TRONCALIDAD”: TRONCO DE LABORATORIO Y … ALEGACIONES RD... · Le adjunto un dossier que incluye...

Madrid 08.08.2011 D. Juan Antonio López-Blanco Subdirector General de Ordenación Profesional Ministerio de Sanidad Política Social e Igualdad Estimado Subdirector General, Habiéndose iniciado el periodo de presentación de Alegaciones al Real Decreto de Troncalidad le adjunto el dossier de Alegaciones elaborado por la Comisión Nacional de Inmunología en relación con el Tronco de Laboratorio y Diagnóstico Clínico: Programa Troncal Especialidad de Inmunología. Este documento tiene el consenso de las Sociedades Españolas de Inmunología (Sociedad Española de Inmunología-SEI, Sociedad de Inmunología de la Comunidad de Madrid-SICAM y Sociedad Catalana de Inmunología). A la espera de su atención y resolución sobre este tema importante para la Especialidad de Inmunología y para el Tronco de Laboratorio y Diagnóstico Clínico. Le saluda atentamente

Eduardo Fernández-Cruz Presidente de la Comisión Nacional

D. JUAN ANTONIO LOPEZ BLANCO SUBDIRECTOR GENERAL DE ORDENACION PROFESIONAL MINISTERIO DE SANIDAD, POLÍTICA SOCIAL E IGUALDAD

Madrid, a 4 de Agosto de 2011.

Estimado Subdirector General de Ordenación Profesional

Le adjunto un dossier que incluye las Alegaciones en relación con el Proyecto de Real Decreto Troncalidad y, de forma específica, con el Tronco de Laboratorio y Diagnóstico Clínico y el Programa Troncal de la Especialidad de Inmunología.

Según me indicó en la última reunión mantenida el 6 de Junio de 2011 en la Subdirección General de Ordenación Profesional del Ministerio de Sanidad, Política Social e Igualdad se aporta el documento de Alegaciones con la justificación documentada de la necesidad de la implantación de un itinerario formativo medico en el programa troncal para la especialidad de Inmunología, así como la justificación de la modificación del TRONCO DE LABORATORIO Y DIAGNOSTICO CLINICO Este documento de Alegaciones incluye la siguiente información en cinco ANEXOS: 1) Programa formativo vigente de la Especialidad, donde consta un itinerario formativo medico y otro de laboratorio diferenciados para la Especialidad de Inmunología (ANEXO I); 2) Definición de las competencias Médicas de la Especialidad de Inmunología (ANEXO II); 3) Recopilación actualizada de la actividad médica de esta Especialidad, en la práctica habitual en las Unidades Docentes acreditadas en España (ANEXO III); 4) Cartas de Expertos internacionales y de los Presidentes de las principales Sociedades Europeas de Inmunología (Alemania, Inglaterra, Italia) apoyando la implantación en España de un programa formativo en Inmunología Clínica con las características que se especifican en el dossier (ANEXO IV); y 5) documentación sobre la actividad de la Inmunología Médica en el entorno Europeo (programas formativos de Inglaterra, Alemania e Italia) como elemento de referencia (ANEXO V).

Como expresé en la reunión mencionada de la Subdirección General para el desarrollo de la Troncalidad es básico contar con el consenso profesional representado por la Comisión Nacional y las Sociedades Científicas (SEI), por lo que en este escrito de Alegaciones se Solicita:

Que la formación troncal para la Especialidad de Inmunología pueda tener dos programa formativos diferenciados: uno que contemple la formación médica para los MIR, que les capacite fundamentalmente en el manejo clínico y terapéutico de los enfermos con patologías inmunológicas, y cuyo itinerario estaría vinculado principalmente al tronco médico (durante el periodo troncal); y otro programa formativo para el especialista inmunólogo multidisciplinar de diferentes licenciaturas (Biólogo, Bioquímico y Farmacéutico) que garantice la adquisición de competencias transversales genéricas, comunes y específicas del laboratorio especializado de inmunología, y cuyo itinerario estaría vinculado al tronco de laboratorio de diagnóstico clínico (siempre que se modifique el Tronco de Laboratorio y Diagnóstico Clínico del Anteproyecto respecto a lo mencionado anteriormente).

En espera de su pronta atención a estas Alegaciones para que tras el trámite de audiencia pública puedan ser incorporadas al Proyecto Real Decreto de Troncalidad, Le saluda atentamente Eduardo Fernández-Cruz Presidente de la Comisión Nacional de Inmunología

ALEGACIONES AL PROYECTO “REAL DECRETO DE

TRONCALIDAD”: TRONCO DE LABORATORIO Y

DIAGNOSTICO CLINICO-PROGRAMA TRONCAL DE LA

ESPECIALIDAD DE INMUNOLOGÍA.

COMISION NACIONAL DE LA ESPECIALIDAD DE INMUNOLOGIA (CNI) Presidente: Dr Eduardo Fernández-Cruz 4 de Agosto de 2011

ALEGACIONES AL PROYECTO “REAL DECRETO DE TRONCALIDAD”: TRONCO DE LABORATORIO Y DIAGNOSTICO CLINICO- PROGRAMA TRONCAL DE LA ESPECIALIDAD DE INMUNOLOGÍA. Índice: 1.- Documento Alegaciones al Proyecto “Real Decreto Troncalidad”: Tronco de Laboratorio y Diagnostico Clinico-Programa Troncal de la Especialidad de Inmunología. 2.- Anexos:

• Anexo I.- Guía de Formación de Especialistas de Inmunología actualmente vigente.

• Anexo II.- Definición de las competencias transversales del Inmunólogo Médico.

• Anexo III.- Actividad Asistencial Médica y de Laboratorio de la especialidad de Inmunología en las Unidades Docentes acreditadas en España:

o Anexo III.1: Actividad Asistencial en Inmunología Clínica de las Unidades Docentes Acreditadas de la Especialidad de Inmunología en los Hospitales del SNS del Estado Español.

o Anexo III.2: Cartera de Servicios de Laboratorio Diagnóstico de Inmunología Consensuada por las Unidades Docentes de Inmunología acreditadas en la Comunidad de Madrid.

o Anexo III.3: Cartera de Servicios de Inmunología Clínica del Hospital General Universitario Gregorio Marañón (HGUGM).

o Anexo III.4: Referencia a la WEBSITE del Registro de Inmunodeficiencias Primarias de España (REDIP).

• Anexo IV.- Cartas de expertos internacionales apoyando la implantación en España de un programa formativo en Inmunología Clínica.

• Anexo V.- Programas Formativos Europeos en Inmunología Clínica y de Laboratorio Diagnóstico

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DOSSIER ALEGACIONES AL PROYECTO REAL DECRETO DE TRONCALIDAD:

PROGRAMA TRONCAL DE LA ESPECIALIDAD DE INMUNOLOGIA

A.- JUSTIFICACIÓN DOCUMENTADA DE LA NECESIDAD DE IMPLANTACIÓN DE UN ITINERARIO FORMATIVO EN EL TRONCO MEDICO EN EL PROGRAMA TRONCAL PARA LA ESPECIALIDAD DE INMUNOLOGÍA

En la última reunión mantenida el 6 de Junio de 2011 en la Subdirección General de Ordenación Profesional del Ministerio de Sanidad, Política Social e Igualdad como Presidente de la Comisión Nacional de Inmunología (CNI) expresé, una vez más, la preocupación de la CNI y de los inmunólogos españoles con respecto a la integración de la Especialidad de Inmunología en el Tronco específico de Laboratorio y Diagnóstico Clínico, según aparece en el Anteproyecto de Troncalidad. La razón principal de nuestra no conformidad es que la estructura de dicho tronco no se adecua a las necesidades formativas que exige el perfil amplio actual del especialista en Inmunología, obviando fundamentalmente el marcado componente clínico de esta especialidad.

La Comisión Nacional de Inmunología ya ha expresado oficialmente su opinión sobre este asunto como consta en: el escrito de Alegaciones incluido como Anexo al Acta de 16 de Marzo de 2010; el Pleno del Consejo Nacional del 7 de Julio del 2010; la reunión del 27.09.2010 en la Subdirección General de Ordenación Profesional (en esta visita entregué una carta oficial de la Presidenta de la Sociedad Española de Inmunología); el escrito presentado por registro el 17.10.2010; y posteriormente en la última reunión del Pleno del Consejo Nacional el 20.07.2011, durante la cual solicité la rectificación del planteamiento del Tronco de Laboratorio y Diagnóstico Clínico en relación con la especialidad de Inmunología, anticipando, a su vez, que presentaríamos un escrito de alegaciones al respecto.

En la mencionada reunión del 6 de Junio de 2011 en la Subdirección General con D. Juan Antonio López Blanco, esencialmente revisamos la problemática que plantea el hecho de que la especialidad de Inmunología tiene dos vertientes o ramas, una de diagnóstico clínico de laboratorio y la otra médica asistencial. Esta circunstancia, ocurre también en algunas otras especialidades con componente de laboratorio, entre las que se encuentra la Hematología. En nuestra especialidad, el manejo clínico del paciente se realiza por el especialista (inmunólogo médico), el cual solicita pruebas específicas al laboratorio especializado de diagnóstico clínico, que se realizan por el especialista de laboratorio (inmunólogo multidisciplinar). Ambos aspectos, médico-asistencial y de laboratorio diagnóstico, se recogen en la Guía de Formación de especialistas de Inmunología actualmente vigente (Anexo I).

En la reunión con el Subdirector General se evidenció que había un acuerdo respecto a que para el desarrollo de la Troncalidad es básico contar con el consenso profesional, por lo que planteamos la posibilidad de que la formación troncal para la Especialidad de Inmunología pueda tener dos programa formativos diferenciados: uno que contemple la formación médica para los MIR, que les capacite fundamentalmente en el manejo clínico y terapéutico de los enfermos con patologías inmunológicas, y cuyo itinerario estaría vinculado principalmente al tronco médico (durante el periodo troncal); y otro programa formativo para el especialista inmunólogo multidisciplinar de diferentes licenciaturas (Biólogo, Bioquímico y Farmacéutico) que garantice la adquisición de competencias transversales genéricas, comunes y específicas del laboratorio especializado de inmunología, y cuyo itinerario estaría vinculado al tronco de laboratorio de diagnóstico clínico (siempre que se modifique el Tronco de Laboratorio y Diagnóstico Clínico del Anteproyecto respecto a lo mencionado anteriormente y a lo que se explicita sobre dicho tronco en el apartado B de este documento).

Para la posibilidad de desarrollar el planteamiento anteriormente mencionado el Subdirector General nos solicitó a la CN la preparación de un dossier que incluyese

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la siguiente información: 1) Definir las competencias Médicas de la Especialidad de Inmunología; 2) Recoger la actividad médica de esta Especialidad, en el programa formativo y en la práctica habitual en las Unidades Docentes acreditadas en España; y 3) Recoger la actividad de la Inmunología Médica en el entorno Europeo (programas formativos) como elemento de referencia y aportar cartas de expertos internacionales apoyando la implantación en España de un programa formativo con las características anteriormente mencionadas. A.1 PRUEBAS DOCUMENTALES QUE JUSTIFICAN LA NECESIDAD DE LA IMPLANTACIÓN DE UN ITINERARIO FORMATIVO MEDICO EN EL PROGRAMA TRONCAL PARA LA ESPECIALIDAD DE INMUNOLOGÍA ANEXO I. Guía de Formación de Especialistas de Inmunología actualmente vigente (BOE

Núm 252, 21 Octubre 2006, Orden SCO/3255/2006). Ver ANEXO Programa Oficial de la Especialidad de Inmunología apartados: 4.2.2; 5.1; 5.3; 6.1; 6.2; 6.3; 6.6.2 y 8 (Inmunología Clínica) ANEXO II. Definición de las competencias transversales del inmunólogo médico.

Se propone la formación de un profesional Médico (MIR) especialista en Inmunología que pueda adquirir las competencias transversales médicas, compatibles con el conjunto de especialidades afines adscritas en el tronco Médico, así como las competencias específicas relativas al tronco de Laboratorio y Diagnóstico Clínico- Inmunología. Ver ANEXOS II.1, II.2, y II.3.

ANEXO III. Actividad Asistencial Médica y de Laboratorio de la especialidad de Inmunología en las Unidades Docentes acreditadas en España.

La actividad Clínica en Inmunología es una realidad emergente por su continuo progreso aunque ya consolidada y con amplia implantación en el SNS en nuestro país. Trece de las 26 Unidades Docentes desarrollan este tipo de actividad clínica (el 80% de las 5 nuevas unidades docentes tienen una unidad clínica especializada, por lo que ratifica que es un proceso en constante expansión). Ello obedece al enorme avance en el conocimiento de la inmunopatogenia de muchas enfermedades de diversos órganos y sistemas, y en la expansión del manejo de las terapias biológicas y tratamientos inmunológicos.

Anexo III.1: Actividad Asistencial en Inmunología Clínica de las Unidades Docentes Acreditadas de la Especialidad de Inmunología en los Hospitales del SNS del Estado Español.

Anexos III.2, III.3: Incluyen la Cartera de Servicios Clínica de Inmunología (SICAR) oficial de la Comunidad de Madrid adscrita al Hospital General Universitario Gregorio marañón (HGUGM) y las Carteras de Servicios de las pruebas de Diagnóstico Clínico Inmunológico de los laboratorios de Inmunología existentes en las Unidades de Inmunología docentes acreditadas (Cartera de Servicios de Laboratorio Diagnóstico consensuada por los 8 Hospitales de la Comunidad de Madrid y registrada en la Consejería de Sanidad).

Anexo III.4: WEBSITE del Registro de Inmunodeficiencias Primarias de España (REDIP): web.hsd.es/redip/

Esta WEBSITE está gestionada por Inmunólogos en colaboración con la Sociedad Española de Inmunología, y está vinculada al Servicio de Inmunología del Hospital Universitario de Son Espases (Son Dureta) de Palma de Mallorca, bajo la supervisión de la Dra. Nuria Matamoros. El Registro REDIP incluye todos los casos españoles de Inmunodeficiencias Primarias acreditados de acuerdo a los criterios internacionales vigentes, y son aportados, en su mayoría, por Inmunólogos Clínicos integrados en

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Unidades Clínicas de Inmunología que son responsables directos del diagnóstico y manejo de estos procesos patológicos.

ANEXO IV.- Cartas de expertos Europeos de Inglaterra, Alemania e Italia apoyando la implantación en España de un Programa Formativo de Inmunología Clínica.

La actividad Médica y de Laboratorio de la especialidad de Inmunología está implantada en la gran mayoría de Hospitales europeos e internacionales de tercer nivel desde hace más de una década. La utilidad demostrada de la actividad clínica en los centros médicos se basa en la implantación, desde hace años, en esos países de programas formativos específicos como el que solicitamos se debiera implantar en España. Adjuntamos las cartas recibidas de líderes Europeos de la Inmunología Clínica de Inglaterra, Alemania e Italia, del Presidente de la Unión internacional de las Sociedades Inmunológicas y de los Presidentes de las Sociedades de Inmunología de Alemania e Italia (estamos pendientes de la recepción de los documentos de varios líderes profesionales de Francia).

A continuación se significan los aspectos más importantes contenidos en las cartas de apoyo remitidas por los expertos internacionales:

IV.1.-Professor Helen Chapel Oxford Centre for Clinical Immunology A FOCIS designated centre of excellence PiA UK Centre of Excellence Clinical Immunology Unit Nuffield Department of Medicine John Radcliffe Hospital Campus University of Oxford “I would like to express my strong support for the developing of a specific Training Programme in “Clinical Immunology” in Spain, along the lines of those in other European countries” “In the UK, it has been mandatory for the training of medical residents to become consultants in Clinical Immunology in the future”.

“Clinical Immunology has evolved over the past three decades from a predominant laboratory based specialty to a clinical section of medicine…. In addition, Consultant Immunologists remain responsible for directing diagnostic immunology services in terms of clinical usefulness”.

“As you know, Clinical Immunology is widely established in different European countries ….. I understand that the UK training programme has been accepted as a model for Europe by UEMS”.

“…is highly desirable that Spain rapidly develops a similar programme, not least so that the new medical interventions in immunology (including monoclonal antibodies and cytokine therapies) can be used appropriately for relevant patients with immunological disease in a cost effective manner”.

IV.2 Professor Dieter Kabelitz President, German Society for Immunology Institute of Immunology UKS-H Campus Kiel D-Kiel. Germany

“.....As the President of the German Society for Immunology (DGFI) I would like to express our strong support for your plans to establish a specific Training Program for Clinical Immunology in Spain.”

“The immune system is increasingly targeted by modern and innovative therapeutic strategies. Therefore, a thorough understanding of basic and clinical aspects of immunology is mandatory for medical residents who aim at a career as consultants in

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clinical immunology.…the DGFI has established a program for certified education and training..”

“….the German Society for Immunology strongly supports your activities to establish a Training Program in Clinical Immunology in Spain.”

IV.3.- Gianpietro Semenzato President. Italian Society of Immunology, Clinical Immunology and Allergy (SIICA) Clinica e Sperimentale “G. Patrassi” Università degli Studi di Padova Padova. Italy “As the President of the Italian Society of Immunology, Clinical Immunology and Allergy, I would like to express our strong support for the developing in Spain of a specific Training Program in “Clinical Immunology”.

“The establishment of this is mandatory for the training of medical residents that will eventually become consultants in Clinical Immunology”.

“…Clinical immunology is a new branch of medicine which is transverse to all sciences and involves diseases of different systems, including the skin, the lung, gastrointestinal ……etc.”

“The possibility to develop a specific Training Program in “Clinical Immunology” in Spain will certainly let young people to face this interesting area of medicine”.

“This speciality is widely represented in different European countries and it is highly desirable that Spain falls into line”.

IV.4.- Prof. Dr. med. R.E. Schmidt

Chairman of the Clinical Immunology Committee of International Union Immunological Societies (IUIS).

Head of Department of Clinical Immunology and Rheumatology Medizinische Hochschule Hannover Hannover. Germany ….The German Society for Immunology has already established a program during the past six years and is providing specialists with the respective certificate ….We also have established training centres for clinical immunology”.

“The establishment of a clinical immunology program should be mandatory for medical residence that will eventually become consultants in clinical immunology”.

IV.5 Dr.G.P.Spickett Head of Regional Immunology Services Regional Department of Medicine, Royal Victoria Infirmary

Consultant & Senior Lecturer in Clinical Immunology

Newcastle upon Tyne. United kingdom.

..” I am writing to express my strong support for the development of a specific postgraduate training programme in Clinical Immunology, to enable junior doctors to train in the speciality and become consultants in Clinical Immunology”.

“Clinical Immunology encompasses both clinical and laboratory dimensions and it is essential that consultant immunologists have indepth training in both aspects”.

“…the Immunology Laboratory has a fundamental role in the diagnosis and management of these diseases. Organ-based specialists require guidance on

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appropriate test selection and results interpretation and this is best carried out by physicians with an understanding of immunological disease”.

“Clinical Immunology is a well-established discipline in the UK and has had a training programme which spans both clinical and laboratory aspects for the last 20 years”.

“In order to ensure harmonisation of postgraduate medical in the European Union, it is essential that Spain has an equivalent training programme”.

IV.6 Professor. Bodo Grimbacher Past Secretary of the European Society for Immunodeficiencies Dept of Immunology and Molecular, Royal Free Hospital, University College Division of infection & immunity London. United Kingdom “….As the Past Secretary of the European Society for Immunodeficiencies (ESID, www.esid.org), and consultant of one of the largest adult primary immune deficiency centres in Europe, I would like to express my strong support for developing a specific training program in Clinical Immunology in Spain”.

“……I have noticed that the care for these patients varies considerably in between European countries. One reason for this is the different training physicians receive, but also the different affiliations and “homes” Clinical Immunology has in the different countries”.

