Diabetes and Endocrine

Guy’s and St Thomas’ Diabetes and Endocrinology Visiting Professional Programme gives international clinicians the opportunity to learn from an experienced Diabetes and Endocrinology team working in the heart of London.

Introduction

Guy’s and St Thomas’ NHS Foundation Trust Diabetes and Endocrinology Visiting Professional Programme (VPP) is designed to allow international visiting professionals with the opportunity to experience and learn from an experienced Diabetes and Endocrinology team working in a busy tertiary medical centre in the heart of London. The Diabetes and Endocrinology department operates at both Guy’s and St Thomas’ sites and very closely with the local primary care services covering a wide geographic area. The department provides a service to people with Diabetes and Endocrine conditions, Obesity and Lipid and Metabolic disorders. There is a research team integrated within the department, and it actively recruits to several research trials. The service comprises several areas of expertise: Complex Endocrinology, Complex Diabetes (Renal and Vascular/Foot), Type 1 Diabetes, Antenatal and Transitional Diabetes and Obesity. In each service, there are specialist multidisciplinary services with strong clinical and academic teams. This is an opportunity to sharpen professional skills and gain clinical experience in one of the UK’s leading Teaching hospitals.

Our Visiting Professional Programme is a unique development experience that allows visitors to observe (Observership) or learn clinical skills (Fellowship) in our leading Diabetes and Endocrine care team in all its settings. The attachment can be tailored to the learning needs of the visitor and can range from broadly generic to highly specialised. We are dedicated to broadening international professionals’ clinical expertise and enabling them to observe and practice new skills that can be transferred back to their work place.


Programme aims

The programme is aimed at those who wish to extend their experience within a leading NHS Diabetes and Endocrinology team and wish to gain an understanding of the way this is practiced and organised within the NHS and how it integrates with patient care pathways.

The programme aims to include:

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


Format

The observer will have a nominated supervisor to coordinate their individual programme and mentor progress during the Clinical Programme.


Who can apply

This programme is intended for non-U.K. advanced trainee clinicians at the level of specialist registrar or consultant, looking for exposure to a leading NHS Diabetes and Endocrine team. 

Visitors can apply for an Observership Programme or a Clinical Fellowship Programme. 

Those wishing to apply for a Clinical Fellowship Programme need to have GMC registration. We would recommend GMC registration for Observership Programmes over 12 weeks, although not mandatory. Applications for GMC registration can be requested through the GMC website. The process is likely to take considerable time to achieve and should be factored into an attachment application. 


Programme duration

We offer Observership Programmes from 4 weeks to 12 months. We recommend Clinical Fellowships for at least 3 months to one year. The experience can be tailored to the applicant’s needs, from a generic overview of our service to a more specialised attachment.


Diabetes and Endocrinology service

The clinical department is an important element of local and tertiary medical services. It is mainly an outpatient speciality and treats approximately 20,000 patients each year. The clinics are supported by “near-patient” testing laboratories, providing on-site testing. The department has a dedicated team for inpatients with daily ward visits and on-call support for local primary care services. There is an extensive and growing participation in multiple national and international studies. As a part of King’s College London, medical students also rotate through the department.

Endocrine

The service includes a range of specific clinics, dedicated in-patient bed, multidisciplinary team meetings (adrenal, NET, pituitary, thyroid and thyroid cancer), on site endocrine dynamic testing and interventional radiology. We give advice and provide support for urgent referrals throughout the hospital and primary care physicians. There are daily general endocrine clinics, a weekly thyroid clinic with clinic thyroid ultrasound scanning and ultrasound guided fine needle aspiration with in clinic cytological confirmation. The department has excellent facilities for dynamic endocrine testing, with more than 400 tests arranged a year. Our department receives regional referrals for complex endocrine tumours and genetic disorders and is well supported by the Genetics and Nuclear Medicine Department. There is a young person’s and transition endocrine service that see paediatric patients transitioning to the adult services as well as patients with growth problems and metabolic bone disease.

