WGH Surgery, Anaesthesia and Critical Care Block
Welcome to the WGH Colorectal surgery unit. We manage all patients with colorectal surgery pathology presenting in Lothian region (approx 800,000 people).
There are 4 main colorectal surgical wards (23, 24, 57, 52).
Ward 57 is the emergency admissions ward, receiving acute patients from the WGH surgical assessment unit (SAU), inter-hospital transfers and clinics. Urology also admits acute patients to ward 57.
Ward 52 is our surgical HDU (SHDU), again shared with Urology.
Ward 23 and 24 look after elective patients and patients transferred or stepped down from SHDU and ward 57.
Red Team (Emergency Team - ET)
One Consultant provides emergency cover for a full week which starts with the handover on Fridays at 8am on ward 57. The emergency team comprises the Consultant, the Registrar (07815 492792), a CY/FY2 (bleep 8272), three FY1's (bleep 8296) and a Clinical Nurse Specialist (CNS). There is also a second-on Registrar to provide support for wards, SHDU and SAU (contactable on 07814 909914). There is a second Consultant on emergency duty covering weekday nights Monday to Thursday (starting at 5pm).
Consultants
Mr P Vaughn-Shaw (PVS) Mr M Potter (MAP)
Miss M Collie (MHSC) Prof M Dunlop (MGD)
Mr C Reddy (CTR) Mr J Mander (BJM)
Mr H Paterson (HMP) Miss D Collins (DC)
Mr M Duff (MJDD) Mr D Speake (DXS)
Mr AJ Clarke (AJEC) Mr F Shaban (FRS)
Miss S Goodbrand (SAXG) Miss F Din (FVND)
Associate Specialist: Mr G Smith
The consultants are supported by 9-11 trainees, 6-7 CT/FY2 doctors and 13 FY1 doctors.
This placement follows a 4-week cycle based on a template for up to 20 students a-t:
1 2 3 4
Emergency Team abcde fghij klmno pqrst
Elective work pqrst abcde fghij klmno
Elective work klmno pqrst abcde fghij
Critical care/anaesthesia fghij klmno pqrst abcde
Initial welcome: Week 1, Monday 8am, Ward 23 Seminar Room
We will meet you to orientate you to the unit, review the team set up and identify educational opportunities including clinical sessions and teaching. For those students starting their block with the Critical care / Anaesthetics week, we will meet you in Week 2 (8am, Ward 23 Seminar Room).
Emergency team
Ward 57
Convenes every date at 8am on Ward 57 for handover and ward round. Most patients are transferred from the Surgical Assessment Unit and students should try to follow up patients they have seen during initial assessment. There is plenty of opportunity to meet and examine patients, assist FY1s with practical procedures, learn principles of management of surgical pathologies, shadow senior trainees in assessment of in-hospital referrals, assist the operating surgeons in emergency (CEPOD) theatres etc.
Surgical Assessment Unit
All unscheduled admissions to the colorectal and urology units attend here initially. It is staffed by experience nurses, FY1s and a CT/FY2 with frequent input from senior surgical trainees and the duty consultant. You should shadow staff, take any opportunities to see patients to practice history-taking and examination, assist with practical procedures and accompany patients to investigations (mainly CT scan). It is often quietest first thing in the morning and busiest from 11am to 9pm.
Seen a patient who needs urgent surgery? Go with them and see the operation.
Student roles
Each day one or two students can be based in SAU; one should shadow the CT/FY2 trainee; one should shadow the Registrar; and one or two assist the FY1 with ward tasks.
Elective work
Approximately 5-8 students will be on an 'Elective week' at any given time. Having this many students on the wards without clear purpose is educationally unsatisfactory, so we intend to allocate each student to specific sessions each week, initially at the Monday morning orientation sessions, and thereafter at Friday afternoon clinical teaching sessions. However, students should fee free to attend any area flexibly if their base unit is quiet, as long as no more than 2 students are in the same location.
