Nephrology in the East of England
Introduction from the Training Program Directors, Dr Sarah Fluck (Lister Hospital in Stevenage) and Dr Lisa Willcocks (Addenbrookes Hospital in Cambridge).
Welcome to the Renal Medicine pages for the East of England! Renal Medicine is a fantastic speciality, encompassing lots of different aspects of medicine, from fascinating science to the pastoral care of long term patients. The East of England is a great place to train in Renal Medicine, with friendly, dedicated clinical teams and lots of opportunities to develop your specialist interest, whether it is in dialysis, transplantation, autoimmune renal disease or acute kidney injury.
Renal medicine encompasses the prevention, evaluation and management of all aspects of renal disease, including the management of immune-mediated renal disease, including vasculitis and systemic lupus erythematosus, hypertension, and fluid, electrolyte and acid base disorders. Management of acute kidney injury and chronic kidney disease, and provision of renal replacement therapy forms a major element of renal medicine. Renal trainees gain experience in:
- Hospital haemodialysis,
- Home haemodialysis and peritoneal dialysis in the treatment of chronic renal failure,
- The evaluation and selection of candidates for renal transplantation, and their pre-operative and post-operative management,
- Long term follow up of renal transplant recipients.
Training is provided in a number of technical skills; these include the biopsy of native and transplant kidneys, and the insertion of temporary and permanent vascular access.
Our Training Programme
The specialist training programme in the Eastern Deanery currently involves rotational appointments that include Cambridge University Hospital, Ipswich Hospital, Norfolk and Norwich University Hospital, Lister Hospital (Stevenage), Broomfield Hospital (Chelmsford) and Basildon Hospital. The programme has expanded as a result of repatriation of posts from London, but we are still one of the smaller training programs. This allows us to be both friendly and flexible, and we try hard to adapt each trainee’s placement to suit their personal circumstances and career aspirations. From August 2019, the training programme will be divided into Northern and Southern Carousels. Trainees based in the Essex Hospitals of Broomfield, Chelmsford and Southend, as well as at Lister Hospital in Stevenage, will be able to rotate into London (Royal Free Hospital) for 1 year or to Cambridge for 1-2 to enable them to obtain transplant experience (the Southern Carousel). Trainees in the Northern Carousel will rotate through Ipswich, Norwich, Lister and Cambridge with posts of one-two years at two-three locations depending on preference and availablility. This will reduce commuting time and preclude trainees from needing to relocate during their training, unless they wish to. We will retain flexibility, however, for trainees to cross Carousels if they wish. We will try to accommodate what would work best for you!
We have regional training days (or half days) every 2 months as well as 6 monthly Eastern Region Multi-Disciplinary Research and Training Days which all SpRs are encouraged to attend. These are friendly and fun opportunities to meet co-workers across the whole region. SpRs are encouraged to attend UK Kidney week, and the Eastern Region is well represented at this national meeting.
We also have weekly regional teaching which is led by Addenbrookes and designed to cover the whole Renal curriculum. It is help via Zoom and recorded - recordings are stored in the Bridge/Panopto platform so available to all trainees at any time.
If you wish to undertake a period of research, the opportunities in the Eastern Region are exceptional! There are excellent opportunities for clinical and laboratory based research, and if you are interested, we will support you to apply for a fellowship to undertake a period of research during your training. In Cambridge, the NIHR Cambridge Biomedical Research Centre provides an outstanding environment for translational research leading to a University of Cambridge MD or PhD. Recent trainees have secured fellowships from Kidney Research UK, the Wellcome Trust and MRC to undertake research in the fields of vasculitis, transplantation, immunology, genetics and vascular biology https://www.med.cam.ac.uk/renal-medicine-2/. The Lister Hospital has strong links with the University of Hertfordshire and is regarded as one of the foremost centres for clinical research in the field of chronic kidney disease and haemodialysis.
