Diabetes – Gaining advanced skills in the assessment and treatment of patients presenting with complaints, both inpatient (emergency) and outpatient (chronic), related to their Diabetes Mellitus diagnosis.
Ask an expert:
My name is Chris Brown, and I am a Consultant Physician in Acute (Internal) Medicine and Diabetes at the Queen Elizabeth University Hospital in Glasgow.
I studied undergraduate Medicine at the University of Dundee, prior to post-graduate training across the West of Scotland Deanery.
I qualified as a Consultant in 2018.
What got you interested in diabetes?
Throughout Foundation, Core, and Higher training I was involved in the management of patients suffering from decompensated Diabetes Mellitus in my role as a general physician trainee, and I often found these patients to be complex.
In seeking to improve my own knowledge of these complexities, and how to best navigate them, I sought rotational work in Diabetes & Endocrinology throughout my training to improve my delivery of acute care to these patient.
During my penultimate year as an A(I)M trainee, I was afforded the opportunity to consolidate this learning in an Out of Programme Clinical Experience (OOPCE) year via NHS Education for Scotland.
How did you train in diabetes?
During my OOPCE year, I spent 6 months focussed on inpatient management of Diabetes Mellitus, followed by a further 6 months focussed on outpatient care.
This allowed me to work in an Endocrine Unit within the hospital and embed myself as one of the rotational Higher trainees.
I contributed to the Inpatient Diabetes team, primarily for liaison reviews of unwell Diabetes patients admitted to non-medical specialities, and I also covered convalescing Diabetes patients who had been admitted to our wards after decompensations such as DKA, HHS, or acute foot disease.
For my outpatient rotation, I was afforded the opportunity to attend daily clinics across the breadth of outpatient Diabetes care, including T1 (Young Adults/Pump), T2, Foot, Pregnancy and relevant associated endocrine clinics (Thyroid).
Given I was associated with the team for a year’s rotation, I was also able to attend all relevant post-graduate teaching and training on site, and contribute to the various sub-speciality MDTs associated with each clinic service.
I felt that this process gave me a broad overview of the approaches needed for each patient group, and afforded me the opportunity to evidence progressing via ePortfolio WBPA.
Were there any challenges?
Once the process was agreed by my local Dean, and the two sites (Queen Elizabeth and Glasgow Royal) agreed the split between inpatient and outpatient working patterns the transition was smooth. Given I had a good background knowledge of the condition and the care requirements for patients, I was able to immediately attend the appropriate liaison activities and clinic sessions. Consultant mentorship and supervision was of a very high standard, and I felt “looked after” throughout the whole experience. I was always clear who to ask if unsure, and how to escalate a clinical concern. I felt that the process was analogous to a compressed Diabetes & Endocrine High trainee experience, but purely in Diabetes Mellitus care.
How does/will this fit into your consultant working?
I currently work 2 PA in Diabetes, within my A(I)M and General Medicine role. I cover one liaison session per week, which comprises leadership of a large multidisciplinary nursing and medical team in Scotland’s largest hospital. We undertake remote and face-to-face reviews of complex Diabetes cases, and advise on comprehensive care from inpatient assessment through to discharging planning and clinic follow-up.
I also spend a session per week in my own T2 clinic, comprising complex case management of T2 patients referred from the community and secondary care colleagues. This includes the management of renal disease, transplant cases, complex cardiovascular morbidity, and pre-pregnancy assessment.
In addition to these sessions, I also participate in secondary care and community MDT working to support DSN colleagues in the management of their own cases, with a view to fostering improved community links with GP stakeholders local to our hospital.
Do you have any tips for trainees who may be interested in diabetes as a specialist skill?
Diabetes Mellitus is an increasingly common condition, presenting at high frequency to both the acute and inpatient services. It is vital that doctors in training have a good grasp of the assessment, treatment, and follow-up of patients suffering with diabetes to ensure we avoid iatrogenic harm. Longer term, the speciality encompasses multiple other interesting areas of clinical practice (CV risk, pregnancy, endocinopathies) that can offer a trainee a more rounded medical experience and inform future good practice. I greatly enjoy the work I do, and the integration with my job plan means that I fully utilise the OOPCE and “skill” and provide another non-A(I)M activity in my day to day practice.
