Blog: UK Fellowship 2016
Professor Baskar Dasgupta and the rheumatology team at Southend University hospital hosted the BSR Travelling Fellowship 2016. These trainees were fortunate enough to be given this prestigious opportunity to be offered a 5-day placement at the rheumatology department at Southend University hospital.
Blog: 2016 BSR UK Fellowship host by Prof. Bhaskar Dasgupta
“More than the calf yearns to suck does the cow yearn to suckle’
As a busy DGH rheumatology unit trying to punch above its weight, our selection by BSR for the 2016 Travelling fellowship filled us at once with trepidation and joy. This was not the first BSR event at Southend, there were the past ultrasound courses and international symposia on GCA PMR and large vessel vasculitis – but to rivet the attention and entertain curious fellows for a whole week? This was indeed a challenge!
Fiona Hayes, my extremely helpful colleague and author of the original idea, and I decided early that the attractions would be entirely indigenous; the fare, both academic and gastronomic, would exhibit the best Southend had to offer. We would depend on the collegiality and goodwill of our clinicians, on our patients valiantly struggling with their illnesses and yet so supportive, on our nurse specialists focussed on good patient experience and education, education, education! The evenings would be spent sampling the cuisine from the best restaurants in Essex so that our wards returned the next day well fed and watered – such was our simple cunning plan.
Over five days we trained the fellows on the fast track GCA pathway that had received kind recognition from the BSR, presented the cases where it had facilitated early diagnosis and even restored sight. We shared with them exciting new therapies on the horizon for GCA PMR and LVV, the ongoing trials that may introduce alternatives to long term corticosteroids and our fellows had the opportunity of hearing all this directly from the horse’s mouth – from our patients reporting their experiences and enabling us to provide practical hands on training in temporal artery and vascular ultrasound.
We strengthened our own multi-disciplinary links by keeping the entire programme lively and interactive (discussing difficult cases and seeking feedback on case vignettes and draft BSR guidelines). Talks by nephrologists, chest physicians, radiologists, obstetricians and R&D on management of complex multi-system diseases and starting a research career were well received. We tried to limit didactic teaching, balancing it every time with hands on MSK and vascular ultrasound and practical lectures on improving clinical practice.
The week left us a bit exhausted but quietly satisfied that we had imbued our fellows with enthusiasm and knowledge for a relatively neglected group of conditions and in so doing made a new set of friends - all of whom have kept in touch with us subsequently. Satisfaction quickly turned to delight after we received the flattering and generous feedback from the fellows regarding their Southend experience (see below).
Once again, thank you BSR!
Blog: 2016 BSR UK Fellows daily summary
M. Abusalameh, P. Chandratre, L.Clarke, A. Pakozdi, V.Quick, S. Rifaei share their experiences of the 2016 Travelling Fellowship in Southend University hospital.
Professor Dasgupta and Dr Fiona Hayes greeted us at the rheumatology department and gave us a tour of the department and handed the each of us a pack which included a programme, notebook and other goodies. Our programme started with a talk by Prof Dasgupta about the Southend fast track GCA pathway that won the BSR best practice award 2016 as an outstanding best practice. It was inspiring to hear their experience and the differences they make. He demonstrated that the success of such a model wouldn’t be possible without the close collaboration with other clinical teams including max fax, ophthalmology and general practitioners.
This was followed by several other valuable including, Dr Philip Stapleton who presented the Southend experience of managing non-cranial GCA, Dr Siwalik Banerjee who went through the emerging therapies in large vessel vasculitis (LVV), Dr Jain (consultant radiologist) who lead an interactive session on imaging of LVV and the final talk was by Dr Mandeep Singh (consultant fetal medicine) who spoke to us about autoimmune diseases in pregnancy and gave us an exclusive tour of the impressive fetal medicine centre at Southend. The day concluded with a hand on practical session of ultrasound scanning of GCA led by Prof Dasgupta.
The day started inside the Education Centre boardroom and was attended by the entire Rheumatology team and two respiratory registrars. This session focused on the management of interstitial lung diseases in Rheumatoid Arthritis and their radiological characteristics presented by Dr G Koduri consultant Radiologist. The next session was led by R&D manager Dr C Mackerness who provided an insight into setting up a NIHR funded research project in a DGH. This was particularly informative for negotiating research PAs as a newly appointed NHS consultant.
The strong multidisciplinary ethos at Southend was apparent through sessions on nurse led group patient education for early inflammatory arthritis and GCA by A Barton and M Whitlock. Dr B Fashanau highlighted the role of extended scope physiotherapists in triaging and reviewing patients with non-inflammatory musculoskeletal conditions. Southend University hopsital's success in switching patients to biosimilar biologics and gaining approvals for IFRs was largely attributed to the Pharmacy department, with the recent acquisition of an independent prescriber pharmacist M Sheppard by the Rheumatology department. To finish the day, the common ophthalmological complications of GCA were presented by a consultant ophthalmologist Mr A Chandra.
The day started with multiple presentations followed by small group discussions. Dr Mark Lazarus gave a presentation on emerging therapeutic options in SLE. Dr Fiona Hayes presented her experience as a Consultant in Acute Medicine and Rheumatology, which was particularly useful to hear both the challenges and the benefits of such job plan.
