Renal Medicine

Yorkshire is a vast area with a population of approximately 5 million and 21 major hospitals. There are 2 regional training programs within the School based around the teaching hospitals in each region namely the East/West (Bradford, Hull, Leeds and York) and South (Sheffield, Rotherham and Doncaster). Each program provides training in all areas of the 2010 curriculum, has well organised teaching and enviable SCE pass rates.

Renal Training is combined with General (Internal) Medicine, and the vast majority of trainees accredit in both specialities. We are part of Health Education Yorkshire and Humber and the programme sits within the School of Medicine.

Recruitment to specialist training is a national process, information about which can be found on the Specialty Recruitment site. Timescales, vacancies, person specifications and how to apply can all be found here. More information about recruitment arrangements can be found by contacting the Training Program Directors from each region. 

 

Training Program Directors (TPD)

There are three TPDs for renal medicine.

Dr Martin Chanayireh (East/West)

Dr Elizabeth Garthwaite (East/West)

Dr Veena Reddy (South)

Working in close collaboration with the TPDs for G(I)M, they ensure that quality training is delivered throughout the region. They have responsibility for the ARCP process and the individual training rotations.

 

Speciality Training Committee (STC)

The STC has consultant representation from all the renal units who host renal trainees. We also have trainee representatives and personnel from the Deanery. The committee meets at least twice yearly, and is charged with the responsibility of ensuring high quality training is delivered. Active feedback to the STC is encouraged, via the trainee representatives. We do our very best to respond to the feedback enabling continuous improvements to the training programme.

 

Rotations.

For trainees on the East/West rotation, there is an expectation that you will rotate to all of the hospitals in the programme (Bradford, Hull, Leeds and York).

St James’ Hospital in Leeds is the only hospital within the rotation where there is no GI)M. Trainees spend at least one year in Leeds to gain experience in acute kidney transplantation, as well as the other areas of the renal curriculum. Within the other hospitals, trainees participate in the G(I)M rota, in addition to working with the renal units.

The annual rotation of renal trainees takes place in September although changes can take place at other times in the year for specific reasons. The Specialty Training Committee meets in early June to plan the rotation following on from the ARCP process (see below). Individual requests will always gain a sympathetic hearing but cannot be guaranteed and the STCs main concern in the rotation is always to find the best solution to the training needs of all on the rotation.

 

Our hospitals.

Leeds Teaching Hospitals

The renal unit in Leeds is in St James’ Hospital, part of the Leeds Teaching Hospitals NHS Trust. The unit is a tertiary referral centre for patients throughout Yorkshire. All aspects of renal care are provided including acute transplantation. There are two inpatient wards, and outreach service (including haemodialysis) to the Leeds General Infirmary, onsite haemodialysis for 130 patients, a peritoneal dialysis unit and a specialist outpatient facility. Haemodialysis is delivered to 800 outpatients via the 7 satellite units. We have an expanding home dialysis service, and more than 50% of our patients are involved in shared care..

In a department of 12 full time consultants, a senior staff grade doctor, an advanced practitioner in haemodialysis and a multidisciplinary team including over 200 nursing staff, clinical nurse specialists and allied health professionals there is opportunity to experience all aspects of the renal curriculum.

Trainees are integrated into the workings of the unit, participating in all facets of the multi-professional teams. Specialty doctors will gain comprehensive exposure to all aspects of the renal curriculum plus specialist vascular access MDTs, young persons’ clinic, ADPKD clinic, vasculitis clinic and live donor work up.

Running one the largest renal transplant programs in the UK, trainees are able to gain experience of complex immunological screening processes and participate in our annual transplant consent clinic, run in collaboration with surgical colleagues.

The renal unit prides itself on providing an excellent training programme, with 100% green flags in the most recent GMC survey. A bespoke timetabling system ensures trainees gain access to all areas of the curriculum to fulfill training needs.

