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Sub-Speciality Training at ST3+ |
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The East Midlands Deanery (
Introduction
Renal Medicine is an exciting specialty
offering the challenge of looking after both acutely ill patients and those
with a chronic disease requiring long term care with the help of a
multidisciplinary team. The majority of renal physicians have received training
as specialist registrars in both Renal and General Internal Medicine, although
not all renal physicians (particularly those in tertiary centres) will
undertake acute general medical duties. However most general medical problems
in renal patients are managed by the Renal team who have a close working
relationship with many branches of medicine reflecting the various problems of
co-morbidity present in most patients with chronic renal disease. With the
introduction of speciality training the dual CCST has been replaced by a single
CCT in renal medicine. Trainees will have the opportunity to achieve level 2
competencies in acute medicine.
Most
renal physicians will have responsibility for the care of patients with end
stage renal failure requiring long term renal replacement therapy either by
dialysis or transplantation. They also manage patients with a wide variety of
general nephrology problems and those with acute renal failure many of whom may
require acute renal replacement therapy in the critical care setting.
The majority of patients on chronic dialysis are managed in those District General Hospitals which have facilities for chronic haemodialysis and peritoneal dialysis; renal transplantation is performed in tertiary centres with most patients continuing long term follow up in the referring hospital. There are many opportunities for research either laboratory based (underlying mechanisms of renal disease, immunology of transplantation); clinical based (examining effects of treatment on various renal conditions), or epidemiological (looking at incidence of various renal diseases in different populations which impact on the planning and delivery of renal services).
There is a single training
programme in Renal Medicine in the
|
Role |
Name |
Contact Details |
|
Post Graduate Dean |
Dr Jas Bilkhu |
Tel: 0115 846 7103 E-mail:jas.bilkhu@nottingham.ac.uk |
|
Director of Medical
Specialities – |
Dr David Williams |
Tel: 0115 846 8523 E-mail: d.williams@nottingham.ac.uk |
|
Head of |
Dr Jonathan Corne |
Consultant Respiratory Physician Respiratory Medicine QMC Campus Nottingham University Hospitals NHS Trust
Tel: 0115 924 9924 Extn 61155 E-mail: jonathan.corne@nuh.nhs.uk |
|
Associate Post-Graduate
Dean |
Dr Charlie Cooper |
Tel: 0115 846 7864 E-mail: charles.cooper@nottingham.ac.uk |
|
Post-graduate Assistant |
Mr Adam Gudalajtys |
Tel: 0115 846 7112 E-mail:
adam.gudalajtys@nottingham.ac.uk |
|
Training Programme
Director |
Dr Simon Roe |
Renal and Transplant Unit NG5 1PB Tel: 0115 9691169 Email: simon.roe@nuh.nhs.uk |
|
Associate Training
Programme Director |
Dr Pete Topham |
Consultant Nephrologist Department of Nephrology, Tel: 0116 258 4122 E-mail: peter.topham@uhl-tr.nhs.uk |
|
Regional Speciality
Adviser |
Dr Sue Carr |
Consultant Nephrologist Department of Nephrology, Tel: 0116 258 8013 E-mail: sue.carr@uhl-tr.nhs.uk |
|
Chair of STC |
Dr Jonathan Barratt |
Consultant Nephrologist Department of Nephrology, Tel: 0116 258 8043 E-mail: jonathan.barratt@uhl-tr.nhs.uk |
The Speciality Curriculum
The Curriculum for the Renal/Acute Medicine speciality training
programme is available on
http://www.jrcptb.org.uk/Specialty/Pages/RenalMedicine.aspx
As a Specialist trainee you should familiarise yourself with the
requirements of the Curriculum, Assessment methods and e-portfolio system used
for documentation of your training.
The Guide to Postgraduate Speciality Training – the “Gold Guide” is
available on http://www.mmc.nhs.uk/pdf/Gold%20Guide%202008%20-%20FINAL.pdf
Achieving your Curriculum
Objectives
As a Speciality registrar (StR) you have a responsibility for your own
training and learning as an “adult learner” - these responsibilities are
defined in the Gold guide.
It is your responsibility to engage in the training and assessment and
appraisal process. You should attend the available formal learning
opportunities and engage in the setting of your educational objectives. It is
also important that you keep careful records of all the training you engage in
for presentation at the annual review.
In addition to the formal training opportunities and the personal study
that you do there are many experiential learning opportunities in your training
programme.
