You will be applying to the academic F2 programme in Norwich and will be allocated one of 4 academic F2 speciality attachments according to your expressed preferences.
You will gain experience in a broad research experience which, depending on the attachment, could include both laboratory and clinical academic research through both structured teaching and hands-on experience. It is expected that you will be able to learn how to formulate a research question, review the literature and write a research proposal including an appropriate power calculation. You will have formal structured teaching sessions on obtaining regulatory approval and issues of informed consent, The Human Tissue Act, confidentiality, Caldicott and data protection issues. Depending on the research project selected, you will gain experience of patient recruitment, data collection and case record form completion according to good clinical practice. Experience in research techniques and data analysis will be gained, as well as presentation skills and report/manuscript writing. It is envisaged that you will be involved in the teaching of the UEA medical undergraduate course and will therefore gain an understanding and practical experience of different methods of teaching and assessment.
It is expected that, while attached to the academic F2 placement, the clinical commitment will be small, however speciality related clinical experience may be available, if required. There will be no on-call commitment required during the academic F2 placement.
How this placement meets the outcomes as set out by the academic foundation programme
This placement provides the successful applicant with key academic competences in line with the UK Foundation Programme's Compendium of Academic competences. In particular, you will complete the following: critical appraisal; question formation and literature searching; and a component of a population-based study.
The UKFPO Compendium of competences also include protocol development, grant writing and ethics approval. Experience over the last three years suggests these are unrealistic expectations for most F2s within a four month attachment. However, it would be possible, to develop a research protocol for a small discrete project that is taken through ethics approval and then carried out during the F2 attachment, but this requires considerable planning and motivation by the F2 doctor concerned and needs to be started a minimum of 12 months ahead of the attachment. You supervisors will be happy to support this so please contact them early to discuss potential plans.
The teaching described below allows you to gain experience of larger group teaching (30-40 students) as well as small group teaching (PBL or consultation skills). You will also gain experience of assessment – both formative (tutor report writing) and summative (OSCE assessment).
The following compulsory academic specific courses are:
1) Norwich Academic F2 induction course
Academic F2 overview
Research Environment in Norwich
How to get the most from the attachment
Norfolk AF2 Required Objectives
How to write a research protocol
How to write a protocol: introduction, methods, patient inclusion and exclusion criteria, analysis etc
How to conduct a literature search and review
Introduction to medical statistics
How to think critically about your own research
How to review a paper
Consort statement requirements
Factors of good and bad report writing
How to present data from a research project
Key aspects of oral and poster presentations
Overview and wrap up
The ups and downs of academic medicine
2) Objective Structured Clinical Examination (OSCE)
This half-day course will explain the practical aspects of examining at OSCEs. Following this course you will be able (and expected to) examine at UEA undergraduate OSCE's
3) Problem Base Learning Tutor
This half-day course will explain the background and rationale of PBL teaching. You will gain the skills needed to tutor a PBL group.
Other training opportunities will be self-led and you will be required to take responsibility for your learning by being involved in the research and teaching activities of the supervisors. It is expected that you will write a protocol and conduct a piece of research. This may include protocol design, regulatory approval application, study co-ordination, data analysis, report preparation and data presentation. You will also be expected to review a research paper and write a case history or audit.
You will have the same clinical educational experience as the clinical F2 post in the respective specialities. You will be expected to attend the structured academic teaching programme described above. Attendance at multidisciplinary radiology, pathology and journal club meetings will be expected. You will be expected to complete a reflective diary and develop adult learning techniques.
The UEA, as one of the new UK medical schools, has a highly innovative undergraduate medical curriculum. Over the course of the year you will experience tutoring, seminar teaching and examination. You will be expected to act as a PBL tutor and as an examiner for Objective Structured Clinical Examinations (OSCEs) after suitable training. You will also have the opportunity to deliver seminars and ward based teaching, and involvement in other medical student assessments e.g. marking critical appraisal essays or written examinations.