There is an active research programme, a well-developed audit and clinical governance system and there are opportunities for trainees to pursue areas of specialist interest within this. Out of programme opportunities are present both as research projects but also through leadership training programmes, and educational posts.

Medical students from the Leeds Medical School are attached to the unit and there are many opportunities to get involved with teaching and education.

Educational Supervision is provided my members of the consultant team, with the lead doctors for training being Dr Elizabeth Garthwaite and Dr Richard Hoefield.

 

York Teaching Hospitals NHS Trust

York Hospital is the largest hospital in an NHS Foundation Trust that also includes sites in Scarborough, Malton, Selby and Bridlington. The Renal Department provides a comprehensive service for patients across North Yorkshire, including tertiary referral services for Harrogate Hospital. All aspects of Renal care are delivered, with the exception of acute transplant which is provided in Leeds. Transplant patients return to our care at the point of hospital discharge. Dialysis for advanced kidney disease is provided onsite, in a local shared care unit and in three satellite units. There is an active home dialysis programme, supporting both home haemo- and peritoneal dialysis.

Speciality trainees join and work within our Multidisciplinary Team. They are supervised by the Renal Consultants, who are always available for advice and support. Speciality trainees have a comprehensive exposure to inpatient Renal Medicine, including our own patients and referrals. Patients with AKI are managed in an Acute Dialysis Unit and Critical Care as appropriate. The Renal Consultants are active participants on the General Internal Medicine rota, and Speciality Trainees' on call commitments are fulfilled within the unselected general medical take. Speciality trainees attend outpatient clinics weekly, encountering a wide range of new and follow up patients.

The Department is supported by the Vascular Surgery/Interventional Radiology MDT, a weekly Urology-Radiology-Nephrology case conference, a monthly Renal Biopsy meeting, a monthly Vasculitis MDT, and a quarterly Transplant Immunology MDT.

York Hospital is one of the primary teaching sites for Hull York Medical School. The Renal Department is very actively involved in supporting both undergraduate and postgraduate training. Speciality trainees are expected to participate in teaching activities. There are active audit and research programmes.

 

Bradford Teaching Hospitals NHS Foundation Trust

The Bradford renal team of seven consultants and one associate specialist offer training in both Renal and General (Internal) Medicine at the two main hospital sites of Bradford Royal Infirmary (BRI) and St Luke’s Hospital.

 

All acute inpatient care is centralised on the BRI site and trainees will experience the full range of inpatient nephrology and general medicine while working with the inpatient team. The Consultants operate a consultant of the week system which ensures that senior support is always close at hand but we ensure that trainees get an appropriate level of leadership experience for their degree of seniority. There is a 17 bed nephology inpatient ward together with office space and a seminar room. There is an acute haemodialysis unit at the BRI for inpatients alongside the home therapies unit. A weekly ‘line list’ takes place and unique to the region the nephrologists insert PD catheters using a local anaesthetic peritoneoscope technique.

 

Acute medicine is based on a large and newly refurbished Acute Medical Unit led by a team of acute physicians with twice daily consultant reviews. Bradford renal trainees take part in the medical registrar on call rota which facilitates a ‘buddying’ system for new or returning trainees. BRI is a large teaching hospital with most medical and surgical specialties represented and although much of the building dates back to the last century there is a very modern Costa and M&S to enjoy during break times. There is a well-equipped library in the postgraduate medical education centre alongside a state of the art simulation centre.

 

Most outpatient facilities are based at St Luke’s (SLH) which is also the main base for the renal MDT and includes our main haemodialysis unit with 36 dialysis stations. Our base at SLH includes office facilities, our specialist nurses, the Bradford transplant team and most of our administrative support. There is also a renal seminar room on site as well as some dedicated clinical rooms used by all members of the MDT. The unit looks after patients on haemodialysis, home haemodialysis and peritoneal dialysis as well as providing MDT support to low clearance including those choosing not to have dialysis. Trainees will spend a period of their attachment based at SLH when they will have the opportunity to attend dialysis MDT meetings, Home Therapies clinics, transplant clinics and pre-transplant assessment work ups including live donors. In addition to general nephrology and transplant clinics there are a number of sub-specialist clinics which trainees will have the opportunity to attend including renal stones, cystic kidney diseases, vasculitis, transitional care and low clearance. There are also outreach clinics held at Airedale Hospital and also in Skipton where the team look after a satellite haemodialysis unit.