Complex Diabetes / Renal and Research

There are multiple clinics per week at Guy’s and St Thomas’ where clinical training and opportunities to learn from experienced clinicians in specialist clinics focused on renal and cardiovascular disease complications. These specialist clinics offer visiting clinicians experience in managing patients with type 1 and type 2 diabetes with complex diabetes complications such as diabetic gastroparesis, autonomic neuropathy, renal disease in diabetes, advanced diabetic peripheral vascular disease and complex diabetes foot disease, pre-dialysis diabetes care, diabetes management in dialysis patients and in post-transplant setting.

Visiting clinicians will have the opportunity to work on diabetes vascular and renal complications projects ongoing in the unit. The clinical trials and studies are focused on cardio-renal protection using GLP-1 RA and SGLT-2 Inhibitors. In parallel we have a large clinical database with data from >10,000 patients with diabetes with prospective data > 10 years duration that can be utilised to by visiting fellows to develop their own projects focused on diabetes complications. We also have ongoing research focused on diabetic cardiac autonomic neuropathy and foot disease.

Training on good clinical research practice, statistics for clinical research and specialist research methods such as arterial stiffness, endothelial function, cardiac imaging, and autonomic testing will be available. Hands on experience and training in working in clinical research and clinical trials will be provided.

Complex Diabetes / Foot

Guy’s and St Thomas’ is a Tertiary centre hence the diabetes team are frequently asked to consult on complex cases requiring diabetes input under the care of other specialist teams including but not limited to oncology, cardiothoracic, gastroenterology.

The Diabetes Foot Team work closely with the vascular surgeons who provide cutting edge vascular and endovascular surgery in a high volume, world class vascular unit in the heart of London. There are diabetes foot clinics daily and multi-disciplinary diabetes foot clinics (Infectious Disease Consultants, Vascular Surgeons, Podiatrists, Pharmacists, Physiotherapists) twice a week covering both out patients and inpatients. There is a weekly complex clinic where patients attend with complications of diabetes such as retinopathy, gastroparesis, renal disease and peripheral neuropathy.

There is the opportunity to participate in ongoing quality improvement projects and / research project in complex diabetes leading to the possibility of a poster/publication.

Type 1 Diabetes / Technology

The type 1 diabetes/technology team cares for about 2000 people with type 1 diabetes. There is a highly skilled and dedicated multidisciplinary team (consultants, diabetes specialist nurses, specialist dietitians, psychologists, diabetes specialist midwives, podiatrists) who work together to provide a full range of clinics for patients with type 1 diabetes. These including intensive type 1 management, insulin pump clinic, pre-conception clinic, an integrated antenatal and post-natal service with Women’s Health, young person’s and transition clinic. A large proportion of patients are using diabetes technology with over 500 on insulin pumps (mainly Medtronic Minimed 640G® and Omnipod®), over 100 using continuous glucose monitoring and several hundred using flash glucose monitoring. In addition, the service delivers patient education/self-management programmes such as Dose Adjustment for Normal Eating (DAFNE), pump DAFNE, educational programmes for patients starting insulin pump therapy, continuous or flash glucose monitoring and programmes for young adults with Type 1 diabetes (YES). Research opportunities are available in diabetes technology and diabetes service redesign.

Obesity

The department is active in assessment and management of patients with obesity. The regional service is provided jointly by Guy’s and St Thomas’ and King’s College Hospitals. Our service sees about 400 new patients per year and prepares around 200 patients a year for metabolic surgery which takes place at KCH. Patients are helped to control their weight with lifestyle and pharmacotherapy interventions, and/or recruitment to clinical trials. The centre offers an introductory briefing on obesity, its complications and the multiple therapeutic options. A comprehensive dietetic, medical and psychological assessment is performed prior to surgery. We work in a multidisciplinary team which includes obesity physicians, metabolic surgeons, dieticians, psychiatrists and sleep medicine physicians. In addition to specialised complex obesity services (Tier 4), GSTT delivers a primary/community care based structured weight loss programme (Tier 3) involving 5 South East London boroughs and approximately 1000 patients.

We have an active research programme and run several clinical trials investigating the use of new pharmacotherapy, endoscopic devices and metabolic surgery for the treatment of obesity. All patients are offered the opportunity to take part in research if eligible to recruiting studies.


