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 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.
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 - firstname.lastname@example.org
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
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.