 

Trainees will have the opportunity to participate in audit projects as well as getting involved in a range of research projects both commercial and non-commercial. We have close links with the Bradford based Improvement Academy (www.improvementacademy.org) where several recent renal trainees have undertaken leadership fellowships focused on quality improvement. Trainees can also take part in the innovative e-consultation service for primary care using the SystmOne primary care electronic record. Our educational program includes radiology, histopathology and journal club meetings as well as the Trust wide Grand Round.

 

Hull and East Yorkshire NHS Foundation Trust

The Hull and East Yorkshire Hospitals NHS Trust employs approximately 8,000 staff and provides a comprehensive range of acute services from 2 hospital sites for a based population of around 650,000, with specialist services including renal medicine aimed at an extended catchment area of 1.2 million people.

 The renal department is based at Hull Royal Infirmary. The Unit serves a population covering Hull, Bridlington, Grimsby, Scunthorpe and Goole. The main Haemodialysis unit is on the Hull royal infirmary site with 40 dialysis stations. There is a Nephrology ward (19 beds, with 4 dialysis stations in an adjoining acute dialysis room) for general Nephrology, dialysis and acute kidney injury patients. Satellite Units are sited at Bridlington (12 stations), Scunthorpe (16 stations) and Grimsby (16 stations). A home haemodialysis programme has been maintained. There are 340 patients on haemodialysis, 75 on CAPD, and nearly 400 functioning transplants. The department treats about140 dialysis-requiring AKI patients annually, about one third of these on ITU/GHDU. All dialysis modalities and plasma exchange are provided. 150 renal biopsies are performed annually. Renal transplantation is performed at St James University Hospital, patients returning at an early stage (day 6 post-operative onwards) for follow up in Hull. The Unit receives excellent support from the departments of Vascular Surgery, Vascular Radiology and Histopathology. The Nephrologists participate equally in the acute medical take (1 in 20 rotas). There is a 42 bed Acute Medicine Unit adjacent to the A&E Department, which has separate junior staffing (14 SHO’s). Patients are then transferred to base wards. There is abundant experience in high intensity unselected general internal medicine.

The department is staffed by 8 Consultant nephrologists, 5 specialist renal trainees, 2 F1, 1 F2, and 2 CMT. The team is supported by specialist nurses in  transplant, low clearance, peritoneal Dialysis, live donor transplant, anaemia, renal dieticians, social workers and a dedicated renal pharmacist.

The Specialist Registrar works in three clinical areas; the 19 bed nephrology ward (ward 50), the renal outreach team providing supervision of patients with Acute Kidney Injury (AKI) on the ICU. The specialist registrars rotate 3 monthly with spells on the renal ward, outreach, transplantation (including transplant work-up), haemodialysis /peritoneal dialysis, clinics and renal procedures.

 All specialist registrars will have an outpatient commitment and have the opportunity to attend Transplant, Transplant Work-up, Low Clearance, Haemodialysis and Peritoneal Dialysis clinics as well as General Nephrology clinics. The details of the rotation are organized after consideration of the training needs of the staff involved. The Consultant working patterns are closely integrated, and a similar level of mutual support and team-working is required from the middle grade staff. Inpatient work includes day to day supervision of the junior medical staff on ward 50, review of referrals prior to discussion with the Consultants and attendance on Consultant ward rounds, renal procedures (insertion of dialysis catheters, native and transplant kidney biopsy). There is a dedicated renal procedure lists on Mondays and Tuesday for training under the supervision by consultants.