During the speciality training programme much of the clinical teaching
is experiential – taking place in the clinical environment based upon ward
rounds, procedures lists, case review and clinics. StR’s will discuss in-patients under their
supervision on ward rounds with Consultants and other members of the medical
team and in addition will discuss cases with other members of the
multidisciplinary team (nurses, dieticians, physiotherapists, occupational
therapist and pharmacists) during MDT meetings, on ward rounds and informally.
In out-patient clinics the Consultant will discuss all cases seen by the StR to
define a management plan and often further reading and literature searches etc
will be identified for study.
In addition, the renal units that you train in organise various formal
teaching sessions including seminars, case presentations, journal club style
review, audit meetings etc. These are described in more detail in the
descriptions of the training posts given below.
Regionally, the Speciality training course takes the form of lectures,
seminars, case discussions and debates many of which require prior preparation
and study by StR’s.
On numerous occasions during the Training Programme an StR will be asked
to become involved in an audit project or in the Final year of training an
optional management project can be arranged.
StR’s are encouraged to become involved in the publication of
interesting case reports/ literature reviews and research projects when
appropriate.
During the speciality training programme the rotation through different
clinical placements presents different learning opportunities. It is important
to study the curriculum documents carefully as certain curriculum objectives
(for example those related to acute transplantation) must be met in fairly
short clinical placements and it is vital to make sure you are aware of these
objectives and that you have adequately achieved these objectives by the end of
your training. If you feel there are areas of the curriculum you have failed to
cover adequately this must be discussed with your Educational Supervisor.
Formal Educational
Opportunities
Postgraduate Medical Education Centres
The Trusts involved in the training programme have active Post Graduate
Medical Education Centres. Generally there are regular grand rounds or
presentations of interesting cases. Most education centres have access to a
medical library.
Educational Activities of the individual units
These are described in more detail in the description of the individual
posts, but include:
·
Educational sessions with local and visiting speakers.
·
·
Journal Clubs
·
X-ray Conferences.
·
Histology Conferences
·
Audit sessions
·
Mortality and morbidity meetings.
This consists of 8 full-day sessions per year (4 held in the North and 4
in the South). Teaching is by a mixture of local and invited speakers. The aim
is to cover as much of the curriculum as possible over a 3 year period.
Attendance is compulsory unless you are on call or on annual leave.
A register of the sessions is kept and information is forwarded to
inform the annual review process.
External Courses
There are many useful courses available and StR’s may wish to consider
some of the following events during their five year rotation. Your personal learning plan should be
developed with your Educational Supervisor and study leave based on this plan.
An extensive list of external educational meetings can be found on the
Renal Association website http://www.renal.org/
Some of the courses you may wish to consider attending during the
Training programme:
The Renal Association
The Advanced Nephrology course
PD Academy
British Renal Society
European Nephrology, Dialysis and Transplant Association
The American Society of Nephrology
British Transplant Society
Membership of Professional Societies
StR’s are recommended to consider joining one of
the professional societies, such as the Renal Association, BRS, or the
International Society of Nephrology
Overview of training - South School
The
rotations
Trainees at ST3 level and above undertaking dual accreditation in
General Internal Medicine and Nephrology will undertake a five year training
programme in Nephrology (3 years) and General (Internal) Medicine (2 years).
The Specialist Trainee (ST) will rotate among the Hospitals of the
University Hospitals of Leicester NHS Trust,
An example of the rotation is as follows:-
Year 1
Year 2 Leicester
General Hospital Department of Nephrology (or
Year 3 Leicester
General Hospital Department of Nephrology
Year 4
Year 5 Leicester
General Hospital Department of Nephrology
The Specialist Trainee will also have a Personal
and Professional Development Plan or Learning Contract with regular appraisals.
University Hospitals of
The University Hospitals of Leicester Trust Board has overall
responsibility for the management of the Trust.
The Trust was established on 1st April 2000 and comprises
Leicester Royal Infirmary, The Glenfield Hospital and the
The East Midlands Renal Network covers a population of approximately 2.5
million. The service covers Leicestershire,
Professor J
Feehally Professor of Renal
Medicine and Consultant Nephrologist
Dr K Harris Reader
and Honorary Consultant Nephrologist
Associate Medical
Director
Dr G Warwick Consultant
Nephrologist
Dr S Carr Consultant
Nephrologist/ Honorary Senior Lecturer
Associate
Postgraduate Dean
Professor N Brunskill Professor of Renal Medicine and
Honorary Consultant Nephrologist
Dr P Topham Senior
Lecturer/ Honorary Consultant Nephrologist
Associate
Training Programme Director
James Medcalf Consultant
Nephrologist
Associate
Clinical Director
Dr J Barratt Senior
Lecturer/ Honorary Consultant Nephrologist
Dr R Al-Jayyousi Consultant
Nephrologist/Sen Lecturer in Medical Education
Dr R Westacott Locum
Consultant Nephrologist
9 Specialist Trainees (2 Walport Clinical
Lecturers)
2 Core medical trainees
4 Foundation Year 1 posts + 1 Foundation Year 2 and
2 Academic Foundation Year 2 rotations (Renal/Urology/Renal Pathology)
In addition there is a multidisciplinary team
including dieticians, social workers, psychologists and community nurses.
