Training Programme Director for Rehabilitation Medicine – Annabel Crossman, Frenchay Brain Injury Rehabilitation Centre
Head of School of Medicine: Dr Ananthakrishnan Raghuram
Associate Dean for Medicine: Dr Geoff Wright
Education programme Manager: Joanne Pickstone / Louise Peckham
Education programme coordinator: Faye Price
Health Education South West Severn supervises all postgraduate medical specialist training in the region.
Information about the specialty
The training programme in Rehabilitation Medicine offers the opportunity to train in a collaborative and holistic speciality, in the vibrant and attractive South West region. The
majority of the attachments will be in Bristol, with spinal injury training in Cardiff and local specialist rehabilitation experience in Taunton, Somerset – both of which are within
easy commuting distance. The four-year programme offers varied and broad training across neurological, spinal, musculoskeletal and amputee rehabilitation, including a
major trauma attachment. The focus will be on neurological rehabilitation – this will comprise two years of the training programme to enable trainees to develop advanced
specialist competencies in this field.
Training opportunities in Southwest - Severn
Dr Angus Graham – Consultant in Rehabilitation Medicine
Dr Annabel Crossman - Consultant in Rehabilitation Medicine
Dr Mark Paramlall – Consultant Neuropsychiatrist
Frenchay Brain Injury Rehabilitation Centre (known locally as BIRU) is a specialist, purpose-built unit providing the Level 1 neurorehabilitation service for the South West region (29 beds) for patients with Category A, severe neurological injuries. During 2016/7 the unit expanded to provide an additional 23 beds for Level 2 rehabilitation of patients with Category B needs. Both the Level 1 and Level 2 services are provided to meet the needs of patients with a recently sustained traumatic or acquired brain injury and resulting functional impairments. This can include patients with a dual diagnosis of spinal cord and brain injury as well as peripheral neurological conditions such as Guillain Barré syndrome.
The centre benefits from its own gardens and grounds, a hydrotherapy pool, two physiotherapy gymnasiums, adapted kitchens for occupational therapy use, and two self-self-contained flats to assess more independent functioning prior to discharge. It is staffed by a full specialist MDT - nursing, physiotherapy, occupational therapy, speech and language therapy, neuropsychology; two Consultants in Rehabilitation Medicine (Dr Angus Graham and Dr Annabel Crossman), a Consultant in Neuropsychiatry (Dr Mark Paramlall) and two Clinical Fellows. There is support from NBT Intensivists for tracheostomy management.
During this post, trainees will be involved in assessment of patients referred for specialist rehabilitation – from Southmead Hospital (which hosts the major trauma centre and regional neuroscience services) and other hospitals in the region, with consultant supervision. They will gain skills in the medical and multidisciplinary management of patients with neurological injury, including physical impairments such as spasticity, assessment of prolonged disorders of consciousness, and rehabilitation for patients with cognitive and behavioural impairments including those who require treatment under the Mental Health Act.
In addition to the inpatient attachment, the trainee will be able participate in weekly spasticity management out-patient clinics supervised by Dr Graham, providing training in Botulinum Toxin Injections and management of Intrathecal Baclofen Pumps.
During the neurological rehabilitation post there will also be opportunity for an attachment to the Stroke Service at Southmead Hospital, to gain experience of assessment and management of patients with acute stroke, including referral for interventions such as thrombectomy and decompressive hemicraniectomy. Clinical supervision for this element will be from Dr Phil Clatworthy, consultant neurologist.
Trainees will be encouraged to attend the weekly Neurosciences Postgraduate meetings at Southmead Hospital which offer an excellent educational opportunity. In addition BIRU has a regular schedule of multidisciplinary teaching which trainees will participate in.
Dr Steve Novak – Consultant in Rehabilitation Medicine
North Bristol NHS Trust / Southmead Hospital host the Major Trauma Centre for the Severn Major Trauma Network (SMTN). The service is housed in the ‘state of the art’ Brunel Building opened in 2014. The service sees around 1200 trauma patients a year.