All registrars take part in the acute medical on-call rota.  Out of hours renal on call is provided by the consultants.

All trainees are expected to participate in departmental clinical meetings. Regular departmental meetings include academic (weekly), renal curriculum (weekly), histology (monthly), transplant(monthly), quality assurance (monthly) and mortality (bi-monthly). Friday afternoon is dedicated to education in medical specialties. The undergraduate medical school (HYMS) has increased the number of medical students attached to the Department.

It is not expected that trainees in the StR programme will be involved in formal research though learning opportunities to promote better understanding of clinical research are available and the Department is active in both clinical and laboratory research. Professor Bhandari has established a basic science research programme, with both clinical and post-doctoral fellows. There is an active Audit/QIP programme a. It is expected that all trainees will complete a clinical audit and/or quality improvement project.

 

Sheffield Teaching Hospitals NHS Foundation Trust

The Sheffield Kidney Institute provides acute and chronic renal failure services for the 1.8m population of South Yorkshire in partnership with Doncaster Royal Infirmary. As one of the largest renal units in the country, Sheffield Kidney Institute currently provides dialysis for 675 patients, with 2 in-centre and 4 satellite dialysis units. 106 patients dialyse at home either by peritoneal or haemodialysis. 650 transplant recipients are followed up in the transplant clinic. 60-70 renal transplants are performed annually, and there is an active live donor programme.

The unit is staffed by 10 consultant nephrologists and 2 academic nephrologists. In addition, 2 Specialty Grade doctors supervise outpatient dialysis and nephrology in conjunction with lead consultants.  Junior Nephrology staff comprises 7 StRs, 5 CMT, 1 FY2 and 1 FY1.  There are 2 in-patient wards with a total of 41 beds, providing acute dialysis, transplant and plasma exchange services. The Renal Assessment Unit provides a rapid access assessment service for advanced CKD and transplant patients, to which patients may self-refer or be asked by medical staff to attend.

Renal training is provided mainly at Sheffield Kidney Institute, with up to 12 months at Doncaster Royal Infirmary. General medicine training is usually provided at Rotherham General Hospital.  Alternative secondments have previously been arranged including acute medicine jobs and hybrid renal/GIM jobs. These are organised according to training needs and availability of alternative vacancies. In addition to gaining experience managing patients in general nephrology, transplant and dialysis out-patient clinics, trainees will also have opportunity to attend a number of specialist clinics including: joint renal/ rheumatology; joint renal/antenatal; immunosuppression; PKD and genetics and low clearance and conservative care clinics.

Sheffield Kidney Institute has been awarded an Academic Directorate status. We promote a culture of research and take part in a number of clinical trials. Current research interests in the directorate include PKD, dialysis (HD and PD) and renal bone disease. The renal department also has a well-developed audit, clinical governance and service improvement programmes with plenty of opportunities for trainees to pursue areas of specialist interest within this.

Doncaster and Bassetlaw NHS Foundation Trust

As a part of South Yorkshire renal training, specialty trainees rotate through the renal unit based in Doncaster and Bassetlaw Teaching Hospitals for a period of 6 months to one year. The unit serves a population of 400,000 people and has 5 renal consultants as a part of the senior management team.

The purpose-built unit comprises renal outpatient clinic, renal inpatient ward with acute dialysis facility, an outpatient dialysis unit and the administrative offices.  The trainees have the opportunity to acquire training in various aspects of renal care such as acute kidney injury, chronic kidney disease, dialysis and transplantation working in close collaboration with the renal multidisciplinary team.

The trainees work in a safe environment closely supervised by the consultant team. A named clinical supervisor ensures that the training needs are fully met. The trainees are encouraged to attend the regional training days and are encouraged to participate in departmental audits.