Ward
10 post
Day to day clinical care of patients on Ward 10
|
Mon |
Tues |
Wed |
Thurs |
Fri |
|
Ward work |
ST Ward round |
ST Ward round |
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ST Ward round |
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Consultant ward round |
Admin |
General Neph clinic (either GW or KH) |
Consultant ward round |
Admin |
General nephrology clinic Wed 1.30pm (either Dr Warwick or Dr Harris)
New patient clinic Tuesday 9am 1:8 weeks with general nephrology
consultant
Clinical responsibility for patients on Ward 15 nephrology
Provide cover for absence of 15A /ITU StR
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Mon |
Tues |
Wed |
Thurs |
Fri |
|
Ward work (15N) |
ST Ward round |
ST Ward round |
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General Neph clinic (either NB or PT/RAJ) |
|
Consultant ward round |
Admin |
Ward work (15N) |
Consultant ward round |
Admin |
General nephrology clinic Friday 8.30am
(either Prof Brunskill or Dr Topham / AlJayyousi)
New patient clinic Tuesday 9am 1:8 weeks with general nephrology
consultant
Day to day clinical care of patients on Ward 15 Acute and ITU
Provide cover for absence of 15N StR
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Mon |
Tues |
Wed |
Thurs |
Fri |
|
ST ward round |
ST ward round |
Admin |
|
ST ward round |
|
Consultant ward round |
General Neph clinic (either SC or JF) |
Renal obstetric clinic alternate weeks |
Consultant ward round |
Ward work |
General Nephrology clinic – Tuesday, 1.30 pm Dr Carr or Prof Feehally
Renal Obstetric clinic,
Weeks 2 & 4, Wednesday 2pm,
antenatal assessment area, LGH
New patient clinic Tuesday 9am 1:8 weeks with general nephrology
consultant
Clinical responsibility for renal and transplant patients on Ward 17
Provide cover for absence of transplant StR2
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Mon |
Tues |
Wed |
Thurs |
Fri |
|
Transplant clinic |
ST ward round |
ST ward round |
|
General nephrology clinic (either NB or
PT/RAJ) |
|
Consultant ward round |
Admin |
Transplant annual review clinic |
Consultant ward round |
Ward work |
Clinics:
Transplant clinic, Monday, 9.30am
Transplant Annual Review clinic, Wednesday 1.30pm
General nephrology clinic Friday 8.30am
(either Prof Brunskill or Dr Topham / AlJayyousi)
New patient clinic Tuesday 9am 1:8 weeks with general nephrology
consultant
Optional
Dr Osborne’s transplant dermatology clinic Wednesday 1.30pm, Clinic 3,
Balmoral Bldg, LRI
Clinical responsibility for renal Day Case Unit.
Cover for absence of Ward 10 StR
|
Mon |
Tues |
Wed |
Thurs |
Fri |
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Day case unit work |
New patient clinic |
Admin |
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PD Clinic |
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(Ultrasound training ) |
Admin |
Day case unit work |
Day case unit work |
Day case unit work |
Clinics:
New patient General Nephrology clinic – Tuesday 8.30am – all consultants
Peritoneal dialysis clinic Friday 9am Dr Medcalf
Cover of CAPD day
training patients attending the day training unit.
Cover for Leicester HD Unit in absence of Leicester
HD StR
|
Mon |
Tues |
Wed |
Thurs |
Fri |
|
In patient dialysis review or Admin |
LB ward round Admin |
LB ward round Or Monday |
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LB OPD clinic |
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LB HD clinic (alt weeks) |
Admin |
LB ward round |
LB HD clinic and MDT (alt weeks) |
Clinics:
General Nephrology – Dr Medcalf, Friday am
Haemodialysis clinic – Dr Medcalf, Tuesday/Friday
pm alt weeks, Loughborough Dialysis unit,
New patient clinic Tuesday 9am 1:8 weeks with Dr Medcalf
Shared responsibility for clinical care of patients on the haemodialysis
Unit LGH including haemodialysis unit ward rounds with consultant
Input to vascular access organisation and trouble shooting.
