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Immunology Job Description
Immunology Job Description
Immunology Job Description
Immunology Job Description
Immunology Job Description
Immunology Job Description
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Immunology Job Description

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  • 1. Clinical Immunology ST3 at Cardiff and Vale NHS Trust Job description Introduction Clinical Immunology is an expanding discipline which covers all aspects of Immunology from laboratory work to responsibility for very sick patients. Immunological research is advancing rapidly and Immunologists need to keep abreast of developments in order to use the latest knowledge, cutting edge diagnostic tools and novel therapies in clinical practice and clinical trials. Immunologists are thus rewarded and challenged by a continuum of patient contact and scientific problems. This is a 5-year post designed for a trainee possessing MRCP to train for and obtain the MRCPath exam in Immunology and achieve the CCST in Immunology. It is based at the University Hospital of Wales and the successful candidate will be responsible to Dr Paul Williams and Dr Stephen Jolles, Consultant Clinical Immunologists. The aims of the post are to produce a fully trained specialist in Clinical Immunology who will be able to provide a consultant-led clinical and laboratory diagnostic immunology service for the investigation and management of patients with immunological disorders. The post-holder will be funded to attend the University of London MSc course in Medical Immunology and to undertake the research project which forms part of this course. The immunology training program complies fully with the Curriculum for Higher Specialist Training in Immunology delineated by the Joint Royal Colleges of Physicians Training Board (JRCPTB) and PMETB. The program will allow the successful candidate to train and achieve certification in Immunology, the necessary training requirements being available in Cardiff. Informal short-term secondments to other adult and paediatric Clinical Immunology centres in the UK may be sought as appropriate to strengthen the training. Location of duties Cardiff is Europe’s newest capital city and has recently undergone a transformation with superb recreational facilities, world-class culture and areas of outstanding natural beauty within easy reach in a very affordable environment. The University Hospital of Wales (UHW) is a 950-bed teaching hospital in the City of Cardiff and is the flagship teaching hospital in Wales. It provides comprehensive clinical services to a local population of approximately 400,000 and regional specialist services in cardiac surgery, thoracic surgery, neurosurgery, renal dialysis and transplantation, bone marrow transplantation, infectious diseases and medical genetics, and acts as a tertiary referral centre for Wales. It includes the Children’s Hospital of Wales and there are very close links with the Medical School at Cardiff University which occupies the same site and has about 300 medical students per clinical year. Llandough Hospital is situated in Penarth (6 miles from UHW) and serves the west of Cardiff and the Vale of Glamorgan, a population of approximately 200,000. In addition to comprehensive DGH services to the local population it provides specialist services in respiratory medicine and toxicology. It is also closely linked with the Medical School, with four academic departments being based on the Llandough site. The 2 hospitals merged into one Trust in April 1999, and a further merger with the remaining Community Trust occurred in April 2000 to create the Cardiff and Vale NHS Trust. It is the third largest NHS Trust in the UK, employing 14,500 staff and with an annual budget of £900 million it provides a single, seamless NHS service for Cardiff
  • 2. and the Vale of Glamorgan, as well as the majority of specialised services for Wales. The National Clinical Immunology services we provide in Immunology, Immunodeficiency and Allergy are provided across Wales. Academic Immunology Academic Immunology (which has been awarded a 5* RAE rating) is a large and vibrant research-dominated Department with many interlinked research strengths with the majority of the senior clinical staff being members of the Academic Department. This integrated approach provides an excellent environment for basic and applied medical research. The Immunology Department The Immunology Department provides 4 national specialised services for Wales: Adult Immunology and Immunodeficiency, Paediatric Immunology, Adult Allergy and the Hub Immunology Diagnostic laboratory. The laboratory provides a comprehensive immunology laboratory assay service for the Trust and local GPs, a specialist laboratory immunology diagnostic service for Wales, and is active in teaching and research. The immunodeficiency cohort at UHW is now one of the largest in the UK encompassing both paediatric and adult primary immunodeficiency with a wealth of rare disorders. The cohort has been extensively biobanked to facilitate research into better understanding primary immunodeficiency disorders. In addition UHW is the lead centre for several international clinical studies into new immunoglobulin treatments. There are weekly outpatient clinics at UHW and Cardiff Royal Infirmary in allergy (Mon am & pm), and at UHW in general immunology (Tue am) and immunodeficiency (Wed pm) where patients with immunological disorders and primary immunodeficiency disorders requiring specialist follow up are seen. There is an all day infusion clinic led by three Immunology specialist nurses on a Tuesday and patients are trained to administer intravenous and subcutaneous immunoglobulin at home. Allergen desensitisation clinics are also carried out on Mondays performing both subcutaneous and sublingual desensitisation. There are also joint clinics with paediatricians in paediatric immunology and paediatric allergy at which attendance is expected. The successful candidate will see paediatric and adult ward consults with consultant support. When Immunology patients require admission they are looked after under shared care arrangements with the Infectious Disease team. The CPA-accredited Immunology laboratory is organised into 4 groups: 1. Immunochemistry (also known as the Protein Reference Unit), which also performs Allergy testing with one of the largest repertoires in the UK and the broadest range of complement testing in the UK 2. Autoimmune Serology (testing for organ- and non organ-specific autoimmunity) 3. Cellular Immunology (which performs investigations for immunodeficiency and CD4+ T-cell enumeration in HIV infection) 4. Molecular immunology which performs sequencing for a number of genes involved in immunodeficiency disorders. The current staff in the Department comprise the 2 Consultant Clinical Immunologists, 1 Specialist Registrar, 1 Clinical Scientist, 1 BMS3, 3 BMS 2 and 7 BMS1 laboratory staff, 3 Clinical Immunology and Allergy Nurse Practitioners and 2 Secretaries. 2
