Immunology

Sub-Speciality Training at ST3+

Specialty School of Medicine,

East Midlands Deanery (South)

 

Job description and training programme

 

Introduction

 

This is a Specialist Trainee (ST3+) placement in Clinical Immunology based at the Leicester Royal Infirmary with training modules at Leicester General Hospital and Glenfield Hospital.  This training programme will equip the trainee to provide a service for the investigation and management of patients with immunological disorders.  This is one of three Specialist Trainee (ST3+) posts in Immunology in Leicester.  There is also a Specialist Trainee (ST3+) post in Allergy in Leicester with aspects of both laboratory and clinical training in common.

 

The post is recognised for Higher Specialist Training in Immunology by PMETB and the Joint Royal Colleges of Physicians Training Board (JRCPTB). Completion of the FRCPath (Immunology) of the Royal College of Pathologists is required before a CCT in Immunology can be awarded.  All the necessary training requirements for Immunology are available in Leicester apart from a training module in Paediatric Immunodeficiency (at one of the two national centres in either Great Ormond Street Hospital, London or Newcastle-upon-Tyne).  There is an optional 6 month rotation to the Department of Immunology, Queen’s Medical Centre, Nottingham University Hospitals NHS Trust (a reciprocal concurrent rotation with one of the two Nottingham Specialist Trainees).

 

The laboratory department provides a comprehensive range of diagnostic tests for patients with allergic, autoimmune and immunodeficiency diseases, and a sub-regional service for the immunophenotyping of haematological malignancies.  The laboratory is CPA accredited and is scheduled for CPA inspection in May 2010.  The location of aspects of training may be subject to change during the course of the training period in line with developments within the Trust.

 

 

Consultants responsible for training:

§         Dr Michael Browning (Consultant Immunologist and Honorary Senior Lecturer)

§         Dr Michael Duddridge (Consultant Clinical Immunologist)

§         Dr Richard Baretto (Consultant Clinical Immunologist)

 

Dr Michael Duddridge is the Training Programme Director for East Midlands Deanery.

 

One of the three consultants will have overall responsibility for the Specialist Trainee’s training and progress as Educational Supervisor.  However, during clinical attachments 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 Immunology, leading to the CCT in Immunology.  In pursuance of this objective, the trainee shall learn the necessary background in basic Immunology in order to benefit from clinical experience.

 

2.      Clinical duties - in conjunction with and under the supervision of the clinical head of each department, the trainee will:

 

  • Help to provide out-patient and in-patient services for adults and children in the investigation and management of patients suspected of immunodeficiency, allergy and auto-immune disease.
  • Help in the medical management of those patients in Leicestershire, Northamptonshire and Rutland (and beyond) with primary immunodeficiency (mainly primary antibody deficiency).
  • Contribute to the intravenous and subcutaneous immunoglobulin replacement therapy programmes, with the aid of the Specialist Nurses in Immunology.
  • Contribute to the allergen immunotherapy service and allergy challenge testing service provided by Clinical Immunology.

 

3.      Depending on the particular needs of the individual trainee, attachments will be arranged for spending time in those clinical disciplines with a high content of immunologically-mediated disorders.  Possible attachments include nephrology, rheumatology, dermatology, infectious diseases and respiratory medicine.  Opportunities exist for obtaining experience in Paediatric Immunology, particularly with respect to immunodeficiency, nephrology, rheumatology, allergy and respiratory diseases.

 

4.      Laboratory duties will include:

 

  • Learning the practical aspects of clinical and laboratory Immunology 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 curriculum for Higher Specialist Training in Immunology.
  • Training in the reporting of immunological laboratory investigations and, after a suitable training period, participation in the clinical authorisation of laboratory tests under Consultant supervision.