Cover for LB HDUnit in the absence of Loughborough ESRF StR
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Mon |
Tues |
Wed |
Thurs |
Fri |
|
HDU |
11.30 access planning meeting and
predialysis meeting |
HDU |
|
HDU |
|
HD clinic |
Pre-dialysis clinic |
General Nephrology clinic (either KH or GW |
TREC training (monthly) |
HD team meeting 13.30 |
Clinics:
Haemodialysis clinic Monday, 2pm, OPD 3, Dr
G Warwick
Predialysis clinic, Tuesday 1.30pm, OPD3 Dr
G Warwick/Dr J Barratt
General Nephrology clinic Wednesday 1.30pm
Dr G Warwick or Dr K Harris
New patient clinic Tuesday 9am 1:8 weeks with general nephrology
consultant
Other commitments
Access planning meeting Tues 11:30 Transplant Seminar Room
Haemodialysis Team meeting Fri 13:30 Home Training Office, Haemodialysis
Unit
Clinical responsibility for renal Outliers at LGH and Renal and
transplant patients on Ward 17
Cover for Ward17T in the absence of Transplant StR1
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Mon |
Tues |
Wed |
Thurs |
Fri |
|
Transplant clinic |
Admin |
Teaching 11am |
|
Admin |
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Outliers round |
General nephrology clinic (either JF or
SC) |
Transplant Annual review clinic |
Outliers round |
Outliers round |
Clinics:
Transplant clinic, Monday, 9.00am
Transplant Annual Review, Wednesday 1.30am
General nephrology clinic Tuesday 1.30pm Dr S Carr or Prof J Feehally
New patient clinic Tuesday 9am 1:8 weeks with general nephrology
consultant
Optional
Dr Osborne’s Transplant Dermatology Clinic Wednesday 1.30pm, Clinic 3,
Balmoral Bldg, LRI
Teaching Teaching
students – 11 am Wednesday
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SpR |
0-6 months |
6-12 months |
12-18 months |
18-24 months |
24-30 months |
30-36 months |
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1 |
15N |
Tx1 |
DCU |
HDLB |
Tx2 |
15A |
10 |
HDLGH |
Tx1 |
15N |
HDLB |
DCU |
|
2 |
10 |
HDLGH |
Tx1 |
15N |
HDLB |
DCU |
15A |
Tx2 |
HDLGH |
10 |
15N |
Tx1 |
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3 |
15A |
Tx2 |
HDLGH |
10 |
15N |
Tx1 |
DCU |
HDLB |
Tx2 |
15A |
10 |
HDLGH |
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4 |
DCU |
HDLB |
Tx2 |
15A |
10 |
HDLGH |
Tx1 |
15N |
HDLB |
DCU |
15A |
Tx2 |
|
5 |
Tx1 |
15N |
HDLB |
DCU |
15A |
Tx2 |
HDLGH |
10 |
15N |
Tx1 |
DCU |
HDLB |
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6 |
HDLGH |
10 |
15N |
Tx1 |
DCU |
HDLB |
Tx2 |
15A |
10 |
HDLGH |
Tx1 |
15N |
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7 |
Tx2 |
15A |
10 |
HDLGH |
Tx1 |
15N |
HDLB |
DCU |
15A |
Tx2 |
HDLGH |
10 |
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8 |
HDLB |
DCU |
15A |
Tx2 |
HDLGH |
10 |
15N |
Tx1 |
DCU |
HDLB |
Tx2 |
15A |
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The STs are rotated
through all the jobs to ensure training in all aspects of Nephrology during 3
years of training. The rotations are:
Each post lasts 3 months
and during each block of 2 posts you will maintain the same general nephrology
outpatient commitment
STs in their final year
of training need to take part in the ST management training programme. See Programme Director for details.
************************************************************************
** NEW STs will all immediately commence attending the
Ultrasound training Monday afternoon – Dr Y Rees, Monday and Tuesday am biopsy
lists and procedures list until they are competent at lines and biopsies. In addition the following website is a useful
resource for learning the rudiments of renal histopathology.