We will aim to allocate each student to one clinic, one theatre session, one colonoscopy session and some ward experience per week. Key to this is the unit 'Matrix' which notes clinical sessions 6 weeks in advance.
Theatre - meet Registrar in DOSA/DBU to see process of consent; attend theatre brief as a member of the team; observe anaesthesia; assist/observe urinary catheter insertion; assist/observe operation.
Outpatient clinics - call patients, help transfer to examination couch, etc. If time/space allows, take and present a patient history/examination. Be prepared to discuss a patient you have seen at Friday tutorial session. The outpatient department (OPD) is on the lower ground floor of the Anne Ferguson building - ask at the desk to be directed to the Colorectal clinic. Morning clinics start at 9am, afternoon clinics 1:30pm.
Colonoscopy - bowel cancer screening and other routes of referral, management of colonic polyps, conscious sedation, talk to the patient about their experience of mechanical bowel prep.
HDU - daily patient review; attend team ward rounds and consultations by other specialties and staff e.g. dieticians, physiotherapy, pain team; use TRAK and HEPMA (under supervision).
Green team ward work - The twice-daily unit ward round starts from the doctors' room on Ward 24 at 8am and approx 5pm, led by a Specialist Trainee. You should help the team by participating as much as possible - e.g. take responsibility for checking the observations chart, undertake prescribing under supervision, obtain investigation results etc. There is plenty of opportunity to undertake practical procedures under supervision. Start time 8am, Ward 24 Doctor's room.
WGH Colorectal Unit Year 6 training
Bedside teaching - we will aim to provide on bedside teaching session per week for each student on the surgical floor (i.e. not those on the critical care/anaesthesia week). You will be allocated to a Tuesday (10am) or Thursday (11am) session meet in ward 23 seminar room. The emphasis will be on clinical history, abdominal examination and case discussion. Note that timings may be altered at short notice depending on allocated tutor commitments.
Friday afternoon case presentations
2pm to 2:40pm RIE case presentations
3pm to 3:40pm Colorectal case presentations
This is a joint session with RIE students, the intention being to educate the students in the 'other' hospital on conditions they will not see (e.g. acute cholecystitis for WGH students). Each student will present a case (3-4 per session) in 4-6 slides (symptoms + relevant PMH/SH; examination findings; investigation results; management) as a vehicle for discussion of the following conditions / presenting complaints:
Anaemia, altered bowel habit, abdominal mass, perianal symptoms, bowel obstruction, abdominal pain, rectal cancer, inflammatory bowel disease, palliative surgery, stoma, rectal bleeding, complications of surgery.
Students should present a case they have seen in clinical practice, and avoid repetition of topics to cover as much of the list above as possible - we do not want a dozen presentations on diverticular disease!
The session will take place in the Ward 23 Seminar Room transmitted online via LEARN blackboard. Please see the timetable document for your session allocation.
Critical care / anaesthetics
A separate timetable will be sent to the students by the clinical leads for this topic.
WGH facilities
Medical Education Centre in the OPD Building (3rd floor): recently renovated with an excellent library, lots of computers, as well as SIM and virtual ward set ups. Lockers are available (£10 deposit) and there are spaces to take breaks.
WGH site has a number of cafes (WRVS and Aroma) on site.
Other educational opportunities on the WGH site:
Breast Unit: clinic most days and and excellent chance to revise the core knowledge of this speciality.
Radiology: Diagnostic and Interventional Radiology is a big part of modern surgical practice and we have excellent radiological support at WGH. Consider spending time with a Radiologist for an interventional session.
Main contacts
The main contacts for this placement are:
Mr Hugh Paterson - Senior Lecturer and Colorectal Surgeon: hugh.paterson@ed.ac.uk
Miss Sarah Goodbrand - Consultant Colorectal Surgeon: sarah.goodbrand@nhslothian.scot.nhs.uk
Katie Killeen - Medical Secretary Team Lead, office in ward 23/24 corridor: katie.killeen@nhslothian.scot.nhs.uk