  • 3. Regular commitments throughout the 5-year program Some commitments will apply throughout the 5-year program, and these include: • Regular attendance at the Monday am and pm Allergy out-patient and desensitisation clinic • Regular attendance at the Tuesday am Immunology out-patient clinic • Regular attendance at the Wednesday pm Immunodeficiency out-patient clinic • Supervision of the management of patients who have primary immunodeficiencies • Responsibility for the intravenous immunoglobulin home-therapy program • Joint result reporting with the Consultant Immunologists and senior staff • Attendance at the Combined Staff (Wed lunchtime) and Medical Unit (Fri am) Rounds • Regular attendance at Thurs lunchtime and other science and research seminars • Regular attendance at the UK immunology trainee study days • Attendance at BSI annual congresses, BSI-UK-PIN Forums and other relevant meetings Am pm Mon Allergy OPD Allergy OPD Tue Immunology OPD Variable Wed Variable Immunodeficiency OPD Thu Variable Variable Fri Variable Variable Years 1 and 2 In the first 2 years of the post the main aims will be to achieve a thorough grounding in the scientific aspects of immunology, training in the direct patient management of adult and paediatric autoimmune, allergic and immunodeficiency disorders, and also basic training in the workings and practices of routine diagnostic immunopathology (to include hands-on benchwork, results interpretation, and troubleshooting). The successful candidate will be funded to attend the University of London MSc course which provides core training appropriate to part 1 of the MRCPath examination in Immunology, held on 1day/week for the first 2 years of the post. The research project which forms part of the MSc will also take place during this time and there is R&D bench space available in the laboratory. Two days per week will be spent in allergy and immunology outpatient clinics. At least one day per week will be spent learning aspects of laboratory diagnostic immunopathology, clinical liaison, pitfalls of laboratory methods, quality control, and requirements for laboratory accreditation. Senior laboratory staff will assist with aspects of this training. The full repertoire of laboratory methods including flow cytometry, cell culture, immunofluorescence, ELISA, protein electrophoresis, etc will be covered in detail. As time goes on, the proportion of time spent learning about the interpretative phase of tests, clinical liaison, laboratory management etc will increase. 1-2 days per week will be spent on private study initially to learn basic immunology, and later the clinical applications of basic immunology. This will include attendance and participation at the hospital’s combined staff and medical unit rounds and the lunchtime science seminar series. Time will be made available for private study and attendance at relevant scientific meetings including the 3
  • 4. annual British Society for Immunology (BSI) congress, BSI-UK-PIN Forum and the nationally organised Immunology trainee teaching days. The clinical training in the first 1-2 years will be via attendance at the immunology and allergy clinics. In the second year attachments will be arranged to other adult and paediatric firms, to gain experience in specialties with a strong immunological interface such as thoracic and renal medicine, rheumatology, dermatology, haematology, gastroenterology, and paediatrics. The trainee’s previous experience and requirements will determine the precise arrangements made, but attachments of 3-4 months duration are anticipated. Such attachments will be concurrent with the above mentioned responsibilities but should nonetheless allow time for outpatient sessions, ward rounds, histology presentations/X-ray sessions etc so as to gain maximum benefit from the secondment. By the end of the second year, the trainee will be eligible to sit MRCPath part 1, and an early attempt will be encouraged. Years 3, 4 and 5 By this stage there should have been acquired a sound grasp of theoretical, practical and clinical immunology such that this period should be devoted to the acquisition of self- sufficiency in the specialty. The trainee will need to consolidate aspects of laboratory management, and (under supervision) take on more of the pathology reporting role. Some self-reliance will arise from the latter for laboratory work such as immunofluorescence and cellular immunology and visits to other laboratories as required. Concurrent attendance at some immunology outreach clinics will be expected, as will the performance of audit projects and detailed laboratory work-up of unusual cases. Basic training in all aspects of medical immunology will continue, but more time will be provided to develop specialist interests, both clinical and laboratory-based. For example if more emphasis on allergy were to be desired, then additional attachments in dermatology, thoracic medicine, otolaryngology, ophthalmology etc. and secondments to other centres would be sought. Research will be strongly encouraged (vide infra). A research thesis may be submitted in-lieu of the dissertation component of MRCPath part 2. The earliest time that part 2 can be taken is four years after commencement of the training post. Attachments