http://library.med.utah.edu/WebPath/RENAHTML/RENALIDX.html#4
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Monday |
Tuesday |
Wednesday |
Thursday |
Friday |
|
AM |
9.00 Day Case Unit 2 Day
Case Renal Biopsies Dr P Topham (alt weeks) Any registrar 9.30 OPD 3 Transplant Dr S Carr/Dr Topham Transplant StR 1 Transplant StR 2 |
11.30am Predialysis clinic meeting (alt weeks) 9.00 Day Case Unit 2 Day
Case Renal Biopsies Dr P Topham (weeks 2 and 4) Any registrar 9.00 OPD1 New Patient Clinic Consultant on 1:8 rota Day Case Unit StR every week StR covering consultant general nephrology clinic |
9.00 OPD 4 General Nephrology Dr J
Barratt (alt wks) Ward
10 ST1/2 |
|
8.30 OPD 3 General Nephrology Dr P Topham/Dr R
Al-Jayyousi Prof N Brunskill Transplant StR 1 Ward 15N post StR 9.00 OPD 1 Peritoneal Dialysis clinic
Dr J Medcalf Home Care Team Leader Day Case Unit StR Loughborough General
Nephrology Clinic
Dr J Medcalf Loughborough End Stage Renal Failure StR |
|
PM |
1.30 OPD 3 Haemodialysis Dr G Warwick 1.30 Radiology USS Training Dr Y Rees New ST |
1.30 OPD 3 General Nephrology Professor J Feehally Dr S
Carr Ward
15A and ITU StR Transplant
StR 2 Pre-dialysis Dr G
Warwick/Dr J Barratt (alt wks each) Haemodialysis Clinic Loughborough (alt weeks) Dr J Medcalf Loughborough End Stage Renal Failure StR |
1.30 OPD 2 General Nephrology Dr K Harris Dr G
Warwick Ward 10 post StR Renal obstetric clinic (wks 2 & 4) Antenatal Assessment Area, Dr Carr/ Dr Brunskill Ward
15A and ITU StR 1.30 OPD 1 Transplant Annual Review Clinic Professor J Feehally Transplant StR 1 Transplant StR 2 |
|
Haemodialysis Clinic Loughborough (alt weeks) Dr J Medcalf Loughborough End Stage Renal Failure StR |
Renal transplantation services are provided by the
University Department of Transplantation headed by a Professor of
Transplantation Surgery. In addition the transplant unit has the following
staff:-
3 Transplant
Surgeons (1 Professor and 2 Consultant)
4 Transplant Surgical SpRegistrar
1 Transplant Surgical SHO
2 Foundation Year 1 doctor
» 90 renal transplants are performed per year and
there is an active living related donor program accounting for 50% of all
transplants. The transplant programme is
supported by a team of Transplant Coordinators.
There is a partial/full shift rota
When you commence as an ST you will be asked to attend the hospital
induction and a local induction will be organised for you. At UHL this will
include a series of sessions relating to Information technology systems.
The Specialist
Trainee is responsible for inpatient discharge letters to the General
Practitioners and letters relating to outpatient consultations.
After
patients are seen in clinic, the notes will go to ward 15 Specialist Trainees office
and placed on your shelf. When the
letters have been dictated on (using Winscribe digital dictation system), the
notes need to be kept together with an elastic band and put onto the “dictated
work” shelf with a label on them stating which consultant clinic, the date of
the clinic and the name of the ST dictating the clinic. Please do not mix notes
from other clinics.
Your
admin tray will also be in ward 15 Specialist Trainees office and all your
post, clinic letters for signing and RBS folders will be put into your
tray.
There
will be general involvement with the administration of the unit, the
supervision of the Foundation and CMT juniors and the teaching programme for
medical students.
STs are allocated an
educational supervisor each year. The
supervisor will be based in the hospital where they work and it is intended
that you will have five different educational supervisors during an ST
rotation. Educational supervisors are
generally rotated in August. STs are expected
to initiate a meeting with their educational supervisor on a three monthly
basis. The contents of the meeting
should be documented in the e-portfolio.
A more formal appraisal will be conducted on an annual basis which is
again documented in the JRCPTB folder.
At the end of each year, the educational supervisor will submit a report
to the RITA / ARCP panel.
u Weekly educational sessions including
education and training workshop with local and visiting teachers.
u Monthly Regional Education Course
u Weekly Journal Club
u Weekly X-ray Conferences.
u Weekly Histology Conferences
u Monthly audit sessions and 3 monthly
multidisciplinary audit sessions.
The department has a
strong background of laboratory and clinical research with a national and
international profile. A number of clinical staff are supported by grants from
research councils, charitable funds, and industry.
Current interests of the
department include:-
·
Mechanisms
of progression of renal failure including the role of proteinuria and
mechanisms of renal scarring
·
Metabolic
abnormalities in uraemia particularly acidosis and hyperlipidaemia
·
IgA
nephropathy
·
Mechanisms
of peritoneal fibrosis in long term CAPD
·
Pathogenesis
of proteinuria
·
Hypertension
in renal disease
·
Long
term outcome in Renal Transplant patients
·
The
department is committed to increasing the amount of clinical research and is
currently recruiting to several large UK nephrology studies including studies
on vasculitis, lipid lowering (UK-HARP), membranous nephropathy and
renovascular disease (ASTRAL).