The most recent figures from the SMTN suggest 2.8%, or on average 36 patients per year, will have Category A, the most complex, rehabilitation needs, at the time of their discharge or transfer out of the Major Trauma Centre (MTC). A further 4.1% or 52 patient will have Category B needs.
Thus a total of 88 patients on average will be judged to have Specialist Rehabilitation needs at the time of their discharge or transfer from the MTC. These patients will come from all over the SMTN. The majority will have suffered, in addition to other injuries, a traumatic brain injury, a smaller number a spinal cord injury and the remainder will have complex musculoskeletal injuries or multiple limb amputations.
A further 54% of patients (or about 675) per annum will be judged to have Category C/D needs. These patients who generally have musculoskeletal injuries will require support from their local Recovery, Rehabilitation and Re-enablement (RR+R) services. These services, which may be delivered in community hospital beds, in the patient’s own home or in outpatients are usually collectively referred to as Level 3 services.
The service works closely with the Bristol Centre for Enablement which is part of the same directorate and the Frenchay Brain Injury Rehabilitation Unit.
This part of the rotation will give ample opportunity to experience the resuscitation, acute management and hyper-acute rehabilitation of traumatic injuries as well as the potential to follow these patients as they move on to local trauma units, specialist rehabilitation services and ultimately, for the majority, home.
Such experience is important not only as hyper-acute rehabilitation and management of the rehabilitation of musculoskeletal injuries takes on more prominence in rehabilitation medicine but also because of the insight gained into the natural history of many acute injuries.
The post will be based at the Major Trauma Centre at Southmead Hospital, supervised by the Consultant in Rehabilitation Medicine and Network Director of Rehabilitation, Dr Steve Novak. Trainees will also be encouraged to visit the other hospitals within the SMTN to gain experience of different approaches to delivering rehabilitation and the opportunity to follow individual patients along their pathway to recovery.
Clinical Supervisor to be confirmed
This rotation will cover training in Amputee rehabilitation, Prosthetics and Orthotics, Wheelchair and Specialist seating, Communication aids and Assistive technology. Bristol Centre for Enablement, situated in Highwood Pavilions at Cribbs Causeway in Bristol has all three services on site.
The prosthetic service consists of a multidisciplinary team which includes the Amputee Specialist Nurse, Physiotherapist, Occupational Therapist, Podiatrist, Counsellor and Prosthetists and technicians. Additionally, there are assistant practitioners who work closely with the therapists in providing care. The department sees 20 new referrals per month from two Major arterial centres, Major trauma, Plastic surgery and orthopaedic services and looks after nearly two thousand patients with upper or lower limb amputation or congenital limb deficiency. The centre is also a Murrison Centre for war veterans and has a large proportion of military amputees who attend for their prosthetic care. Clinics in the centre include primary clinic and follow up clinic with the MDT and consultant respectively. Microprocessor Knee assessment clinics are held every six to eight weeks and a combined clinic with Paediatric orthopaedic team held three times a year. There is a weekly pre-amputation consultation clinic. The centre also offers prenatal consultation and has paediatric patients who are seen regularly. Occupational therapists and Counsellor offer nursery and school visits and liaise closely for educational, sporting and social needs of children with upper and lower limb amputations.
The Orthotic service which has nearly eight hundred new referrals per month consists of Orthotists and assistant practitioners. They run independent clinics at Bristol Centre for Enablement, Cossham, Clevedon, Frome and Wells. Specialist clinics include combined Diabetic foot clinic, Lower Extremity Activity Pain (LEAP), Brain Injury Rehabilitation Unit (BIRU), Bristol and Avon Multiple Sclerosis Centre (BRAMS) and paediatric clinics. Orthotists attend Southmead and Weston Hospitals to give in-reach support on all weekdays. The trainee will have opportunity to attend these clinics.
