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Renal induction handbook

Renal Specialty Trainee Induction

August 2016


Welcome

Welcome to the North Western Deanery and the Renal Medicine training scheme. The deanery has responsibility for over 4000 trainees of which 23 are renal specialist trainees (StRs). Professor Jane Mamelok ([email protected]) is the postgraduate medical dean. Head of School for Medicine is Dr John Anderton ([email protected]).

The renal training committee members are:Dr Harish Shetty, Renal Physician, Lancashire Teaching HospitalsTPD, [email protected]

Dr Ajay Dhaygude, Renal Physician, Lancashire Teaching Hospitals Local training lead and Career Advisor, [email protected]

Dr Anand Vardhan, Renal Physician, Manchester Royal InfirmaryRegional Teaching Programme organizer, [email protected]

Dr Mumtaz Patel, Renal Physician, Manchester Royal Infirmary


mailto:[email protected]




Member TC, [email protected]

Dr Durga Kanigicherla, Renal Physician, Manchester Royal infirmary Local training lead, [email protected]

Dr James Ritchie, Renal Physician, SRFT Local training lead, [email protected]

Dr Rachel Middleton, Renal Physician, SRFTMember, TC, [email protected]

Professor Phil Kalra, Renal Physician, SRFT,Academic advisor, [email protected]

Trainee Representatives;Dr Andrew Nixon [email protected] Dr Qurat Tak [email protected]









TrustsTraining is split between three trusts - Salford Royal NHS Foundation Trust, Central Manchester Teaching Hospitals and Lancashire Teaching Hospitals. All are well linked by motorways.

Salford offers seven renal training posts including one G(I)M training post on the acute admissions ward, and one post on the intensive care unit. The clinical director is Dr Smeeta Sinha ([email protected]) and Dr James Ritchie are the specialty tutors ([email protected]).

Preston offers seven posts including two for G(I)M training. Dr. Mark Brady is the clinical director ([email protected]) and Dr Dhaygude is the specialty tutor ([email protected]).

Manchester Royal Infirmary offers eight training posts including two posts on the acute transplantation ward, and one for G(I)M training. Dr Ebah is the clinical director ([email protected], Dr Durga Kanigicherla ([email protected]) is the specialty tutor and Dr Anand Vardhan is the regional programme organiser.

Wythenshawe Hospital offers one post for G(I)M training.. This post is organized through Manchester Royal Infirmary. This post also provides exposure to renal clinics.

You will rotate between all three trusts during your training period. Due to the busy nature of the training scheme it is not always possible to choose which site you train at each year. However if you have specific training needs e.g. transplantation these will be considered. Please do discuss your specific needs with your educational supervisor and Dr Shetty as soon as possible. Dr Shetty arranges induction meetings with all new trainees and this will be a good opportunity to discuss your individual training needs.






TrustsAll three trusts work a hub and satellite model. As well as covering satellite dialysis units, each trust also provides support for other hospitals. Whilst you do not rotate to these in the training program, there will be out-patient clinics at some sites.

Trust Geographic renal care

Preston KendalBarrow

BlackpoolBlackburnRosendale

BurnleyLancasterChorley

MRI TamesideTrafford

North ManchesterWithington

MacclesfieldStepping Hill

SRFT BuryRochdaleOldhamBoltonWigan



Each trust has different policies regarding patient transfer. These will be covered in the local induction.

Training - GIMThe renal training program provides dual accreditation in renal and general internal medicine. In the current climate, all trainees are strongly encouraged to achieve dual certification. Any plans to pursue single accreditation must be discussed at an early stage with both your educational supervisor and the training program director. The current G(I)M TPD is Dr Vinodh Devakumar, [email protected].

You will have an educational supervisor assigned at each trust. It is your responsibility to arrange regular educational meetings. If you have any difficulties with your supervisor discuss this with the local specialty tutor in the first instance.

Specific training opportunities in GIM are limited to only 6 posts; however GIM skills and competencies can be gained during renal placements. It is vital that you keep track of how many months you have spent in GIM and talk to your educational supervisor early if you are worried you do not have planned rotations to general medical posts. You could also discuss with the local Speciality lead and Training Programme Director.

To progress through your GIM ARCP, evidence of patient contact in clinics and on the acute take must be provided. All trainees are advised to keep an anonymous log book of patient contacts and apply this to the Firth calculator. Please keep your e-portfolios up to date as per the latest decision aid published on the JRCPTB website.

There are five whole day GIM training days each year. Please ask the training programme director for a teaching schedule if you have just joined the programme. Attendance certificates are given for full or half day attendance - if you arrive late or leave early you will only be given a half day certificate. 75% attendance is required to progress through your ARCP; this can be supplemented by attending other teaching sessions e.g. RCP update days.



Training - RenalEach trust offers broad exposure to general nephrology, acute kidney injury, acute dialysis, chronic dialysis and management of patients with renal transplants. Experience of acute transplantation is only available at Manchester Royal Infirmary and all trainees will have at least four months of their rotation on the transplant ward. Though there is currently no requirement to keep patient logs as for GIM, things change and doing so may be a good idea to help provide evidence of progress at your ARCP. Please refer to the up-to-date renal decision aid published on the JRCPTB website. Normally the renal ARCP will be held in the month of June. An outcome 1 at the ARCP is one of the important factor taken into consideration before a trainee is granted out-of-program exemption for research.

The 2010 renal curriculum only requires trainees learn how to place temporary dialysis lines. No matter how many lines you have placed before, now it is vital that you arrange this competency to be signed off as soon as possible for each trust. Even when competent, it is expected that you should arrange regular DOPS assessments to demonstrate that you are maintaining this skill.