Example Timetable

Endocrinology

Monday morning

  • On site endocrine dynamic testing / General endocrine clinic 
  • Transition/Adolescent endocrine clinic (monthly)

Monday afternoon

  • Transititon/Adolescent diabetes clinic (twice a month)

Tuesday morning

  • Adrenal, thyroid, pituitary multi-disciplinary team meeting / Neuroendocrine Tumour Multi-disciplinary team meeting (monthly)
  • Lipid clinic

Tuesday afternoon

  • Endocrine clinic Neuroendocrine tumour clinic (monthly)

Wednesday morning

  • Diabetes Endocrine Inpatients Ward round

Wednesday afternoon

  • Endocrine rapid access

Thursday morning

  • Thyroid clinic / Thyroid Ultrasound & FNA clinic and thyroid cancer multi-disciplinary team meeting

Thursday afternoon

  • Endocrine clinic / Thyroid Ultrasound & FNA clinic

Friday morning

  • Endocrine clinic

Friday afternoon

  • Audit / Service quality improvement

Complex Diabetes/ Foot

Monday morning

  • Diabetes foot and inpatient ward round Virtual peripheral neuropathy clinic (monthly)

Monday afternoon

  • Foot multi-disciplinary team meeting – Inpatient & outpatient review

Tuesday morning

  • Audit / Service quality improvement

Tuesday afternoon

  • Diabetes complications clinic

Wednesday morning

  • Diabetes rapid access clinic / Type 2 Diabetes community clinic

Wednesday afternoon

  • Diabetes foot clinic

Thursday morning

  • Foot multi-disciplinary team meeting

Thursday afternoon

  • Type 1 Diabetes clinic

Friday morning

  • Diabetes foot and inpatient ward round

Friday afternoon

  • Diabetes multi-disciplinary team meeting / Research related activities

Complex Diabetes/ Renal and Research

Monday morning

  • Type 2 Diabetes community renal and cardiovascular complications clinic

Monday afternoon

  • Research related activities

Tuesday morning

  • Research related activities

Tuesday afternoon

  • Diabetes complications clinic Cardiac Autonomic testing clinic (monthly)

Wednesday morning

  • Diabetes rapid access clinic / Diabetes renal clinic

Wednesday afternoon

  • Audit / Service quality improvement

Thursday morning

  • Diabetes renal clinic

Thursday afternoon

  • Audit / Lectures or Symposia at King College London School of Cardiovascular medicine and British Heart Foundation Centre

Friday morning

  • Research related activities / Lectures or Symposia at King College London School of Cardiovascular medicine and British Heart Foundation Centre

Friday afternoon

  • Diabetes multi-disciplinary team meeting / Research related activities

Type 1 Diabetes/ Technology

Monday morning

  • Insulin pump clinic

Monday afternoon

  • Young person’s clinic

Tuesday morning

  • Preconception / postnatal review clinic

Tuesday afternoon

  • Research related activities

Wednesday morning

  • Diabetes rapid access clinic

Wednesday afternoon

  • Antenatal diabetes clinic

Thursday morning

  • Audit / Service quality improvement

Thursday afternoon

  • Multi-disciplinary diabetes clinic

Friday morning

  • Intensive diabetes clinic

Friday afternoon

  • Diabetes multi-disciplinary team meeting / Research related activities

Obesity

Monday morning

  • Research related activities Obesity Multidisciplinary Team Meeting (twice a month)

Monday afternoon

  • Audit / Service quality improvement

Tuesday morning

  • Adrenal and pituitary multi-disciplinary team meeting

Tuesday afternoon

  • Tier 3 1-to-1 initial assessments

Wednesday morning

  • Tier 3 medical clinic

Wednesday afternoon

  • Endocrine rapid access

Thursday morning

  • Tier 3 group sessions

Thursday afternoon

  • Research related activities

Friday morning

  • Medical obesity clinic

Friday afternoon

  • Medical obesity clinic

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

Excellent experience and I got a lot of exposure and training

Doctor from Saudi Arabia