Clinical Academic Attachments
Diabetes and Endocrinology - Prof M Sampson
Research Site Name: Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospitals NHS Foundation Trust (NNUH NHSFT), Norwich, UK / Clinical Research and Trials Unit (CRTU)
The Directorate is the largest Diabetes & Endocrine service in the East of England, and one of the largest in the UK, and information on the services and quality markers in this NHS University teaching hospital, the associated UEA medical school and UEA biomedical schools, and a new functional and well staffed Clinical Research and Trials Unit (CRTU) at these sites are available. The Directorate supports a full range of specialist and general clinical services, for a stable local population of 600,000, and a local diabetes population of 42,000 people with known and unknown diabetes (2011). There are active programmes for DAFNE, CSII, outreach services, primary care support, and mobile retinal screening, as well as among the largest and best described antenatal, paediatric and foot services in the UK. The Trust and UEA are part of the larger Norwich Research Park (NRP) which also includes the John Innes Centre, the Institute of Food Research, the Sainsbury Laboratory and The Earlham Institute and houses over 30 science and IT based companies and is one of Europe's largest concentrations of research in Health, Food and Environmental Sciences. An analysis of the most highly cited scientists in the UK over the past 20 years reveals that Norwich is ranked 4th in the UK after London, Cambridge and Oxford. The Acute Trust and Directorate staff have a long history of clinical – basic science collaboration with colleagues across the NRP, and research in this Directorate is integrated with and fully supported by the East of England DRN.
Clinical Research Experience
The Consultant team in the Elsie Bertram Diabetes Centre are the most research active Directorate in this large University Teaching Hospital and offer a substantial range of expertise and in depth support for academic and industry associated studies. Since the original diabetes research unit (DRU) opened in 1995 (since moved into the CRTU), the diabetes team have undertaken more than 60 research studies with industry, or externally funded with local and UK collaborators. The research team are highly experienced in clinical trial recruitment, GCP, participant retention, eCRF and database management, and in dealing with the regulatory pressures and obstacles in clinical research in the UK. We are aware of the intense recruitment pressures that many industry studies require, and are committed to realistic and accurate recruitment estimates, and have recruited to target in all industry and academic studies in the last decade. Recruitment sample sizes have ranged from up to 6,000 sample size for some studies (Norfolk Diabetes Study, UEA – IFG etc), with 10,000 planned for NDPS down to small numbers in highly specialist trial recruitment and intense recruitment effort. Recruitment locally is supported by excellent research working relationships with local practices individually and through PCRN support. The Consultant team are all research active and offer a range of expertise and research outputs and are Dr Ketan Dhatariya (clinical and research interest in DAFNE, foot disease, clinical therapeutics, and hypertension in diabetes), Dr Swe Myint (clinical and research interest in clinical therapeutics, obesity management, transitional care and hypertension management), Prof. Mike Sampson (PI or CI on most Norwich studies since 1995 , with £3.54M in external grant income in last 5 years from Diabetes UK or NIHR, and Deputy Lead East of England DRN), Dr Francesca Swords (Clinical Director, with a clinical and research interest in adrenal function, ACTH receptor function and pituitary disease and CLRN metabolic medicine co - lead locally), Dr Rosemary Temple (clinical and research interest in preconception care and diabetes pregnancy), Dr Jeremy Turner (clinical and research interest in obesity and adipose tissue inflammation with recent BHF and DRWF funding), Dr Tara Wallace (clinical and research interest in insulin resistance, insulin sensitivity and vascular risk and CSII). All provide internal cover and a pool of local co investigators.
Therapeutic and Research Areas
- Obesity and adipose inflammation
- Metabolism, insulin sensitivity, hypertension
- Paediatric care and insulin management and T1DM prevention
- Retinopathy outcomes
- Neuropathy management
- T2DM prevention & Screening
- Education (DAFNE and new patient education)
- Clinical therapeutics, oral agents and insulin management in T2DM
- Clinical therapeutics, oral agents and insulin management in T1DM
- Diabetes Pregnancy management and outcomes
- Foot disease management in diabetes
- Nutrition, exercise and T2DM
- Service Delivery
Gastroenterology is a major clinical department in NNUH and a major research theme in the Norwich Medical School. 7 full time NHS consultants lead the clinical department. The department is extremely actively clinically with a large endoscopy unit in the UK with a throughput of 17000 patients per year. The endoscopy department is acknowledged as one of the leading units and training centres in the UK. It also a leading screening centre and was among the first in the UK to start colorectal cancer screening in 2007 and flexible sigmoidoscopic screening in 2013. It has a major interest in Hepatology, Inflammatory Bowel Disease and Nutrition.
Academic gastroenterology within the clinical department is led by Professor Watson with 2 senior lecturers (Beales, Hart) and one lecturer (Chan). There are also 2 academic clinical fellows and one NIHR research fellow. Clinical gastroenterological research is part of a much broader research programme of Gastroenterology and Gut Biology led by a partnership of the Norwich Medical School (13 Principal Investigators, including 3 Professors) and the Institute of Food Research (25 Principal Investigators).
Current ongoing projects include clinical trials in inflammatory bowel disease, the epidemiology of food risk factors in gastrointestinal disease, the role of gut bacteria in gastrointestinal disease, clinical and preclinical studies in sclerosing cholangitis, clinical studies in nutrition, the development of new therapies for inflammatory bowel disease. While attached to gastroenterology practical experience will be obtained by supervised periods of "hands-on" research. This will include opportunities in clinical, laboratory-based and epidemiological research and the chance to experience and learn many experimental techniques of the post-holders choosing.