Training in renal biopsy and tunneled line placement is not required in the 2010 curriculum but may be available dependent on local trust policies. If you have a specific training need or interest, this should be discussed with your educational supervisor.


Renal Teaching DaysThe renal teaching program is arranged by Dr Anand Vardhan; the program is structured over three years and covers all major curriculum topics over this time. Time table will be circulated beginning of each year. Sessions are usually held at The Centre, Birchwood Park, Warrington, WA36YN, but will occasionally be held at one of the three trust sites (thecentreatbirchwoodpark.co.uk)

Your host trust should facilitate arrangements for you to meet this requirement.


The Centre, Birchwood

Postcode: WA3 6YNPhone: 01925 282 940

In addition to the Birchwood teaching days, a range of other training opportunities exist: REMEC: Regional updates on specific topics with guest lecturers invited from around the country. REMEC is held four times per year at Birchwood.

Each trust also provides a local education program including biopsy meetings, grand rounds and StR teaching.

Keep a record of all educational activities on your e-portfolio.


MembershipsThere are several renal societies, all with annual meetings. Trainees are encouraged to join the Renal Association and, when possible attend part of the annual meeting.

Other societies include the American Society of Nephrology (ASN), The European Renal Association - European Dialysis and Transplant Association (ERA-EDTA) and International Society of Nephrology (ISN).

Please look at individual websites as some societies offer free membership or subsidized membership for trainees.

Each society has an annual meeting. Support and advice is available for anyone wishing to submit abstracts. Please note that currently the study budget does not support international travel unless under exceptional circumstances.


Out of Program (OOP)There is a strong research heritage in the region. The training program will always try to support trainees wishing to take time out of program to undertake a period of research.

Early planning is vital! If you are considering taking time out, please speak to your educational supervisor and the TPD as soon as possible. Applications, with details of funding, research timetable, should be submitted at least six months in advance.

The deanery OOP web-page with links to application forms can be found here: https://www.nwpgmd.nhs.uk/time-out-of-programme

Each trust has different active research interests: Salford has interests in the epidemiology of CKD, cardio-renal disease, atherosclerotic renovascular disease and quality improvement. Central Manchester has interests in transplantation, peritoneal dialysis, membranous nephropathy and vasculitis. Preston has interests in ultrasound and long term outcomes in CKD.


Training CoursesThere is a study budget of approximately £805 per trainee per year to support attendance at courses to complement experiential learning.

Whilst trainees can apply to attend any course they wish, they must be able to demonstrate how this will aid them in completing all the curriculum competencies. Unfortunately the study budget does not extend to support attendance at international conferences, unless exceptional circumstances. A new policy for study leave is being prepared during writing this document. Please refer to the HEENW website.

A list of suggested courses and appropriate year to attend is given below:

Year Courses Conference

ST3 Renal physiology for the clinician

ST4 Edge Hill Medical Education - Module 1Advanced Nephrology Course Part 1

UK Renal Association

ST5 Advanced Nephrology Course Part 2Specialty certificate exam course

ST6 Edge Hill Medical Education - Module 3Special interest course (see below)

ST7 Management and leadership course UK Renal Association

Suggested special interest courses include the Preston Ultrasound course, the Royal Free dialysis course; the Hammersmith supportive care for the renal patient course; the Imperial College pathology course.


Annual LeaveAt ST3 you are entitled to approximately 30 days annual leave but the exact number of days would depend on the number of years you have worked for the NHS prior to your current post. It is YOUR responsibility to make the most of this!

Each trust has a policy for arranging leave, but as an absolute minimum, 6 weeks notice must be given for leave to be arranged. This allows changes to be made to clinics and appropriate staffing to be arranged.

Most trusts ask that you spread your leave throughout the year. If you need to arrange a long period of leave or wish to arrange leave before you rotate to your new trust, contact the local specialty tutor.


Study LeaveAll study leave must be applied for at least six weeks in advance with the local trust. The deanery form can be filled in, at the latest, a day before the course begins and the expenses claims must be received by three months after the first day of the course.

The deanery requires that a study leave application form is completed. This form, along with local study leave guidelines can be found at: https://www.nwpgmd.nhs.uk/studyleave

For renal medicine, the study leave coordinator is Ms Joanne Parker ([email protected]). When the study leave form is signed by your educational supervisor and rota master, forward it to her for approval.

The flowchart for applying for study leave is on the following page:



Dr John Adams Deputy Dean of Hospital and Community, and Chair of the Policies and Guidelines Development [email protected]

Dr Ray Clarke Associate Dean of Hospital and community care. Dr Clarke oversees the renal training [email protected]

Dr Andy Watson Associate Dean - Hospital and Community [email protected], from a deanery perspective, formal academic training for all grades of medical trainees including the Academic Foundation Programme, Academic Clinical Fellows, and Academic Clinical Lecturers.

Ms Claire McGovern is the current specialty school manager and is involved in recruitment, doctors in difficulty, complex panel Bs, appeals and reviews, and configuration of training programme/high level rotation [email protected]

Liz Housby is the current school leader and is involved in Rotations, Panel Bs attendance, ARCP management, OOP, complex queries re. trainees/posts. [email protected]

Denise McCracken is the school administrator and is involved in ARCP and Training committee arrangements, e-portfolio management and general queries. [email protected]

Disclaimer. The information in this trainee handbook is a general information resource only. Individual trust requirements will be discussed in the local induction. For up-to-date information, please refer to information on the HEENW website.



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