“I therefore strongly support Prof. Fernandez-Cruz’ initiative to overhaul the training program for Clinical Immunology in Spain moving it to a Clinical- and Laboratory-based speciality”.

ANEXO V.- Programas Formativos Europeos en Inmunología Clínica y de Laboratorio Diagnóstico.

Anexos V.1, V.2 y V.3: Incluyen los programas formativos vigentes en el Reino Unido, Italia y Alemania, respectivamente [estamos pendientes de la recepción del programa formativo de Francia que anticipamos es similar].

B) LA ESPECIALIDAD DE INMUNOLOGÍA ANTE EL TRONCO DE LABORATORIO Y DIAGNOSTICO CLINICO

La adscripción de Inmunología dentro del tronco común de Laboratorio y Diagnóstico Clínico que aparece en el borrador de RD es inadecuada en dos aspectos:

1.- No da cabida al natural desarrollo de la actividad clínica directa con pacientes con enfermedades de base inmunológica por especialistas inmunólogos médicos, no existiendo actualmente una vía de formación adecuada para este profesional médico.

2.- La adscripción del laboratorio de Inmunología en el Tronco de Laboratorio y Diagnóstico Clínico, tal como consta en el actual borrador de RD, no asegura que la formación para la competencia y realización de pruebas diagnósticas inmunológicas se pueda hacer con las necesarias garantías técnico-científicas que exige este laboratorio altamente especializado.

En la primera parte de este documento hemos aportado soluciones al aspecto de formación de especialistas inmunólogos médicos (Apartado A), dentro del ordenamiento actual, y respetando sustancialmente el RD.

Con respecto al segundo aspecto que afecta a la formación de los inmunólogos de otras licenciaturas (Biólogos, Bioquímicos y Farmacéuticos) la Sociedad Española de Inmunología (SEI) ha transmitido a esta Comisión Nacional la gran preocupación de este colectivo profesional en relación con este tema, la cual hacemos nuestra por el

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presente escrito. A los efectos de buscar soluciones en relación con la formación del especialista de Inmunología en el ámbito del Laboratorio se quiere significar:

1.- La Especialidad de Inmunología debe contar con especialistas capaces de afrontar con adecuadas garantías científico-técnicas el conjunto de pruebas de laboratorio que posibilitan el establecimiento del diagnóstico, pronóstico y evaluación terapéutica de las enfermedades de base inmunológica.

2.- El anteproyecto del RD propone la creación de un tronco común denominado de Laboratorio y Diagnóstico Clínico en el que se formarían los especialistas que han de realizar las pruebas diagnósticas bioquímicas, microbiológicas, hematológicas, genéticas e inmunológicas. El RD regula la formación polivalente inicial (primeros dos años de tronco común) de los especialistas que se generen, pero dada las características de las especialidades actualmente adscritas al tronco (ninguna de las especialidades adscritas al tronco, Bioquímica y Análisis Clínicos, es una especialidad afín a la Inmunología) se siembran dudas importantes sobre la utilidad de este periodo común, para adquirir, además de las competencias genéricas, las competencias transversales especificas necesarias para que aporten una suficiente formación científico-técnica, relevante y competente para los especialistas inmunólogos.

En el RD los criterios de troncalidad requieren que las especialidades que formen tronco deben de tener competencias transversales (conocimientos, habilidades y actitudes) comunes, deben beneficiarse de estancias formativas comunes y deben compartir áreas en las que el trabajo conjunto mejora la efectividad y eficiencia del sistema. Las especialidades anteriormente mencionadas no comparten competencias transversales con la Inmunología. Además, esta situación ocurre en un contexto de relativa indefinición de las competencias exigibles a los profesionales que asumen actualmente las tareas propias de las especialidades de laboratorio mencionadas anteriormente. En alguna medida esta situación podría paliarse en el caso de profesionales ya incluidos en los laboratorios hospitalarios, cuya actividad no está suficientemente acreditada, gracias a las medidas de Reespecialización Troncal propuestas en el borrador del RD.

3.- Por otra parte, el RD establece que el profesional se forme inicialmente en el tronco de Laboratorio y Diagnóstico Clínico (primeros dos años), para adquirir las competencias polivalentes propias de dicho tronco (competencias troncales) y, posteriormente, desarrollar la formación específica en Inmunología (siguientes 2 años). Sin embargo, este diseño formativo no sería adecuado para profesionales que tras el periodo formativo troncal continúen el desarrollo de formación polivalente durante la fase formativa específica. Es decir, que las fases específicas de formación sólo se desarrollarían para las especialidades de Bioquímica e Inmunología.

El análisis del tronco de laboratorio y Diagnóstico Clínico evidencia que la especialidad de Inmunología carece de una integración adecuada dentro del sistema de distribución troncal de especialidades propuesto en el RD.

C) CONCLUSIONES

Por todo lo dicho anteriormente, la Especialidad de Inmunología se Configuraría en el Anteproyecto de Troncalidad con un doble itinerario:

a) Uno para especialistas médicos, con formación esencial dentro del tronco Médico, para afrontar los crecientes retos clínicos de la especialidad; y b) Otro para especialistas de origen multi-disciplinar (BIR, FIR y BQIR), que afrontarían la actividad de laboratorio de Inmunología, vinculados a un tronco de Laboratorio y Diagnóstico Clínico en el que todos sus profesionales compartan competencias transversales comunes y desarrollen un equivalente y adecuado nivel de formación polivalente y que en el caso del inmunólogo adquiera las competencias especializadas del laboratorio de Inmunología con la suficiente profundidad y especificidad.

ANEXO I. GUÍA DE FORMACIÓN DE ESPECIALISTAS DE INMUNOLOGÍA ACTUALMENTE VIGENTE (BOE Núm 252, 21 Octubre 2006, Orden SCO/3255/2006). Ver ANEXO Programa Oficial de la Especialidad de Inmunología apartados: 4.2.2; 5.1; 5.3; 6.1; 6.2; 6.3; 6.6.2 y 8 (Inmunología Clínica)

36894 Sábado 21 octubre 2006 BOE núm. 252

Conocer los aspectos relativos al Banco de Sangre en el trasplante de progenitores hematopoyéticos y de otros órganos, así como la autotrans-fusión.

Conocer el funcionamiento y manejo de los programas de aféresis (plasma, plaquetas, y células progenitoras) y plasmaféresis.

Conocer el funcionamiento y manejo de los programas de criopreser-vación.

Conocer las indicaciones y la metodología de la exanguinotrans-fusión.

Conocer las técnicas de extracción, aféresis, cultivos, procesamientos y criopreservación de progenitores hematopoyéticos.

Después de cada rotación, el responsable de cada Sección que ha tute-lado la formación y el trabajo realizado por el MIR realizará una valora-ción en las hojas que se adjuntan, estas hojas, una vez cumplimentadas serán entregadas al Tutor.

8.2.2 Actividades científicas:

Realizará diversas presentaciones en sesión clínica en relación con los pacientes hospitalizados.

Participará activamente en las sesiones bibliográficas del Servicio.Participará activamente en sesiones conjuntas programadas con otros

Servicios, en relación con la especialidad (p.e. Radiodiagnóstico, Anato-mía Patológica).

Presentará algunas de las sesiones monográficas programadas en el Servicio.

Presentará un mínimo de 3 comunicaciones a congresos.Habrá participado directamente en la publicación de, al menos, 2 tra-

bajos en revistas que se incluyan en el «Journal of Citation Reports».Colaborará en la docencia de los estudiantes que roten por el

Servicio.Participará en Cursos o Seminarios de Gestión Clínica, Bioética y

Metodología de la investigación clínica-básica.Participará en el desarrollo de ensayos clínicos.

8.2.3 Conocimiento de idiomas:

El conocimiento del inglés científico es una adquisición altamente recomendable en el transcurso de la residencia, por lo que se realizarán escalonadamente las siguientes actividades:

Lectura del inglés científico.Escritura de comunicaciones y trabajos en inglés.Presentaciones orales en inglés en reuniones científicas.

18430 ORDEN SCO/3255/2006, de octubre, por la que se aprueba y publica el programa formativo de la especialidad de Inmunología.

El artículo 21 de la Ley 44/2003, de 21 de noviembre, de ordenación de las profesiones sanitarias, establece el procedimiento para aprobar los programas formativos de las especialidades sanitarias en ciencias de la salud, previendo su publicación en el Boletín Oficial del Estado para general conocimiento.

La Comisión Nacional de la Especialidad de Inmunología ha elaborado el programa formativo de dicha especialidad que ha sido verificado por el Consejo Nacional de Especialidades Médicas, órgano asesor en materia de formación sanitaria especializada al que, de conformidad con lo pre-visto en la disposición transitoria sexta de la Ley 44/2003 antes citada, corresponde ejercer las competencias del todavía no constituido Consejo Nacional de Especialidades en Ciencias de la Salud.

Asimismo, dicho programa formativo ha sido estudiado, analizado e informado por la Comisión de Recursos Humanos del Sistema Nacional de Salud al que se refiere el Real Decreto 182/2004, de 30 de enero, por el que se creó dicho órgano colegiado del que forman parte, entre otros, los consejeros de sanidad de las diversas comunidades autónomas y el Direc-tor General de Universidades del Ministerio de Educación y Ciencia.

En su virtud, de conformidad con lo previsto en el artículo 21 de la Ley 44/2003, previos informes favorables de la Comisión de Recursos Humanos del Sistema Nacional de Salud y del Ministerio de Educación y Ciencia, dispongo:

Primero.–Aprobar el programa formativo de la Especialidad de Inmu-nología, cuyo contenido se publica como anexo a esta Orden.

Segundo.–Dicho programa formativo será de aplicación a los residen-tes de la Especialidad de Inmunología que obtengan plaza en formación en Unidades Docentes de dicha especialidad, a partir de la Orden del Ministerio de Sanidad y Consumo por la que se apruebe la convocatoria nacional de pruebas selectivas 2006 para el acceso en el año 2007 a plazas de formación sanitaria especializada.

Disposición transitoria única.

A los residentes que hubieran iniciado su formación en la Especialidad de Inmunología por haber obtenido plaza en formación en convocatorias anteriores a la que se cita en el apartado segundo de esta Orden les será de aplicación el programa anterior de dicha especialidad, aprobado por Resolución de 25 de abril de 1996, de la Secretaria de Estado de Universi-dades e Investigación del Ministerio de Educación y Ciencia.

No obstante lo anterior, la Comisión de Docencia de la Unidad Docente en la que se haya obtenido plaza podrá adaptar, a propuesta del responsable de la Unidad y con la conformidad del residente, los planes individuales de formación previstos en el Apartado segundo 2.c de la Orden de 22 de junio de 1995, al nuevo programa formativo en la medida en que, a juicio de dicha Comisión, sea compatible con la organización general de la Unidad y con la situación específica de cada residente.

Disposición final.

Esta Orden entrará en vigor el día siguiente al de su publicación en el «Boletín Oficial del Estado».

Madrid, 2 de octubre de 2006.–La Ministra de Sanidad y Consumo, Elena Salgado Méndez.

ANEXO

Programa oficial de la Especialidad de Inmunología

1. Denominación oficial de la especialidad y requisitos de titulación

Inmunología.Duración: 4 años.Licenciaturas previas: Medicina, Biología, Bioquímica y Farmacia.

2. Introducción

2.1 Origen y desarrollo de la especialidad.–El rápido desarrollo de la Inmunología durante el pasado y presente siglo ha hecho que cada vez sea más necesaria su aplicación en la práctica clínica, tanto en la prevención, como en el diagnóstico y tratamiento de un gran número de enfermeda-des. Por lo tanto, es de gran importancia definir los contenidos y la orga-nización de la Inmunología y agrupar los criterios que se deben utilizar para la educación postgraduada y la titulación correspondiente. La Orga-nización Mundial de la Salud (OMS) y la Unión Internacional de Socieda-des de Inmunología (IUIS) publicaron sendos informes en 1972 y 1976, respectivamente, que versaban sobre el contenido y la organización de la especialidad médica de Inmunología. En similares términos se pronuncia-ron la IUIS, y la Sociedad Inglesa de Inmunología. Con posterioridad, un Comité conjunto de Inmunología Clínica de la IUIS, de la OMS y de la Aso-ciación de Alergología y de Inmunología Clínica (IAACI) compararon los distintos programas de enseñanza para postgraduados en diferentes paí-ses e hicieron unas recomendaciones que sirvieran de guía para su integra-ción en los diversos sistemas de salud y para la obtención del título de especialista para aquéllos que deseen dedicarse a esta disciplina. Reciente-mente, el Grupo de Inmunología Clínica (CIG) de la European Federation of Immunological Societies (EFIS-CIG) y el Grupo de Inmunología Clínica de la IUIS (IUIS-CIC) han publicado revisiones sobre la situación de los Programas de Inmunología en diversos países Europeos y EEUU y donde se definen los diferentes componentes de diagnóstico de laboratorio, clí-nico-asistencial y de investigación de la Inmunología. Es igualmente de gran interés considerar el desarrollo de la investigación básica y aplicada en el contexto de la formación de los especialistas en Inmunología en línea con las recomendaciones publicadas al respecto.

El presente programa se basa en los documentos actualizados elabora-dos por las Sociedades Internacionales de Inmunología, en la experiencia adquirida durante el desarrollo de la especialidad y en la situación del sistema sanitario de nuestro país.

Dado que los R. D. 1663/2002, de 8 de noviembre y 365/2004, de 5 de marzo, posibilitan que además de los licenciados en medicina, accedan a la especialidad los licenciados en Biología, Bioquímica y Farmacia, se ha estimado necesario elaborar un programa que incluya las actividades y responsabilidades que corresponden a dichos licenciados en función de su formación previa, definiendo un conjunto común para todos los licen-ciados centrado en el contexto de la actividad de laboratorio, especifi-cando asimismo las actividades reservadas a los licenciados en Medicina en el área clínica.

2.2 Contribuciones de la Inmunología a la Medicina.–Las primeras contribuciones de la Inmunología a la Medicina partieron del reconoci-miento de que era posible inducir inmunidad frente a los agentes patóge-nos y prevenir así la aparición de enfermedades infecciosas; es decir, el fundamento de las vacunas representa el nacimiento histórico de la Inmu-nología. Este conocimiento empírico fue de gran utilidad, permitió estu-

BOE núm. 252 Sábado 21 octubre 2006 36895

diar los mecanismos que conferían esta resistencia y condujo al descubri-miento de los anticuerpos. Hasta los años sesenta del pasado siglo, el mayor progreso de la Inmunología se produjo en la elucidación de la natu-raleza de los anticuerpos, del complemento y de la reacción antígeno-anti-cuerpo. Estos avances hicieron posible el perfeccionamiento de los métodos de diagnóstico serológico y su aplicación a otros campos, con la aparición subsiguiente del radioinmunoanálisis y el enzimoinmunoanáli-sis. En las últimas décadas del siglo se produjo la gran eclosión de los estudios referentes al papel fundamental de la inmunidad celular en las reacciones inmunes, que completaban el conocimiento de los mecanis-mos de la inmunidad adquirida. Más recientemente la inmunidad innata, sus células y moléculas participantes, han ocupado asimismo un impor-tante lugar en el estudio de los mecanismos defensivos.

Cada día aumenta el número de enfermedades en las que se reconoce que la participación del sistema inmunitario es la causa o contribuye de forma importante al proceso patológico. Estas enfermedades podrían clasificarse en cuatro grandes grupos: inmunodeficiencias, enfermedades autoinmunes, enfermedades aloinmunes (rechazo de injertos) y enferme-dades por hipersensibilidad. Es igualmente importante el sistema inmuni-tario en el control y tratamiento de tumores. La implicación del sistema inmunitario en la patogenia de estas enfermedades hace necesario un mayor grado de conocimiento de los mecanismos reguladores de la res-puesta inmunitaria del que ahora poseemos. Sin embargo, aun sin com-prender detalladamente los mecanismos de muchas de estas enfermeda-des inmunológicas, ya existen tecnologías de laboratorio que permiten confirmar su diagnóstico clínico. Una mención especial merece la contri-bución de la Inmunología al conocimiento de los mecanismos de rechazo de trasplantes de órganos y tejidos, así como a su prevención y trata-miento inmunosupresor. Sin duda, el papel de los inmunólogos en los estudios de histocompatibilidad y, concretamente en el estudio de recep-tores y donantes de trasplantes de órganos y tejidos ha sido fundamental para el desarrollo de la inmunología en la medicina española.

Actualmente, las pruebas de laboratorio, además de incluir la determi-nación de parámetros de inmunidad humoral, incorporan parámetros celulares y moleculares. La caracterización bioquímica y funcional de las citocinas, quimiocinas y moléculas de adhesión está abriendo nuevas vías de valoración de la situación del sistema inmunitario y de aplicación inmunoterapéutica.

Por último, se cuenta actualmente con la existencia de protocolos inmunoterapéuticos para el tratamiento de las diversas patologías con componente inmunológico, tales como terapias con agentes inmunomo-duladores (gammaglobulina intravenosa, citocinas recombinantes, anti-cuerpos monoclonales, terapias inmunorestauradoras o preventivas (vacunas terapéuticas y profilácticas)), nuevos inmunosupresores para el control del rechazo de injertos, vacunas antitumorales y terapia celular y génica.

3. Definición de la especialidad y sus competencias

3.1 Definición.–La palabra inmunología deriva del latín immunis que significa «sin carga», entendiéndose por carga un impuesto, ley o enfer-medad. Se dice que aquellos individuos que no sucumben ante la enferme-dad cuando se infectan, se hallan inmunes y este estado de resistencia específica a una enfermedad se denomina Inmunidad.

La OMS definió la Inmunología como una disciplina que trata del estu-dio, diagnóstico y tratamiento de pacientes con enfermedades causadas por alteraciones de los mecanismos inmunológicos y de las situaciones en las que las manipulaciones inmunológicas forman una parte importante del tratamiento y/o de la prevención.

La especialidad de Inmunología incluye el estudio de las enfermeda-des en las que los mecanismos inmunitarios no actúan adecuadamente, bien sea por razones genéticas o adquiridas (inmunodeficiencias, inclu-yendo el SIDA), o debido a otras causas intrínsecas al sistema como pue-den ser la transformación neoplásica de células del sistema inmunitario (tumores linfoides), la actuación anómala de anticuerpos específicos y/o linfocitos sensibilizados, u otros sistemas efectores asociados, todo lo cual produce como resultado lesiones tisulares en el hospedador (hiper-sensibilidad inmediata, infecciones y autoinmunidad).

También se ocupa la Inmunología de las situaciones en las que las lesiones pueden ser el resultado de la acción del sistema inmunitario en la defensa contra microorganismos (infección e inmunidad) o durante el rechazo de aloinjertos (transplantes y transfusiones). Por último, la espe-cialidad de Inmunología abarca asimismo el uso de la inmunoterapia o tratamientos de base inmunológica, transplantes y, más recientemente, de protocolos de terapia celular y génica.

El ejercicio de la Inmunología en un Hospital incluye, para todos los licenciados, la práctica en laboratorios especializados, adecuadamente dotados con una tecnología propia, así como la consulta en relación al diagnóstico y procedimientos inmunoterapeúticos. Los médicos especia-listas llevarán a cabo la asistencia a pacientes mediante consultas con

otros especialistas o en una Unidad de Inmunología Clínica especiali-zada.

3.2 Competencias.–La especialidad Inmunología es una actividad profesional que, basándose en la Biología y la Medicina, aplica los conoci-mientos inmunológicos en el ámbito sanitario y competencial que corres-ponda a los distintos titulados que puedan acceder a la misma.

La especialidad de Inmunología conlleva las siguientes competencias:

3.2.1 Comunes a todos los Licenciados:

Capacitación profesional para realizar las técnicas de laboratorio refe-ridas al estudio de patologías de base inmunológica.

