- Number 1 would be to make sure you have a copy of the curriculum. The version I used had a check list on page 12. Simply ensured I had some evidence for every single point. I then used the format of the curriculum to group all my SPIN evidence and I compiled my evidence and stuck to the same headings.
- Start early and get cracking!!! I kept my portfolio up to date, logging any clinics, procedure lists (like intrathecals etc)
- There weren't enough clinics where I trained so instead I kept a diary of the patients we had admitted to the ward - removed all patient identifiable data. But just wanted to show the volume of work that we saw and made sure it included the full spread of haematology and oncology patients.
- Get advice from those doing oncology GRID. Just find out what evidence they need and then tailor yours to match - for example, my friend who was doing GRID told me the number of short and long cases they needed, I just copied that and prepared them as I would a case presentation.
- Network with each other and get ideas on how people have presented different parts of the spin evidence. I spoke with one or two trainees doing SPIN in other disciplines. One of them showed me how she kept a log of all the patients she saw in clinic and how she'd managed them. She was so successful with her SPIN she got a respiratory consultant job in a tertiary institution!
- I ended up with a massive lever arch file with over 200 pages!!! I had to scan and print each one which is why I advise to start early.
Good luck!!
Dorothy Msimanga
As a trainee you probably do not get much experience of shared care yet if you plan to work in a DGH and want to do some oncology this will be your role. There is a lot of variation in the level of care provided by different DGHs. The examples from my own experience are Gloucester and York/Scarborough and are at opposite ends of the scale. The former is level 3 and provides inpatient and outpatient chemotherapy and intrathecal lists. Essentially most children go to Bristol for their initial diagnostic work up and, following that, most of their treatment can be delivered in Gloucester. My role there was to see all the routine admissions for chemotherapy, prescribe chemotherapy using chemocare and run the intrathecal lists. I would also do an oncology follow up clinic and a large part of my time was taken up with ordering and checking follow up imaging. All this was very well supported by Bristol with visiting joint haematology and oncology clinics several times a year. I had one other colleague to share the workload. This kind of job is ideal for someone who has done the SPIN and has a reasonable amount of experience in oncology. It provided a lot of job satisfaction as I was able to get to know the patients very well and they really appreciated only ever really seeing 2 doctors, who knew them well. However a lot of the work we did, like routine fit for chemo, is devolved to SHOs in tertiary centres but this is not usually possible in a DGH. This kind of job is rare. There are not many level 3 units and each only has usually 2 consultants so your chance of a job coming up in one of these places is small.
By contrast York/Scarborough does not even provide level 1 care. Essentially York can manage febrile neutropaenia and do a small amount of supportive care (blood products etc) and that is it. No chemo is prescribed from level 1 units. Level 2 may give day case chemo (eg vincristine for ALL). Almost all the DGHs attached to Leeds are level 1. The role of Haem/onc lead in these units can be pretty minimal. Nonetheless I am discovering ways in which I can improve the delivery of services, taking good practice and common sense from elsewhere. For example I’m introducing the febrile neutropaenia proforma that is already used in Leeds and creating an 'oncology passport’ for patients to hold, with a copy in the notes detailing their diagnosis, treatment, PHx etc so they don’t have to repeat their story every time they come in with a fever. Many units already have this kind of paperwork. However I rarely ever actually see the oncology patients for whom I am the named consultant. This is not a great job for anyone who really wants to do oncology.
Essentially, unless you are willing to move anywhere in the country to seek your ideal post, there is an element of luck involved in what jobs are available where you want to live when you finish training. Setting your heart on doing oncology if you are geographically limited may be unrealistic. You may need to be flexible - I’m doing some rheumatology now and having to get trained up...
I’m happy to be contacted personally with any specific queries. Good luck!
Dr Rebecca Proudfoot
Credentials
I am a shared care consultant for York and Scarborough Hospitals (sub level 1 shared care with Leeds) and have held that position since January 2019.
I was previously lead for oncology in Gloucester (level 3 shared care with Bristol) for one year as a locum consultant covering maternity leave. I have previously worked in oncology for 6 months as an SHO at UCLH, one year in Bristol at ST6 and one year in Oxford at ST7. I completed the SPIN module in paediatric oncology in 2014.