The Wheelchair and Specialist seating service sees nearly three hundred referrals a month. A full multidisciplinary team of highly skilled occupational therapists, physiotherapists, rehabilitation engineers, OT technicians, Workshop technicians and assistant practitioners provide daily clinics and domiciliary and school visits which the prospective trainee can join.
The trainee will also benefit from attending limited sessions with the Electronic Assistive Technology (EAT) Southwest service and Bristol Communication aid service which are co-located in Highwood Pavilion. These may be organised during their neurorehabilitation rotation.
Dr Swaroop Shanbhag – Consultant in Spinal Injuries
Mr Sreedhar Kolli – Consultant in Spinal Injuries
The Welsh Spinal Injuries and Neurological Rehabilitation Unit is located in Rookwood Hospital in Llandaff, Cardiff. It is the main centre for training for specialist rehabilitation trainees in Wales for spinal cord injury rehabilitation. Along with Neurorehabilitation, the spinal unit is a premier service in the Neurosciences directorate at Cardiff and Vale University Health Board. This tertiary unit is one of the 12 specialist spinal centres in the UK and covers a population of nearly 2.5 million. The service is led by two Consultant in Spinal Injuries, Dr Swaroop Shanbhag and Mr Sreedhar Kolli, and has a full multidisciplinary team including a speciality doctor, Foundation one trainee, and a ST3-6 in rehabilitation medicine, nursing care, Clinical Nurse Specialist, Physiotherapy, Occupational therapy, Psychology, Dietician and Discharge Liaison Nurse. In addition, there is support from Consultant Intensivists and Urologists.
The unit has 2 wards with 26 inpatient beds and outpatient facilities including radiology and urodynamic studies. Patients are referred via National Spinal Cord Injury database. Both traumatic and non-traumatic spinal injuries are accepted for rehabilitation if they fulfil the criteria. A multidisciplinary in-reach team assesses patients in the Acute Hospital to provide input into early rehabilitation. The trainee will participate and be supervised for twice weekly ward rounds, outpatient clinics which include Sexual function clinic, Clinical nurse specialist led Bowel clinic and a monthly Spina Bifida clinic.
Additionally, there is scope to attend urology and spasticity clinics and specialist non-traumatic (Multiple sclerosis) clinic led by Neurorehabilitation service. A multidisciplinary team meeting is held once a week at which referrals are discussed. Goal planning meetings for patients are held twice a week which the trainee is expected to attend. Key worker training is provided and the trainee will have the opportunity to be a key worker for a spinal injured patient. This will provide a good insight into rehabilitation pathway through till discharge into community.
Rookwood site also has the Driving assessment centre and National Assistive technology centre which provide input to spinal cord injured patient. The trainee will have the opportunity to attend assessments for spinal patients .The trainee can attend weekly Grand round and Neurology teaching in University hospital of Wales. Audit and clinical governance meetings are held monthly which the trainee can attend.
Dr Robert Marshall – Consultant Rheumatologist
The attachment to the Rheumatology Centre at Bristol Royal Infirmary will facilitate the trainee to meet curriculum requirements in musculoskeletal rehabilitation. There is a team of 7 Consultants, 2 Rheumatology Specialty Registrars, and 7 Specialist Rheumatology Nurses, in addition to specialist physiotherapists and occupational therapists. All outpatient activities take place within the integrated rheumatology unit, which includes a day care and teaching area, a patient education facility and a bone densitometry service. There are close links with the adjoining medical research unit, with opportunities to participate in research, audit, and service development. The case-mix is varied, with a preponderance of patients with inflammatory conditions and osteoporosis.