Capacidad de interpretación de los datos generados en el laboratorio, poniéndolos en el contexto clínico y, por tanto, contribuyendo a estable-cer el diagnóstico clínico y la toma de decisiones terapéuticas.

Capacidad para diseñar protocolos diagnósticos y emisión de infor-mes inmunológicos.

Capacidad para diseñar y desarrollar proyectos de investigación bási-cas y clínicas, especialmente aquellos dirigidos a profundizar en el cono-cimiento y control de los mecanismos fisiopatogénicos en los que inter-viene el sistema inmunitario.

3.2.2 Específicas de los Licenciados en Medicina:

Capacidad para el diagnóstico y tratamiento de enfermedades de base inmunológica.

4. Objetivos de la formación

4.1 Objetivos generales.–La formación de especialistas con conoci-mientos teóricos y prácticos sobre la fisiopatología de la inmunidad humana, su diagnóstico y su aplicación terapéutica en un entorno hospi-talario, dentro de las competencias que corresponden a su licenciatura de origen, incluyendo conocimientos básicos de gestión, bioética e investi-gación.

4.2 Objetivos específicos:

4.2.1 Comunes a todos los licenciados:

Adquisición de conocimientos teóricos sobre los principios básicos de la inmunología y la patología de base inmunológica.

Adquisición de conocimientos prácticos para la evaluación de la inmu-nidad y su aplicación diagnóstica y terapéutica en el laboratorio.

Formación en gestión, control de calidad, bioética e investigación.

4.2.2 Específicos de los licenciados en Medicina:

Adquisición de experiencia clínica para el diagnóstico y tratamiento de enfermedades de base inmunológica.

4.3 Objetivos relativos a la docencia e investigación.–El residente debe terminar su periodo formativo sabiendo exponer y discutir los con-tenidos teóricos y prácticos de la especialidad, así como los aspectos básicos de la investigación biomédica, mediante la realización de las siguientes actividades formativas:

Preparación y exposición de sesiones clínicas.Seminarios de revisión temática.Preparación y comentario de sesiones bibliográficas.Sesiones clínicas conjuntas con otros servicios donde sea posible.Cooperar en la formación de otros Residentes.Participación activamente en todos los actos docentes, conferencias,

seminarios, sesiones clínicas, etc., que el hospital programe a través de la Comisión de Formación Continuada, y que a juicio del tutor sean de inte-rés para la formación en Inmunología.

En las unidades docentes que asuman formación de pregrado se esti-mulará la participación de los residentes en el desempeño de las mismas.

Asimismo, se considerará como un objetivo importante en la forma-ción del residente de Inmunología la adquisición de conocimientos teó-rico-prácticos relativos a la planificación de la investigación biomédica, participando en las líneas de investigación de la Unidad. A cuyos efectos debe conocer:

Método y procedimiento científico.Planificación, ejecución y verificación científica.Aspectos generales de la medición.Medidas de frecuencia de la enfermedad. Proyectos de investigación: forma y contenido.Rigor metodológico.Presentación de resultados.Conocimientos básicos de estadística descriptiva e inferencial.Desarrollo de un protocolo de investigación.

Se estimulará al residente para que inicie sus Estudios de Doctorado durante el período de formación.


5. Contenidos formativos

5.1 Conocimientos específicos: Enfermedades y terapias de base inmunológica.

Conceptos generales:

5.1.1 Antecedentes y desarrollo histórico de la Inmunología:

Inmunología: Área multidisciplinar en las ciencias de la salud.Inmunología y Medicina clínica: situación actual en el marco de la

Unión Europea.

Inmunología básica:

5.1.2 Anatomía y elementos celulares del sistema inmune:

Órganos linfáticos primarios y secundarios.Ontogenia, fenotipo y función de las células del sistema Inmune.

5.1.3 Respuesta Inmune:

Inmunidad innata y adaptativa: características, significación biológica e interacciones.

Mecanismos de reconocimiento inmunológico:

Receptores de inmunidad innata: receptores tipo TOL, tipo manosa, de las células NK.

De la inmunidad adaptativa: receptores clonotípicos de los linfoci-tos T y B.

El complejo principal de histocompatibilidad: estructura, polimor-fismo, función y regulación.

Otras moléculas presentadoras.

Formas de respuesta inmune adaptativa:

Respuesta inmune humoral y celular.Cooperación celular.Memoria inmunológica.

Regulación de la respuesta inmune y homeostasis inmunológica:

Tolerancia central y periférica.Apoptosis inducida por activación.Anergia e inmunosupresión.Linfocitos T reguladores.Actividades reguladoras de citocinas, quimiocinas e inmunomodula-

dores.

5.1.4 Moléculas efectoras de la inmunidad:

Anticuerpos: estructura y función de los diversos isotipos de inmuno-globulinas.

Sistema complemento: vías de activación, funciones biológicas, regu-lación e interacciones con otros sistemas efectores.

Maquinaria lítica celular: Perforina, granzima, apoptosis vía Fas.Citocinas y quimiocinas: Origen, familias, efectos biológicos, recepto-

res, polimorfismos, regulación y señales de activación.Moléculas que regulan el tráfico y alojamiento de las células inmuno-

lógicas: Integrinas y moléculas de adhesión. Selectinas, adresinas, defen-sinas.

Mediadores bioquímicos de esosinófilos, mastocitos y basófilos.Mediadores inflamatorios: Leucotrienos, prostaglandinas, factor acti-

vador de plaquetas, proteinas de fase aguda, citocinas proinflamatorias, factores quimiotácticos.

5.1.5 Mecanismos de hipersensibilidad:

Mediados por IgE: Reacciones de fase aguda y tardía.Mediados por IgG, IgA e IgM: Opsonización, fijación del complemento,

citotoxicidad dependiente o independiente de anticuerpo, estimulación y bloqueo.

Mediados por complejos inmunes: Mecanismos de aclaramiento y propiedades físico-químicas que condicionan el depósito de los comple-jos inmunes.

Mediados por células: Células participantes, mecanismos efectores y formación de granulomas.

Otros: Células NK, células asesinas activadas por citocinas e hipersen-sibilidad cutánea por basófilos.

5.1.6 Inmunidad e Infección:

Respuesta inmunológica a virus, bacterias intra y extracelulares, pro-tozoos, helmintos y hongos.

Mecanismos de evasión viral.Infecciones en el huésped inmunosuprimido.

5.1.7 Inmunología tumoral:

Oncogenes: translocaciones y puntos de ruptura.

Vigilancia anti tumoral.Principios de inmunoterapia del cáncer.

Inmunología clínica:

5.1.8 Inmunoalergia:

Aspectos generales de las enfermedades atópicas.Urticaria y anafilaxis. Alergias medicamentosas y ocupacionales.Asma y neumonitis por hipersensibilidad.

5.1.9 Inmunodeficiencias:

Inmunodeficiencias primarias.Inmunodeficiencias secundarias.Síndrome de Inmunodeficiencia Adquirida.

5.1.10 Enfermedades Autoinmunes Órgano específicas:

Endocrinológicas (Tiroiditis autoinmune, síndromes poliglandulares autoinmunes, Diabetes mellitus tipo I autoinmune, insuficiencia suprarre-nal primaria).

Cutáneas (Dermatitis y dermatosis de origen inmunológico).Sistema hematológico (neutropenia autoinmune, anemia hemolítica

autoinmune, púrpura trombocitopénica idiopática).Sistema neuromuscular (síndrome de Guillain-Barré, miastenia gravis,

neuropatías autoinmunes periféricas).Sistema Hepatobiliar (hepatitis autoinmune, cirrosis biliar primaria,

colangitis esclerosante autoinmune).Tubo digestivo (enfermedad celiaca, anemia perniciosa, enfermedad

inflamatoria intestinal).Oculares (Enfermedades inflamatorias oculares, trombosis de retina

por anticuerpos antifosfolípidos).Sistema Reproductor (infertilidad de causa inmunológica, abortos de

causa autoinmune).

5.1.11 Enfermedades Autoinmunes No-órgano específicas:

Enfermedades del Tejido conectivo (Lupus eritematoso sistémico, artritis reumatoide, esclerodermia, espondilitis anquilopoyética, dermatomiositis/polimiositis, síndrome de Sjögren, Enfermedad de Behcet).

Síndrome antifosfolípido.Vasculitis (poliarteritis nodosa, granulomatosis de Wegener).

5.1.12 Neoplasias y sistema inmune:

Leucemias y linfomas.Neoplasias asociadas a inmunodeficiencias.Neoplasias asociadas a infecciones virales.Gammapatías monoclonales.

5.1.13 Otras enfermedades inmunológicas con afectación de órganos y sistemas:

Sistema respiratorio: Asma, neumonitis por hipersensibilidad, fibrosis pulmonar y enfermedades relacionadas.

Sistema nervioso: Esclerosis Múltiple.Sistema Renal: Glomerulonefritis, nefropatía IgA.

5.1.14 Trasplante de órganos y de médula ósea.

Histocompatibilidad.Selección de receptores.Rechazos alorreactivos: Mecanismos.Enfermedades del injerto contra el huésped: MecanismosInmunosupresión.

5.1.15 Inmunotoxicología:

Mecanismos de reacciones nocivas.Evaluación de componentes citotóxicos in vivo e in vitro.Alteraciones inmunitarias inducidas por fármacos o sustancias quí-

micas.

5.1.16 Protocolos terapéuticos de base inmunológica:

Agentes inmunosupresores: corticosteroides, citostáticos, ciclospo-rina, tacrolimus, globulina anti linfocito y anti timocito, anticuerpos monoclonales de uso clínico (anti TNF-alfa, anti CD20, etc.). Fundamen-tos de su aplicación, efectos biológicos y principios farmacológicos.

Terapias de sustitución, inmunorestauradoras: Ganamaglobulinas intravenosas, citocinas, factores de crecimiento, transplante de médula ósea; transplantes de celulas inmunológicas activadas «ex vivo»; vacunas terapéuticas,

Terapias preventivas.Vacunas profilácticas, plasmaféressis.Terapia génica y celular.


5.1.17 Principios biotecnológicos:

Propiedades fisicoquímicas de la reacción antígeno-anticuerpos y apli-caciones prácticas: técnicas ELISA, RIA, aglutinación, etc.

Técnicas de cultivo celular y producción de anticuerpos monoclo-nales.

Fundamentos y aplicaciones de la citometría de flujo.Tecnología del ADN recombinante.

5.2 Formación práctica: Metodología de laboratorio.

Las pruebas analíticas que se realizan en los laboratorios de Inmunolo-gía, reflejan los avances producidos en esta disciplina en los últimos años. Estos avances se deben a la investigación básica, a una mejor compren-sión de las bases inmunológicas de las enfermedades y a las observacio-nes empíricas y de investigación clínica efectuadas en los pacientes. Los contenidos prácticos de laboratorio de la especialidad de Inmulogía inclu-yen todos los tests orientados al diagnóstico y seguimiento de todas las enfermedades de base inmunológica, cualquiera que sea el procedimiento a seguir, que puede incluir el estudio de la inmunidad humoral, celular o alteraciones genéticas. También incluye el aislamiento y/o la manipula-ción de tejidos.

Las pruebas analíticas que, entre otras, se deben desarrollar en un laboratorio de inmunología son las siguientes:

5.2.1 Inmunoquímica e inmunoalergia:

Espectro electroforético de suero y orina.Determinación cuantitativa y cualitativa de las inmunoglobulinas en

suero: Cuantificación de Inmunoglobulinas en suero, cuantificación de subclases de IgG e IgA, cuantificación de IgA secretora, determinación de anticuerpos específicos en suero, respuesta específica a vacunas.

Determinación de inmunoglobulinas en otros fluidos biológicos (orina, saliva, LCR, líquido sinovial, líquido pleural, lavado broncoalveo-lar, lágrimas, leche materna).

Determinación funcional e inmunoquímica de los componentes del complemento y sus productos de activación. Determinación de alotipos de factores del complemento.

Determinación en suero de proteínas inflamatorias.Determinación de inmunoglobulinas y bandas oligoclonales en IgG.

Indices LCR/Suero.Identificación y cuantificación de paraproteínas en suero y orina.Caracterización y cuantificación de crioglobulinas en suero.Medidas de citocinas y quimiocinas así como de sus receptores solu-

bles en el plasma y en los fluidos del organismo.Medida de los productos de las reacciones inflamatorias.Cuantificación de proteína unidora de manosa.Determinación otras proteínas y moléculas relevantes (vg. Beta-2

microglobulina).Cuantificación de la adenosindesaminasa y de purín-nucleótido fosfo-

rilasa.Cuantificación de IgE total e IgE específica.Cuantificación de anticuerpos bloqueantes.Estudio de precipitinas.Estudio de la proteína catiónica del eosinófilo.

5.2.2 Inmunidad celular:

Subtipos de linfocitos y marcadores fenotípicos: Estudio celular feno-típico para evaluación de Inmunodeficiencias, de la infección por el VIH, de síndromes linfoproliferativos.

Estudio fenotípico de granulocitos y plaquetas.Estudio fenotípico de células precursoras hematopoyéticas.Técnicas de aislamiento y purificación de poblaciones celulares.Estudio de la expresión de antígenos HLA, (asociación de alelos HLA

con patologías: espondiloartropatías, celiaca, narcolepsia, hemocromato-sis, etc.).

Determinación de la clonalidad de las células linfoides.Función de los linfocitos: respuesta proliferativa y producción de

inmunoglobulinas in vitro en respuesta a setímulos tipo lectinas, ionófo-ros, citocinas; anticuerpos monoclonales y antígeneos específicos.

Cuantificación de citocinas y quimiocinas en fluidos biológicos.Pruebas cutáneas de hipersensibilidad retardada.Citotoxicidad de células linfoides y otras células efectoras.Apoptosis linfocitaria.Actividad funcional de macrófagos, neutrófilos, mastocito-basófilos y

eosinófilos.Movilización de calcio citosólico en linfocitos.Capacidad quimiotáctica de células fagocíticas.

5.2.3 Autoinmunidad:

Anticuerpos no órganos específicos:

Anticuerpos antinucleares (ADN, histonas, Ku, Scl-70, ENA, aparato mitótico, NOR-90, fibrilarina, etc.).

Anticuerpos anticitoplásmicos (mitocondriales, ribosomas, tRNA sin-tetasas).

Anticuerpos específicos de tejido (músculo liso, dérmicos, endomisio, miocardio, cartílago, enterocitos, membrana basal glomerular, etc.).

Anticuerpos órgano específicos (tiroideos, ICA, GAD, ovario, células de Leydig, adrenales, etc.).

Anticuerpos neurológicos (gangliosidos, receptor acetil colina, Hu, Ri, Yo, proteina básica de la mielina)

Otros: Ac antifosfolípidos (cardiolipina), ANCA, transglutaminsa, etc.

5.2.4 Histocompatibilidad y trasplantes:

Tipaje HLA por técnicas serológicas.Determinación génica de alelos HLA de clase I y clase II: PCR-SSO,

PCR-SSP, PCR-dot-blot reverso. Análisis de asociación de HLA y enfermedad.Determinación de antígenos HLA solubles.Determinación de anticuerpos citotóxicos anti-HLA.Estudio de antisueros anti-HLA.Compatibilidad HLA-D. Cultivo mixto linfocitario.Prueba cruzada para transplante de órgano.Niveles sanguíneos de inmunosupresores: ciclosporina A, micofeno-

lato, rapamicina, etc.Anticuerpos anti-CD3 (OKT3).

5.2.5 Inmunogenética e inmunobiología molecular:

Determinación fenotípica y genotípica de alotipos de proteínas séricas.Diagnóstico prenatal y herencia de enfermedades inmunitarias de ori-

gen genético (Inmunodeficiencias).Estudio de mutaciones del locus HEF (hemocromatosis familiar).Estudio genético del reordenamiento de las cadenas pesadas de inmu-

noglobulinas y del receptor de célula T.Prueba de confirmación de la infección por VIH-1 y VH-2 por técnicas

de inmunotransferencia o Western Blot.Detección y cuantificación de carga viral en pacientes VIH positivos.Amplificación proviral del VIH y cuantificación DNA proviral.Prueba de detección del correceptor CCR5.Diagnóstico molecular de inmunodeficiencias:

Determinación de la expresión y actividad de proteínas alteradas (Btk).

Estudio de portadores: Inactivación del cromosoma X.Mutaciones génicas: Cadena CD3-epsilon, PNP, ADA, Rag, receptores

de interleuquinas, factor de transcripción CIITA, etc.).

5.2.6 Biotecnología: Dependiendo de las posibilidades de cada cen-tro, el residente deberá conocer y aplicar en el laboratorio alguna de las tecnologías que a continuación se citan:

Tecnología de producción de anticuerpos monoclonales.Producción de otras moléculas de interés inmobiológico.

5.3 Formación práctica en inmunología clínica.

En la actualidad, en algunos hospitales se han desarrollado Unidades de Inmunología Clínica Especializada, a través de las cuales se presta una atención directa al paciente, ejercida exclusivamente por el inmunólogo clínico o en colaboración con otros especialistas. Los contenidos de este punto del programa afectan exclusivamente a los licenciados en Medi-cina. Las actividades que pueden desarrollar estas unidades son las siguientes:

5.3.1 Diagnóstico y tratamiento de las patologías de base inmunoló-gica:

Evaluación y tratamiento de inmunodeficiencias primarias, inmunode-ficiencias secundarias, enfermedades autoinmunes (coordinadamente con especialistas relacionados con la patología de base inmunológica), reacciones de hipersensibilidad y de otras patologías que pueden deberse a alteraciones de base inmunológica.

Evaluación y monitorización inmunológica de infecciones crónicas.Evaluación y monitorización inmunológica de terapias de base inmu-

nológica y transplantes.Evaluación y monitorización de crioglobulinemias y paraproteine-

mias.

5.3.2 Administración de terapias de base inmunológica:

Terapia sustitutiva con gammaglobulina intravenosa (GGIV).Terapia inmunosupresora: Corticoides, Azatioprina, Ciclofosfamida,

Ciclosporina, Tacrolimus, Sirolimus, Rapamicina, Micofenolato Mofetil entre otros; GGIV a altas dosis; anticuerpos monoclonales (p.e. anti-CD3, anti-CD52, anti-TNF, anti-rIL2).


Terapia inmunomoduladora [anticuerpos monoclonales, citocinas (IL-2, Interferon-gamma) y otros agentes biológicos utilizados para la inmunomodulación (anticuerpos anti-TNF)].

5.3.3 Inmunoterapia de enfermedades prevenibles:

Indicaciones y contraindicaciones de la administración de vacunas.Prevención y tratamiento de reacciones adversas.Inmunización de pacientes con inmunodeficiencia.

En los cuadros que figuran como anexo en el apartado 7 de este pro-grama se resumen los conocimientos prácticos y las habilidades que deben desarrollar los residentes en cada sección funcional de la especia-lidad de Inmunología, que asimismo coinciden con las secciones de rota-ción obligatoria para los residentes.

5.4 Formación en técnicas de gestión.

El programa de formación de residentes de Inmunología incluye el conocimiento de técnicas y herramientas de gestión, necesarias para la organización eficiente de las unidades de Inmunología y el mejor aprove-chamiento de los recursos.

5.4.1 Organización Sanitaria: El modelo de organización sanita-ria se corresponde con el regulado, fundamentalmente por la Ley General 14/1986, de 25 de abril, General de Sanidad, por la Ley 16/2003, de 28 de mayo, de cohesión y calidad del Sistema Nacional de Salud y por las disposiciones que dicten las comunidades autónomas en el ámbito de sus competencias como consecuencia de haber concluido el proceso de transferencias sanitarias a las mismas.