The department is also heavily involved in undergraduate and postgraduate teaching and the FY2 post will have the opportunity to further their experience in teaching and assessments. A major interest in the "teaching" side of academic training can be accommodated and is encouraged. This could involve planning and giving teaching sessions under supervision. The exact make up of the post would be decided following discussion with the post-holder.
Respiratory and Medicine for Older People
Overview of Placement
Within Norwich, there is a close collaboration between Respiratory Medicine (Resp Med) and Older People Medicine (OPM). In particular, both groups have a strong interest in Chronic Obstructive Pulmonary Disease (COPD), idiopathic pulmonary fibrosis, exercise in lung disease and pneumonia. AMW currently applicant or co-applicant on grants totalling £4.6M, including studies to evaluate therapeutic interventions in patients with COPD and a meta-analysis of outcomes in asthma. He is the investigator for a further 6 clinical trials or investigational studies in COPD or idiopathic pulmonary fibrosis. This is in addition to an extensive research portfolio including asthma, rhinitis, bronchiectasis (Resp Med) and hypertension, physiology of cardiovascular ageing, syncope, stroke, movement disorders, mental health, physical and mental comorbidities (MFE). An academic F2 doctor is able to benefit from the research generated by these projects and to participate in aspects of these research projects.
The group currently have a Clinical Academic Chair, 2 Clinical Senior Lecturers, 2 Clinical Lecturers, 3 Academic Clinical Fellows, 6 Research Nurses and 1 Research Assistant. In addition, there are close links with basic clinical researchers including epithelial biology (Dr Darren Sexton), matrix metalloproteinases (Prof Ian Clark) muscle cell biology (Dr Gabriel Mutungi), exercise physiology (Prof John Saxton) and academics with expertise in meta-analyses (Dr Yoon Loke, Prof Paul Hunter, Prof Phyo Myint).
The post holder will have access to:
1) Clinical laboratory facilities: OPM Cardiovascular Laboratory (including Transcranial Doppler, BP monitors, Tilt table, Pulse wave velocity measures); Physiology Research Laboratory (including Spirometry, Impulse oscillometry, Airways resistance, Muscle strength and endurance, Exercise challenge tests); Clinical Respiratory Laboratory (including Body Plethysmography, and cardiopulmonary exercise testing)
2) Studies: At present there are 4 multicentre studies hosted by MFE and 6 studies hosted by Respiratory. These offer the experiences only available by well-resourced large scale studies including electronic data capture, electronic case record forms and independent specialist monitors. There are an additional 20 studies on going in the two departments providing a wide choice of studies in which an academic F2 can be involved.
3) Registers: there are currently registers in stroke, TIA, hip fracture and interstitial lung disease. These provide opportunities for data analysis
4) Meta-analyses, Audit and Reviewing Journal Articles: Researchers within Resp and MFE have experience undertaking meta-analyses, undertake audit regularly and frequently review articles for peer reviewed journals. This provides a resource for training in these areas.
Examples of Work Undertaken and Outputs
Previous academic foundation doctors have been involved in a wide range of projects including assessment of lung function using novel and experimental techniques including breath condensate, impulse oscillometry, airways resistance measurements; assessment of in patients with COPD and interstitial lung disease using laboratory walking tests and accelerometry, meta-analyses and reviews in the following topics: pneumonia scoring, dysarthria, oral anti-coagulants and antiplatelets, pulmonary rehabilitation, non-lipid lowering effects of statins.
- Original article: Mannu GS, Loke YK, Curtain J, Pelpola KN, Myint PK: Prognosis of multi-lobar pneumonia in community-acquired pneumonia: a systematic review and meta-analysis for European Journal of Internal Medicine for August 2013
- Mannu, G. S., Zaman, M. J., Gupta, A., Rehman, H. U. & Myint, P. K. (2012) Update on guidelines for management of hypercholesterolemia. Expert Rev Cardiovasc Ther, 10, 1239-49.
- Mannu GS, Zaman MJ, Gupta A, Rehman HU, Myint PK. (2012) Evidence of lifestyle modification in the management of hypercholesterolemia. Curr Cardiol Rev. Sep 17.