 

5.      Liaison and Laboratory Management:

 

  • The trainee will obtain experience of clinical liaison with Primary Care Physicians and Hospital Clinicians.  The trainee is expected to be available on the telephone and to be prepared to answer clinical enquiries during periods when a Consultant is not available during laboratory working hours.  At most times, full Consultant cover is provided by a Consultant Immunologist based in Leicester, but when local Consultant cover is not available, access to Consultant supervision is arranged elsewhere within the Region.
  • When suitably experienced, a Specialist Trainee will be expected to obtain experience in Quality Assurance and Laboratory Management.
  • The trainee will actively participate in formulating, executing and evaluating the department’s clinical audit activity.

 

6.      Academic - The trainee must become a regular attendee and participate in hospital clinical meetings and help with organising department clinical review meetings.  Regular attendance at the University of Leicester’s Department of Infection, Immunity and Inflammation’s seminars and East Midlands Regional Immunology Group Meetings is recommended.

 

7.      Teaching Immunology to Medical Students - this would include giving lectures, tutorials and clinic-based teaching as appropriate to the knowledge and experience of the trainee.  In addition, the trainee will be expected to participate in the teaching of clinical and basic immunology to trainee laboratory staff.

 

8.      The trainee will be expected to develop a research interest under the guidance of their training supervisor.

 

Courses

 

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

 

Rotation

 

There is an optional 6 month rotation to the Department of Immunology, Queen’s Medical Centre, Nottingham University Hospitals NHS Trust (a reciprocal concurrent rotation with one of the two Nottingham Specialist Trainees).  The educational supervisor during this period would be one of the Nottingham Consultant (Clinical) Immunologists (Dr Elizabeth McDermott or Dr Elizabeth Drewe).  It is anticipated that this will become a formal rotation for Specialist Trainees (ST3+) recruited in future years.  Previous trainees have commented on the benefit of such experience in a second (and third) training centre, and opportunities may also be available to attend other Immunology centres within the Trent region.

 

 

Out of Hours Duties

 

The trainee will be expected to be available from 8.30am to 5.30pm / 9.00am to 6.00pm Monday to Friday for clinical liaison (both clinical problems and laboratory enquiries). This is subject to review of payment for additional duty hours.

 

Training Programme for Specialist Trainee (ST3) in Immunology in Leicester

 

 

Introduction

 

This is a 5 year specialist training programme leading to a CCT in Immunology.  The training is based in the Department of Immunology, Leicester Royal Infirmary, with additional clinical attachments to other relevant clinical departments within the University Hospitals of Leicester NHS Trust, and external attachments as required for completion of the training programme.

 

The training programme is based on the JRCPTB higher medical training curriculum for Immunology.  Years 1 and 2 focus on a core training programme (including the opportunity to undertake an MSc in immunology on a day release basis), leading to the FRCPath Part 1 examination.  Years 3 and 4 include further training in clinical and laboratory Immunology, with the opportunity to undertake a research project.  The FRCPath Part 2 examination will normally be taken at the end of year 4.  Year 5 of the programme is for completion of essential requirements for the award of a CCT in Immunology, with scope for attachments in areas of personal interest.

 

Entry Requirements (see national person specification)

 

§         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 2010

§         MRCP (UK) or equivalent

§         Eligible to work in the United Kingdom

 

Educational Supervision

 

Regional Specialty Adviser and Chair of East Midland Deanery and Yorkshire & Humberside Deanery Immunology and Allergy Training Committee:

Dr Michael Duddridge, Consultant Clinical Immunologist, Leicester Royal Infirmary

 

East Midlands Deanery Training Programme Director:

Dr Michael Duddridge, Consultant Clinical Immunologist, Leicester Royal Infirmary

 

Educational Supervisors involved in the training in Leicester:

Dr Michael Browning, Consultant Immunologist and Honorary Senior Lecturer, Leicester Royal Infirmary

Dr Michael Duddridge, Consultant Clinical Immunologist, Leicester Royal Infirmary

Dr Richard Baretto, Consultant Clinical Immunologist, Leicester Royal Infirmary

 

Allergy training is supervised by Dr Richard Baretto, with support from Dr Alex Croom, Consultant Allergist, Glenfield Hospital, Leicester and Dr David Luyt, Consultant Paediatrician (with an interest in Allergy), 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 diseases characterised by immunodeficiency, allergy, or autoimmunity

§         Direct a diagnostic Immunology laboratory service

 

Main Elements of the Training Programme

 

1.         Acquisition of a core body of knowledge in fundamental Immunology and its applications, through structured learning of basic and clinical Immunology, with the possibility of undertaking an MSc in Allergy and Clinical Immunology or Medical Immunology by day release for specialist trainees who do not have appropriate previous experience (MSc or PhD).

