Allergy

Sub-Speciality Training at ST3

Specialty School of Medicine,

East Midlands Deanery (South)

 

Job description and training programme

 

 

Introduction

 

This is a Specialty Registrar (ST3+) placement in Allergy based at Glenfield Hospital, Leicester with training modules at Leicester General Hospital and Leicester Royal Infirmary.  This training programme will equip the specialist trainee to provide a service for the investigation and management of patients with allergic disorders.  There are also three Specialty Registrar (ST3+) posts in Immunology in Leicester and aspects of laboratory and clinical training are common to both training programmes.

 

The post is recognised for Higher Specialist Training in Allergy by PMETB and the Joint Royal Colleges of Physicians Training Board (JRCPTB).  It is centrally funded by the Department of Health.  The Allergy service based at Glenfield Hospital is part of the Department of Respiratory Medicine, Allergy and Thoracic Surgery within the Cardiorespiratory Directorate. It has close links with the Clinical Immunology and Allergy service based at Leicester Royal Infirmary.

 

 

Responsible Consultant:

§         Dr Alexandra Croom (Consultant Allergist, Training Programme Director for Allergy and Educational Supervisor)

 

 

Acting in consultation with:

§         Professor Andy Wardlaw (Professor in Respiratory Medicine)

§         Dr LN Khan (Consultant Respiratory Physician with an interest in Allergy)

 

 

As Educational Supervisor, Dr Croom will have overall responsibility for the Specialty Registrar’s training and progress.  During clinical attachments in other specialities the trainee will be supervised by the named Consultant responsible for the attachment.

Duties

 

1.      The trainee will be expected to register for Higher Specialist Training in Allergy, leading to the CCT in Allergy.  Throughout the training programme they will participate fully in the local appraisal and supervision process. The content of their training programme will be determined by the JRCPTB Speciality Training Curriculum for Allergy (May 2007) alongside the Generic Curriculum for medical specialties.

 

2.      In order to benefit from experiential training in allergy the trainee shall learn the necessary background in basic immunology (as detailed in JRCPTB Speciality Training Curriculum for Allergy (May 2007) tables 1.1 and 1.2).

 

3.      Under appropriate supervision the trainee will:

 

  • Help to provide out-patient and in-patient services for adults in the investigation and management of patients suspected of allergic disease.
  • Contribute to the allergen immunotherapy service and allergy challenge testing service provided by the Allergy Service.

 

4.      To enhance training and ensure that the requirements of the allergy curriculum are met, attachments to organ-based specialities will be arranged in respiratory medicine, dermatology, gastroentology and ENT.

 

5.      Clinical immunology training will be provided over a number of attachments throughout the training programme and be based at Leicester Royal Infirmary. 

 

6.      Laboratory training will involve learning the practical aspects of clinical and laboratory immunology and be achieved by rotation through the various sections of the Department of Immunology’s diagnostic laboratory.  The content of this training will follow the guidelines set out in the JRCPTB Speciality Training Curriculum for Allergy (May 2007) table 2.

 

7.      The trainee will obtain experience of clinical liaison with Primary Care Physicians and Hospital Clinicians.  At an appropriate point in their training and skill development the trainee will be expected to be available on the telephone and to be prepared to answer clinical enquiries.

 

8.      The trainee will actively participate in formulating, executing and evaluating the Allergy Service’s clinical audit activity.

 

9.      The trainee must become a regular attendee and participate in hospital clinical meetings. These will include the weekly Allergy Case discussion meeting and the Friday Grand Round.

 

10. Teaching experience will be gained by giving lectures, tutorials and clinic-based teaching as appropriate to the knowledge and experience of the trainee.

 

 

Courses

 

The trainee will be encouraged to attend regional and national courses in Allergy as may be accessible and/or appropriate during the period of appointment.  This includes attending the national Allergy training days organised by the British Society for Allergy and Clinical Immunology (BSACI), the national Immunology training days (“Hitchhikers”) organised by the Association of Clinical Pathologists (ACP), and the Basic and Clinical Allergy Course arranged by the National Heart and Lung Institute, London. The trainee will be encouraged to become a member of the BSACI, and to participate in their scientific and professional activities.

 

 

Out of Hours Duties

 

There are no out of hours duties with this post. When an appropriate level of experience and competencies have been demonstrated the trainee will be expected to be available during their contracted hours to answer clinical questions and provide advice.

Training Programme for Specialty Registrar (ST3) in Allergy in Leicester

 

 

 

Introduction

 

This is a 5 year specialist training programme leading to a CCT in Allergy.  The training is based in the department of Respiratory Medicine, Allergy and Thoracic Surgery, Glenfield Hospital, Leicester with additional clinical attachments to other relevant clinical departments within the University Hospitals of Leicester NHS Trust.

 

The training programme is based on the JRCPTB higher medical training curriculum for Allergy.  It will enable trainees to acquire the knowledge and clinical skills required to diagnose and manage allergic disease.  Trainees’ progress will be monitored throughout the 5 year programme using objective assessment tools and the local appraisal process.

