Blog: Travelling Fellowship 2015

E. Lim, M. Cates, A. Papou and M. Chan share their experiences of the 2015 Travelling Fellowship in Aberdeen

I was fortunate to be one of four colleagues chosen for the prestigious 2015 BSR Travelling Fellowship in Aberdeen. This 5-day placement focused on the Rheumatology experience at The Aberdeen Royal Infirmary, the Institute of Medical Sciences and the Institute of Applied Health Sciences at the University of Aberdeen.

Day 1 of our experience began when we arrived at Ashgrove House reception where we were greeted by Dr Ejaz Pathan, Dr Alan MacDonald and Dr Alison Black, who gave us a tour of the rheumatology department. The department had recently relocated in order to accommodate all the different rheumatology services under one roof which has enhanced communication between teams, improved service development and fostered departmental cohesiveness and camaraderie.

We then visited The Suttie Centre for Teaching and Learning in Healthcare where we had a presentation from Dr Pathan and the MDT team: Ms Fiona McCurdy, Mrs Karen Secombes, Ms Lesley Davidson. The presentation focused on patient education and the role of the multidisciplinary team in patients with rheumatoid arthritis (RA), including the setting up of a multidisciplinary ankylosing spondylitis clinic. We learnt how the Rheumatoid Arthritis Management Programme (RAMP) and the ankylosing spondylitis clinic have been very successful historically and how regular review of their services has made it possible for teams to maintain and even enhance the services for the modern cohort of patients with inflammatory arthritis and spondyloarthritis.
"We learnt that with the wealth of evidence available, it is imperative to use clinical judgement when applying this to the patient."

After lunch, we met up with Professor David Reed, Dean of the School of Medicine and Dentistry who gave us first-hand tips on how to develop new services and the importance of links between NHS and universities in cross-institution support and development of its human resources. The day ended with Dr Hazem Yousef's overview about the musculoskeletal ultrasound service and its importance as “the stethoscope of the rheumatologist” in modern day rheumatology practice; a fine example of a successful service development project.

The day did not end there as we were invited to Dr Alison Black (Lead Consultant for Rheumatology) and Dr Alan Macdonald’s home for a hearty home-prepared meal. We felt the warmth and friendship of the Aberdeen team as it was attended by a wide range of team members including SHO, SpR, academics and clinical staff, all engaging in conversations ranging from clinical to social and even personal advice. We are thankful to all members of the team who took time out of their busy schedule to welcome us.

Day 2 commenced with a series of osteoporosis-related topics delivered by Dr Alison Black. This included a tour and demonstration of the DEXA machines, tips on analysing and reporting DEXA scans, and on developing the osteoporosis and fracture liaison services in Aberdeen. From this we could see the importance of good leadership and vision, difficulties in starting a service, importance of supporting staff such as specialist radiographers and osteoporosis nurses, and the workings of a direct access bone density service that is more than just a technical service, but also includes a fracture liaison service and specialist metabolic bone disease clinic.

We were next introduced by Dr Alan MacDonald to the challenges and solutions of remote and rural rheumatology service delivery including the chance to experience live telemedicine with a clinic in Elgin. Dr Rosemary Hollick told us how the department was trying to extend its osteoporosis service to the rural regions of Aberdeenshire and Orkney via a mobile bone density scanning service. After a networking lunch with the clinical trainees, Dr Black shared with us her experience on developing the SIGN osteoporosis guideline. Dr Alan Macdonald followed after, with a talk on the workings of the Scottish Medicines Consortium.

Day 3 involved a showcase of activities by the staff of the Institute of Medical Sciences (IMS). Dr Anke Roelofs took us on a tour of the laboratories, co-owned by the Musculoskeletal Research Programme and ARUK Tissue Engineering Centre. Dr Fraser Coxon presented a lecture on the key discoveries in the pharmacology of bisphosphonates, while Dr Lynn Hockings gave us a better understanding into the biological risk factors for musculoskeletal disorders. Professor Richard Aspden revealed tips on research methods and the translational pathway to clinic by using the clinic experience to generate research questions and using research outcomes back to the bedside (i.e. “Bedside to Bench and back to Bedside”). We were also introduced to regenerative medicine in rheumatology by Dr Anke Roelofs and Professor Cosimo De Bari. Here we learnt the role of mesenchymal stem cells as potential treatment options in skeletal regenerative medicine such as stem cell transplantation in early osteoarthritis treatment.

Our day ended with a medical walking tour entitled “Burkers & Bodysnatchers: Murky Medical Doings in Aberdeen”. We were brought back into the dark history of Aberdeen where professional bodysnatchers were paid by surgeons to “acquire” cadavers for their students to practice on. This was both fascinating and surprising as it involved actors performing on the streets of Aberdeen during the 2-hour walk.

Day 4 was about epidemiology with talks given by the staff of The Musculoskeletal Collaboration at the Institute of Applied Health Sciences (IAHS) which is a EULAR Centre of Excellence. Professor Gary Macfarlane demonstrated how epidemiological research can identify risk factors and direct interventions, eventually improving patient outcomes in daily care. This was followed by the weekly literature review meeting by the epidemiology group where interesting recent literature is summarised in 3 minutes. Katie Druce showed us how data from the BSR Biologics Register in rheumatoid arthritis was used to create pathways to improve fatigue in RA patients while Marcus Beasley explained the MUSICIAN trial and how CBT is a cost effective therapy for chronic widespread pain.

After a networking lunch with the applied health researchers, we had a session on critical appraisal by Dr Kathryn Martin. Lastly, we were shown the role of disease registers in musculoskeletal research, its importance evident as the BSR Biologics Register in Ankylosing Spondylitis is able to define and reflect a real-life disease phenotype in comparison to published trial patients.

Day 5 started with a talk by Professor Lars Erwig, who discussed the modern evidence base in the treatment of renal vasculitis and treatment variation between different regions based on experience and local set-up. We learnt that with the wealth of evidence available, it is imperative to use clinical judgement when applying this to the patient. This was followed by an interactive case discussion, facilitated by Dr Neil Basu, on alternative approaches to managing complex multi-system auto-immune disease. We then witnessed the Aberdeen Vasculitis Clinic in action in a post-clinic results meeting at the Aberdeen Royal Infirmary. We also had the chance to meet the medical director, Dr Nick Fluck for a short talk on his role in NHS Grampian. The busy day ended with a lecture by Dr Ejaz Pathan who updated us on the latest in the diagnosis and management of axial spondyloarthritis.

What a brilliant week!
Thank you to everyone within the department of Rheumatology (NHS Grampian) and the University of Aberdeen who gave up their time to share their ideas and experience with us. 

Seeing how everybody worked together to provide high level research and patient care was genuinely inspiring. The solidarity of knowledge and work is analogous to the cultural heritage and granite carved buildings within which the people of Aberdeen work and live. The travelling fellows Edwin (Norwich), Matt (Cornwall), Alex (Nottingham) and Marian (Liverpool) are ever so grateful to Dr Neil Basu and the BSR for co-ordinating and sponsoring this event. Not only have we been impressed with the dynamic functioning of the clinical and academic units, we have ALSO taken home a wealth of knowledge and endeavour to apply and translate what we have learnt and what you have impressed upon us to our respective abodes