The department sees about 1500 new patients, 6500 follow-up patients, and around 1000 day cases per year, providing continuing care to around 4000 patients. There are a number of specialist clinics including osteoporosis, psoriatic arthritis, connective tissue disease, vasculitis, and combined clinics including podiatry and orthopaedics. Training in intra-articular injections can be provided. 2 Consultants also offer musculoskeletal ultrasound as a service. There are opportunities to get involved with teaching undergraduate medical students on their musculoskeletal attachment. The department also has close links with other medical specialties (such as ophthalmology, respiratory, dermatology, gastroenterology), which helps facilitate care of patients with complex multisystem inflammatory diseases.
The trainee will be able to attend a weekly radiology meeting and a weekly postgraduate afternoon, which rotates around the Rheumatology departments in Bristol, Bath, and Weston-super-Mare, in addition to joining the monthly Rheumatology Regional Training Days.
Dr Mohammed Hai – Consultant in Rehabilitation Medicine
The Somerset Neurological Rehabilitation Centre (SNRC) is a specialist neurological rehabilitation unit located at Dene Barton Community Hospital, Cotford St Luke, Somerset, about 5 miles from the main county town of Taunton. It is part of the acute Taunton and Somerset NHS Trust which is based at Musgrove Park Hospital, the local District General Hospital in Taunton. The service is part of the neurosciences department at Musgrove, which also has an acute neurology service staffed by 4 consultant neurologists and a consultant neurophysiologist.
The neurological rehabilitation service based at SNRC serves most of the county of Somerset and some neighbouring areas of the county of Dorset. SNRC is essentially a Level 2b service with mainly Category B patients. Currently, it has 10 beds and admits patients with acquired brain injury, some with long-term neurological conditions and occasionally with spinal injuries.
Patients to SNRC are referred mainly from the acute wards at Musgrove, Yeovil District Hospital, Royal United Hospital Bath, and occasionally from the Brain Injury Rehabilitation Unit (BIRU) in Bristol. Trainees would be expected to participate in the referral pathway.
SNRC is staffed by a specialist MDT consisting of nurses, neuro-physiotherapists, neuro-occupational therapists, speech and language therapists, a consultant neuropsychologist with fixed hours input into the service, and a consultant in neurological rehabilitation who is supported by a Foundation Year 1 Trainee.
As part of the training programme, SNRC rotation will include participation in the twice weekly senior ward round, weekly MDT meetings, weekly FIM/FAM meetings, GAS scoring meetings, family meetings, case conferences, monthly specialty meetings, and managing patients who may become acutely ill. The acute teams at Musgrove are very supportive of SNRC.
Besides SNRC, the neurological rehabilitation service consists of bi-monthly general neuro-rehabilitation clinics, bi-monthly multidisciplinary Botulinum Toxin injection clinics for limb spasticity management, monthly multidisciplinary spasticity clinics, monthly head injury clinics, monthly multidisciplinary transition clinics, and an annual joint clinic with the paediatric consultant to facilitate transition of patients into our adult service the following year. Usually, the Botulinum Toxin injections are done under ultrasound guidance. There are currently 3 injectors - the consultant and 2 very experienced clinical specialist neuro-physiotherapists. These clinics are held at Musgrove Park Hospital.
Additionally, there are bi-monthly neurorehabilitation clinics at Bridgwater Community Hospital and monthly clinics at Yeovil District Hospital, which the trainee would be expected to participate in.
Our service has close links with all the acute services at Musgrove Park Hospital, which has an active postgraduate Academy. Trainees would be expected to attend the weekly Medical Grand Round at Musgrove.
The Training Hospitals
Frenchay Brain Injury Rehabilitation Unit – Neurological Rehabilitation
Bristol Centre for Enablement – Amputee Rehabilitation & Assistive Technology
Bristol Royal Infirmary - Musculoskeletal Rehabilitation (Rheumatology)
Dene Barton Community Hospital - Neurological Rehabilitation
Welsh Spinal Injuries and Neurological Rehabilitation Unit – Spinal Rehabilitation
Annual Assessment Information
Annual Review of Competence Progression (ARCP) will take place on a yearly basis to assess trainee development.