 

2.         Structured clinical training, consisting of cumulative clinical experience in immunodeficiency, systemic autoimmune disorders, organ specific autoimmune diseases, allergy, and the laboratory diagnosis of lymphoproliferative diseases, and acquisition of relevant practical procedures, including administration of intravenous and subcutaneous immunoglobulin, management of home therapy programmes, skin prick testing, patch testing, allergen immunotherapy, and lung function tests.  In addition to the training in Immunology and Allergy (including adult and paediatric immunology, immunoglobulin therapy, adult and paediatric allergy, and allergen immunotherapy), this may include additional clinical attachments in:

 

Allergy - Adult

Dr Alex Croom

Glenfield Hospital, Leicester

Allergy - Paediatric

Dr David Luyt

Leicester Royal Infirmary

Dermatology

Dr Karen Harman

Leicester Royal Infirmary

Haematology

Dr Hafiz Qureshi

Leicester Royal Infirmary

Hepatology

Dr Allister Grant

Leicester Royal Infirmary

Infectious Diseases

Dr Martin Wiselka

Leicester Royal Infirmary

Nephrology

Professor John Feehally

Leicester General Hospital

Respiratory Medicine

Professor Andrew Wardlaw

Glenfield Hospital, Leicester

Rheumatology

Dr Waji Hassan

Leicester Royal Infirmary

Bone Marrow Transplantation

Dr Ann Hunter

Leicester Royal Infirmary

Renal Transplantation

Professor John Feehally

Leicester General Hospital

Histocompatibility and Immunogenetics

Dr Terry Horsburgh

Leicester General Hospital

 

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

§         Paediatric immunology and immunodeficiency (including bone marrow transplantation and gene therapy) at Newcastle-upon Tyne or Great Ormond Street Hospital, London (mandatory)

§         Paediatric immunology and immunodeficiency, Sheffield Children’s Hospital

§         Auto-inflammatory disease, Queen’s Medical Centre, Nottingham

§         Systemic vasculitis, Queen’s Medical Centre, Nottingham

 

3.         Cumulative laboratory experience in immunochemistry, 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 – Core Training in Immunology

 

a)         Fundamental Immunology and its applications.  This will involve acquisition of the elements of basic immunological knowledge as detailed in the JRCPTB curriculum.  This may be acquired by undertaking either the  MSc in Allergy and Clinical Immunology in Nottingham or the intercollegiate MSc in Medical Immunology in London on a day release basis, or by a combination of attendance at relevant courses / meetings (e.g. BSI Annual Congress, update courses in Clinical Immunology and / or Allergy) combined with both self and directed learning.

 

b)         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 year 1 of the training programme will normally involve 4 half days per week.

 

Specific topics to be covered will include:

 

§         Protein immunochemistry (nephelometry / turbidimetry), 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

§         Measurement of total and specific IgE for type I hypersensitivity reactions

§         Direct immunofluorescence for biopsies (i.e. skin)

§         Flow cytometry for immunodeficiency, including HIV monitoring

§         Flow cytometry for haematological malignancies

§         Cellular assays of lymphocyte and neutrophil function

 

c)         Clinical experience in Immunology and practical procedures.  The trainee will gain relevant clinical and practical experience through attendance at Immunology and Allergy clinics and day case immunoglobulin therapy.  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.  In years one and two of the training programme, trainees will normally attend 2–3 clinics per week.

 

            It is expected that the trainee will sit the FRCPath Part 1 examination at the end of year 2, or early in year 3, of the training programme.