- Hayton, C, Clark, A, Olive (NNUH), Sandra, Browne (NNUH), Paula, Galey, Penny, Knights, E, Staunton (Norwich Comm H/Care), Lindi, Jones, Alison, Coombes, Emma and Wilson, Andrew (2013) Barriers to pulmonary rehabilitation: Characteristics that predict patient attendance and adherence. Respiratory medicine, 107 (3). pp. 401-407. ISSN 1532-3064
Public Health/Primary Care Group
The Primary Care Group brings together expertise in social and health services research, where the primary focus and data source is the individual patient. This accords with the definitions of the role of general practice and primary care (for example, "an approach to the delivery of health care which routinely applies a broad and holistic perspective to the patient's problems"). The essential quality is that our focus is health and ill-health in the context of people's wider lives, recognising and accepting wide variation in the way those lives are lived, and in the context of the whole person.
The group has 3 clinical and 3 social science academics, and uses research methods which range from epidemiology to discourse analysis. Current research interests include the relevance of NICE guidelines to primary care, the epidemiology of quality in health services (English Longitudinal Study of Ageing), primary care interventions to reduce secondary care utilisation, statin use, the impact of the Quality and Outcomes Framework, resilience, adherence to medication, and chronic disease prevention, as well as condition-focused studies in diabetes and osteoporosis. There are opportunities to work with the local NHS to evaluate interventions, current examples being referral management, case management, and obesity services. You will be supervised by a member of our group, and will have clinical primary care experience within easy reach of UEA to permit attendance at core UEA meetings. You will gain experience with primary care consultations and home visits under supervision of an experienced Primary Care physician and their specialist nurse practitioners and multi-disciplinary team
Public Health Post
This rotation will allow one of three appointed F2s to focus on academic public health, whilst the other two posts will be in academic primary care. All posts will include one clinical day per week with Dr Young and partners in North Walsham. This incorporation of a clinical component is a new and very positive development. It will mean that the F2 will have exposure to general practice as well as academic public health, and will be able to maintain their clinical skills during this placement.
Overview of Placement
The public health F2 appointment will work with Professor Richard Holland under day-to-day supervision of one of our Public Health lecturers or Academic Clinical Fellows (currently, Dr John Ford). This placement gives the successful candidate the opportunity to undertake Public Health/Health Services research with the aim of working towards 1-2 potential publications; broadening your knowledge of the application of Public health principles within an academic environment and extending your teaching skills. You will develop key clinical research skills, of use in any future academic role. In addition, training and experience is provided in NHS public health.
Key research knowledge and skills covered:
- basic study design and critical appraisal
- literature searching and review writing
- basic data handling and statistical methods
- report writing
Key public health skills covered:
- Health needs assessment
- Health protection and communicable disease (up to 5 days with Health Protection Unit)
- Health promotion (opportunity for experience with the smoking cessation team)
Other NHS public health experience can include experience with the Exceptional treatment panel, or Therapeutics advisory Group at the PCT.
The application of these knowledge and skills is demonstrated as follows:
- You will undertake approximately two projects during your placement. These projects may include the opportunity to undertake literature review tasks, systematic review, data analysis, and report writing. In general, these will involve attaching the F2 to on-going studies undertaken within the Population Health Group's research team that are currently either in their final stages of completion, or are completed. The aim is to complete 1-2 reports of which at least one should be prepared for publication.
- You will participate in the monthly Journal Club in association with the Norfolk NHS Public Health F2. You would be expected to present at least once at this journal club.
- Presentation of work undertaken to the Regional Public Health F2 group (this group meets monthly for a half-day training session in Cambridge).
- Teaching on our innovative MB BS programme, as follows (all delivered after suitable training):
- Acting as a PBL tutor on our undergraduate programme for one rotation (8 half-day sessions) or working as a Consultation Skills tutor
- Potential to undertake clinical skills teaching work – including prescribing seminars, or Clinical Case Based Discussions (so-called ‘long-case teaching) with year 3-4 Undergraduate students
- Potential to undertake research methods seminars (these are parallel seminars delivered to approximately 30-40 students, all material is pre-planned by the research methods team):
- literature searching
- descriptive statistics
[Note: this teaching is designed to consolidate your own learning in these areas]
- Assessment experience, in particular as an OSCE assessor
Examples of Work Undertaken and Outputs
Previous work undertaken by UEA F2's in public health has included analysis of data from RCTs, cross-sectional studies, and health needs assessment work. Work has encompassed topics in heart Failure, osteoporosis, substance misuse, and most recently work with those in police custody. Previous F2s have used both quantitative and qualitative research methods and have succeeded in gaining publications or conference abstracts from their attachments:
- Holland, R., Rechel, B., Stepien, K., Harvey, I., and Brooksby, I. Patients' self-assessed functional status in heart failure by New York Heart Association class: a prognostic predictor of hospitalizations, quality of life and death. J Card Fail, 16: 150-6.