There
are opportunities to develop areas of both laboratory and clinical research
including Health Services research.
Participation in research is encouraged and excellent facilities are
available. ST’s may decide to take time
out from the rotation to complete a period of research training and complete a
higher degree (MD or PhD) if appropriate funding is secured.
Undergraduate
medical students from the
The Specialist
Trainee will be expected to participate in the undergraduate and postgraduate
teaching activities.
The consultant trainer
in renal biopsy is Dr Topham.
Prior to commencing
training in renal biopsy, it is mandatory that you have attended the five
sessions of ultrasound training delivered by Dr Rees. These sessions must be documented and signed
as attended by Dr Rees and a record of this training kept in your portfolio.
This training will
fulfil the curriculum objectives given for ultrasound training on page 46 of
the renal curriculum. www.jchmt.org.uk/renal/index.asp
The department has a
training video entitled “Performing a Renal Biopsy”, which should be viewed
before beginning practical training in renal biopsy. An accompanying CD ROM package is provided to
fulfil the curriculum objectives required for renal biopsy. (see page 45 of the renal curriculum) . www.jchmt.org.uk/renal/index.asp
Practical training is
conducted within the procedures lists on Monday and Tuesday mornings.
Your competency will be
assessed by the consultant trainers and the DOPPS procedure performed to
formally assess competency in this area.
A list (anonymised) of
all renal biopsies undertaken with a record of the date, suitability of sample
obtained and any complications should be recorded and kept in your ST folder to
help inform the RITA / ARCP process and your appraisal.
Consultant trainers for
this procedure are Drs Al Jayyousi, Warwick and
Barratt. In addition, Nick
Brylkamee, a Dialysis Access Nurse Specialist who undertakes a large proportion
of our line insertions, is able to teach line insertion and undertake
assessment.
Training is given in the
use of the site rite device prior to commencing training in the practical
procedure.
Training in the
insertion of temporary haemodialysis catheters (femoral and internal jugular)
and the insertion of permanent haemodialysis catheters is conducted within the
procedures list on Monday, Tuesday and Wednesday afternoons.
Occasionally lines are
inserted in the X-ray department using fluoroscopy. If you are involved in
these it is important that you review your IRMER training prior to using X-ray
screening and this should be documented with Dr Warwick. (see page 48 renal curriculum – JCHMT
website).
During parts of the
rotation, you will be involved in a range of regular general nephrology
out-patient clinics, dialysis, transplant and specialist clinics.
The specific educational
goals and objectives which can be achieved during theses clinics are shown in
the curriculum map.
Patients seen in clinic
will be discussed with the supervising consultant following the clinic and any
renal histology requested etcetera is viewed at the renal biopsy meeting. In addition, specialist radiological studies
performed can be reviewed at the radiology meeting.
Many of these curriculum
objectives will also be met by certain aspects of ward work and in other clinic
settings.
This clinic is led by Drs
Graham Warwick and Jonathan Barratt.
In addition to many of
the educational objectives as outlined above, this clinic provides particular
opportunities to gain expertise in the management of renal bone disease, renal
anaemia, nutritional issues, preparing patients for dialysis and making the
choice between different modalities of dialysis. In addition, referral of
predialysis patients for deceased and living donor renal transplantation.
In
this clinic patients transplanted for more than 1 year are reviewed annually by
a Nurse Practitioner and Doctor. Special attention is given to the long term
issues relating to transplantation : reducing immunosuppressive burden, general
medical review, assessment of cardiovascular risk and optimising of treatment,
skin surveillance, bone management and management of declining kidney function.
This clinic involves two
consultant nephrologists, Dr Carr and Prof Brunskill and three consultant
obstetricians Mr Scudamore, Dr Hodgett and Mr Howarth. The clinic offers pre-conception counselling
to women with underlying renal disease and antenatal care to women with any
form of renal disease occurring during pregnancy. This clinic enables the ST to achieve all the
curriculum objectives outlined for renal disorders in pregnancy. The clinic has access to a specialist
mid-wife with midwifery and renal training and a specialist pharmacist.
The Leicester
Royal Infirmary NHS Trust is an acute hospital located approximately one mile
from the city centre. It contains 1,141
beds covering all of the major specialties and in addition is a major acute
teaching hospital. The hospital contains
the only Accident and Emergency unit in the district.
