Job Description for Renal Component-CMT Training, City Hospital
Campus. Nottingham University Hospital
Summary of Learning Objectives
1. To gain an appreciation of a wide range of renal conditions that are
managed in secondary care
2. To gain experience in the assessment and management of patients with
acute renal failure, including the indications for dialysis
3. To gain experience of the management of patients with chronic kidney
4. To gain experience in the management of patients requiring renal
replacement therapy (including haemodialysis, peritoneal dialysis and
5. To gain experience in the end of life care of patients with kidney failure.
6. To gain experience in the assessment of fluid balance in patients with
7. To gain an understanding of prescribing for patients with impaired renal
8. To gain experience in the insertion of temporary jugular and femoral
dialysis catheters and the use of ultrasound localisation for these
The Renal and Transplant Unit
Trainees working in the Renal and Transplant Unit will see the full spectrum of
renal diseases, including renal transplantation. There are full diagnostic
facilities including access to diagnostic and interventional radiology support
and histopathology. Apart from medical staff there are Nurse Specialists in
anaemia management, peritoneal dialysis, transplantation and pre-dialysis
care. In-patient work is based on Carrel and Bramley wards. There are 4
general nephrology clinics, 3 modality clinics (transplant, haemodialysis and
peritoneal dialysis) and a new patient clinic weekly, as well as a number of
Dr C.E. Bebb (lead consultant for haemodialysis)
Dr R.P. Burden (lead consultant for peritoneal dialysis)
Dr M.J.D. Cassidy (transplantation) – part-time until Summer 2007
Dr S.D. Roe (lead consultant for haemodialysis – Kings Mill Hospital)
Dr C. Byrne (transplantation)
Locum Consultant Position (pending substantive appointment)
The Renal and Transplant Unit inpatients are spilt between 2 firms. Dr Roe
and Dr Burden are responsible for one firm and Dr Bebb and Dr Byrne the
other. The consultants rotate on and off the inpatient service, so that at any
one time only one consultant is in charge of each team.
Medical Consultant cover for the in-patient transplant service is provided on a
monthly rota basis.
4 SHOs are allocated to the Renal and Transplant Unit. SHO’s are divided
between the two teams. There is one Specialist Registrar covering each in-
In addition there are 3 other specialist registrars covering the dialysis unit,
peritoneal dialysis unit and transplantation.
Most of the units inpatients are on Bramley and Carrel wards. There are close
links with the diabetes teams at the City hospital campus and joint patients
are often cared for on Patience 1 and 2 wards.
One SHO is invited to attend the weekly new-patient clinic held on a
Wednesday afternoon. This is an educational requirement. All new cases
should be presented to the consultant in charge of the clinic to determine
management and further follow up plans.
For SHO’s that are interested there are opportunities to sit in on modality
clinics (haemodialysis, transplant and peritoneal dialysis) on an ad hoc basis
providing service commitments allow.
There is a weekly teaching programme led by the Consultant staff. There is a
weekly x-ray meeting, fortnightly renal biopsy meeting and a regular
programme of clinical audit meetings.
The Department has a comprehensive handbook for the management of
patients with renal disease. SHO’s attend a renal induction morning at the
start of their attachment.
AM Lunchtime PM
Handover meeting Ward work
Tuesday Consultant Ward Postgraduate Core curriculum
Round Meeting teaching
Wednesday Teaching X-Ray Meeting New patient clinic
SHO ward round
Thursday Registrar Ward Renal biopsy / Ward work
Round Clinical audit
Friday Consultant Ward Renal Unit Grand Ward work
Achievement of Learning Objectives
To gain an understanding of the wide range of renal conditions that are
managed in secondary care. Attendance at the Wednesday afternoon new
patient clinic, together with inpatient based work on the renal wards will
expose the trainee to the variety of renal conditions. These would include
nephrotic syndrome, acute renal failure, vasculitis and glomerulonephritis.
Trainees will gain skills in the interpretation of electrolytes and arterial blood
gases as well as diagnostic investigations relevant to renal medicine.
To gain experience in the assessment and management of patients with
acute renal failure, including the indications for dialysis. Trainees will be
involved in the initial assessment and subsequent management of patients
presenting with acute renal failure (including transfers from other hospitals).
This will involve exposure to patients requiring acute haemodialysis and other
extra-corporeal therapies, including plasma exchange. The SHO teaching
programme includes sections on acute renal failure and the indications for
To gain experience of the management of patients with chronic kidney
disease. Patients with chronic kidney disease are frequently admitted for
investigation and management. The trainee will be involved in the admission
of patients for renal biopsy and will have the opportunity to watch renal
To gain experience in the management of patients requiring renal
replacement therapy (including haemodialysis, peritoneal dialysis and renal
transplantation). The trainee will be involved in the assessment and
management of in-patients treated with haemodialysis, peritoneal dialysis and
transplantation. As well as a variety of general medical problems this will
involve experience of vascular access problems, complications of peritoneal
dialysis and exposure to patients undergoing renal transplantation (both
deceased and live donor). The trainee will also be involved in the care of
patients attending the out-patient dialysis unit. Unit based teaching around
renal replacement therapies will be provided by the senior medical staff and
To gain experience in the end of life care of patients with kidney failure.
End of life care is covered in the trainee induction programme. The unit also
has a dedicated palliative care nurse practitioner. The trainee will gain
experience of looking after renal patients at the end of life, including the use of
end of life care pathways.
To gain experience in the assessment of fluid balance in patients with renal
failure. Fluid balance assessments are a vital part of the management of
patients with both acute and chronic renal failure. Trainees will have ample
opportunity to develop their clinical skills in fluid balance assessment
throughout the attachment.
To gain an understanding of prescribing for patients with impaired renal
function. The unit has a renal specialist pharmacist. Drug dosing in renal
failure and common prescribing errors will be covered in teaching sessions by
the pharmacist. The pharmacist is available on a daily basis on the in-patient
wards and will discuss prescribing decisions with the trainee.
To gain experience in the insertion of temporary jugular and femoral dialysis
catheters and the use of ultrasound localisation for these procedures. There
will be opportunities for trainees to develop their skills in the insertion of
jugular and femoral lines for dialysis. Elective lines are placed under
ultrasound guidance and trainees will be taught this technique in addition to
the standard landmark based techniques.
Other Learning Opportunities
There will be opportunities for trainees to be involved in the management of
patients with renal failure in a critical care setting. Trainees can attend the
renal histology meetings if they wish. There is a regular audit programme
(including quarterly mortality and morbidity meetings).
This post forms part of the CMT training program for the Mid-Trent
Deanery This job description supplements that of the CMT training
program and describes the training opportunities offered by this post.