08 FYi • Career


CARING T


LIFELONG


A career in nephrology off ers great variety and a chance to build long-term patient care relationships


HE UK’s aging population presents many healthcare challenges, one of which is an increase in the number of people with kidney disease. This rise has seen continued expansion in the


specialty of renal medicine where doctors provide care across a wide range of clinical need, from acutely ill patients to those with chronic conditions. It is this opportunity to provide long-term


treatment that holds much appeal for specialists in the fi eld who often care for patients over many years, allowing a partnership to develop between the patient and the renal multidisciplinary team. There is great variety in the medical


conditions that nephrologists treat, from diabetes to scleroderma, and amyloidosis to liver failure. Nephrologists are also increasingly sub-specialising in areas such as transplantation, while academic nephrology provides many opportunities to drive new research and improve patient care in renal medicine, dialysis and transplantation.


Entry and training Doctors who have completed foundation training can enter renal medicine via core training (usually two years), choosing either core medical training (CMT) or acute care common stem in acute medicine (ACCS-AM). This is followed by higher


specialty training for at least three more years. The specialty training curriculum for renal


medicine from the Joint Royal Colleges of Physicians Training Board (JRCPTB) details what is required to achieve a certifi cate of completion of training (CCT). (This includes payment to enrol with JRCPTB.) The JRCPTB describes core training as


providing physicians with: the ability to investigate, treat and diagnose patients with acute and chronic medical symptoms; and high quality review skills for managing inpatients and outpatients. Higher specialty training builds on these core skills to develop the specifi c competencies required to practise independently as a consultant in renal medicine. Renal medicine has primary responsibility for the management of patients with kidney disease and specialists treat:


• disorders that primarily or solely aff ect the kidneys (such as some forms of glomerulonephritis)


• disorders that aff ect the kidney as part of a multi-system disease (such as diabetic nephropathy)


• disorders that are linked to changes or abnormalities in renal physiology (such as acid-base disturbances).


The curriculum requires competency in two main procedures - renal biopsy under ultrasound guidance (though this is not essential for CCT and trainees can opt not to gain this competency) and the insertion of temporary vascular access for haemodialysis, which is essential for CCT. Some nephrologists also become competent in the insertion of tunnelled catheters for haemodialysis vascular access and in the insertion of peritoneal dialysis catheters. For a renal physician to participate in the


acute medical take and to be responsible for the care of unselected, acutely ill general medical patients as a senior medical appointment, the JRCPTB requires dual CCTs in renal medicine and general internal medicine (GIM). It is also possible to dual accredit with other related specialties such as intensive care medicine. Dual accreditation means specialty training will usually be extended to seven years.


The job The job of a nephrologist is both varied and challenging. Most work in renal units based in district general hospitals or in university teaching hospitals, where renal transplantation most commonly takes place. Many renal units also provide care in satellite haemodialysis units, either in other hospitals, independent treatment centres or in community-based facilities. Nephrologists who manage


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