 

Entry Requirements

 

§         GMC registration – full or limited eligibility

§         Foundation programme competencies at time of appointment

§         ST1 competencies in Medicine at time of appointment

§         ST2 competencies in Medicine by August 2008

§         At least 24 months experience at SHO level (not including Foundation modules) in Medicine by August 2008

§         MRCP (UK) or equivalent

§         Eligible to work in the United Kingdom

 

Educational Supervision

 

Regional Specialty Adviser and Chair of Trent Regional Immunology and Allergy Training Committee:

Dr Michael Duddridge, Consultant Clinical Immunologist, Leicester Royal Infirmary

 

Regional Training Programme Director for Allergy:

Dr Alexandra Croom

Consultant Allergist, Glenfield Hospital

 

Educational Supervisors:

Dr Alexandra Croom

Consultant Allergist, Glenfield Hospital

 

Consultant Physicians involved in Allergy training in Leicester:

Dr Alexandra Croom, Consultant Allergist, Glenfield Hospital

Professor Andy Wardlaw, Professor of Respiratory Medicine, Glenfield Hospital

Dr LN Khan, Consultant in Respiratory Medicine with an interest in Allergy, Glenfield Hospital

Immunology training (both laboratory and clinical) for the Allergy trainee is provided under the supervision of Dr Michael Duddridge, Consultant Clinical Immunologist, Leicester Royal Infirmary, Dr Richard Baretto, Consultant Clinical Immunologist, Leicester Royal Infirmary, and Dr Michael Browning, Senior Clinical Lecturer & Honorary Consultant Immunologist, Leicester Royal Infirmary.

 

 

Aims of the Training Programme

 

The aims of the training programme are to:

·         enable the trainee to acquire the specialised scientific knowledge, clinical and laboratory skills required to diagnose, treat and (where relevant) prevent allergic disease

·         develop the management skills to effectively deliver care for patients with allergic disease

 

 

Main Elements of the Training Programme

 

  1. Structured clinical training in allergy and acquisition of skills in relevant practical procedures including skin prick testing, patch testing, allergen immunotherapy, nasal endoscopy, and lung function tests.

 

  1. Collaborative training within other relevant specialities including.

 

Dermatology

Dr Graham Johnston

Leicester Royal Infirmary

Paediatric Allergy

Dr David Luyt

Leicester Royal Infirmary

Respiratory Medicine

Professor Andrew Wardlaw

Professor Ian Pavord

Dr Gerrit Woltmann

Glenfield Hospital, Leicester

ENT

Mr Anil Bannerjee

Leicester Royal Infirmary

Immunology

Dr Michael Duddridge

Dr Michael Browning

Dr Richard Baretto

Leicester General Hospital

Gastroenterology

Dr John DeCastecker

Leicester General Hospital

 

      In addition, external clinical attachments can be arranged, including:

    • Adult Allergy Service, Queen’s Medical Centre, Nottingham

 

  1. Acquisition of a core body of knowledge in fundamental immunology and its applications, through structured learning of basic and clinical immunology. This may include the undertaking of an MSc in Medical Immunology by day release.

 

  1. Cumulative laboratory experience in immunochemistry/serology, immunohistology, cellular immunology, molecular studies, and generic laboratory skills including health and safety, quality assurance and laboratory management.

 

Details of the Training Programme

 

 

Years 1 and 2

 

Clinical experience in Allergy and practical procedures. 

  • The trainee will gain relevant clinical and practical experience through attendance at Allergy clinics.
  • Trainees will see both new and follow up patients, under Consultant supervision.  In addition, the trainee will start to undertake additional clinical attachments, as detailed above.
  • Training will be given in relevant practical procedures such as skin prick testing, drug and food challenges, lung function testing and the administration of immunotherapy
  • In years one and two of the training programme, trainees will normally attend 3-4 clinics per week.
 

Immunology knowledge and relevant laboratory experience

 

The order in which knowledge and skills are acquired is not critical but it is desirable that the trainee starts to accumulate their knowledge of theoretical immunology and laboratory experience from the beginning of their training programme.

 

Fundamental Immunology and its applications:

·         This will involve acquisition of the elements of basic immunological knowledge as detailed in the JRCPTB Speciality Training Curriculum for Allergy (May 2007) tables 1.1 and 1.2.

·         This may be acquired by either undertaking the intercollegiate MSc in Medical Immunology on a day release basis in London, or undertaking the MSc in Immunology on a day release basis in Nottingham, or by a combination of attendance at relevant courses / meetings and  both self and directed learning.

 

Laboratory Immunology:

  • The trainee will gain practical laboratory experience in immunochemistry, immunohistology, autoimmune serology, and cellular immunology, together with generic laboratory skills including health and safety and quality assurance. 
  • Laboratory work in years 1 and 2 of the training programme will normally involve 4 half days per week.

