Paediatric Metabolic Medicine

Introduction

The Guy’s and St Thomas’ NHS Foundation Trust Paediatric Metabolic Medicine Visiting Professional Programme (VPP) is designed to provide international visiting professionals with the opportunity to experience firsthand our unique paediatric metabolic service, which is one of only six tertiary centres in the UK. The programme offers a unique chance to be fully integrated within a service which is at the forefront of clinical activity, training and research.

The programmes are designed by our clinical leads to provide unique development experiences which enable visiting professionals to broaden their clinical expertise and learn new skills that can be transferred back to their work place. We are excited to deliver exclusive access to observe and work alongside our paediatric metabolic faculty and to provide an opportunity for international professionals to gain insight into our Trust and the role that our staff play within the NHS.

Programme aims

The programme is aimed at those who wish to extend their clinical expertise in paediatric metabolic medicine within Evelina London Children’s Hospital.

The aims of the programme include:

• The opportunity to have direct experience and exposure to board rounds, clinics and ward rounds at a unique paediatric metabolic centre
• Participation in multidisciplinary team meetings
• Access to departmental and national seminars and teaching sessions
• The opportunity to develop networks and close links for future close working relations through peer mentorship throughout the programme from a named mentor
• The opportunity to complete specialty projects and research with a view to submission for peer review
• Individual weekly timetables will be created depending on each visiting professional’s requirements.

A Certificate of Attendance will be awarded to visitors upon the end of their programme.

Format

The Paediatric Metabolic Medicine programme is delivered within the hospital work place and it includes exposure to clinics, inpatient ward rounds, multidisciplinary team meetings, depending on the length of programme that visitors request.

Visiting professionals will be aligned with supervisors from within the clinical teams who will facilitate agreed learning and development needs. We would expect visiting professionals to be totally integrated in the day to day service within our paediatric metabolic team.

We will also provide visitors with the opportunity to get involved in research and improvement projects.

Who can apply

This programme is intended for non-U.K. paediatricians, trainee paediatricians, dietitians and nurses with an interest in metabolic medicine.

Visitors have the choice of applying for a hands-on attachment or observership programme. Those wishing to apply for a hands-on attachment must have GMC registration and NMC registration. You can apply for GMC registration directly through the main GMC website, alternatively The Royal College of Physicians run a medical training initiative which facilitates GMC registration and provides sponsorship for a Tier 5 visa. You can find out more about their Medical Training Initiative by visiting their website. NMC registration can be applied for via the NMC website.

Programme duration

It is recommended that in order to get the most out of the Paediatric Metabolic programme, that visiting professionals undertake a hands-on attachment placement between 6 weeks – 6 months. However, the programme’s duration can be tailored to the specific learning requirements of those visiting the Trust.

Paediatric Metabolic service

Inherited metabolic diseases (IMD) are a group of genetic, inherited disorders of the metabolism. They can lead to a dangerous imbalance of chemicals in the body, ultimately resulting in organ damage and disabilities.

In the UK, at least 600 babies are born with IMD every year. There are currently around 20,000 children and adults living with IMD in the UK, and half of those affected do not attend a specialist service to treat their condition. Our adult services (for over 16s) are based at St Thomas’ Hospital.

Our service

We are the regional IMD service for south Thames covering south London, Kent, Sussex, Surrey and beyond with outreach clinics as far as Portsmouth, Cambridge and Norwich. Here, we see more than 300 new patients each year with over 200 admissions to the ward.

We have close links with all of the clinical services at Guy’s and St Thomas’, in particular the genetics department.

We are one of the main IMD centres in the UK offering treatment to patients with all types of IMD. This includes procedures for diagnosis and acute and long-term management.

We work closely with the children’s liver service and the adult neurology service at King’s College Hospital.

Conditions

Our service includes procedures to diagnose patients and acute and long-term management of metabolic disorders.

The most common conditions include:

• amino acid disorders, eg phenylketonuria (PKU), tyrosinaemia
• carbohydrate disorders, eg galactosaemia
• fatty acid oxidation defects, eg medium chain acyl CoA enzyme dehydrogenase deficiency (MCADD)
• glycogen storage disorders
• hypoglycaemia
• lipid disorders including familial
• hypercholesterolaemia
• lysosomal storage disorders (LSDs)
• mitochondrial disorders
• organic acid disorders
• purine/pyrimidine disorders
• urea cycle disorders

Laboratories

Our centre is supported by four metabolic laboratories with national and international reputations for research and innovation:

• General metaboli
• Regional Newborn screening
• Enzymology and Biochemical Genetics
• Purine research laboratory
• WellChild research laboratory

Inherited metabolic diseases clinics

• Metabolic clinic
• Phenylketonuria (PKU) clinic
• Lipid clinic
• Glycogen storage disease (GSD) clinic
• Metabolic liver clinic
• Neurometabolic clinic
• Adult metabolic clinics

Transition to adult inherited metabolic diseases service

The move from the children’s to the adult inherited metabolic diseases IMD service is a gradual process. From the age of 14 years a patient is slowly introduced to the adult inherited metabolic disease service and attends transition at Evelina London. Patients will have four appointments over the two-year period between 14-16 years old. At the last appointment patients will be shown where the adult IMD clinic is, at Gassiot House, St Thomas’ Hospital. At the first two clinic appointments patients see staff from the children’s IMD team while at the last two appointments; they see both the children’s and adult teams.

When the transition process begins, we work with the patient to set some goals that they want to achieve. At each appointment we will talk through these goals with the patient and how they think they’re doing.

During the first two clinic visits, parents/guardians will be invited to come along to the appointments, but patients will also be given the opportunity to see us on their own. During the last two visits, we ask patients to see us without their parent/guardian to help them become more independent.

This position would provide the opportunity to spend time with the adult metabolic team.

Example Timetable

Fees

A course fee per week will be applied; this fee excludes accommodation and travelling expenses. To find out the fee amount please email [email protected].

Please note

Clinicians are able to offer bursaries or discounted placements on an individual basis. This is at the discretion of the Directorates of GSTT and does not affect the terms and conditions of the Visiting Professional Programme agreements.