Asimismo, el desarrollo en los próximos años de la Ley 44/2003, de 21 de noviembre de ordenación de las profesiones sanitarias, tendrá un papel destacado en la configuración de las profesiones sanitarias al pre-ver en su artículo 9, la formación de unidades clínicas integradas por equipos de carácter multiprofesional y multidisciplinar.

En este marco, la Inmunología encaja como especialidad mixta (labora-torio-clínica) para la atención especializada de la patología que le es propia en hospitales de la red sanitaria, mayoritariamente públicos y por lo tanto sujetos a las condiciones legales que regulan el funcionamiento de estas instituciones, en lo referente a la contratación de personal, adquisición de material y equipos, condiciones laborales, ámbito de actuación, etc.

Los residentes deberán conocer las características básicas de la orga-nización sanitaria y el marco de actuación en el que van a a desarrollar su actividad profesional.

5.4.2 Herramientas de gestión: Los residentes deberán conocer los instrumentos básicos de negociación y gestión que habrán de aplicar en su futura actividad profesional.

5.4.3 Sistemas de información: En la sociedad de información, donde cualquier actividad laboral o profesional esta condicionada por el manejo de datos informatizados, el programa de formación de residentes deberá cubrir los siguientes aspectos:

Programas de ofimática en entorno windows e internet.Programas de estadística básica.Sistemas de clasificación de enfermedades.Sistemas de gestión de datos de laboratorio.Garantías de confidencialidad de datos.

5.4.4 Sistemas de aseguramiento de la calidad: Uno de los requisitos que se va imponiendo en las actividades laborales y profesionales es la necesidad de someterse a programas de aseguramiento de la calidad. Esta necesidad afecta a los procedimientos del laboratorio, a la calidad de los equipos y reactivos, a la calidad ambiental y a la formación del personal, que deben ser garantizadas por organismos evaluadores (agencia ENAC) con sujeción a las normas de aseguramiento de calidad reconocidas inter-nacionalmente, como son las normas ISO.

En el caso de los laboratorios de inmunología existen asimismo nor-mas de acreditación específicas para determinados procesos como la histocompatibilidad, objeto de acreditación por la EFI (European Foun-dation of Immunogenetics), o para determinados modelos de calidad total como el Baldridge o el EFQM, que en estos momentos están siendo consi-derados.

Los residentes de inmunología deben participar en estos programas de aseguramiento de calidad, tanto en lo que se refiere a los aplicados a la calidad de los ensayos, como a los procedimientos generales del labora-torio.

5.4.5 Optimización de recursos: El sistema de información de costos (contabilidad analítica) aplicado en la gestión económica de numerosos centros permite conocer los resultados por producto y centro de costo (servicio, unidad de gestión clínica), imputar los gastos y establecer pre-visiones para ejercicios anuales en contratos programa o mediante cual-quiera otra forma de gestión económica programada.

La actividad de los laboratorios tiende a medirse en URV (unidades relativas de valor), concepto que asigna un valor relativo a cada prueba analítica, en función de los costos reales.

Los residentes de inmunología deberán conocer los instrumentos de control de gasto que son aplicados en sus unidades.

5.4.6 Análisis y evaluación: El sistema de gestión por procesos obliga a revisiones periódicas conforme a matrices de evaluación, PDCA, REDER, ampliamente utilizados en gestión de empresas. Esta metodolo-gía esta siendo aplicadas en centros sanitarios y debería ser conocida por los Residentes en formación.

5.5 Formación en aspectos bioéticos.

Los residentes de Inmunología deben conocer y recibir formación adecuada en las diferentes normativas vigentes en nuestro País sobre los aspectos bioéticos de la práctica médica y de la actividad investigadora. Esta formación se realizará siempre en estrecho contacto y, principal-mente, a través de los Comités de Bioética de cada hospital.

Los residentes deberán adquirir una formación específica sobre los siguientes aspectos:

Derechos de los pacientes y su marco legal.Confidencialidad y seguridad en la intimidad y privacidad.Criterios acerca del derecho a la información.Aplicación práctica y cumplimiento del consentimiento informado.Medidas de seguridad en el manejo de ficheros automatizados de

pacientes, que incluirá:

Cumplimiento de la normativa de acceso a los datos informatizados.Funciones y obligaciones del personal en el manejo de los ficheros.Procedimiento de acceso que garantice la confidencialidad.Control de salida de datos informáticos de carácter personal.Gestión de incidencias.

Aspectos bioéticos de la experimentación animal.

6. Articulación del periodo formativo: rotaciones y actividades

6.1 Rotaciones internas en áreas fundamentales de la Inmunología:

Para los residentes licenciados en Medicina: las rotaciones internas comportarán un período de tres años por las siguientes unidades:

Inmunoquímica (Inmunoproteínas y Alergia), mínimo 6 meses.Autoinmunidad, mínimo 6 meses.Inmunidad celular e Inmunodeficiencias, mínimo 6 meses.Inmunogenética e Histocompatibilidad, mínimo 6 meses.Unidad de Inmunología Clínica, mínimo 6 meses.

Para los residentes licenciados en Biología, Bioquímica y Farmacia: las rota-ciones internas de formación básica en laboratoio comportarán los dos primeros años de residencia en cada una de las unidades ciadas anteriormente para los licenciados en medicina (excepto la de Inmunología Clínica).

Durante el resto del programa formativo estos residentes se adscribi-rán a una de las Unidades existentes en el Servicio a fin de profundizar en un aspecto particular de la especialidad. Periódicamente y a criterio del Tutor correspondiente, el residente deberá acometer períodos menores de rotación interna por las otras Unidades a fin de renovar los conoci-mientos adquiridos y acceder a las novedades técnicas introducidas, así como familiarizarse con los procedimientos de Gestión de Laboratorio.

El objetivo general de estas rotaciones internas es que el residente adquiera el conocimiento teórico y la habilidad práctica necesaria para realizar cada una de las técnicas diagnósticas de las enfermedades con componente inmunológico, que le permitan una interpretación de los resultados, con especial referencia al significado patológico y valor pro-batorio de las determinaciones realizadas, así como la emisión de infor-mes inmunológicos, con la supervisión del tutor o el responsable del área. Simultáneamente, el residente colaborará en la ejecución de los controles de calidad y la introducción de nuevas tecnologías, siempre bajo la super-visión de un miembro de la plantilla y/o el tutor.

Toda esta labor de aprendizaje debe ser compatible con la formación investigadora del residente, al que se le facilitará la integración en los progra-mas de investigación de la Unidad Docente y en la medida de lo posible la iniciación de los estudios del doctorado sin perjuicio del cumplimiento de sus obligaciones laborales y de su formación como especialista.

Nota: Los contenidos teóricos, prácticos y actividades a realizar son los que se citan en los cuadros que figuran como anexo en el apartado 9 de este programa.

6.2 Rotaciones internas en otros servicios/unidades asistenciales del hospital:

Los residentes médicos (MIR) realizarán rotaciones por Unidades Docentes Clínicas por un periodo mínimo de 6 meses. Estas rotaciones


serán, igualmente, diseñadas por el tutor de acuerdo con las peculiarida-des de cada Hospital y pueden incluir:

Medicina Interna.Nefrología/trasplantes renales.Reumatología.Alergia.Neumología.Hematología/trasplantes de médula ósea.Pediatría.

El objetivo de estas rotaciones es que el MIR adquiera conocimientos clínico-prácticos de las enfermedades de base inmunológica.

Se recomienda que los MIR se integren en el programa de Guardias Médicas del Hospital realizando entre 4 y 6 guardias mensuales en Servi-cios de Urgencia por un periodo de un año.

Los residentes licenciados en Biología, Bioquímica y Farmacia realiza-rán rotaciones externas por un periodo total no superior a 6 meses por otras Unidades Docentes que pueden variar dependiendo de connotacio-nes locales hospitalarias. Serán diseñadas por los respectivos tutores y tratarán de suplir carencias formativas de la Unidad Docente de Inmuno-logía como:

Genética Molecular.Microbiología.Hematología.Anatomía Patológica.

El objetivo de estas rotaciones será el de suplir carencias formativas de la unidad docente de Inmunología.

Se aconseja que las rotaciones externas se realicen después de haber adquirido los conocimientos básicos de la especialidad, esto es, durante los periodos de R3 y/o R4. No obstante, y, según las peculiaridades de cada Unidad, el tutor podrá establecer el calendario de rotaciones exter-nas intercaladas con las rotaciones internas, siempre que el residente haya cumplido una rotación en el Servicio de Inmunología no inferior a 6 meses.

6.3 Rotaciones externas por otros hospitales: Los residentes podrán rotar por un tiempo no superior a 6 meses por Unidades Docentes de Inmunología para completar su formación en áreas carentes en el propio hospital.

Para los MIR se aconseja la rotación por Unidades Clínicas de Inmuno-deficiencias, Unidades Clínicas de Conectivopatías y Unidades de Inmu-nología Clínica Especializada.

Para los licenciados en Biología, Bioquímica y Farmacia, se aconseja rotación por Servicios de Inmunología de otros Hospitales que dispongan de formación en un área concreta de la que carezca el Servicio de origen.

6.4 Rotaciones para la formación en protección radiológica: Los resi-dentes deberán adquirir de conformidad con lo establecido en la legisla-ción vigente conocimientos básicos en protección radiológica ajustados a lo previsto en la Guía Europea «Protección Radiológica 116», en las siguientes materias.

a) Estructura atómica, producción e interacción de la radiación.b) Estructura nuclear y radiactividad.c) Magnitudes y unidades radiológicas.d) Características físicas de los equipos de Rayos X o fuentes radiac-

tivas.e) Fundamentos de la detección de la radiación.f) Fundamentos de la radiobiología. Efectos biológicos de la radia-

ción.g) Protección radiológica. Principios generales.h) Control de calidad y garantía de calidad.i) Legislación nacional y normativa europea aplicable al uso de las

radiaciones ionizantes.j) Protección radiológica operacional.k) Aspectos de protección radiológica específicos de los pacientes.l) Aspectos de protección radiológica específicos de los trabajado-

res expuestos.

La enseñanza de los epígrafes anteriores se enfocará teniendo en cuenta los riesgos reales de la exposición a las radiaciones ionizantes y sus efectos biológicos y clínicos.

Duración de la rotación: Los contenidos formativos de las anteriores letras a), b), c), d), e), f), g), h), i), se impartirán durante el primer año de especialización. Su duración será, entre seis y diez horas, fraccionables en módulos, que se impartirán según el plan formativo que se determine.

Los contenidos formativos de las letras j), k) y l): Se impartirán progre-sivamente en cada uno de los sucesivos años de formación y su duración será entre una y dos horas destacando los aspectos prácticos.

Lugar de realización: Los contenidos formativos de las letras a), b), c), d), e), f) g), h), i), se impartirán por lo integrantes de un Servicio de Radiofísica Hospitalaria/ Protección Radiológica/ Física Médica. Los contenidos formativos de las letras j), k) y l): Se impartirán en una Ins-titución Sanitaria con Servicio de Radiofísica Hospitalaria/Protección Radiológica/Física Medica, en coordinación con las unidades asistencia-les de dicha institución específicamente relacionadas con las radiaciones ionizantes.

Organización de la formación: Cuando así lo aconseje el número de residentes, especialidades y Servicios de Radiofísica/Protección Radiológica/Física Médica implicados, los órganos competentes en mate-ria de formación sanitaria especializada de las diversas comunidades autónomas podrán adoptar, en conexión con las Comisiones de Docencia afectadas, las medidas necesarias para coordinar su realización con vistas al aprovechamiento racional de los recursos formativos.

6.5 Actividades clasificadas según niveles de responsabilidad:

Nivel 1: Actividades realizadas directamente por el residente sin nece-sidad de una tutorización directa.

Nivel 2: Actividades realizadas directamente por el residente bajo supervisión del tutor.

Nivel 3: Actividades realizadas por el personal sanitario y observadas/asistidas en su ejecución por el residente.

R1 R2 R3 R4

Técnicas de Laboratorio

Conocimiento teórico de todo el contenido de la especialidad …………………………………… 1 1 1 1Cuantificación de inmunoproteínas ………………………………………………………………… 2 1 1 1Cuantificaciones de IgE total y específica ………………………………………………………… 2 1 1 1Degranulación de basófilos ………………………………………………………………………… 3 3 2 1Estudio de crioglobulinas y paraproteínas ………………………………………………………… 2 2 1 1Purificación de proteínas séricas (cromatografía, isolelectroenfoque) ………………………… 3 3 3 2Ensayos funcionales de la actividad del complemento …………………………………………… 3 3 2 1Análisis de precipitinas ……………………………………………………………………………… 3 2 2 1Técnicas de inmunofluorescencia …………………………………………………………………… 2 1 1 1Patrones de fluorescencia: identificación e interpretación ……………………………………… 3 2 2 1Contraelectroforesis ………………………………………………………………………………… 2 1 1 1Técnicas de ELISA …………………………………………………………………………………… 2 1 1 1Extractos antigénicos e inmunoblotting …………………………………………………………… 3 2 2 1Inmunoprecipitación ………………………………………………………………………………… 3 3 2 2Citofluorometría: poblaciones linfocitarias ………………………………………………………… 3 2 2 1Inmunofenotipaje de leucemias y linfomas ………………………………………………………… 3 3 2 1Separaciones celulares ……………………………………………………………………………… 3 2 2 1Cultivos celulares y ensayos de proliferación ……………………………………………………… 3 2 2 1Cuantificación de citocinas ………………………………………………………………………… 3 2 2 1Citotoxicidad y apoptosis …………………………………………………………………………… 3 3 2 1Ensayo de fagocitosis y estress oxidativo ………………………………………………………… 3 3 2 1Tipaje HLA serólogico y genómico ………………………………………………………………… 3 2 2 1Anticuerpos citotóxicos anti-HLA ………………………………………………………………… 2 2 2 1


Análisis mutaciones génicas ………………………………………………………………………… 3 3 2 2Polimorfismos genéticos ……………………………………………………………………………… 3 3 2 1

Actividad clínica

Emisión de informes clínicos ………………………………………………………………………… 3 3 2 1Elaboración de protocolos …………………………………………………………………………… 3 3 2 1Consulta especializada ……………………………………………………………………………… 3 3 3 2

Actividad científica

Elaboración de proyectos de investigación ………………………………………………………… 3 3 2 1Confección de comunicaciones científicas ………………………………………………………… 3 3 2 1Elaboración de artículos científicos ………………………………………………………………… 3 3 2 1

Actividad docente

Seminarios revisión temática ………………………………………………………………………… 2 2 1 1Seminarios bibliográficos …………………………………………………………………………… 3 2 1 1Sesiones clínicas ……………………………………………………………………………………… 3 2 2 1Seminarios de investigación………………………………………………………………………… 3 3 2 2

Otras actividades

Conocimientos básicos de gestión clínica ………………………………………………………… 3 3 2 1Aspectos bioéticos………………………………………………………………… 1 1 1 1Conocimiento informático: Bases de datos, seroteca, gráficos, etc. ……………………………… 2 1 1 1Controles de calidad internos y externos …………………………………………………………… 3 2 2 1Normativa sobre acreditaciones …………………………………………………………………… 3 2 2 1Idiomas: inglés ………………………………………………………………………………………… 2 1 1 1

R1 R2 R3 R4

6.6 Actividades segun objetivos específicos operativos:

6.6.1 Para todos los Residentes:

Aprendizaje tutelado por especialistas en inmunología y de otras espe-cialidades relacionadas que comprenda la observación, ejecución y discu-sión, de las diferentes actividades y procedimientos incluidos en el apar-tado 6 y su consiguiente evaluación.

Realización de un mínimo anual de 2000 informes inmunológicos de laboratorio diagnóstico.

Asistencia y participación en las actividades docentes programadas en el Servicio de Inmunología y el hospital. El Servicio de Inmunología deberá organizar periódicamente sesiones bibliográficas, teóricas y de investigación básica y clínica.

Asistencia a cursos de tercer ciclo y otros cursos de post-grado orga-nizados por entidades avaladas científicamente (Colegios Profesionales, Sociedades Nacionales e Internacionales) así como a congresos naciona-les e internacionales relacionados con la especialidad.

Participación en equipos multidisciplinarios para la evaluación del trabajo de laboratorio y clínico. Elaboración de protocolos de diagnóstico propios del laboratorio de Inmunología.

Utilización de recursos de aprendizaje a través de internet. Búsquedas bibliográficas.

Estudio personal orientado por los tutores. Reuniones periódicas de tutoría.

Participación en grupos de trabajo internos y externos (p.e. Grupos de trabajo hospitalarios, Registro Español de Inmunodeficiencias).

Participación en la realización de talleres de histocompatibilidad, inmunidad celular e inmunoproteínas organizados por la Sociedad Espa-ñola de Inmunología (SEI) y en aquellos organizados por otras Socieda-des Internacionales [European Federation of Immunological Societies (EFIS) y European Confederation of Laboratory Medicine (ECLM), etc.].

Participación en programas de Control de calidad externos e internos.Participación en actividades de gestión del Laboratorio Diagnóstico

de Inmunología.Participación en programas de formación biomédica continuada.Participación en la elaboración y ejecución de proyectos de investiga-

ción. Presentación de trabajos de investigación en congresos y publica-ción de los mismos en revistas nacionales e internacionales.

6.6.2 Para los Residentes Licenciados en Medicina que roten por Unidades Clínicas Especializadas:

Realización de un mínimo de 100 informes clínicos inmunológicosParticipación en las actividades de las Unidades Clínicas Especiali-

zadas.

7. Referencias bibliográficas

1. WHO. Clinical Immunology. WHO Technical Report Series n.º 496, 1972.

2. IUIS. Report of the Clinical Immunology Committee. Lancet 1976;1:196.

3. IUIS/WHO. Report. Use and abuse of laboratory tests in clinical immunology. WHO Bull 1981; 59,717-728.

4. IUIS/WHO. Report. Appropriate uses of human immunoglobulin in clinical practice. Clin. Exp Immunol 1983;52:417.

5. IUIS/WHO. Report on AIDS. Ann Internal Med 1987.6. IUIS/WHO Report. Laboratory investigations in clinical immuno-

logy Clin Exp Immunol 1988;74:494-503./WHO. Current status of allergen immunotherapy. Lancet 1989;1:259.

7. Report of the British Society for Immunology working party on clinical immunology:1981-1982: Functions and training of the Clinical Immunologist. Clin. Exp.Immunol 1983; 52:702-705.

8. Report of the British Society for Immunology working party on clinical immunology: 1984.Guidelines for training the physician immuno-logist. Clin. Exp. Immunol. 1985; 61:216-218.

9. The physician immunologist: future role and manpower needs. Report by the Royal College of Physicians committee on clinical immuno-logy. Clin. Exp. Immunol. 1987; 70: 664-675.

10. Waldmann T.A. 1988 Presidential adress of the Clinical Immuno-logy Society: Clinical Immunology is everywhere and nowhere-strength or weakness? Clin. Immunol.Immunopathol.1989;51:2-12.

11. Barnes R, Chapel H. Current practice and future directions in clinical immunology. J Royal Soc Med 1995; 88: 395-97.

12. WHO/IUIS/IAACI Report. Clinical Immunology. Guidelines for its organization, training and certification. The Immunologist 1993; 1,57-63.

13. Bene MC by the EFIS group for Clinical Immunology (Fernández-Cruz, E, Peña J). State-of-the-art of clinical immunology in Europe. Immu-nology Letters 2000; 71: 191-201.

14. Fontan G., Fernández-Cruz E., Carbone J., Matamoros N., Brieva J.A, Vives J. State-of-the-art of clinical immunology in Europe. Immunol Lett 2000, 1;71 (3):191-201.

15. Fahey J. Clinical immunology: a distinct area of immunology. Immunologist 1995; 3: 104-7.

16. Revillard JP, Celada F. Guidelines for the PhD degree in immuno-logy, International Union of Immunological Societies Education Comit-tee. Immunol Today 1992; 13: 367-73.

