Acute and General Medicine

Guy’s and St Thomas’ Acute and General Medicine Visiting Professional Programme offers international clinicians hands-on experience of services including toxicology, hypertension, urgent care, A&E, respiratory medicine, ageing and health services and stroke.

Programme aims

The programme is aimed at those who wish to extend their clinical expertise in acute and general medicine within Guy’s and St Thomas’ Hospital.

The aims of the programme include:

Individual weekly timetables will be created depending on each visiting professional’s requirements.

A Certificate of Attendance will be awarded to visitors upon the end of their programme.


Format

The Acute and General Medicine programme is delivered within the hospital workplace and it includes exposure to clinics, inpatient ward rounds, multidisciplinary team meetings, depending on the length of programme that visitors request.

Visiting professionals will be aligned with supervisors from within the clinical teams who will facilitate agreed learning and development needs. We would expect visiting professionals to be totally integrated in the day to day service within our acute and general medicine teams.

We will also provide visitors with the opportunity to get involved in research, audit and improvement projects.


Who can apply

This programme is intended for non-U.K. doctors looking for exposure to a NHS emergency department.

Visitors can apply for an observership programme. Those wishing to apply must have GMC registration. You can apply for GMC registration directly through the main GMC website, alternatively The Royal College of Physicians run a medical training initiative which facilitates GMC registration and provides sponsorship for a Tier 5 visa. You can find out more about their Medical Training Initiative by visiting their website.


Programme duration

It is recommended to undertake a placement of 4-12 weeks. The programme’s duration can be tailored to the specific learning requirements of those visiting the Trust. 


Acute and General Medicine Service

Guy’s and St Thomas’ Hospital has eight ward areas, five outpatient departments and many specialities dedicated to the field of acute medicine and emergency care including:

Emergency Services

We offer three distinct emergency department (A&E) services

A&E

We see approximately 140,000 patients per year, making us one of the busiest emergency departments in London. We also see around 100 ambulances every day. Our emergency department (A&E) was recently rated ‘outstanding’ by the Care Quality Commission after an inspection they carried out at the end of 2015.

We aim to provide gold-standard emergency care and improved health outcomes for all our patients through education, research, and leadership development. In 2016, the emergency department got an ‘outstanding’ rating from the Care Quality Commission inspection.

We treat patients who have suffered a recent injury or accident or who have developed a sudden illness. All A&E departments use a priority system where the most seriously ill patients are seen first.

Urgent Care Team

The urgent care centre at Guy’s Hospital offers an alternative to the emergency department (A&E) for a range of minor injuries and urgent medical problems.

It is a walk-in NHS service for patients whose condition is urgent enough that they cannot wait for the next GP appointment (usually within 48 hours) but who do not need emergency treatment at the emergency department (A&E). It is staffed by a GP working alongside emergency nurses.

We have facilities to x-ray limbs for suspected fractures and prescribe medicines and will usually treat patients with less serious injuries more quickly than the emergency department (A&E).

Injuries and illnesses treated at the urgent care centre include:

General Medicine

General medicine provides acute medical services for adults of all ages across a wide range of specialties.

Most of our general medicine patients are admitted through accident and emergency (A&E). Only 2% of our general medicine admissions are planned.

Admissions from A&E generally go to the Admissions Ward. Here, patients are reviewed by a team of doctors, nurses and therapists. Some patients may be discharged home the same or following day (often with rapid outpatient follow-up and your appointment may be either at Guy’s Hospital or St Thomas’ Hospital), whereas other patients may need to stay for a few days or longer. Those who need to stay in hospital will be transferred to one of our general medical wards at St Thomas’ Hospital or to a speciality ward either at St Thomas’ or Guy’s Hospital.

There are many medical conditions often looked after by the general medicine team, such as sickle cell disease, HIV/AIDS, infectious diseases, rheumatology and neurology.

Wards for general medicine:

Respiratory medicine services

We provide services for all respiratory disorders except for cystic fibrosis. Our specialist outpatient clinics are run at both Guy’s Hospital and St Thomas’ Hospital.

They include:

Our service also includes the sleep disorders centre at St Thomas’ Hospital.

We also provide a range of diagnostic services and have close links with other specialties such as allergy, thoracic surgery, cancer and the Lane Fox unit.

Clinics include:

Ageing and health services H3 sub-heading

We provide a range of specialist medical services across both hospitals and in the community. Inpatient services are provided from dedicated wards at St Thomas’ Hospital, with outpatient clinics held at both hospitals.

We provide general and geriatric medicine services:

We provide the following specialist services:

Heart failure clinic

At Guy’s and St Thomas’ we have a comprehensive service for patients with heart failure, which includes:

We aim to make sure all patients receive evidence-based treatments in accordance with national and international guidelines.

We have good links with GPs and community services to help make sure patients’ needs are dealt with efficiently, with great emphasis on their concerns and wishes. For our local patients, we work in partnership with King’s College Hospital to provide a specialist community heart failure service.

