have work experience student, medical students (including those on special study modules) and other allied healthcare professionals whom we have a duty to teach (and in many cases, learn from).

Within the department there are weekly lunchtime journal clubs both in Gastroenterology and Hepatology (with lunches provided by pharmaceutical companies typically) which are good educational opportunities.  In addition, the department is the main support to the regional ‘Mersey Gut Club’ hosted in central Liverpool – this provides access to excellent speakers regionally and nationally and there are likely opportunities to present at these meetings.

A successful applicant will be encouraged into participating in all aspects of the departmental education programme – both as a learner and teacher.

Opportunities will be available to gain all relevant CPD points (external and internal) throughout the year of the fellowship, including attendance at national and international meetings.

Research/Audit/Quality Improvement (QI)

The successful applicant will be expected to identify a research/audit/QI project to be completed during the training period with a view to publication / presentation at national/international Gastroenterology meetings such as ECCO or the BSG.  The applicant will be supported in doing this by their educational supervisor/mentor.  It is likely multiple opportunities will be made available throughout the year but applicants will need to be motivated in order to ensure they are completed proactively within the timeframe of the fellowship. There will be an opportunity to be either principal investigator (PI) or co-PI on one or more research studies.

Patient initiatives

The department is keen to develop more patient led initiatives within the department, such as a ‘Patient Panel’.  A successful applicant could help spearhead such initiatives alongside existing IBD team members.

Time Table

Below is an example of a current time-table but this will be flexible and aimed to meet the fellows needs.

AM (08.30-12.30) PM (12.30-16.30)

Monday IBD Flare clinic / Specialist monthly IBD clinic * 12.30-15.30

APEX meeting followed M+M, Directorate and Clinical Governance meetings

15.30-16.30

Histology MDT meeting/Research

Tuesday Admin time 12.30-13.00

Journal club and LUNCH

13.00-17.00

Main IBD clinic (RIBDFTF)

Wednesday Colonoscopy list Colonoscopy list

Thursday*** Research/QI time Research/QI time

Friday 08.00-09.00

IBD MDT

09.00-12.30

Main IBD clinic (RIBDFTF)

Admin time

* Specialist monthly IBD clinics:

1. Joint surgical clinic – this occurs once a month with the colorectal surgeons – contact CNS Dan Storey for further details

2. IBD Transition clinic – this occurs in the last week of each month with the paediatric team – contact Dr Joseph Fiske for further details

3. Obstetric clinic – this occurs once a month at the Liverpool Women’s Hospital – contact Prof Paul Collins for further details