17. Cabrera T. Oferta docente, asistencial y científica para Residen-tes de Inmunología en España. Inmunología. 1995; 14: 19-27.

18. Manual de toma de muestras para el laboratorio clínico. Volu-men II. Inmunología. Editado por el INSALUD en coordinación con la Sociedad Española de Inmunología. Madrid, 1996.


INMUNOQUIMICA

Objetivos básicos de la rotación: Conocimiento de las técnicas inmunoquímicas de aplicación clínica; de su utilidad diagnóstica y de su

correcta interpretación y valoración. De los procesos de organización y gestión del laboratorio con especial hincapié en la automatización e

informatización.

Contenidos

Teóricos Prácticos

Acciones

• De las moléculas implicadas en las

funciones de la inmunidad natural y

adaptativa

• De la valoración de estas moléculas en

patología

• De los fundamentos técnicos para su

valoración cuantitativa y su actividad

funcional

• Cuantificación de Igs de las diferentes clases

y subclases

• Análisis de paraproteinas en suero y orina

• Caracterización y cuantificación de

crioglobulinas

• Cuantificaciones de IgE total y específica

• Purificación y análisis de proteinas del suero

y otros líquidos orgánicos (cromatografía

líquida, electroforesis, isoelectroenfoque)

• Realización de técnicas de elisa y “blotting”

• Cuantificación de proteinas del complemento

y otros sistemas efectores de la inmunidad

• Ensayos funcionales de la actividad del

complemento

• Cuantificaciones de IgE total y específica

• Análisis de precipitinas

• Control informatizado de seroteca

• Manejo de equipos automáticos para el

análisis de proteinas

• Utilización de recursos informáticos para

el manejo de datos (demográficos,

control de peticiones, resultados e

informes)

• Conocer los circuitos pre y post analítico

de las pruebas del laboratorio

• Aplicación de los controles de calidad

indicados para los distintos procesos y las

diferentes pruebas

• Revisión de resultados e informes bajo la

supervisión del tutor

• Presentación de seminarios sobre los

temas teóricos y las técnicas que se

incluyen en la rotación

Al final de la rotación se pretende que el residente este en condiciones de controlar la realización de las técnicas arriba indicadas, de valorar su

significación clínica y supervisar los resultados e informes de dichas pruebas.

8. ANEXO RELATIVO A LOS CONTENIDOS EN ÁREAS FUNDAMENTALES DE LA ESPECIALIDAD DE INMUNOLOGÍA

(ROTACIONES APARTADO 6.1)

AUTOINMUNIDAD

Objetivos básicos de la rotación: Conocimiento de las base teóricas de la tolerancia y autoinmunidad; de la patogenia y características clínicas

de las enfermedades autoinmunes, de la significación de los diversos autoanticuerpos, de las técnicas empleadas para su detección, y de su

correcta interpretación y valoración.

Contenidos


Acciones

• Conocimiento de los mecanismos

etiopatogénicos de la autoinmunidad

• Predisposición genética a la

autoinmunidad

• Regulación inmunológica de la

autoinmunidad

• Espectro clínico y serológico de las

conectivopatías autoinmunes

• Espectro clínico y serológico de los

síndromes poliglandulares

• Diabetes tipo I

• Autinmunidad gastrointesinal

• Autoinmunidad hepato biliar

• Autoinmunidad neurológica

• Dermatopatías ampollosas

• Autoanticuerpos en patología vascular y

renal

• Otras patologías de carácter autoinmune

• Realización de técnicas de

inmunofluorescencia

• Interpretación de patrones de fluoresecencia

en celulas y tejidos

• Preparación de extractos antigénicos de

tejidos

• Preparación de cortes histológicos de tejidos

para fluorescencia

• Técnicas de elisa e inmunoblot

• Técnicas de inmunoprecipitación

• Técnicas de contraelectroforesis

• Valoración de los resultados obtenidos con

otras técnicas de detección de autoanticuerpos

• presentación de seminarios relacionados

con el programa teórico

• participación activa en programas de

control de calidad

• revisión de resultados obtenidos en

patologías concretas

• interpretación de resultados con

asesoramiento del tutor

• colaboración en el desarrollo de pruebas

de detección de autoanticuerpos

• Comunicación fluida y normalizada con

los clínicos que habitualmente atienden

estas patologías

Al final de la rotación se pretende que el residente este en condiciones de deternminar y evaluar los autoanticuerpos habitualmente utilizados en

la clínica, y poder asesorar acerca de su significado e interés clínico a los médicos que lo soliciten


INMUNIDAD CELULAR

Objetivos básicos de la rotación: Adquirir los conocimientos y destreza necesarios para la purificación y cultivo de células, realización de

ensayos funcionales y pruebas cutáneas; conocer los principios, tecnologia básica y principales aplicaciones de la citometría de flujo (CF).

Contenidos


Acciones

• Conocer las propiedades fenotípicas y

funcionales de las subpoblaciones de

linfocitos y demás componentes

celulares de la respuesta inmune

• Conocer los órganos linfáticos, su

maduración, función, técnicas de

estudio

• Conocer la patología básica de las

celulas del sistema inmune (leucemias,

linfomas e inmunodeficiencias)

• Principios básicos de la CF

• Instrumentación, técnicas de marcaje,

fluorocromos, programas de aplicaciones

• Diferenciación y maduración celular de

la médula ósea normal

• Características inmunofenotípicas de los

neoplasias hematológicas

• Analísis fenotípico y funcional de los

leucocitos polinucleares

• Técnicas de separación y purificación de

celulas

• Técnicas de cultivo

• Técnicas de marcaje (incorporación de

isótopos, inmunoenzimas y trazadores

fluorescentes

• Métodos de análisis, parámetros, controles de

calidad

• Ensayos de proliferación en respuesta a

antígenos y mitógenos

• Técnicas de citotoxicidad

• Análisis de poblaciones linfocitarias en sangre

periférica de pacientes con infección VIH y

otras patologías

• Inmunofenotipaje de leucemias y linfomas

• Tipaje HLA-B27

• Cuantificación de citocinas

• Ensayo de fagocitosis y estress oxidativo

intracelular

• Ensayos de proliferación celular y apoptosis

• Ensayo de degranulación de basófilos

• Presentación de seminarios relacionados

con el programa teórico

• Revisiónes bibliográficas

• participación activa en programas de

control de calidad

• revisión de resultados obtenidos en

patologías concretas

• interpretación de resultados con

asesoramiento del tutor

• Comunicación fluida y normalizada con

los clínicos solicitan estudios de

inmunidad celular

Al final de la rotación se pretende que el residente este en condiciones de trabajar eficazmente en técnicas de cultivo celular, utilizar el citómetro

de flujo para las aplicaciones clínicas mas comunes, y de interpretar resultados de las pruebas de inmunidad celular arriba inicadas.

INMUNOGENETICA E HISTOCOMPATIBILIDAD

Objetivos básicos de la rotación: Conocer el polimorfismo genético y estructural, significado, funcionalidad y métodos de análisis del

complejo principal de histocompatibilidad (CPH), particularmente en el contexto de los transplantes de órganos y tejidos, y con la

susceptibilidad a las enfermedades autoinmunes. Conocer el significado y métodos de estudio del polimorfismo de otros genes importantes en la

fisiología del sistema inmune (receptor T, Igs, citocinas y sus receptores..)

Contenidos


Acciones

• Inmunobiología del CPH

• Técnicas de análisis del polimorfismo

del sistema HLA

• Inmunología del Transplante de médula

ósea

• Inmunología del transplante de órganos

(riñón, hígado, corazón y pulmón)

• Asociación HLA y enfermedades

autoinmunes

• Genética de la hemocromatosis

• Defectos genético- moleculares de las

inmunodeficiencias primarias

• Genes de citocinas, quimiocinas y sus

receptores; implicaciones en patología

• Tipaje HLA serológico

• Tipaje HLA genómico

• Detreminación de anticuerpos citotóxicos anti

HLA

• Cultivo linfocitario mixto

• Prueba cruzada para transplante de órgano

• Análisis de mutaciones del gen HFE

• Determinación fenotípica y genotípica de

alotipos de proteinas séricas

• Estudio genético de reordenamiento de

cadenas pesadas de Igs y del receptor de la

célula T

• Análisis del polimorfismo de genss de

citocinas, quimiocinas y sus receptores

• Marcadores genéticos de leucemia y linfomas


con los temas de la rotación

• Analizar estudios familiares con objeto

de identificar donantes compatibles y

segregación de caracteres. Establecer

genotipos y haplotipos familiares

• Aplicar los adecuados tests estadísticos a

los resultados de laboratorio referentes a

asociacion de polimorfismos genéticos a

patologías cocretas

• Participar activamente en talleres y

controles de calidad externos

• Elaborar informes bajo la supervisión del

tutor

• Colaborrar con el personal del laboratorio

en estudios de investigación en ésta área

Al final de la rotación se pretende que el residente este capacitado para tomar responsabilidades en la selección de donantes de transplante

renal alogénico y otras actuaciones en materia de transplante, de interpretar y valorar polimorfismos genéticos en el sistema HLA y otros

sistemas genéticos que afectan al funcionamiento del sistema inmune, y de su aplicación a estudios familiares y al análisis de riesgo de

enfermedad.


INMUNOLOGIA CLINICA

Objetivos básicos de la rotación: Los residentes médicos que opten por una formación médica en Inmunología Clínica deben recibir los

conocimientos, habilidades y actitudes requeridas para el diagnóstico y tratamiento de patologías de base inmunológica incluyendo

inmunodeficiencias, enfermedades autoinmunes y reacciones de hipersensibilidad

Contenidos


Acciones

• El Sistema Sanitario Español.

• Gestión clínica y financiación

hospitalaria.

• Medicina basada en la evidencia.

• Habilidades con el paciente.

• Capacitación en aspectos relacionados

con la ética clínica y con la

responsabilidad civil y penal del acto

médico.

• Protocolos de atención del paciente

urgente.

• Protocolos y guías de actuación clínica

para la prevención, diagnóstico y

tratamiento de las patologías de base

inmunológica.

• Evaluación y tratamiento de:

Inmunodeficiencias primarias y secundarias,

enfermedades autoinmunes, reacciones de

hipersensibilidad y de otras patologías de base

inmunológica.

• Admistración de terapias de base

inmunológica.

• Asesoramiento en el campo de la

inmunoprofilaxis de enfermedades

prevenibles.

• Organización y mantenimiento de serotecas

para la monitorización de la seguridad

biológica de los tratamientos con

hemoderivados (GGIV).

• Utilización de registros nacionales e

internacionales de enfermedades de base

inmunológica.


con los temas de la rotación.

• Asistencia a unidades clínicas de consulta

externa, hospitalización y de hospital de

día relacionadas con la especialidad.

• Realización de guardias de medicina

(mínimo 1 año).

• Participación en actividades de gestión de

las Unidad Clínica de Inmunología.

• Participar activamente en grupos de

trabajo clínico hospitalarios e inter-

hospitalarios.

• Elaborar informes clínicos bajo la

supervisión del tutor.

• Colaborrar con el personal de las

Unidades Clínicas en estudios de

investigación en éstas áreas.

Al final de las rotaciones clínicas se pretende que el residente este capacitado para tomar responsabilidades en la aplicación de los diferentes

protocolos de diagnóstico y tratamiento de patologías de base inmunológica.

ANEXO II.- DEFINICION DE LAS COMPETENCIAS TRANSVERSALES DEL INMUNÓLOGO MÉDICO.

Se propone la formación de un profesional Médico (MIR) especialista en Inmunología que pueda adquirir las competencias transversales médicas, compatibles con el conjunto de especialidades afines adscritas en el tronco Médico, así como las competencias específicas relativas al tronco de Laboratorio y Diagnóstico Clínico- Inmunología. Ver ANEXOS II.1, II.2, y II.3.

ANEXO II.- COMPETENCIAS TRANSVERSALES DEL INMUNÓLOGO MÉDICO II.1 DEFINICIÓN DE LAS COMPETENCIAS TRANSVERSALES DEL INMUNOLOGO

MEDICO

Descripción de las competencias transversales a adquirir por el inmunólogo médico para su formación y capacitación en la actividad clínica y en el manejo terapéutico de los enfermos con patologías inmunológicas. Se agrupan en los siguientes apartados: 1. Conocimientos, habilidades y actitudes en el manejo de patologías con problemas infecciosos recurrentes de base inmunológica y su atención en el laboratorio de diagnóstico clínico inmunológico 2. Conocimientos, habilidades y actitudes en el manejo de patologías con problemas linfoproliferativos (asociados a hipogammaglobulinemia, a expansiones LGK/NK y clonales linfocitarias) y hematológicos de base inmunológica y su atención en el laboratorio de diagnóstico clínico inmunológico. 3. Conocimientos, habilidades y actitudes en el manejo de problemas de base inmunológica en los transplantes de órganos y terapia celular y su atención en el laboratorio de diagnóstico clínico inmunológico. 4. Conocimientos, habilidades y actitudes en el manejo de patologías con problemas de reacciones de hipersensibilidad y angioedema y su atención en el laboratorio de diagnóstico clínico inmunológico. 5. Conocimientos, habilidades y actitudes en el manejo de patologías con problemas del tracto respiratorio de base inmunológica y su atención en el laboratorio de diagnóstico clínico inmunológico. 6. Conocimientos, habilidades y actitudes en el manejo de patologías con problemas del tracto digestivo y del hígado de base inmunológica y su atención en el laboratorio de diagnóstico clínico. 7. Conocimientos, habilidades y actitudes en el manejo de patologías con problemas inflamatorios de los vasos y músculo-esqueléticos y cutáneos de base inmunológica y su atención en el laboratorio de diagnóstico clínico inmunológico. 8. Conocimientos, habilidades y actitudes en el manejo de patologías con problemas del sistema endocrino de base inmunológica y su atención en el laboratorio de diagnóstico clínico inmunológico. 9. Conocimientos, habilidades y actitudes en el manejo de patologías con problemas del sistema nervioso y aparato ocular de base inmunológica y su atención en el laboratorio de diagnóstico clínico inmunológico. 10. Conocimientos, habilidades y actitudes en el manejo de patologías con problemas del sistema reproductivo (abortos recurrentes/fallos de fertilización in vitro) de base inmunológica y su atención en el laboratorio de diagnóstico clínico inmunológico. 11. Conocimientos, habilidades y actitudes en el manejo y prevención de patologías con tratamientos de base inmunológica (terapias biológicas con anticuerpos monoclonales e inmunoglobulinas, inmunosupresores, e inmunoterapia con vacunas profilácticas y terapéuticas) y su atención en el laboratorio de diagnóstico clínico inmunológico.

II.2 COMPATIBILIDAD DE LAS COMPETENCIAS TRANSVERSALES DEL INMUNOLOGO

MEDICO CON EL TRONCO MEDICO

Las once competencias descritas en el Anexo II.1 son compatibles con las siguientes once competencias del tronco médico (B, D, E, F, G, I, J, K, L, M y Q) que se transcriben más abajo y que aparecen en el documento del Ministerio de Sanidad de Marzo del 2011 “Competencias tronco médico, instrumentos y sistemas de evaluación”. En dicho documento las competencias se agrupan por apartados: A. Enfermedades cardiovasculares B. Enfermedades endocrinas, nutricionales y metabólicas C. Enfermedades renales y de las vías urinarias D. Enfermedades del aparato digestivo E. Enfermedades infecciosas F. Enfermedades del aparato locomotor y autoinmune sistémicas G. Enfermedades del sistema nervioso H. Enfermedades otorrinolaringológicas I. Enfermedades oculares J. Patología neoplásica K. Enfermedades de la piel L. Enfermedades de la sangre y de los órganos hematopoyéticos M. Enfermedades respiratorias N. Salud mental O. Geriatría P. Cuidados paliativos Q. Enfermedades alérgicas R. Atención al paciente crítico y situaciones de urgencia S. Signos y síntomas mal definidos No hacemos mención a los instrumentos de evaluación que serían los mismos que los propuestos en el tronco médico, aunque restringidos a los problemas de base inmunológica.

II.3 COMPATIBILIDAD DE LAS COMPETENCIAS TRANSVERSALES DEL INMUNOLOGO

MEDICO CON EL TRONCO DE LABORATORIO

Las once competencias descritas en el Anexo II.1 para el Inmunólogo médico implican además un conocimiento de las competencias específicas del tronco de laboratorio-Inmunología listadas más abajo en este Anexo II.3. Dichas competencias no se encuentran descritas como tales en el documento del anteproyecto de Troncalidad del Ministerio de Sanidad de Marzo del 2011 “Competencias del tronco de laboratorio y diagnóstico clínico, instrumentos y sistemas de evaluación”. A continuación se describen las competencias transversales específicas del Laboratorio Diagnóstico de Inmunología y que se agrupan en los siguientes apartados: 1. Conocimientos, habilidades y actitudes para los estudios celulares básicos, que incluyan la separación celular, citometría de flujo, los cultivos y la criopreservación. 2. Conocimientos, habilidades y actitudes en la utilización de las tecnologías básicas, automatizadas y de grandes instrumentos necesaria para la validación de otras pruebas diagnósticas, que incluyan la inmunofluorescencia y la secuenciación. 3. Conocimientos, habilidades y actitudes para los estudios de proteómica que incluyan la inmunoquímica, los inmunoenzimoensayos y las técnicas de separación analítica. 4. Conocimientos, habilidades y actitudes para los estudios de los principales alergenos y para la indicación e interpretación de las pruebas diagnósticas relacionadas con las enfermedades por hipersensibilidad y alergia. 5. Conocimientos, habilidades y actitudes para los estudios de biología molecular, que incluyan al menos las técnicas de extracción y amplificación de ácidos nucleicos. 6. Conocimientos, habilidades y actitudes para los estudios de inmunogenética molecular e histocompatibilidad. 7. Conocimientos, habilidades y actitudes en Sistemas de Información y Comunicación del Laboratorio, que incluyan la Bioestadística. 8. Competencias, habilidades, y actitudes en bioseguridad y otras competencias obligatorias determinadas por directiva: protección radiológica.

ANEXO III. ACTIVIDAD ASISTENCIAL MÉDICA Y DE LABORATORIO DE LA ESPECIALIDAD DE INMUNOLOGÍA EN LAS UNIDADES DOCENTES ACREDITADAS EN ESPAÑA.

ANEXO III.1: ACTIVIDAD ASISTENCIAL EN INMUNOLOGÍA CLÍNICA DE LAS UNIDADES DOCENTES ACREDITADAS DE LA ESPECIALIDAD DE INMUNOLOGÍA EN LOS HOSPITALES DEL SNS DEL ESTADO ESPAÑOL.