There were presentations on specific ongoing research projects in PMR and GCA, and a recently commenced multicentre research project in gout. Dr Gowrie Balasubramaniam, Professor Selim Cellek and Dr Saquib Adnan also provided fantastic talks.
We spent the afternoon at the regional meeting of the Essex Rheumatology Association. This is a monthly research meeting held in the beautiful Hylands House, surrounded by a stunning landscape park near Chelmsford. The talks included various short presentations on exciting new developments; upcoming research projects and clinical trials, and NIHR funded research opportunities.
The day started with stimulating case discussions from several of the Southend Registrars – Dr Achilleos, Dr Adnan and Dr Benerjee, as well as one of the fellows, Dr Vanessa Quick. These covered some unusual presentations of diseases such as lupus, Susac’s and interesting discussions around optimizing care and reducing complications in GCA.
Next was some practical ultrasound experience. Two patients were attending the department for assessment, which enabled first hand experience of ultrasound in PMR and GCA.
In the afternoon Dr Gouri Kodouri presented the proposed GCA/large vessel vasculitis registry. This will enable identification of complication rates of both the disease and the treatment. The 5 year follow up data will inform on GCA mimics as well as increased understanding of the factors influencing disease and damage.
Dr Saqib presented a case highlighting an important and under recognised cause of back pain, followed by a review of the literature regarding the rates, presentation, risk factors and treatment of sacroiliac insufficiency fractures and steroid induced osteoporosis.
Dr Way Wong and his team then gave a comprehensive presentation of the excellent pain service in Southend. This is a multidisciplinary team of Rheumatology and Pain Consultants, Nursing and Physiotherapy with access to psychological support. The team is able to provide a variety of services including the Pain Management Program, the Hypermobility pathway and developing pathways in fibromyalgia, osteoarthritis and others.
The day concluded with a final team dinner on the waterfront – delicious food and great company.
We started our last day with Professor Dasgupta's lecture on temporal and axillary artery ultrasound theory, which included his new semi-quantitative scoring system and a really clear explanation of ROC curves. We then learnt about vasculitis from a consultant renal physician's perspective from Dr Moro-Azuela. This was followed by a brilliant practical session where we all scored case vignettes as low, moderate or high probability of GCA, then compared our thoughts to a panel of 28 clinicians and discussed each case. Our morning finished with an interesting talk on Lyme disease by consultant in infectious diseases Dr Day. After lunch we heard about Southend's plan to develop an online educational toolkit on GCA for patients and doctors. We finished the week with a practical MSK ultrasound session on the foot and ankle where we saw tenosynovitis, plantar fasciitis and osteoarthritis.
Here’s what the UK Fellows had to say:
Dr Mahdi Abusalameh
: It was inspiring and certainly stimulating to spend this week with Professor Dasgupta and his team. I’m certain that what I’ve learned will help shaping my future consultant career. I’m full of enthusiasm and energy to develop a service model similar to this in my region. I’m grateful to Professor Dasgupta and his team. Thank you so much BSR for giving me this golden opportunity. Special thanks to the BSR events team (Gabrielle and colleagues) for an excellent organisation and planning.
Dr Priyanka Chandratre
: Overall I would highly recommend the travelling fellowship as it allowed me to gain an insight into the best practices of another unit and spend an enjoyable week with a great bunch of colleagues from around the country.
Dr Sufian Rifaei
: This was then the middle of this exceptionally informative period of the fellowship. Our group has already been amazed by the previous couple of days. Again, we cannot thank you enough for such an informative week, with lots of relaxed time mixed up with enthusiasm and excitement to learn about all these advances.
Dr Lynsey Clarke
: The fellowship has been a great experience and I would thoroughly recommend it to other senior registrars and new consultants. The Southend team were supremely welcoming and friendly. All the sessions were all brilliant and informative with lots of opportunity for interaction and even practical ultrasound experience.
Dr Vanessa Quick
: What a fantastic week! I learnt a huge amount, particularly about the management of GCA/PMR and the use of ultrasound in rheumatology. The small group allowed each session to be very interactive and I have taken away numerous new ideas to apply to my practice. The whole rheumatology team at Southend made us feels extremely welcome and made every effort to make the week informative and fun. Their hospitality was second to none. I've also made some really great new friends. I would highly recommend the fellowship to anybody and found it particularly useful in the first year of my substantive consultant post.
Dr Angela Pakozdi
: If only I could suggest the BSR fellowship takes place in Southend Hospital every year so future fellows could gain benefit from it as well! The amount of lessons we were taught on large vessel vasculitis was amazing, the practical hands on workshops on ultrasound imaging of the large vessels were invaluable (and certainly changed my practice!), the teachings on service development and research opportunities were extremely useful, and the enthusiasm of the hosting team led by Professor Dasgupta was exemplary. And not only that the educational value was high, but the evenings were also filled with fun social events! I would like to thank you for them as well as the BSR for giving us the opportunity to participate in such amazing top class fellowship programme!