The unit also provides excellent training in procedural skills such as renal biopsy and fluoroscopically guided tunnelled dialysis catheter insertion. Moreover, the trainees have the opportunity to develop their leadership skills by supervising and mentoring the six-member renal junior doctor team

 

Educational Programme

The Northern Postgraduate Nephrology Course is a well-established bi-monthly full day teaching programme that covers the entire renal curriculum. Coordinated by Drs Garthwaite, Hoefield and Roberts, the programme attracts both local and national speakers.

The course is funded by the Deanery, and attracts universally high quality feedback, as well as RCP CPD points.

This course is free to all trainees in the region. There is an expectation that trainees are released to attend. Likewise you should also attend the Royal College of physicians G(I)M study days which take place at similar frequency and are advertised by the Deanery.

Simulation training is also provided – with an annual simulation training day covering dialysis related emergencies, communication skills and other areas.

We encourage all trainees to supplement their training with appropriate study leave and other CPD events both clinical and non-clinical. All of the units run an internal educational program including CPCs, x-ray conferences, journal clubs etc and you will get more details from each unit. You will also have access to library and on-line facilities as well as a number of e-learning resources.

Study Leave

Study Leave is authorised on an individual basis. There are a number of ‘Deanery Approved Courses’ where funding is provided. These are listed below. You should discuss the courses with your educational supervisor and of course aim to spread these out throughout your training.

Courses outside this list are judged on an individual basis, but are unlikely to be remunerated by the Deanery.

Approved External Courses

Advanced Nephrology Course*

Transplant Course*

Dialysis Course*

Histology Course*

National Conference (BRS/RA/BTS/UKKW)

International Conference – if presenting.

*Generally funded once within training programme

 

Out of Programme Opportunities

Trainees are encouraged and supported to explore opportunities for out of program training that may enhance and supplement your training but do bear in mind that this takes a lot of organisation and planning with a minimum notice period of six months required for an application to be processed.

The policy for OOP and more information can be found here.

 

Less than Full Time Training

There are a number of reasons why trainees may wish to pursue less than full time training. We have a number of LTFT trainees in renal medicine working within the region. Information regarding eligibility and application for LTFT training can be found here.

 

ARCP

An annual review takes place each spring to ensure that you are making satisfactory progress with your training. This is entirely dependent upon the e-portfolio and you must ensure that this is kept up to date with the required numbers of Workplace Based Assessments together with evidence for regular meetings with your supervisors and linked evidence to show progress through the curriculum.

 

If you are dual accrediting please remember to pay equal attention to the G(I)M curriculum and to ensure that a proportion of WPBAs reflect this. You should also use the eportfolio to keep a record of study leave, audit, teaching and other educational activities.

 

The requirements to ensure satisfactory progress are clearly described in the ARCP decision aids for Renal Medicine and G(I)M.

 

You will not be able to achieve a satisfactory outcome at ARCP without an up to date e-portfolio and the STC takes a dim view of assessments all being crammed into the last few weeks before the date of assessment, they do need to be spaced out.

 

Following the ARCP you will be invited to an informal face to face meeting with at least two members of the STC. This is not part of the assessment of your training but is an informal opportunity to discuss your training to date and to focus on the future.

 

As you approach the final year of training you will receive a formal face to face assessment known as a Penultimate Year Assessment (PYA) chaired by an external representative from another deanery which aims to confirm that you are on course for CCT the following year.

 

The Guide is a long document but provides the information required to ensure your training is completed satisfactorily.

The Gold Guide - 7th Edition - Conference Of Postgraduate Medical Deans

 

 

For more information please contact

Programme Support Administrator - Leanne Thompson

Email: Leanne.thompson@hee.nhs.uk

 

TPDs

Martin Chanayireh, Martin.Chanayireh@hey.nhs.uk (east/west)

Dr Elizabeth Garthwaite, Elizabethgarthwaite@nhs.net (east/west)

Veena Reddy, veena.reddy@sth.nhs.uk (south)

 

Further information on the specialty

For further information on the specialty and on the curriculum covered can be found on the JRCPTB site.

X