The Nephrology Senior Registrar (later Specialist Registrar) Club

 The Beginning

The Nephrology Senior Registrar (SR) Club held its first meeting in 1988, and has been active ever since, changing its name to the Specialist Registrar (SpR) Club in 1996 when training grades were reorganised.

From 1986 some nephrology senior registrars began to talk about the need for opportunities for them to meet together as a group.  Among the ringleaders involved in these discussions were (alphabetically) John Feehally (Leicester), Chris Kingswood (3Ps), Caroline Savage (Hammersmith), Colin Short (Manchester), and  Mike Venning (Manchester).

Why did they think such a forum was needed? The first generation of nephrologists had been a small and tight-knit group. They had supported each other, and gained from the close camaraderie of setting out together in a new and pioneering specialty. There only a  few SRs at any one time, they were widely known, and  consultants would be well aware who were the prospective candidates if they had an opportunity to appoint another  consultant in their unit. In the 1980s Renal Association (RA) meetings still typically had a fewer than one hundred attendees. The meetings held at the Institute of Child Health in London, they were intellectually rigorous – questioning was demanding. At the  end of formal proceedings, the meeting would continue round the corner at  The Lamb in Conduit Street filling the bar and spilling onto the pavement.  Everyone knew everyone, the atmosphere was convivial, supportive and energetic. Ideas were tossed around, research collaborations were sketched out on beer mats; it was fun to be part of it.

But things were changing. The (welcome) increase in the size of the renal medical workforce meant that it could no longer be assumed that everyone knew everyone. Inevitably RA meetings were getting larger and busier, there was less chance of meeting the right people, less chance of SRs to have time together time to discuss things that mattered to them.

In that context the SR Club was conceived with several purposes:

Joining the renal community

SRs were conscious of the excellent community they were joining, that they represented the ‘future of the specialty’ and that there was real merit in ensuring that they knew each other well, to help  maintain and grow that community. The specialty would grow numerically, and that was of course welcome. But with that growth the original  coherence and camaraderie would be harder to sustain, and this would be made easier if the SRs got to know each other properly, with time  to meet, to  talk, to listen, and to encourage each other.

 Education

The one educational opportunity was the regular RA meeting, the RA Advanced Nephrology Course was not yet established.  RA meetings were research-focused, with an intellectual rigour which made asking a question for many an intimidating prospect. Many SRs were wanting more talks with less esoterica and a stronger clinical focus – in an environment where questioning was comfortable and welcome.

 Job prospects

Nephrology at that time was a very competitive specialty. Despite the evident need to increase the workforce with the growing prevalence of treated RRT in the country, there were only three or four consultant jobs being advertised each year with about a dozen eligible SRs.  The workforce pyramid was steeper than in many other specialties; the notion of ‘workforce planning’ seemed remote.  While the SRs had no obvious levers to change their circumstances, they wanted the opportunity to get together and discuss their concerns.

 Was the SR Club really needed?

Among the early founders there was much enthusiasm to found a ‘club’. No one recalls exactly who had the idea first, but it was almost certainly first discussed in the bar of the Lamb. I was one of the founders and I mentioned the plan to the consultant who was training me, John Walls.  I received the crisp response that not only was such a club unnecessary it would do the careers of the perpetrators no good, since the club would just be viewed as a group of malcontent juniors bemoaning the lack of consultant jobs, and could be taken to imply that the existing consultants were not trying to help (which was of course not the intention). His advice was duly ignored.

  The first meeting

To test the waters a first meeting was planned, which took place at Wadham College, Oxford in March 1988 with 35 enthusiastic attendees (the majority of eligible SRs attended). The nascent Club had no financial resources or organisational structure, but happily Bayer stepped in (their active interest in nephrology was at that time based the high profile of their calcium channel blocker, nifedipine). Bayer covered the costs of that first meeting including venue hire, speaker costs, dinner and bar bill.

The full programme is no longer to be found, but speakers included a meld of senior registrars and consultants of all seniorities. Some of the talks were:

• What cause acute renal failure?               Peter Ratcliffe[1] (Oxford)
• What causes hypertension?               Tony Heagerty (Leicester)
• What causes cyclosporin nephrotoxicity? Guy Neild (Middlesex Hospital, London)
• Experimental glomerular disease Steve Holdsworth (Melbourne[2])
• The nuts and bolts of dialysis               David Kerr (Royal Postgraduate Medical School)

The meeting was deemed  a success – the quality of the speakers being well matched by the congenial environment of an Oxford college, and by the open-ended bar bill Bayer was prepared to fund. Camaraderie was evident, opportunities to share and exchange were welcome. The original goals were met then,  and have continued to be met since.

 Later developments

Since 1988 the Club has continued, flourished and changed. A committee has been developed consisting of a representative from each training area in the UK, and 4 executive committee roles.  Twice yearly meetings soon became the norm. A range of corporate sponsors have over the years ensured financial viability and successful meetings.  Meetings currently rotate across different regions of the UK, to ease travel burden and allow trainees to visit new areas, and are organised by a local representative on the SpR club committee.  Meetings moved over to a virtual format from 2020 to 2022 in light of the COVID pandemic but have returned to face-to-face from 2023 with favourable feedback from attendees.

Early on there was some discussion about making membership also open to ‘young’ consultants; thus enabling the founders to keep their membership for a bit longer. This was rightly rejected; there would be a genuine risk that a competitor to the Renal Association would be established if the group of friends who originated the SR Club continued to meet. So membership automatically lapsed when consultant status was achieved. The author for example  started his consultant job just a few weeks after that first SR Club meeting in Wadham, and therefore was no longer a member of the Club, not attending its meetings again until invited  several years later to share his experience of the transition to being a consultant in a talk entitled ‘Crossing the Rubicon’.

From time to time the success and independence of the SR Club has provoked discussions.  SRs (and later SpRs)  were automatically Club members and a high percentage attended meetings. But the RA Executive Committee realised that  a diminishing proportion of them were became RA members either as SpRs or later as consultants.  This was an unfortunate development – one of the RA’s strengths having been its representative influence because of the high proportion of the nephrologists in the country who were members. Closer links were therefore forged between the SpR Club and RA with an SpR Club representative becoming a statutory member of the RA (and recently the UKKA) Executive Committee.  Members of the SpR club currently sit on several of the UKKA subcommittees and assist with the organisation of the annual UK Kidney Week conference, where several sessions are developed specifically for and by trainees.

More recently the SpR club has also sought to promote renal medicine as a career to foundation and internal medicine doctors, developing a junior form of the group titled the ‘Renal Starter Club’ in 2022.  This encompasses a renal taster day and crash course event and distributes an email newsletter on upcoming opportunities to around 140 interested trainees in the UK.  Discussions are currently being had around where new groups within the medical workforce, such as Physician Associates, will sit within the structure of the Renal Starter Club or SpR Club.

 Is the SpR Club successful?

It is very difficult to make objective measurements of the benefits of the SpR Club,  but the sustained strong support from SpRs  and persistently good attendance at meetings over the years leave little doubt that it has  continued to have real value ever since its foundation.  The current leadership (in 2023) hopes to share its experience of  running the SpR club with trainees internationally who may wish to develop a similar group, and are assisting with the development of a young nephrologists toolkit in collaboration with the ISN.

 

John Feehally

December 2023

[1] Ratcliffe, now well known as a Nobel laureate for his work on oxygen sensing, had in 1988 recently completed a thesis (supervised by George Radda in Oxford) applying NMR-spectroscopy to the metabolic signals in acute renal injury.

[2] Holdsworth was at the time on sabbatical in London

Last Updated on January 9, 2024 by John Feehally