Comunidad autónoma AndalucíaCiudad Hospital Responsable Actividad Clínica Patologías

InmunológicasCádiz H. Universitario Puerta del Mar José Antonio Brieva Consulta / Interconsulta /

Hospital de díaID / AI / IV

Córdoba H. Universitario Reina Sofía José Peña Consulta / Interconsulta IDComunidad autónoma BalearesCiudad Hospital Responsable Actividad Clínica Patologías

InmunológicasPalma de Mallorca

H. Universitario Son Espases (Son Dureta)

Nuria Matamoros Consulta / Interconsulta ID / EHA

Comunidad autónoma CantabriaCiudad Hospital Responsable Actividad Clínica Patologías

InmunológicasSantander H. Universitario Marqués de Valdecilla Francisco Leyva Covián Consulta / Interconsulta ID / AI

Comunidad autónoma Castilla LeónCiudad Hospital Responsable Actividad Clínica Patologías

InmunológicasLeón Complejo Asistencial de León José María García Ruiz de MoConsulta / Interconsulta ID / UVComunidad autónoma CataluñaCiudad Hospital Responsable Actividad Clínica Patologías

InmunológicasBarcelona H. Universitario Vall d'`Hebron Ricardo Pujol Borrell Consulta / Interconsulta ID / AI / MTC

H. Santa Creu i Sant Pau Cándido Juárez Rubio Consulta / Interconsulta ID

Comunidad autónoma ExtremaduraCiudad Hospital Responsable Actividad Clínica Patologías

InmunológicasBadajoz Complejo Hospitalario Universitario de

Badajoz (H Infanta Cristina)Emilio Doblare Castellano Consulta / Interconsulta /

Hospital de díaID

Cáceres H. San Pedro de Alcántara Luis Miguel Fernández PereiraConsulta / Interconsulta / Hospital de día

ID / UV / AI

Comunidad autónoma MadridCiudad Hospital Responsable Actividad Clínica Patologías

InmunológicasMadrid H. Universitario La Paz Eduardo López Granados Consulta / Interconsulta ID / AI / IC / Tx

H. Universitario Ramón y Cajal Javier Coll Martí Consulta / Interconsulta IDH. General Universitario Gregorio Marañón

Eduardo Fernández-Cruz Consulta / Interconsulta / Hospitalización / Hospital de día

ID / UV / AI / IC / EHA / IR /T x / TB / IV

Fundación Jiménez Díaz Rosa García Delgado Interconsulta IF / AIComunidad autónoma MurciaCiudad Hospital Responsable Actividad Clínica Patologías

InmunológicasMurcia H. Universitario Virgen de la Arreixaca Rocío Álvarez Consulta / Interconsulta /

Hospital de díaID / AI / EHA

Abreviaturas de las Patologías Inmunológicas:AI = Enfermedades autoinmunesEHA = Enfermedades por Hipersensibilidad y AlergiaIC = Enfermedades Inflamatorias CrónicasID= InmunodeficienciasIF = InfecciosasIR = Enfermedades Inmunología ReproductivaIV = Inmunización con VacunasMTC = Monitorización Terapia CelularTB = Terapias BiológicasTx = Tratamientos en TrasplantesUV = Uveítis

Anexo III.1: Actividad Asistencial en Inmunología Clínica de las Unidades Docentes Acreditadas de la Especialidad de Inmunología en los Hospitales del SNS del Estado Español.

ANEXO III.2: CARTERA DE SERVICIOS DE LABORATORIO DIAGNÓSTICO CONSENSUADA POR LAS UNIDADES DOCENTES DE INMUNOLOGÍA ACREDITADAS EN LA COMUNIDAD DE MADRID.

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ANEXO III.3: CARTERA DE SERVICIOS CLÍNICA DE INMUNOLOGÍA DEL HOSPITAL GENERAL UNIVERSITARIO GREGORIO MARAÑÓN (HGUGM). Esta Cartera de Servicios está incluida en la base de datos SICAR 2010 (Sistema de Información sobre el Catálogo o Cartera de Servicios de Asistencia Especializada), gestionada por la Dirección General de Sistemas de Información sanitaria de la Comunidad de Madrid. A través de este organismo, o de las Gerencias y/o Departamentos de Admisión de los distintos Hospitales se puede acceder a las Carteras de Servicios específicas de cada Servicio de Inmunología de la Comunidad de Madrid y de otras Comunidades Autónomas.

ANEXO III.4: WEBSITE DEL REGISTRO DE INMUNODEFICIENCIAS PRIMARIAS DE ESPAÑA (REDIP): web.hsd.es/redip/

Esta WEBSITE está gestionada por Inmunólogos en colaboración con la Sociedad Española de Inmunología, y está vinculada al Servicio de Inmunología del Hospital Universitario de Son Espases (Son Dureta) de Palma de Mallorca, bajo la supervisión de la Dra. Nuria Matamoros. El Registro REDIP incluye todos los casos españoles de Inmunodeficiencias Primarias acreditados de acuerdo a los criterios internacionales vigentes, y son aportados, en su mayoría, por Inmunólogos Clínicos integrados en Unidades Clínicas de Inmunología que son responsables directos del diagnóstico y manejo de estos procesos patológicos.

ANEXO IV.- CARTAS DE EXPERTOS EUROPEOS DE INGLATERRA, ALEMANIA E ITALIA APOYANDO LA IMPLANTACIÓN EN ESPAÑA DE UN PROGRAMA FORMATIVO DE INMUNOLOGÍA CLÍNICA.

La actividad Médica y de Laboratorio de la especialidad de Inmunología está implantada en la gran mayoría de Hospitales europeos e internacionales de tercer nivel desde hace más de una década. La utilidad demostrada de la actividad clínica en los centros médicos se basa en la implantación, desde hace años, en esos países de programas formativos específicos como el que solicitamos se debiera implantar en España. Adjuntamos las cartas recibidas de líderes Europeos de la Inmunología Clínica de Inglaterra, Alemania e Italia, del Presidente de la Unión internacional de las Sociedades Inmunológicas y de los Presidentes de las Sociedades de Inmunología de Alemania e Italia (estamos pendientes de la recepción de los documentos de varios líderes profesionales de Francia).

ANEXO IV.1.-Professor Helen Chapel Oxford Centre for Clinical Immunology A FOCIS designated centre of excellence PiA UK Centre of Excellence Clinical Immunology Unit Nuffield Department of Medicine John Radcliffe Hospital Campus University of Oxford

Oxford Centre for Clinical Immunology A FOCIS designated centre of excellence PiA UK Centre of Excellence Professor Helen Chapel

email: [email protected]

Clinical Immunology Unit Nuffield Department of Medicine

Level 7 John Radcliffe Hospital Campus

Headley Way Oxford

OX3 9DU Tel: 01865 740361

Professor Eduardo Fernandez-Cruz President of National Committee of Immunology Head of Division Clinical Immunology Hospital General Universitario Gregorio Marañón Department Microbiology e Immunology Universidad Complutense de Madrid Dear Prof. Fernandez-Cruz, I would like to express my strong support for the developing of a specific Training Programme in “Clinical Immunology” in Spain, along the lines of those in other European countries. In the UK, following the establishment of such a programme in the 1980s, it has been mandatory for the training of medical residents to become consultants in Clinical Immunology in the future. Clinical Immunology has evolved over the past three decades from a predominant laboratory based specialty to a clinical section of medicine. The clinical work of Immunologists is largely but not exclusively out-patient based and involves chronic disease. Such practice involves primary immunodeficiencies, allergy, autoimmune rheumatic diseases and systemic vasculitis (jointly with Rheumatologists), joint paediatric clinics for children with immune deficiencies or allergy as well as immunoglobulin infusion clinics for patients with all types of antibody deficiencies or autoimmune diseases. In addition, Consultant Immunologists remain responsible for directing diagnostic immunology services in terms of clinical usefulness. The variety of clinical problems encountered by an Immunologist gives an opportunity to solve difficult diagnostic problems in patients with complex immune deficiencies or multi-system diseases and is closely linked to new immunomodulatory therapies that require understanding of basic immunological principles as well as clinical knowledge. As you know, Clinical Immunology is widely established in different European countries and we often have European trainees on secondment for clinical training, which

UNIVERSITY OF OXFORD

enhances our training programmes and provides cross European links and collaborations. I understand that the UK training programme has been accepted as a model for Europe by UEMS. We are always pleased to welcome those from Spain in Oxford but it is highly desirable that Spain rapidly develops a similar programme, not least so that the new medical interventions in immunology (including monoclonal antibodies and cytokine therapies) can be used appropriately for relevant patients with immunological disease in a cost-effective manner. Should you need any help, do not hesitate to contact the chairman of the JRCPTB Board for Immunology – Professor Chris Corrigan or the UEMS representative – Dr Siraj Misbah. Best wishes Yours sincerely

Professor Helen Chapel

ANEXO IV.2 Professor Dieter Kabelitz President, German Society for Immunology Institute of Immunology UKS-H Campus Kiel D-Kiel. Germany

ANEXO IV.3.- Gianpietro Semenzato President. Italian Society of Immunology, Clinical Immunology and Allergy (SIICA) Clinica e Sperimentale “G. Patrassi” Università degli Studi di Padova Padova. Italy

1

CF: 94088680486

www.siica.it

EXECUTIVE COMMITTEE

President Gianpietro Semenzato

Vice-President Vincenzo Barnaba

Secretary-Treasurer Massimo Locati

Members Andrea Cossarizza Piergiuseppe De Berardinis Armando Gabrielli Giampiero Girolomoni Paola Parronchi Carlo Pucillo Angelo Vacca

Office of the President Dipartimento di Medicina Clinica e Sperimentale “G. Patrassi” Università degli Studi di Padova Via Giustiniani 2 - 35128 Padova Tel 049-8212298 FAX 049-8211970 [email protected] Office of the Secretary Dipartimento di Medicina Traslazionale Università degli Studi di Milano Istituto Clinico Humanitas Via Manzoni, 56 – 20089 Rozzano (MI) Tel 02-82245116 FAX 02-82245101 [email protected]

Padova, July 13, 2011

Professor Eduardo Fernandez-Cruz President of National Committee of Immunology

Head of Division Clinical Immunology Hospital General Universitario Gregorio Marañón Department Microbiology e Immunology Universidad Complutense de Madrid

Dear Prof. Fernandez-Cruz,

As the President of the Italian Society of Immunology, Clinical Immunology and

Allergy, I would like to express our strong support for the developing in Spain of a

specific Training Program in “Clinical Immunology”. The establishment of this is

mandatory for the training of medical residents that will eventually become consultants

in Clinical Immunology.

Immunological mechanisms are involved in the pathogenesis of almost all human

several diseases and Clinical immunology is a new branch of medicine which is

trasverse to all sciences and involves diseases of different systems, including the skin,

the lung, gastrointestinal and cardiovascular systems, etc. etc.

The possibility to develop a specific Training Program in “Clinical Immunology” in Spain

will certainly let young people to face this interesting area of medicine. This speciality

is widely represented in different European countries and it is highly desirable that

Spain falls into line.

Should you need any help, do not hesitate to contact us.

Sincerely,

Gianpietro Semenzato, M.D.

SIICA President

ANEXO IV.4.- Prof. Dr. med. R.E. Schmidt

Chairman of the Clinical Immunology Committee of International Union Immunological Societies (IUIS).

Head of Department of Clinical Immunology and Rheumatology Medizinische Hochschule Hannover Hannover. Germany

Zentrum Innere Medizin

Klinik für Immunologie und Rheumatologie Prof. Dr. med. R. E. Schmidt, Direktor Telefon: 0511 532- 6656 Fax: 0511 532- 9067 [email protected] www.mh-hannover.de/kir.html Carl-Neuberg-Straße 1 30625 Hannover Telefon: 0511 532-0 www.mh-hannover.de

MHH, Klinik für Immunologie und Rheumatologie, OE 6830

Carl-Neuberg-Str. 1, 30625 Hannover

Professor Eduardo Fernandez-Cruz President of National Committee of Immunology Head of Division Clinical Immunology Hospital General Universitario Gregorio Marañón Department Microbiology e Immunology Universidad Complutense de Madrid

20. Juli 2011 Ihr Zeichen Ihre Nachricht vom Mein Zeichen

Dear Prof. Fernandez-Cruz, As chairman of the Clinical Immunology Committee of the International Union of Immunologi-cal Societies (IUIS) and Head of Clinical Immunology and Rheumatology at the Medical Uni-versity of Hannover I would like to express our strong support for your interest in developing in Spain a Training Program in Clinical Immunology. There is a real need to establish a specific program for understanding pathogenesis of almost all human diseases and modern treatment modalities particularly in immunodeficiencies, rheumatology, infectious diseases, transplanta-tion and tumor immunology as well as allergy. The German Society for Immunology has therefore already established such a program during the past six years and is providing specialists with the respective certificate. We also have established training centres for clinical immunology. The establishment of a clinical immunology program should be mandatory for medical resi-dence that will eventually become consultants in clinical immunology. Yours sincerely,

Prof. Dr. med. R.E. Schmidt Head of Department of Clinical Immunology and Rheumatology Chairman of the Clinical Immunology Committee of IUIS

Zentrale der MHH: Immunol. Rheumatol. Ambulanz Station 32 Tel.: 0511/532-0 Tel.: 0511/532-3014 Rheumatologie/Immunologie Tel.: 0511/532-2321/2 Immunol. Infektiol. Ambulanz Station 78 a Tel.: 0511/532-3637 Infektionsstation Tel.: 0511/532-3269

mailto:[email protected]

http://www.mh-hannover.de/kir.html

ANEXO IV.5 Dr.G.P.Spickett Head of Regional Immunology Services Regional Department of Medicine, Royal Victoria Infirmary

Consultant & Senior Lecturer in Clinical Immunology

Newcastle upon Tyne. United Kingdom.

Dr.G.P.Spickett Dip CBT MA LLM DPhil FRCPath FRCP FRCPE Consultant in Clinical Immunology, Allergy and General Medicine

Regional Department of Medicine, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP Tel: 0191 2824281; email: [email protected]

Private Secretary: Miss Anne Bell; Tel: 0191 28225750; Fax 0191 2825070; email: [email protected] 28 July 2011

Professor Eduardo Fernández-Cruz Head Division of Clinical Immunology Hospital General Universitario Gregorio Marañón de Madrid Universidad Complutense de Madrid. Spain Dear Professor Fernandez-Cruz, In response to your email I am writing to express my strong support for the development of a specific postgraduate training programme in Clinical Immunology, to enable junior doctors to train in the speciality and become consultants in Clinical Immunology. Clinical Immunology encompasses both clinical and laboratory dimensions and it is essential that consultant immunologists have in-depth training in both aspects. The immune system is involved in disease of all organ systems and the Immunology Laboratory has a fundamental role in the diagnosis and management of these diseases. Organ-based specialists require guidance on appropriate test selection and results interpretation and this is best carried out by physicians with an understanding of immunological disease. Clinical Immunologists will undertake the diagnosis and clinical management of patients with primary immunodeficiencies, a highly specialised area of medicine, and in the UK will also undertake the diagnosis and management of patients with severe allergic disease. They will be involved, with other organ-based specialists, in the increasing use of biological immunotherapeutic agents in the management of immune-based disease. Clinical Immunology is a well-established discipline in the UK and has had a training programme which spans both clinical and laboratory aspects for the last 20 years. This is supervised by the Royal Colleges of Physicians and Pathologists, and there is an exit examination in the form of the Fellowship examination of the Royal College of Pathologists. In order to ensure harmonisation of postgraduate medical in the European Union, it is essential that Spain has an equivalent training programme. I am happy to provide any further information that may be required. Yours sincerely,

Dr.G.P.Spickett Consultant & Senior Lecturer in Clinical Immunology Head of Regional Immunology Services

ANEXO IV.6 Professor. Bodo Grimbacher Past Secretary of the European Society for Immunodeficiencies Dept of Immunology and Molecular, Royal Free Hospital, University College Division of infection & immunity London. United Kingdom

Dr. Bodo Grimbacher Professor and Consultant, Head of EU Marie-Curie Research Group Dept of Immunology, Royal Free Hospital, University College London Pond Street, London NW3-2QG, United Kingdom Tel: +44 (0)207 794 0500 ext 33321, Fax: +44 (0)207 433 1943 E-mail: [email protected]

DIVISION OF INFECTION & IMMUNITY DEPARTMENT OF IMMUNOLOGY AND MOLECULAR PATHOLOGY ROYAL FREE HOSPITAL London, June 27th, 2011 RE: Letter of support Dear Prof. Fernandez-Cruz, As the Past Secretary of the European Society for Immunodeficiencies (ESID, www.esid.org), and consultant of one of the largest adult primary immune deficiency centres in Europe, I would like to express my strong support for developing a specific training program in Clinical Immunology in Spain. I have established a patient registry for primary immunodeficient patients across Europe, which now contains clinical and laboratory data on more than 12.000 patients with primary immune deficiencies. Doing this, I have noticed that the care for these patients varies considerably in between European countries. One reason for this is the different training physicians receive, but also the different affiliations and “homes” Clinical Immunology has in the different countries. I therefore strongly support Prof. Fernandez-Cruz’ initiative to overhaul the training program for Clinical Immunology in Spain moving it to a Clinical- and Laboratory-based speciality. Should you need any more information, please do not hesitate to contact me. Best regards,

Bodo Grimbacher B. Grimbacher, MD Professor and Consultant Dept. of Immunology and Molecular Pathology (2nd floor) Royal Free Hospital & University College Medical School Pond Street, London NW3 2QG, UK Tel: +44-(0)20-7794-0500 ext.34399 Fax: +44-(0)20-7433-1943

To whom it may concern

ANEXO V.- PROGRAMAS FORMATIVOS EUROPEOS EN INMUNOLOGÍA CLÍNICA Y

DE LABORATORIO DIAGNÓSTICO

ANEXO V.1.- PROGRAMAS FORMATIVOS EN INMUNOLOGÍA CLÍNICA Y DE

LABORATORIO DIAGNÓSTICO VIGENTES EN EL REINO UNIDO.

Immunology Curriculum August 2010 Page 1 of 94

SPECIALTY TRAINING CURRICULUM

FOR

IMMUNOLOGY

AUGUST 2010

Joint Royal Colleges of Physicians Training Board

5 St Andrews Place Regent’s Park

London NW1 4LB

Telephone: (020) 79351174 Facsimile: (020)7486 4160 Email: [email protected]

Website: www.jrcptb.org.uk


Table of Contents 1 Introduction........................................................................................................3 2 Rationale ............................................................................................................3

2.1 Purpose of the Curriculum 3

2.2 Development 3

2.3 Training Pathway 4

2.4 Enrolment with JRCPTB 5

2.5 Duration of Training 5

2.6 Less Than Full Time Training (LTFT) 5

3 Content of Learning...........................................................................................6 3.1 Programme Content and Objectives 6

3.2 Good Medical Practice 6

3.3 Syllabus 7

4 Learning and Teaching......................................................................................45 4.1 The Training Programme 45

4.2 Teaching and Learning Methods 45

4.3 Research 47

4.4 Academic Training 48

5 Assessment .......................................................................................................49 5.1 The Assessment System 49

5.2 Assessment Blueprint 49

5.3 Assessment Methods 49

5.4 Decisions on Progress (ARCP) 51

5.5 ARCP Decision Aid - Minimal Standards Determining Satisfactory Progress 53

5.6 Penultimate Year Assessment (PYA) 54

5.7 Complaints and Appeals 54

6 Supervision and Feedback ...............................................................................55 6.1 Supervision 55

6.2 Appraisal 56

7 Managing Curriculum Implementation.............................................................57 7.1 Intended Use of Curriculum by Trainers and Trainees 57

7.2 Recording progress 57

8 Curriculum Review and Updating.....................................................................57 9 Equality and Diversity .......................................................................................58 10 Appendix A.........................................................................................................59


1 Introduction Immunology as a medical specialty deals with the clinical and laboratory care of patients with diseases due to disordered immunity. Immune-mediated disease covers a wide spectrum of disorders, ranging from failure of the immune system (immunodeficiency) to disorders characterised by heightened immune reactivity (allergy and autoimmunity). In practice, clinical immunologists take a lead role in the investigation and management of patients with immunodeficiency and severe allergy whilst working collaboratively with relevant organ-based specialists to provide optimal care for patients with systemic autoimmune disease and vasculitis. Alongside the provision of a clinical service to the aforementioned group of patients, immunologists direct a comprehensive diagnostic laboratory service which underpins the diagnosis and monitoring of this broad range of immunological diseases.