Lastly, the Eastern Region is a lovely place to live! There is something for everyone, from bustling, lively towns within easy reach of London (but with lower house prices!) like Stevenage and Chelmsford, the beautiful rural coastlines of Norfolk and Suffolk, and the historic University town of Cambridge. We love it here and are sure you will too!
Please get in touch if you have questions or about pursuing renal research in the East of England - email@example.com
It is anticipated that trainees will take advantage of the academic opportunities available. Trainees are encouraged to apply for fellowships to undertake a period of research leading to a higher degree during their training. Kidney Research UK has further information about research in nephrology.
In the Eastern Region, trainees usually undertake research based in Cambridge or Lister.
Through the Cambridge University School of Medicine, the Cambridge Institute for Medical Research and the Cambridge Biomedical Research Centre there are excellent opportunities for translational and clinical research, focusing on the broad areas of immune-mediated renal disease and renal genetic disorders. Professors Clatworthy and Smith have large laboratories investigating basic and translational research into immune mediated renal disease, including vasculitis and transplantation, whilst Professor Jayne's group is more clinically focussed, leading a number of multi national clinical trials in Vasculitis. Professor Karet's leads a world renowned group investigating tubular and genetic renal disorders. There are usually at least 7 trainees undertaking a period of research in Cambridge, supported by Fellowships from KKRF, Wellcome Trust and MRC. We are lucky to have the Addenbrookes Charitable Trust, which often supports trainees to start in research so they are well placed to obtain one of these prestigious Fellowships.
The Lister Hospital is linked to the University of Hertfordshire. Professor Ken Farrington is a world leader in Dialysis Research and is Head of the Centre for Health Services and Clinical Research at the University of Hertfordshire. His group is an excellent place for those trainees with a special interest in Dialysis.
- Completion of a core medical training programme or equivalent.
- Documented evidence of achievement of level 1 competencies in general internal medicine (acute) and generic curricula.
- MRCP Part I, but note that full MRCP with PACES is highly desirable, and essential for progression from ST3 to ST4.
- Broad general medical interest and experience
- Ability to offer consultative advice to a wide variety of different specialities (for example: intensive care, haematology, obstetrics, paediatrics) involving excellent communication skills and conscientious follow up
- A genuine interest in the management of chronic disease
- A capacity for teamworking
ARCP requirements: PLEASE DO LOOK AT THE DECISION AIDS
- ES report: If you have the same ES for Renal and GIM, only one ESR is required to cover both. Do the ESR after curriculum ratings updates/assessments otherwise these won't be pulled through to the ESR. The Generic CiPs ideally need to be rated under both Renal and IM. Your ES can supervise IM even if they don’t do Acute Unselected Take.
- 1 MSF
- If you are progressing in IM CiP 1, you need minimum x2 MCRs from Consultants delivering AUT.
- 4 GIM ACATs, each with 5 patients
- 3 SLEs (CbD/Mini CEX), by consultants supervising IM
- Valid ALS
- 5 Clinics in non renal speciality (can include STEC, non renal ward rounds)
- Acute medical take: Record estimate of number of patients presenting with acute medical problems – aim for 200 a year
- General medical inpatient work: Record number of months of experience and training in continuing ward care of patients admitted with acute medical problem
- Simulation: record number of hours of simulation training (aim 4 hours per year)
- GIM DPD: Record GIM CPD (20 hours per year)
- IM CiPs : Update IM CiPs ratings every year as you will progress both Curricula every year - including during Renal Clinics/MDT/Ward activities when not doing Acute Unselected Take. You may have a year without new IM CiP 1 experience though if it’s a pure renal year.
- ES report
- 1 MSF (12 raters including 3 consultants and a mixture of other staff (medical and non-medical)
- 4 MCRs (excluding ES)
- Participation in QIP – please do use the QIPAT. ST6 - Completion of quality improvement project with satisfactory QIPAT
- Renal CPD: 70% attendance at regional training days (this can include watching presentations on Bridge). You need 100 hours of Renal CPD in total, ie a minimum 25 hours per year – this includes attendance at the weekly CUH and Lister led educational sessions.