The
The
The
A new wing for Oncology and Haematology opened in
1997 and enables patients to receive treatment in a modern and appropriate
environment. This building will also
include a new
The STR post is
based in the department of Diabetes and Endocrinology but also has links to the
Department of Vascular medicine undertaking regular hypertension clinics and
with opportunities to become involved in research.
Department of Diabetes and Endocrinology
Department of Medicine (Division of Cardiovascular
Medicine)
The Division of
Vascular Medicine is situated in the Clinical Sciences building at the
Leicester Royal Infirmary Trust. The
clinical activities of the unit take place in the Cardiovascular Medicine
service which is one of 6 services which comprise the Medical Directorate. Professor Williams runs a Speciality
hypertension clinic. The Division of
Vascular Medicine has a major research base in the
Duties of the Post
In the course of
these duties, the Speciality Registrar will be exposed to a wide range of
General Medicine, via the acute medical take and the general medical outpatient
clinic and diabetes clinics. They will
be responsible for inpatient management of a general (integrated) medical ward
with a special interest in diabetes together with a second StR (Diabetes), and
Foundation year doctors. In addition,
the Speciality hypertension clinic provides experience in all aspects of the
investigation and management of hypertension and cardiovascular risk
assessment. The Hypertension clinic at
the Leicester Royal Infirmary has a considerable reputation and now offers a single
visit service for the complete assessment of patients with hypertension. The Speciality Registrar also will be
provided with protected time study and research (at least one session per
week).
Job Plan for
Nephrology StR Attached To Diabetes And Endocrinology At
|
|
Monday |
Tuesday |
Wednesday |
Thursday |
Friday |
|
Morning |
Ward 8 Problems
(New Admissions and Potential Discharges) Admin |
Ward 8 Problems
(New Admissions and Potential Discharges) Admin |
9am StR Ward Round Ward 8 |
9am Consultant
Ward Round Ward 8 Alt/weeks 8.45am Hypertension
Clinic |
8.30am PGM/TAH GIM, Diabetes & Endocrine Clinics |
|
Lunchtime |
12.30pm AMU Clinical
Governance / Journal Club Meeting |
|
1pm Endocrine
Journal Club (MJL’s office) |
12.30pm Lunch
and Diabetes Seminar / Clinical Governance Meeting (Dept Seminar Room) |
12.30pm Lunch
and Medical Directorate Meeting (Postgrad Centre) |
|
Afternoon |
2pm Consultant
Ward Round Ward 8 |
1.15pm IGL GIM, Diabetes & Endocrine Clinic General Medicine
Training Programme (Alternate Months) |
2pm Medical Student
Teaching Ward 8 Discharge
Summaries / Admin |
Research and
Audit General Medicine
Training Programme (Alternate Months) |
Research and
Audit 2pm Medical
Andrology Clinic (optional) (Week 2) |
MEDICAL STAFFING AND WORK OF THE DEPARTMENT
On call/Emergency
Duty
The postholder
will be resident on call.
Research
The Speciality
Registrar will be encouraged to take up research opportunities available in the
Division of Vascular Medicine
Administration
The Speciality
Registrar is responsible for discharge summaries for in-patients and letters
relating to outpatient consultations as well as other written or verbal
communication (e.g. with general practitioners) necessary for clinical care. There will be general involvement with the
administration of the medical firm and the teaching programme for medical
students.
Teaching
The Speciality
Registrar will be expected to participate in both undergraduate and
postgraduate teaching activities.
Educational
Activities of the Department
These include -
* Weekly x-ray conferences with the
Department of Radiology.
* A weekly journal club.
* A
seminar programme in the Division of Vascular Medicine with meetings at regular
intervals.
* Inter-divisional
department of Medicine research meetings for one whole afternoon each academic
term.
Postgraduate
Medical Education Centre
The Postgraduate Centre at the hospital has a
full programme of lectures and seminars.
There are weekly postgraduate lectures and monthly clinical forum (grand
rounds) meetings take place during the academic terms. The main Leicester University Clinical
library is housed on the ground and first floor in the
Educational Activities of the Department
These include -
* Weekly x-ray
conferences with the Department of Radiology.
* A weekly journal club.
* A
seminar programme in the Division of Vascular Medicine with meetings at regular
intervals.
* Inter-divisional
department of Medicine research meetings for one whole afternoon each academic
term.
Kettering General
Hospital NHS Trust is situated on the western outskirts of
Most of the
hospital is of relatively recent construction and there are excellent
laboratory and radiology facilities on site. The recently opened treatment centre
has excellent facilities for the provision of day case surgery.