2 Rationale

2.1 Purpose of the Curriculum

The purpose of this curriculum is to define the process of training and the competencies needed to produce a consultant immunologist capable of independent practice in the United Kingdom. The award of a certificate of completion of training in the specialty will denote that a trainee is equipped with the requisite specialised scientific knowledge, clinical and laboratory skills required to diagnose, treat and where relevant, prevent diseases characterised by immunodeficiency, autoimmunity and allergy coupled with the ability to direct a diagnostic immunology laboratory service. The UK clinical practice of immunology is fully consistent with the World Health Organisation's (WHO) definition of Immunology as a specialty , encompassing clinical and laboratory activity dealing with the study, diagnosis and management of patients with diseases resulting from disordered immunological mechanisms, and conditions in which immunological manipulations form an important part of therapy(Lambert PH et al.Clinical Immunology: -guidelines for its organisation, training and certification: relationships with allergology and other medical disciplines - a WHO/IUIS/IAACI report. Clin Exp Immunol 1993;93:484-91). In practice, this translates in to Immunologists providing combined clinical and laboratory services for patients with immunodeficiency, autoimmune disease, vasculitis and allergy. The curriculum has been designed to build upon the knowledge and core competencies in general internal medicine that trainees will bring with them as they enter immunology training. Throughout specialty training, the curriculum provides a structured framework to enable incremental learning and reflection across the whole breadth of clinical and laboratory immunology.

2.2 Development

This curriculum was developed by the Immunology SAC of JRCPTB for Immunology which includes lay representation and training programme directors, in consultation with all stakeholders including trainees and trainers. It replaces the previous version of the curriculum dated May 2007 with changes to ensure the curriculum meets GMC’s standards for Curricula and Assessment, and to incorporate revisions to the content and delivery of the training programme. Major changes from the previous curriculum include the incorporation of leadership, health inequalities and common competencies. A draft version of the curriculum was circulated to all immunology consultants and trainees. Patient’s views on the curriculum were obtained through the Primary Immunodeficiency Association (PiA), the national patient support organisation for patients with immunodeficiencies .


The content of this curriculum was chosen by the SAC to reflect current UK hospital practice in Immunology. Educational supervisors and trainees were involved in its development via their representation on committees such as the Immunology SAC of JRCPTB.

2.3 Training Pathway

Specialty training in Immunology consists of core and higher speciality training. Core training provides physicians with: the ability to investigate, treat and diagnose patients with acute and chronic medical symptoms; and with high quality review skills for managing inpatients and outpatients. Higher speciality training then builds on these core skills to develop the specific competencies required to practise independently as a consultant Immunologist. Core training may be completed in either a Core Medical Training (CMT) or Acute Care Common Stem (ACCS) programme. The full curriculum for specialty training in Immunology therefore consists of the curriculum for either CMT or ACCS plus this specialty training curriculum for Immunology. There are common competencies that should be acquired by all physicians during their training period starting within the undergraduate career and developed throughout the postgraduate career, for example communication, examination and history taking skills. These are initially defined for CMT and then developed further in the specialty. This curriculum supports the spiral nature of learning that underpins a trainee’s continual development. It recognises that for many of the competences outlined there is a maturation process whereby practitioners become more adept and skilled as their career and experience progresses. It is intended that doctors should recognise that the acquisition of basic competences is often followed by an increasing sophistication and complexity of that competence throughout their career. This is reflected by increasing expertise in their chosen career pathway. Completion of CMT or ACCS and acquisition of full MRCP (UK) will be required before entry into Specialty training at ST3 (2011 onwards). The approved curriculum for CMT is a sub-set of the Curriculum for General Internal Medicine (GIM). A “Framework for CMT” has been created for the convenience of trainees, supervisors, tutors and programme directors. The body of the Framework document has been extracted from the approved curriculum but only includes the syllabus requirements for CMT and not the further requirements for acquiring a CCT in GIM.


Diagram 1.0 Training Pathway for Immunology

2.4 Enrolment with JRCPTB

Trainees are required to register for specialist training with JRCPTB at the start of their training programmes. Enrolment with JRCPTB, including the complete payment of enrolment fees, is required before JRCPTB will be able to recommend trainees for a CCT in Immunology. Trainees can enrol online at www.jrcptb.org.uk

2.5 Duration of Training

Although this curriculum is competency based, the duration of training must meet the European minimum of 4 (four) years for post registration in full time training adjusted accordingly for flexible training (EU directive 2005/36/EEC) requires that flexible training can be no less than 50% whole time equivalent). The SAC has advised that training from ST1 will usually be completed in 7 (seven) years in full time training.

2.6 Less Than Full Time Training (LTFT)

Trainees who are unable to work full-time are entitled to opt for less than full time training programmes. EC Directive 2005/36/EC requires that:

• LTFT shall meet the same requirements as full-time training, from which it will differ only in the possibility of limiting participation in medical activities.

• The competent authorities shall ensure that the competencies achieved and the quality of part-time training are not less than those of full-time trainees.

The above provisions must be adhered to. LTFT trainees should undertake a pro rata share of the out-of-hours duties (including on-call and other out-of-hours commitments) required of their full-time colleagues in the same programme and at the equivalent stage. EC Directive 2005/36/EC states that there is no longer a minimum time requirement on training for LTFT trainees. In the past, less than full time trainees were required to work a minimum of 50% of full time. With competence-based training, in order to retain competence, in addition to acquiring new skills, less than full time trainees would still normally be expected to work a minimum of 50% of full time. If you are returning or converting to training at less than full time please complete the LTFT application form on the JRCPTB website www.jrcptb.org.uk .

FY2

MRCP (UK) & WPBAs

Immunology Training

Core Medical Training or Acute Care Common Stem

Selection Selection 84 months to completion minimum

FRCPath


Funding for LTFT is from deaneries and these posts are not supernumerary. Ideally therefore 2 LTFT trainees should share one post to provide appropriate service cover. Less than full time trainees should assume that their clinical training will be of a duration pro-rata with the time indicated/recommended, but this should be reviewed during annual appraisal by their TPD and chair of STC and Deanery Associate Dean for LTFT training. As long as the statutory European Minimum Training Time (if relevant), has been exceeded, then indicative training times as stated in curricula may be adjusted in line with the achievement of all stated competencies.

3 Content of Learning

3.1 Programme Content and Objectives

The syllabus (subject matter) for the curriculum comprises the following principal areas:

• Acquisition of a core body of knowledge in fundamental immunology and its applications

• Investigation and management of patients with congenital and acquired immunodeficiency disorders

• Investigation and management of patients with autoimmune (including rheumatic) disease and systemic vasculitides in liaison with appropriate organ-based specialist colleagues

• Investigation and management of patients with allergic diseases. As a group, Immunologists comprise the single biggest specialty currently providing specialist allergy services. In recognition of this important service need, trainees must demonstrate competence in the independent diagnosis and management of common allergic disorders of all degrees of severity

• Delivery of a diagnostic immunology laboratory service in accordance with accreditation standards laid down by Clinical Pathology Accreditation (CPA UK) or other recognised accrediting bodies

• In addition, trainees should be able to explain the principles underlying solid organ and stem cell transplantation

• Acquire “Generic Skills” required for immunology, in accordance with Good Medical Practice (see below)

On completion of the immunology training programme, the trainee must have acquired and be able to demonstrate:

• Appropriate attitudes and behaviours in order to be able to work as a consultant

• Good working relationships with colleagues and the appropriate communication skills required for the practice of immunology

• Knowledge, skills, attitudes and behaviours to act in a professional manner at all times

• Knowledge, skills, attitudes and behaviours to provide appropriate teaching and to participate in effective research to underpin immunology practice

• Understanding of the context, meaning and implementation of clinical governance

• Knowledge of the structure and organisation of the NHS

• Acquisition of management skills required for the running of an Immunology laboratory

• Familiarity with health and safety regulations, as applied to the work of an Immunology department

3.2 Good Medical Practice

In preparation for the introduction of licensing and revalidation, the General Medical Council has translated Good Medical Practice into a Framework for Appraisal and Assessment which


provides a foundation for the development of the appraisal and assessment system for revalidation. The Framework can be accessed at http://www.gmc-uk.org/Framework_4_3.pdf_25396256.pdf The Framework for Appraisal and Assessment covers the following domains: Domain 1 – Knowledge, Skills and Performance Domain 2 – Safety and Quality Domain 3 – Communication, Partnership and Teamwork Domain 4 – Maintaining Trust The “GMP” column in the syllabus defines which of the 4 domains of the Good Medical Practice Framework for Appraisal and Assessment are addressed by each competency. Most parts of the syllabus relate to “Knowledge, Skills and Performance” but some parts will also relate to other domains.

3.3 Syllabus

In the tables below, the “Assessment Methods” shown are those that are appropriate as possible methods that could be used to assess each competency. It is not expected that all competencies will be assessed and that where they are assessed not every method will be used. See section 5.2 for more details. “GMP” defines which of the 4 domains of the Good Medical Practice Framework for Appraisal and Assessment are addressed by each competency. See section 3.2 for more details. Each section of the curriculum outlines the knowledge, skills and behaviours that must be obtained by the trainee in order to successfully complete training. During their training, it is expected that the trainee will progress through three levels of competence, as outlined below:

Level 1: Introductory - The trainee has comprehensive understanding of principles and practices under direct supervision.

Level 2: Intermediate - The trainee has a good general knowledge and understanding of most principles and practices under indirect supervision. He/she should be able to deal with most of the day-to-day issues in a hospital immunology laboratory and outpatient clinic/ward to an adequate level but will still require consultant input with regard to complex management and clinical issues.

Level 3: Independent - The trainee has an in-depth knowledge and understanding of principles. He/she should be competent to discuss and deal with the subject (or, where appropriate, perform the task/procedure), demonstrating a level of clinical or professional judgement commensurate with independent practice at consultant level. It is anticipated that a trainee at this level should have consultant input readily available at all times where required

Syllabus Contents

1. Common Competencies................................................................................................... 9 1.1 History Taking........................................................................................................... 9

1.2 Clinical Examination ................................................................................................. 10

1.3 Therapeutics and Safe Prescribing ........................................................................... 10

1.4 Time Management and Decision Making .................................................................. 12

1.5 Decision Making and Clinical Reasoning .................................................................. 13


1.6 The Patient as Central Focus of Care ....................................................................... 14

1.7 Prioritisation of Patient Safety in Clinical Practice ..................................................... 15

1.8 Team Working and Patient Safety ............................................................................ 16

1.9 Principles of Quality and Safety Improvement........................................................... 17

1.10 Infection Control...................................................................................................... 18

1.11 Managing Long-Term Conditions and Promoting Patient Self-Care ........................ 19

1.12 Relationships with Patients and Communication within a Consultation ................... 20

1.13 Breaking Bad News ................................................................................................ 21

1.14 Complaints and Medical Error................................................................................. 22

1.15 Communication with colleagues and cooperation ................................................... 23

1.16 Health Promotion and Public Health ....................................................................... 24

1.17 Environmental Protection and Emergency Planning................................................ 25

1.18 Principles of Medical Ethics and Confidentiality ...................................................... 26

1.19 Obtaining of Consent .............................................................................................. 27

1.20 Legal Framework for Practice ................................................................................. 28

1.21 Ethical Research..................................................................................................... 29

1.22 Evidence and Guidelines ........................................................................................ 29

1.23 Audit ....................................................................................................................... 30

1.24 Teaching and Training ............................................................................................ 31

1.25 Personal Behaviour ................................................................................................ 33

1.26 Management and NHS Structure ............................................................................ 34

2. Medical Leadership and Management ............................................................................ 36 2.1 Personal Qualities..................................................................................................... 36

2.2 Working with Others ................................................................................................. 36

2.3 Managing Services ................................................................................................... 37

2.4 Improving Services ................................................................................................... 38

2.5 Setting Direction ....................................................................................................... 38

3. Content of learning........................................................................................................... 40 3.1 Fundamental Immunology ........................................................................................ 40

3.2 Primary and Secondary Immunodeficiency Diseases................................................ 41

3.3 Systemic Autoimmune Rheumatic Disease and Systemic Vasculitides..................... 42

3.4 Allergic Diseases ...................................................................................................... 43

3.5 Laboratory Immunology ............................................................................................ 44


1. Common Competencies

1.1 History Taking

To elicit a relevant focused history from patients with increasingly complex issues and in increasingly challenging circumstances

To record the history accurately and synthesise this with relevant clinical examination, establish a problem list increasingly based on pattern recognition including differential diagnosis and formulate a management plan that takes account of likely clinical evolution

Knowledge

Assessment

Methods

GMP

Comprehends the importance of different elements of the history mini-CEX 1

Comprehends that patients do not always present their history in a structured fashion

mini-CEX 1,3

Knows the likely causes and risk factors for conditions relevant to mode of presentation

mini-CEX 1

Recognises that the patient’s wishes and beliefs and the history should inform examination, investigation and management

mini-CEX 1

Recognises the importance of social and cultural issues and practices that may have an impact on health

mini-CEX 1

Skills

Identifies and overcomes possible barriers to effective communication mini-CEX 1,3

Communicates effectively with patients from diverse backgrounds and those with special communication needs, such as those who need interpreters

mini-CEX

Manages time and draws consultation to a close appropriately mini-CEX 1,3

Comprehends that effective history taking in non-urgent cases may require several discussions with the patient and other parties, over time

mini-CEX 1,3

Supplements history with standardised instruments or questionnaires when relevant

mini-CEX 1,3

Manages alternative and conflicting views from family, carers, friends and members of the multi-professional team and maintains focus

mini-CEX 1,3

Assimilates history from the available information from patient and other sources including members of the multi-professional team.

mini-CEX 1,3

Where values and perceptions of health and health promotion conflict, facilitates balanced and mutually respectful decision making

mini-CEX

Recognises and interprets appropriately the use of non verbal communication from patients and carers

mini-CEX 1,3

Focuses on relevant aspects of history mini-CEX 1,3

Behaviours

Shows respect and behaves in accordance with Good Medical Practice mini-CEX 3,4


1.2 Clinical Examination

To perform focused, relevant and accurate clinical examination in patients with increasingly complex issues and in increasingly challenging circumstances

To relate physical findings to history in order to establish diagnosis and formulate a management plan

Knowledge

Assessment Methods

GMP

Understands the need for a targeted and relevant clinical examination CbD, mini-CEX 1

Understands the basis for clinical signs and the relevance of positive and negative physical signs

CbD, mini-CEX 1

Comprehends constraints (including those that are cultural or social) on performing physical examination and strategies that may be used to overcome them

CbD, mini-CEX 1

Comprehends the limitations of physical examination and the need for adjunctive forms of assessment to confirm diagnosis

CbD, mini-CEX 1

Recognises when the offer/use of a chaperone is appropriate or required CbD, mini-CEX 1

Skills

Performs a valid, targeted and time efficient examination relevant to the presentation and risk factors

CbD, mini-CEX 1

Recognises the possibility of deliberate harm (both self harm and harm by others) in vulnerable patients and reports to appropriate agencies

CbD, mini-CEX 1,2

Actively elicits important clinical findings CbD, mini-CEX 1

Performs relevant adjunctive examinations CbD, mini-CEX 1

Behaviours

Shows respect and behaves in accordance with Good Medical Practice CbD, mini-CEX, MSF 1,4

Considers social, cultural and religious boundaries to clinical examination, appropriately communicates and makes alternative arrangements where necessary

CbD, mini-CEX, MSF 1,4

1.3 Therapeutics and Safe Prescribing

To prescribe, review and monitor appropriate therapeutic interventions relevant to clinical practice including non – medication based therapeutic and preventative indications

Knowledge

Assessment Methods

GMP

States indications, contraindications, side effects, drug interactions and dosage of commonly used drugs

CbD, mini-CEX 1

Recalls range of adverse drug reactions to commonly used drugs, including complementary medicines

CbD, mini-CEX 1

Recalls drugs requiring therapeutic drug monitoring and interprets results CbD, mini-CEX 1

Outlines tools to promote patient safety and prescribing, including electronic clinical record systems and other IT systems

CbD, mini-CEX 1,2

Defines the effects of age, body size, organ dysfunction and concurrent illness on drug distribution and metabolism relevant to the trainees practice

CbD, mini-CEX 1,2

Understands the roles of regulatory agencies involved in drug use, CbD, mini-CEX 1,2


monitoring and licensing (e.g. National Institute for Clinical Excellence (NICE), Medical Healthcare Products Regulatory Agency (MHRA) and hospital formulary committees

Understands the importance of non-medication based therapeutic interventions including the legitimate role of placebos

CbD, mini-CEX 1,2

Recalls in detail the propensity of drugs to elicit IgE-mediated and non-IgE mediated systemic anaphylactic reactions in certain individuals and the capacity of structurally related drugs to cross-react

CbD, mini-CEX

Recalls a rational basis for the use of alternative drugs in drug allergic patients

CbD, mini-CEX

Is familiar with the indications, products, modes of delivery and dosage regimens for allergen immunotherapy

CbD, mini-CEX

Skills

Reviews the continuing need for, effect of and adverse effects of long term medications relevant to the trainees clinical practice

CbD, mini-CEX 1, 2

Anticipates and avoid defined drug interactions, including complementary medicines

CbD, mini-CEX 1

Advises patients (and carers) about important interactions and adverse drug effects

CbD, mini-CEX 1,3

Prescribes appropriately in pregnancy, and during breast feeding CbD, mini-CEX 1

Makes appropriate dose adjustments following therapeutic drug monitoring, or physiological change (e.g. deteriorating renal function)

CbD, mini-CEX 1

Uses IT prescribing tools where available to improve safety CbD, mini-CEX 1,2

Employs validated methods to improve patient concordance with prescribed medication

mini-CEX 1,3

Provides comprehensible explanations to the patient, and carers when relevant, for the use of medicines and understands the principles of concordance in ensuring that drug regimes are followed

CbD, mini-CEX 1,3

Ensures safe systems for monitoring, review and authorisation where involved in “repeat prescribing”

CbD, mini-CEX 1

Recognises the importance of resources when prescribing, including the role of a Drug Formulary and electronic prescribing systems

CbD, mini-CEX 1

Is able to provide advice on, and perform relevant skin prick and other challenge tests for drug allergy and interpret the results

CbD, mini-CEX, DOPS

1,2

Behaviours

Minimises the number of medications taken by a patient to a level compatible with best care

CbD, mini-CEX 1

Appreciates the role of non-medical prescribers CbD, mini-CEX 1,3

Remains open to advice from other health professionals on medication issues

CbD, mini-CEX 1,3

Ensures prescribing information is shared promptly and accurately between a patient’s health providers, including between primary and secondary care

CbD 1,3

Participates in adverse drug event reporting mechanisms CbD 1

Takes particular care to disseminate information about drug allergies appropriately and instructs patients to do the same

CbD, mini-CEX 1

Remains up to date with therapeutic alerts, and responds appropriately CbD 1


1.4 Time Management and Decision Making

Learn how to prioritise and organise clinical and clerical duties in order to optimise patient care and make appropriate clinical and clerical decisions in order to optimise the effectiveness of the clinical team resource.

Knowledge Assessment Methods

GMP

Understands that effective organisation is key to time management CbD 1

Understands that some tasks are more urgent and/or more important than others

CbD 1

Understands the need to prioritise work according to urgency and importance

CbD 1

Understands that some tasks may have to wait or be delegated to others CbD 1

Understands the roles, competences and capabilities of other professionals and support workers

CbD 1

Outlines techniques for improving time management CbD 1

Understands the importance of prompt investigation, diagnosis and treatment in disease and illness management

CbD, mini-CEX 1,2

Skills

Maintains focus on individual patient needs whilst balancing multiple competing pressures

CbD 1

Identifies clinical and clerical tasks requiring attention or predicted to arise CbD, mini-CEX 1,2

Estimates the time likely to be required for essential tasks and plans accordingly

CbD, mini-CEX 1

Groups together tasks when this will be the most effective way of working CbD, mini-CEX 1

Recognises the most urgent / important tasks and ensures that they managed expediently

CbD, mini-CEX 1

Regularly reviews and re-prioritises personal and team work load CbD, mini-CEX 1

Organises and manages workload effectively and flexibly CbD, mini-CEX 1

Makes appropriate use of other professionals and support workers CbD, mini-CEX 1

Behaviours

Works flexibly and deals with tasks in an effective and efficient fashion CbD, MSF 3

Recognises when self or others are falling behind and takes steps to rectify the situation

CbD, MSF 3

Communicates changes in priority to others MSF 1

Remains calm in stressful or high pressure situations and adopts a timely, rational approach

MSF 1

Appropriately recognises and handles uncertainty within the consultation MSF 1


1.5 Decision Making and Clinical Reasoning

Acquire the ability to formulate a diagnostic and therapeutic plan for a patient according to the clinical information available.