- Evidencing CiPs: for each CiP, you should have at least 3 different types of evidence (ACAT, miniCEX, CbD, reflection) and at least 6 pieces of evidence in total. One ACAT could be used up to 5 times. To achieve sufficient evidence, we recommend at least 1 ACAT/OPCAT a year, as well as at least 1 miniCEX, CbD and reflection.
- Complete Summary of Clinical Activity/ Teaching Form before ARCP- this is a good option to summarise running total of AUT, NonSpecialty Clinics, CPD [Renal & IM]/Teaching. This is the the eportfolio under the assessment tab (all forms). Other CPD evidence/logbooks can also be in library for more detail.
- Complete updated Training Calculator before ARCP
- Patient survey: Use the Patient Survey Forms on the eportfolio - this is similar to MSF with results visible to ES who can release summary to you. This should be done in ST5 and ST7. You need 20 responses – and then this needs to be reviewed and released by your supervisor
- Form R : appears to be new format via TIS. Record TOOT for year being assessed only rather that whole Training time.
- Please remember to rate yourself on the CiPs
- If you’re an academic trainee, please remember you need an academic report.
For the pre August 2022 curriculum
We thought it would be useful to clarify the minimum requirements in terms of SLEs for passing the ARCP, as most of you are joint training in GIM and Renal concurrently, and using the Decision Aids together can be confusing:
For joint years you need a minimum of 8 SLEs [GIM 3 ACATs/1 Cbd/1 MiniCex; Renal 1 ACAT/1 Cbd/1 MiniCex]. This will allow you to obtain the minimum of 10 SLEs for GIM (with 6 ACATs) for Stage 1 GIM during ST3 and 4. By the end of ST7, you will have a total of 25 GIM SLEs, including 15 GIM ACATs. This is less than the 30/18 required for the GIM decision aid by CCT, but we have confirmed with the GIM TPD that some of your Renal SLEs can be counted to the total.
We have also confirmed with the GIM TPD that these should be spread across your 5 years of training, so even if you have done additional GIM ACATs earlier in training, if you are doing joint training in ST7, you should complete GIM 3 ACATs/1 Cbd/1 MiniCex in that year.
This will also give you a total of 5 Renal ACATs, CbDs and MiniCexs - you should have 6 of each in total across the 5 years of training to complete the targets in the decision aid, so please try to get some extra assessments done where possible.
You should also have an MCR with at least 4 responses every year - two of these should be GIM for a joint year.
In terms of procedures, if you have been signed off at CMT and are doing them regularly, then please ask your ES to counter sign them for you about three times during training (eg lines - although you do need 6 line DOPs for the renal curriculum over the 5 years). However, for a procedure that you have not done for more than a year, you are likely to need a DOPs prior to CCT.
In terms of linking - each curriculum item usually needs 2-3 pieces of linked evidence to reach highest level sign off - on occasion a single piece of good evidence may be sufficient. The maximum numbers of linkages for a single SLE are ACAT 8; Cbd/MiniCex 2.
Regular Nephrology Remote Training (also recorded and available on Bridge/Panopto)
Weekly on Zoom, 2-3pm every Tuesday, hosted by CUH. Contact Dr Anil Chalisey anil.chailsey@.nhs.net. Consultant led, aims to cover the renal curriculum
Weekly on Teams, 8-8.30am every Wednesday, hosted by Lister. Contact Dr Oscar Swift 'firstname.lastname@example.org. Renal journal club
Monthly on Teams, 2-3pm every third Tuesday of the month, hosted by Lister. Contact Dr Laura Ratcliffe, email@example.com. Consultant led, aims to cover the renal curriculum
Upcoming training days:
IN PERSON: 23rd May at Great Chesterford Research Park (Joint with the East Region Renal Research Meeting). Contact firstname.lastname@example.org
October 2023 Norwich. Date and venue tbc
December 2023 Lister. Tuesday 19th December. Contact email@example.com