Clinics

Hypertension

The Cardiovascular Clinical Pharmacologists run the following clinical services:

Specialist hypertension clinics at Guy’s and St Thomas’

‘HOT’ clinic facility

Inpatient hypertension ward referrals

We liaise closely with the vascular surgeons, especially for the medical management of patients with Type B aortic dissection; also aortic aneurysms, peripheral arterial disease, carotid surgery.

We review medical inpatients with severe or resistant hypertension, including patients with stroke, emergency admissions with accelerated hypertension, pregnancy.

Multidisciplinary Team approach

We link with other MDTs – especially the Adrenal/NET MDT for review of patients with potential Endocrine causes of their hypertension, such as hyperaldosteronism, pheochromocytoma/paraganglioma and renal/interventional radiologists/vascular surgeons for renal artery stenting in patients with fibromuscular dysplasia and atherosclerotic renal artery stenosis.

Stroke services

Our stroke service cares for patients at our rehabilitation stroke unit on Mark Ward. Our stroke service has achieved an ‘A’ star rating in the Sentinel Stroke National Audit Programme (SSNAP).

Patients who have suffered an acute stroke, will be cared for at a hyper acute stroke unit such as King’s College Hospital. Patients who come to accident and emergency, or have an acute stroke while they are in hospital will be transferred to a hyper acute stroke unit.

We work closely with colleagues across London to ensure that patients can be looked after in a hospital closer to their home for the remainder of their care. We will transfer patients back to Mark Ward around 48-72 hours after admission to a hyper-acute stroke unit.

Stroke and neurovascular clinic

This clinic covers:

Toxicology

Our clinical toxicology service is led by three consultant clinical toxicologists, along with a team of junior doctors. We’re further supported by two dedicated clinical toxicology database scientists, and a number of research assistants/fellows.

We have close links with the information and liaison psychiatry services at our hospitals and with the laboratory services at King’s College Hospital, London.

Medical toxicology clinic

Patients with recognised or suspected poisoning are seen and assessed in the medical toxicology clinic, held weekly at in Gassiott House, St Thomas’ Hospital. This clinic receives patient mainly from greater London and south east England, but can accept referrals from anywhere in the UK.

Part of this clinic is a weekly dedicated ‘club drug clinic’, where patients are seen jointly with a clinical toxicologist and addiction psychologist.

Patients must be referred by their GP or local hospital; we do not take direct referrals from patients.

Paediatric cases will normally need to be reviewed by a local paediatrician prior to referral, for clinical assessment and examination.

The clinic is supported by a team of consultant psychiatrists and psychologists.

Inpatient clinical toxicology service

This inpatient service provides specialist advice in the management of poisoned patients presenting to St Thomas’. Patients who have been admitted to the emergency medical unit (EMU), a medical ward, critical care ward or Evelina London Children’s Hospital with the diagnosis of poisoning are seen and assessed on the twice daily clinical toxicology ward round.

Where appropriate the ongoing care of these patients is provided by the clinical toxicology team.

A specialist registrar in clinical toxicology and/or consultant is available on call to assess and/or provide advice on acutely poisoned patients who come to A&E.


Example Timetable

Week 1

Monday morning

  • General Chest Clinic (daily)
  • TB Clinic (weekly)

Monday afternoon

  • N/A

Tuesday morning

  • General Chest Clinic (daily)
  • Sarcoidosis Clinic (weekly)
  • Interstitial Lung Diseases Clinic (weekly)
  • Ambulatory Oxygen
  • Assessment Clinic (1st Tuesday of month)

Tuesday afternoon

  • Pulmonary Rehabilitation Clinic (3rd Tuesday afternoon of month)
  • Interstitial Lung Diseases Clinic (weekly)

Wednesday morning

  • General Chest Clinic (daily)
  • TB Clinic (weekly)

Wednesday afternoon

  • Lung Cancer Clinic (weekly)
  • Pleural Clinic (weekly)
  • COPD Clinic (weekly)
  • LTOT Oxygen Assessment Clinic (weekly)

Thursday morning

  • General Chest Clinic (daily)
  • Difficult Asthma Clinic (weekly)

Thursday afternoon

  • Pleural Clinic (weekly)

Friday morning

  • General Chest Clinic (daily)
  • Lung Cancer Clinic (weekly)
  • Ambulatory Oxygen Assessment Clinic (2nd and 3rd Fridays of month

Friday afternoon

  • N/A

Fees

A course fee per week will be applied; this fee excludes accommodation and travelling expenses. To find out the fee amount please email [email protected]


Please note

Clinicians are able to offer bursaries or discounted placements on an individual basis. This is at the discretion of the Directorates of GSTT and does not affect the terms and conditions of the Visiting Professional Programme agreements

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Visiting Professional Programme attendee

I feel privileged to witness one of the greatest healthcare systems in the world and the experience was simply amazing. My attachment was rewarding in all aspects. Starting the day shadowing consultants during ward rounds, getting handovers, consulting patients about management options and then discussing medical topics with junior doctors, it was exhilarating

Doctor from India