The Department of
Medicine has 14 Consultant Physicians. They share junior medical staff. In
addition to General Medicine the following specialities are represented:
Cardiology, Respiratory Medicine, Diabetes/Endocrinology, Gastroenterology,
Nephrology, Elderly Medicine, Haematology, Rheumatology and Dermatology
Nephrology
services at
Patients treated
by CAPD/APD attend the CAPD/APD clinic at the Harborough Lodge Dialysis Unit in
Nephrology junior
medical staff at KGH includes a Specialty Training Registrar [GIM/Nephrology]
and a Foundation Year 1 trainee [GIM/Nephrology].
Patients with
acute kidney injury or chronic kidney disease are admitted to KGH under the
care of the admitting general physician. Patients referred to the Nephrology
team may be managed at KGH with support from the nephrology team or transferred
to the Northamptonshire Kidney Centre for further expert care. Patients
requiring acute dialysis therapy are currently transferred to
Nephrology
Consultants
Dr Robert Preston
[Currently based at KGH]
Dr
Dr Warren
Pickering [based at NGH]
The Nephrology/GIM
STR will be expected to provide inpatient care for both GIM and Nephrology
patients under the supervision of Dr Hubbard [consultant Physician] and the
Nephrology Consultants. They will be expected to provide a nephrology opinion
with subsequent review by the consultant nephrologists [2 consultant ward
rounds per week]. The STR will also attend 1 consultant GIM ward round per
week. The STR will be expected to conduct at least 1 STR led ward round per
week [GIM/Nephrology]. The STR will attend 1 GIM outpatient clinic per week.
Nephrology, Chronic Kidney Disease, renal transplant and Haemodialysis clinics
will provide the basis for the nephrology training. The STR will be expected to
provide medical advice to the haemodialysis unit under the supervision of the
consultant nephrologists on site. Renal biopsies are performed in the medical
day case unit. The STR will be expected to be trained to perform renal biopsy
under consultant supervision. KGH Medical Directorate provide an excellent GIM
academic ˝ day on Friday afternoon. There are excellent postgraduate education
facilities on site, including the newly refurbished library.
On call rota
[GIM]; partial shift system 1 in 8
Educational
Supervisors
Dr Robert Preston
[Nephrology]
Dr Irene Hubbard
[GIM]
Outline of weekly
programme
|
|
Monday |
Tuesday |
Wednesday |
Thursday |
Friday |
|
am |
Renal biopsy Consultant ward
round [GIM] |
Nephrology
clinic |
GIM clinic |
Clinical admin. |
Consultant ward
round [nephrology] |
|
pm |
Consultant ward
round [Nephrology] |
Dialysis Clinic
[monthly] or research/audit |
STR ward round
[GIM/Neph] |
CKD clinic |
GIM Academic Renal transplant
clinic [monthly] |
Speciality
registrars (STRs) may rotate to a post at Northampton General Hospital (NGH) as
part of their training within the East Midlands Renal Network.
Located in
Duties of the post
Post 1 –
Nephrology
Post 2-
GIM/Nephrology
Nephrology/general
internal medicine (GIM) STRs will be provided with comprehensive training in
all aspects of Nephrology [except acute renal transplantation].The newly built
Northamptonshire kidney centre at NGH [12 inpatient beds plus 6 day case beds]
will provide inpatient services to the population of Northamptonshire. These
services will include vascular access and full diagnostic services. The STR
will have the opportunity to attend General nephrology, CKD, Haemodialysis,
CAPD and renal transplant clinics at NGH [and Harborough Lodge]. Protected time
for research/audit will be provided. There will be a weekly [2 hour]
seminar/teaching session in Nephrology at NGH in addition to the regional
nephrology training days. The STR will be trained to perform renal biopsy,
temporary vascular access and permanent vascular access under the supervision
of the consultant nephrology team.
There is a busy
general internal medicine service at NGH and the STR [GIM/Nephrology] will be
attached to the Rowan Ward based medical team. NGH is in the enviable position
of STRs performing GIM acute take with
their own consultant teams. The STR will attend at least 1 consultant ward
round per week and 1 GIM clinic per week.
NGH Medical Directorate provides an excellent academic ˝ day [Wednesday
afternoon] and has excellent postgraduate facilities.
Weekly Timetable
Post 1
[Nephrology]
|
|
Monday |
Tuesday |
Wednesday |
Thursday |
Friday |
|
Am |
Consultant ward
round and renal biopsy |
Haemodialysis
clinic [alt wks] or STR ward round |
CKD clinic [alt
wks] or STR ward round |
STR ward round
and procedures |
Consultant ward
round |
|
Pm |
Nephrology
clinic |