 

Specific topics, as detailed in JRCPTB Speciality Training Curriculum for Allergy (May 2007) table 2, to be covered will include:

 

  • Protein immunochemistry (nepholometry / turbidometry), including electrophoresis and protein quantitation
  • Indirect immunofluorescence for auto-antibodies
  • Non-immunofluorescent autoimmune serology for organ specific and non-organ specific autoimmune diseases
  • General ELISA techniques / standard curves / internal QC
  • Complement and related assays
  • Measurements of total and specific IgE and type I hypersensitivity reactions
  • Flow cytometry for immunodeficiency, including HIV monitoring
  • Flow cytometry for haematological malignancies
  • Cellular assays of lymphocyte and neutrophil function

 

Years 3 and 4

 

Years 3 and 4 of the training programme focus on consolidating and extending the clinical Allergy experience of the trainee. Further collaborative training within related specialities (as detailed above) will continue and cover the specific requirements of the curriculum.

 

It is also expected that trainees will undertake increasing responsibilities in areas such as audit, teaching, and management.

 

Uninterrupted time for original research will be made available during years 3 and 4 and it is envisaged that the trainee will undertake a project under the supervision of one of the consultants or clinical academics within the department.

 

Year 5

 

Training in year 5 of the programme will focus on completing the training requirements for a CCT in Allergy.  In addition, should this have not been undertaken already, the trainee will be expected to attend a relevant management course.

 

Rotation

 

Experience of an Allergy service outside Leicester may be possible and there is scope within the programme for attendance of clinics at Queens Medical Centre, Nottingham.

 

 

Additional Activities

 

Personal Study

 

Throughout the training programme, the trainee will be allotted dedicated time for personal study within the weekly programme.

 

Courses and Meetings

 

Participation in the national Allergy training day programme (organised by the British Society for Allergy and Clinical Immunology) and the national Clinical Immunology training day programme (organised by the Association of Clinical Pathologists) is desirable throughout the training programme.  In addition, trainees are expected to attend and participate in the Trent Immunology and Allergy Consortium (TRIAC) meetings (quarterly).  Trainees are also expected to attend the annual congress of the British Society for Allergy and Clinical Immunology. Attendance at the Basic and Clinical Allergy Course (National Heart and Lung Institute, London) is also desirable.

 

Within the Trust there is a weekly Grand Round (Clinical Education Centre, LRI). A number of educational opportunities are available within the department:

 

·         weekly allergy case based discussion meeting

·         weekly postgraduate meeting

·         weekly X ray meeting

·         weekly journal club

 

Audit

 

Familiarisation with the principles of clinical audit and clinical governance are an essential component of the training.  The Department has an ongoing programme of clinical and laboratory audits, to which trainees are expected to contribute with increasing responsibility throughout the training programme.  On completion, the audits are presented at the weekly postgraduate meeting.

 

Teaching

 

Trainees are expected to contribute to the training of laboratory staff and specialist nurses, and to participate in the teaching of Allergy to medical undergraduates and medical postgraduates training in other specialties.

 

Research

 

During the training programme trainees are encouraged to undertake supervised research projects in Allergy and time will be made available for this in years 3 and 4. There may also be opportunities to undertake full time research training ‘out of programme’ with the purpose of obtaining a higher degree.

 

Management

 

Trainees are expected to develop the knowledge and skills necessary to participate in managing an Allergy service.  They will be expected to attend the bi-monthly Allergy board meetings and enrol in a formal management course during the last 2 years of the training programme.

 

 

Assessment and Appraisal

 

Regular assessment will be undertaken throughout the training programme using tools recommended by the JRCPTB (including CbD, DOPS, Mini-CEX, and MSF).  In addition, progress is formally evaluated through the annual ARCP and penultimate year assessments.

 

Regular meetings with the Consultant educational supervisor are an integral part of specialist training with a formal annual appraisal and personal development plan.  Informal progress assessments will also be made at these meetings every three to four months, including any revisions to the weekly programme that are essential to meet the training requirements.  However, trainees experiencing particular or specific difficulties that interfere with their training or work should draw these to the attention of the Consultant supervisors at any time throughout the training programme.

 

 

Resources

 

Office

 

A shared office with personal computers is provided for the trainee.  This is shared with the specialist trainees in Respiratory Medicine.  Teaching aids are available in the Department, including AV projector, OHP and 35mm slide projector.  The hospital and university audio-visual departments are available for assistance with the preparation of slide and poster presentations.

 

Library

 

There is a library within the Education Centre at Glenfield Hospital as well as hospital library facilities at Leicester Royal Infirmary and  Leicester General Hospital. The Clinical Sciences library on the Leicester Royal Infirmary site, houses the University clinical library with additional journals available in the main University library on the main University of Leicester campus within a short walking distance of Leicester Royal Infirmary.

 

Secretarial

 

The secretarial staff of supervising consultants will provide appropriate support.

 

 

Further information

 

For further information on the University Hospitals of Leicester NHS Trust, the University of Leicester, the East Midlands Deanery (South), and both Leicester and Leicestershire as places to live and work please use the links provided from the website www.lnrmed.org.uk

 

Dr AJ Croom 18/12/2007