 

Years 3 and 4

 

Years 3 and 4 of the training programme focus on consolidating and extending the clinical and laboratory Immunology experience of the trainee, and give the opportunity to undertake a research project under the supervision of one of the consultants or clinical academics associated with the Department (if this has not been achieved in year 2 as part of an MSc degree).

 

Laboratory Immunology training is maintained throughout, with an increasing emphasis on interpretation and clinical authorisation of laboratory tests and results (3–4 sessions per week).

 

Core Clinical Immunology is maintained with the opportunity for additional clinical attachments, and for attachments to more specialised clinics or services (e.g. a supraregional Paediatric Immunology centre).  Trainees will normally attend 3 clinics per week.

 

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

 

Time will also be set aside for the preparation of a clinical casebook for submission for the FRCPath Part 2 examination. It is expected that the trainee will sit the FRCPath Part 2 examination late in the 4th year of the programme.

 

Year 5

 

Training in year 5 of the programme will be more flexible, with the focus on completing the training requirements for a CCT in Immunology.  In addition, the trainee will be expected to attend a management course relevant to Medicine / Pathology, if this has not already been undertaken.

 

Rotation

 

There is an optional 6 month rotation to the Department of Immunology, Queen’s Medical Centre, Nottingham University Hospitals NHS Trust (a reciprocal concurrent rotation with one of the two Nottingham Specialist Trainees).  The planning for such a rotation will be taken in agreement with the two Specialist Trainees concerned to avoid disruption in their preparation for FRCPath (Immunology) examinations.

 

 

Additional Activities

 

Personal Study

 

Throughout the training programme, the trainee will be allotted dedicated time for personal study within the weekly programme.  Additional study leave may be granted in the lead up to the FRCPath Part 1 and Part 2 examinations.

 

Courses and Meetings

 

Participation in the National Clinical Immunology Training Programme (organised through the Association of Clinical Pathologists) is mandatory throughout the training programme.  In addition, trainees are expected to attend the Trent Immunology and Allergy Consortium (TRIAC) meetings (quarterly), and Departmental Educational Meetings / Journal Clubs (monthly).  Trainees are also expected to attend the annual congresses of the British Society for Immunology and British Society for Allergy and Clinical Immunology as appropriate.  The University Department of Infection, Immunity and Inflammation hosts a regular seminar programme, and trainees are encouraged to attend these seminars.  Monthly medical Grand Rounds and weekly physicians meetings are held in the Clinical Education Centre at Leicester Royal Infirmary, and case based discussion meetings are held in the department.

 

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 monthly Departmental meeting.

 

Teaching

 

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

 

Research

 

Trainees are encouraged to undertake research projects in Immunology, under the supervision of either a Consultant Immunologist or a clinical academic, as part of the training programme.  Up to one year of research may be undertaken within the training programme.  There are also opportunities to undertake more extensive training in research, leading to a higher degree, through the Department of Infection, Immunity and Inflammation at the University of Leicester, as out of programme experience.

 

Management

 

Trainees are expected to attend the monthly primary immunodeficiency multi-disciplinary team meeting through-out their training, and other relevant departmental management and multi-disciplinary team meetings, particularly from year 3 onwards of the training programme.  They are also expected to attend a formal management training course in Medicine / Pathology in year 4 or 5 of the programme.

 

Assessment and Appraisal

 

Immunological knowledge is formally assessed through the FRCPath Part 1 and Part 2 examinations, and 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 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 and laboratory reporting facilities, is provided for the trainees.  This is shared with the specialist trainee in Allergy during their secondments for laboratory training.  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

 

The Department has a small library.  A number of Immunology and Allergy textbooks and current Immunology journals are available.

 

There are two university libraries. The Clinical Sciences library on the Leicester Royal Infirmary site, houses the clinical library with additional journals available in the main University library on the main University of Leicester campus within a short walking distance.

 

There are additional hospital library facilities at the Leicester General Hospital and Glenfield Hospital, and an increasing number of journals may be accessed electronically.

 

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 (South) Deanery, and both Leicester and Leicestershire as places to live and work please use the links provided from the website www.lnrmed.org.uk

 

Dr M Duddridge 14/02/2010