to other specialties Some secondments elsewhere will be arranged in order to provide a complete training and to help in the development of areas of special interest and expertise. Where possible these will be arranged in Cardiff, but secondments to other centres will also be arranged if feasible and if required. The attachments and corresponding experience envisaged include: Specialty Experience Thoracic Medicine Immunological lung disease, bronchoscopy, inhalant challenge tests Dermatology Patch testing Otolaryngology Rhinoscopy and nasal mucosal biopsy Ophthalmology Allergic + infective conjunctivitis, diagnosis of the painful red eye Renal medicine Vasculitis, glomerulonephritis, transplantation Rheumatology Arthritides, autoimmune inflammatory disorders, vasculitis Haematology Leukaemia, lymphoma, immunosuppression, bmt, plasmapheresis Blood transfusion Transfusion medicine, Histocompatibility testing Histopathology Renal, skin and lymph node biopsy pathology 4
  • 5. Infectious Diseases Management of HIV infection, other infectious diseases Oncology Immunological approaches to treatment of cancer Paediatrics Eczema, food allergy, other paediatric immunological disorders Paediatric immunology Specialist training in a paediatric immunodeficiency centre Research The last UK government Research Assessment Exercise awarded the department the highest possible rating (5*) and acknowledged the high calibre of the department’s research output. The academic arm of the department has grown considerably in recent years, with the active recruitment of high profile research groups to complement the Department’s previous work. The Academic Department is now accommodated in two buildings on the site - the Tenovus Building and the Henry Wellcome Building. We occupy two floors of the Henry Wellcome Building, opened in 2001 as a result of a >£11m investment from the Joint Infrastructure Fund, and two floors of the recently refurbished Tenovus Building. These new and improved laboratories and adjacent core facilities (flow cytometry, fluorescence microscopy, microarray, proteomics, surface plasmon resonance, mass spectrometry etc.) have greatly enhanced the research infrastructure within the Department. Much of the recent expansion has been in immunology; however, the historical strengths in Biochemistry and Cell Biology remain and will continue to be an important part of the Department. Departmental Groups are major players in the Infection, Immunity and Inflammation Interdisciplinary Research Group (i3 IRG) and also contribute to the IRGs in Cancer Biology, Cardiology and Neurosciences and Mental Health. Translational research is strongly encouraged and the recent opening of a purpose-built Clinical Research facility will help us to move our research from the bench to the bedside. Research is central to the practice of Immunology and will be strongly encouraged in this post. Encouragement will be given to undertake research projects and to develop special interests that can be taken on to the permanent post eventually attained. The Immunology Department’s research interests include the use of flow cytometry and microarray techniques and there are very close links with the academic side of the Department. Ongoing research in the Immunology Department aims to discover new knowledge for academic reasons and to develop novel assays of clinical significance – major interests include the use of microarrays in the diagnosis of PID and Allergy, basophil function, flow cytometry and complement disorders. There are regular in-house research meetings and attendance at these is encouraged. In addition to the above, many collaborative projects are ongoing with research groups of international repute on-site with interests in most aspects of Immunology. Support will be given to individuals who may wish to perform research leading to a MD, DM or PhD degree which would require time beyond the 5-year remit of the post for its completion. Every encouragement would be given to the interested trainee to make contacts with scientists in the academic side of the Department so as to arrange an appropriate research project and to obtain the necessary funding. Teaching The lead role in the teaching of clinical immunology in the medical school is taken by the Consultant Clinical Immunologists, and some assistance in the teaching of undergraduate medical and other students may be expected after a suitable period in post. 5
  • 6. On-call There are no formal ‘on-call’ duties other than normally to be available to answer queries and give advice from 9am to 5pm on weekdays. The post holder will be required to work flexibly to allow for clinics to be completed and from time-to-time the appointee may be expected to answer out-of-hours clinical problems and queries. General training The trainee will be encouraged, where practicable, to take part in the day to day running of the Immunology service and will deal with various administrative aspects relating to immunology reports on individual patients. Participation in clinical audit will be essential, and suitable projects will be identified. Training will be given in health and safety awareness, information technology and technical aspects of laboratory practice. The Postgraduate Department will organise "generic" training in management, medical education, clinical effectiveness and ethical issues. Progress will be monitored through the use of logbooks, records of in training assessment (RITAs), informal review meetings and formal annual reviews with the Regional Specialty Adviser. Conditions of Service The post is covered by the Terms and Conditions of Service for Hospital and Dental Staff (England and Wales) and the General Whitley Council Terms and Conditions of Service as amended from time to time. It will be possible for a post holder to apply for part time training if he/she so desires by application to the Postgraduate Dean. The appointment is designated non-resident and is available from 1st August 2008. Short-listed applicants are invited to telephone Dr S Jolles on 02920-74-5814 or Dr PE Williams on 02920-74-8358. 6

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