Acquire the ability to prioritise the diagnostic and therapeutic plan.

Acquire the ability to communicate a diagnostic and therapeutic plan appropriately.


GMP

Defines the steps of diagnostic reasoning CbD, mini-CEX 1

Conceptualises clinical problems in a medical and social context CbD, mini-CEX 1

Understands the psychological components of disease and illness presentation

CbD, mini-CEX 1

Recognises how to use expert advice, clinical guidelines and algorithms CbD, mini-CEX 1

Recognises and appropriately responds to sources of information accessed by patients

CbD, mini-CEX 1

Defines the concepts of disease natural history and assessment of risk CbD, mini-CEX 1,2

Outlines methods and associated problems of quantifying risk e.g. cohort studies

CbD, mini-CEX 1

Outlines the concepts and drawbacks of quantitative assessment of risk or benefit e.g. numbers needed to treat

CbD 1

Describes commonly used statistical methodology CbD 1

Knows how relative and absolute risks are derived and the meaning of the terms predictive value, sensitivity and specificity in relation to diagnostic tests

mini-CEX 1

Skills

Interprets clinical features, their reliability and relevance to clinical scenarios including recognition of the breadth of presentation of common disorders

CbD, mini-CEX 1

Incorporates an understanding of the psychological and social elements of clinical scenarios into decision making through a robust process of clinical reasoning

CbD, mini-CEX 1

Interprets history and clinical signs CbD, mini-CEX 1

Generates hypothesis within context of clinical likelihood CbD, mini-CEX 1

Tests, refines and verifies hypotheses CbD, mini-CEX 1

Develops problem list and action plan CbD, mini-CEX 1

Comprehends the need to determine the best value and most effective treatment both for the individual patient and for a patient cohort

CbD, mini-CEX 1

Recognises critical illness and respond with due urgency CbD, mini-CEX 1

Generates plausible hypotheses following patient assessment CbD, mini-CEX 1

Constructs a concise and applicable problem list using available information

CbD, mini-CEX 1

Constructs an appropriate management plan in conjunction with the patient, carers and other members of the clinical team and communicate this effectively to the patient, parents and carers where relevant

CbD, mini-CEX 1,3,4

Applies the relevance of an estimated risk of a future event to an individual patient

CbD, mini-CEX 1


Uses risk calculators appropriately CbD, mini-CEX 1

Considers the risks and benefits of screening investigations CbD, mini-CEX 1

Applies quantitative data to assess the risks and benefits of therapeutic intervention in an individual patients

CbD, mini-CEX 1

Searches and comprehends the medical literature to guide reasoning CbD, mini-CEX 1

Behaviours

Recognises the difficulties in predicting occurrence of future events CbD, mini-CEX 1

Shows willingness to discuss intelligibly with a patient the notion and difficulties of prediction of future events, and benefit/risk balance of therapeutic intervention

CbD, mini-CEX 3

Shows willingness to adapt and adjust approaches according to the beliefs and preferences of the patient and/or carers

CbD, mini-CEX 3

Shows willingness to facilitate patient choice CbD, mini-CEX 3

Shows willingness to search for evidence to support clinical decision making

CbD, mini-CEX 1,4

Demonstrates ability to identify one’s own biases and inconsistencies in clinical reasoning

CbD, mini-CEX 1,3

1.6 The Patient as Central Focus of Care

Prioritises the patient’s wishes encompassing their beliefs, concerns, expectations and needs


GMP

Outlines health needs of particular populations e.g. ethnic minorities and recognise the impact of health beliefs, culture and ethnicity in presentations of physical and psychological conditions

CbD 1

Ensures that all decisions and actions are in the best interests of the patient and the public good

CbD 1

Skills

Gives adequate time for patients and carers to express their beliefs ideas, concerns and expectations

mini-CEX 1,3,4

Encourages the health care team to respect the philosophy of patient focussed care

CbD, mini-CEX, MSF 3

Develops a self-management plan with the patient CbD, mini-CEX 1,3

Supports patients, parents and carers where relevant to comply with management plans

CbD, mini-CEX, PS 3

Encourages patients to voice their preferences and personal choices about their care

mini-CEX, PS 3

Behaviours

Supports patient self-management CbD, mini-CEX, PS 3

Responds to questions honestly and seeks advice if unable to answer CbD, mini-CEX 3

Recognises the duty of the medical professional to act as patient advocate

CbD, mini-CEX, MSF, PS

3,4

Responds to people in an ethical, honest and non-judgmental manner CbD, mini-CEX, MSF, PS

1,3

Adopts assessments and interventions that are inclusive, respectful of CbD, mini-CEX, 1,3


diversity and patient-centred MSF, PS

1.7 Prioritisation of Patient Safety in Clinical Practice

To understand that patient safety depends on:

• The effective and efficient organisation of care

• Health care staff working well together

• Safe systems not just individual competency and safe practice

To understand the risks of treatments and to discuss these honestly and openly with patients so that they are able to make decisions about risks and treatment options

To understand that all staff should be made aware of risks and work together to minimise risk

To act always to promote patient safety


GMP

Outline the features of a safe working environment CbD, mini-CEX 1

Outlines the hazards of medical equipment in common use CbD 1

Recalls unwanted effects and contraindications of medications prescribed CbD, mini-CEX 1

Recalls principles of risk assessment and management CbD 1

Recalls the components of safe working practice in personal, clinical and organisational settings

ACAT, CbD 1

Outlines human factors theory and understands its impact on safety CbD 1

Knows about root cause analysis CbD 1

Knows about significant event analysis CbD 1

Outlines local procedures and protocols for optimal practice e.g. GI bleed protocol, safe prescribing

CbD, mini-CEX 1

Understands the investigation of significant events, serious untoward incidents and near misses

CbD, mini-CEX 1

Is very familiar with the principles of management of systemic anaphylaxis and the governance required to deal with the possibility of anaphylaxis in the allergen challenge clinic

CbD, mini-CEX 1

Skills

Recognises limits of own professional competence and practises only within these

ACAT, CbD, mini-CEX

1

Recognises when a patient is not responding to treatment, reassesses the situation and encourages others to do so

CbD, mini-CEX 1

Ensures the correct and safe use of medical equipment, ensuring faulty equipment is reported appropriately

CbD, mini-CEX 1

Improves patients’ and colleagues’ understanding of the side effects and contraindications of therapeutic intervention

CbD, mini-CEX 1,3

Sensitively counsels a colleague following a significant untoward event, or near incident, to encourage improvement in practice of individual and unit

CbD 3

Recognises and respond to the manifestations of a patient’s deterioration or lack of improvement (symptoms, signs, observations, and laboratory results) and supports other members of the team to act similarly


Behaviours

Maintains a high level of safety awareness and consciousness at all times CbD, mini-CEX 2


Encourages feedback from all members of the team on safety issues CbD, mini-CEX, MSF 3

Reports serious untoward incidents and near misses and co-operates with the investigation of the same


Shows willingness to take action when concerns are raised about performance of members of the healthcare team, and act appropriately when these concerns are voiced to you by others


Continues to be aware of own limitations, and operates within them competently

CbD, mini-CEX 1

1.8 Team Working and Patient Safety

To work well in a variety of different teams and team settings and to contribute to discussion on the team’s role in patient safety

To display the leadership skills necessary to lead teams so that they are more effective and better able to deliver safer care


GMP

Outlines the components of effective collaboration and team working CbD 1

Describes the roles and responsibilities of members of the healthcare team

CbD 1

Outlines factors adversely affecting a doctor’s and team performance and methods to rectify these

CbD 1

Skills

Practises with attention to the important steps of providing good continuity of care

CbD, mini-CEX 1,3,4

Keeps accurate and attributable notes including appropriate use of electronic clinical record systems

CbD, mini-CEX 1,3

Demonstrates leadership and management in education and training of junior colleagues and other members of the healthcare team

CbD, mini-CEX 1,2,3

Recognises deteriorating performance of colleagues (e.g. stress, fatigue) CbD, mini-CEX 1,2,3

Provides high quality care CbD, mini-CEX 1,2,3

Leads and participates in interdisciplinary team meetings CbD, mini-CEX 3

Provides appropriate supervision to less experienced colleagues CbD, MSF 3

Behaviours

Encourages an open environment to foster and explore concerns and issues about the functioning and safety of team working

CbD, MSF 3

Recognises limits of own professional competence and practises within these

CbD, MSF 3

Recognises and respect the request for a second opinion CbD, MSF 3

Recognises the importance of induction for new members of a team CbD, MSF 3

Recognises the importance of prompt and accurate information sharing with Primary Care team following hospital discharge



1.9 Principles of Quality and Safety Improvement

To recognise the desirability of monitoring performance, learning from mistakes and adopting a no blame culture in order to ensure high standards of care and optimise patient safety


GMP

Understands the elements of clinical governance CbD, MSF 1

Defines local and national significant event reporting systems relevant to allergy

CbD, mini-CEX 1

Outlines local health and safety protocols (fire, manual handling etc) CbD 1

Understands risks associated with training in allergy including biohazards and mechanisms to reduce risk

CbD 1

Outlines the use of patient early warning systems to detect clinical deterioration

CbD, mini-CEX 1

Keeps abreast of national patient safety initiatives including National Patient Safety Agency , NCEPOD reports, NICE guidelines etc

CbD, mini-CEX 1

Skills

Adopts strategies to reduce risk CbD 1,2

Recognises that governance safeguards high standards of care and facilitates the development of improved clinical services

CbD 1,2

Recognises importance of evidence-based practice in relation to clinical effectiveness

CbD 1

Reflects regularly on personal standards of medical practice in accordance with GMC guidance on licensing and revalidation

AA 1,2,3,

4

Behaviours

Shows willingness to participate in safety improvement strategies such as critical incident reporting

CbD, MSF 3

Develops reflection in order to achieve insight into own professional practice

CbD, MSF 3

Demonstrates personal commitment to improve self performance in the light of feedback and assessment

CbD, MSF 3

Contributes to quality improvement processes such as: CbD, MSF 3

• Audit of personal and departmental/directorate/practice performance

• Errors / discrepancy meetings

• Critical incident and near miss reporting

• Unit morbidity and mortality meetings

• Local and national databases

Maintains a portfolio of information and evidence drawn from personal medical practice

CbD, MSF 3

Engages with an open no blame culture CbD, MSF 3

Responds positively to outcomes of audit and quality improvement CbD, MSF 1,3

Co-operates with changes necessary to improve service quality and safety

CbD, MSF 1,2


1.10 Infection Control

To learn how to manage and control infection in patients, including controlling the risk of cross-infection, appropriately managing infection in individual patients, and working appropriately within the wider community to manage the risk posed by communicable diseases.


GMP

Understands the principles of infection control as defined by the GMC CbD, mini-CEX 1

Understands the principles of preventing infection in high risk groups (eg managing antibiotic use to reduce Clostridium difficile infection) including understanding the local antibiotic prescribing policy

CbD, mini-CEX 1

Understands the role of Notification of diseases within the UK and identify the principle notifiable diseases for UK and international purposes

CbD, mini-CEX 1

Understands the role of the Health Protection Agency and Consultants in Health Protection (previously Consultants in Communicable Disease Control – CCDC)

CbD, mini-CEX 1

Understands the role of the local authority in relation to infection control CbD, mini-CEX 1

Knows how to access and use local health data CbD, mini-CEX 1

Skills

Recognises the potential for infection within patients being cared for CbD 1,2

Counsels patients on matters of infection risk, transmission and control CbD, mini-CEX, PS 2,3

Recognises potential for cross-infection in clinical settings CbD, mini-CEX 1,2

Practices aseptic technique whenever relevant DOPS 1

Behaviours

Actively engages in local infection control procedures CbD 1

Actively engages in local infection control monitoring and reporting processes

CbD 1,2

Prescribes antibiotics according to local antibiotic guidelines and works with microbiological services where this is not possible

CbD 1

Encourages all staff, patients and relatives to observe infection control principles

CbD, MSF 1

Recognises personal ill-health as a risk to patients and colleagues and its effect on performance

CbD, MSF 1,3


1.11 Managing Long-Term Conditions and Promoting Patient Self-Care

To learn how to pursue a holistic and long term approach to the planning and implementation of patient care, in particular to identify and facilitate the role of the patient, the family and other carers in the long term management of severe allergic diseases


GMP

Describes the natural history of allergic diseases that run a chronic course CbD, mini-CEX 1

Defines the role of services and the multi-disciplinary teams to facilitate long-term care of patients with allergic diseases

CbD, mini-CEX 1

Outlines the concept of quality of life and how this can be measured whilst understanding the limitations of such measures for individual patients

CbD, mini-CEX 1

Outlines the concept of patient self-care and the role of the expert patient CbD, mini-CEX 1

Works with an appropriate knowledge of guidance documents on supporting people with long term conditions to self care

CbD, mini-CEX 1

Knows, understands and is able to compare and contrast the medical and social models of disability

CbD, mini-CEX 1

Knows about and practises within the key provisions of disability discrimination and other contemporary legislation

CbD, mini-CEX 1

Understands the relationship between local health, educational and social service provision including the voluntary sector and how they can be accessed

CbD, mini-CEX 1

Is familiar with the range of agencies that can provide care and support in and out of hospital and how they can be accessed

CbD, mini-CEX 1

Skills

Develops and agrees a management plan with the patient (and carers), ensuring awareness of alternatives to maximise self-care within care pathways where relevant

CbD, mini-CEX 1,3

Assesses the patient’s ability to access various services in the health and social system and offer appropriate assistance

CbD, mini-CEX 1,3

Advocates and facilitates appropriate self care CbD, mini-CEX 1,3

Develops and sustains supportive relationships with patients with whom care will be prolonged and potentially life long

CbD, mini-CEX 1,4

Provides relevant evidence-based information and where appropriate effective patient education, with support of the multi-disciplinary team

CbD, mini-CEX 1,3,4

Provides relevant and evidence based information in an appropriate medium to enable sufficient choice, when possible

CbD, PS 1,3

Behaviours

Shows willingness and support for patient in his/her own advocacy, within the constraints of available resources and taking into account the best interests of the wider community

CbD, mini-CEX 1,3

Promotes and encourages involvement of patients in appropriate support networks, both to receive support and to give support to others

CbD, mini-CEX 3,4

Recognises the potential impact of long term conditions on the patient, family and friends

CbD 1

Ensures equipment and devices relevant to the patient’s care are discussed

CbD, mini-CEX 1,2,3,4


Puts patients in touch with the relevant agency including the voluntary sector from where they can procure the items as appropriate

CbD, mini-CEX 1,3

Provides the relevant tools and devices when possible CbD, mini-CEX 1,2

Shows willingness to facilitate access to the appropriate training and skills in order to develop the patient's confidence and competence to self care and adapt appropriately as needs change with time

CbD, mini-CEX, PS 1,3,4

Shows willingness to maintain a close working relationship with other members of the multi-disciplinary team, primary and community care


Shows willingness to engage with expert patients and representatives of charities or networks that focus on diseases and comprehends their role in supporting patients and their families/carers


1,3

Recognises and respect the role of family, friends and carers in the management of the patient with a long term condition

CbD, mini-CEX, PS 1,3

Puts patients in touch with the relevant agencies including the voluntary sector from where they can procure the items as appropriate


1,3

1.12 Relationships with Patients and Communication within a Consultation

To recognise the need, and develop the abilities, to communicate effectively and sensitively with patients, relatives and carers


GMP

Demonstrates how to structure a consultation appropriately CbD, mini-CEX, PS 1

States the importance of the patient's background, culture, education and preconceptions (beliefs, ideas, concerns, expectations) to the process

CbD, mini-CEX, PS 1

Skills

Establishes a rapport with the patient and any relevant others

Utilises open and closed questioning appropriately


Listens actively and questions sensitively to guide the patient and to clarify information

mini-CEX, PS 1,3

Identifies and manages communication barriers, tailoring language to the individual patient and others and using interpreters when indicated


Delivers information compassionately, being alert to and managing personal and patients emotional responses

CbD, mini-CEX 1,3,4

Uses, and refers patients to, appropriate written and other evidence based information sources

CbD, mini-CEX 1,3

Checks the patient's/carer's understanding, ensuring that all their concerns/questions have been covered

CbD, mini-CEX 1,3

Indicates when the consultation nearing its end and conclude with a summary and appropriate action plan; ask the patient to summarise back to check his/her understanding

CbD, mini-CEX 1,3

Makes accurate contemporaneous records of the discussion CbD, mini-CEX 1,3

Manages follow-up effectively and safely utilising a variety of methods CbD, mini-CEX 1

Ensures appropriate referral and communications with other healthcare professional resulting from the consultation are made accurately and in a timely manner

CbD, mini-CEX 1

Behaviours


Approaches situations with courtesy, empathy, compassion and professionalism, especially by appropriate body language and endeavouring to ensure an appropriate physical environment, acting as an equal not a superior


1,3,4

Ensures appropriate personal language and behaviour CbD, mini-CEX, MSF, PS

1.3

Ensures that the approach is inclusive and patient centred and respects the diversity of values in patients, carers and colleagues.


13

Is willing to provide patients with a second opinion CbD, mini-CEX, MSF, PS

1,3

Uses different methods of ethical reasoning to come to a balanced decision where complex and conflicting issues are involved


Is confident and positive in personal values CbD, mini-CEX 1,3

1.13 Breaking Bad News

To recognise the fundamental importance of breaking bad news

To use strategies for skilled delivery of bad news according to the needs of individual patients and their relatives and/or carers


GMP

Understands that how bad news is delivered irretrievably affects the subsequent relationship with the patient


1

Appreciates that every patient may desire different levels of explanation and have different responses to bad news


Knows that although bad news is confidential the patient may wish to be accompanied

CbD, mini-CEX, PS 1

Appreciates that once the news is given, patients are unlikely to take anything subsequent in, so an early further appointment should be made

CbD, mini-CEX, PS

Appreciates that breaking bad news can be extremely stressful for the doctor or professional involved

CbD, mini-CEX 1,3

Is aware that the interview during which bad news is delivered may be an educational opportunity

CbD, mini-CEX 1

States and understands the importance of adequate preparation for breaking of bad news

CbD, mini-CEX 1,3

Knows that “bad news” may be expected or unexpected and cannot always be predicted

CbD, mini-CEX 1

Knows that sensitive communication of bad news is an essential part of professional practice

CbD, mini-CEX 1

Knows that “bad news” has different connotations depending on the context, individual, social and cultural circumstances

CbD, mini-CEX, PS 1

Understands that a post mortem examination may be required and what this involves

CbD, mini-CEX, PS 1

Is familiar with the local organ retrieval process CbD, mini-CEX 1

Skills

Demonstrates to others good practice in breaking bad news CbD, DOPS, MSF 1,3

Involves patients and carers in decisions regarding their future management

CbD, DOPS, MSF 1,3,4


Comprehends the impact of the bad news on the patient, carer, supporters, staff members and self

CbD, DOPS, MSF 1,3,4

Encourages questioning and ensures comprehension CbD, DOPS, MSF 1,3

Responds to verbal and visual cues from patients and relatives CbD, DOPS, MSF 1,3

Acts with empathy, honesty and sensitivity avoiding undue optimism or pessimism

CbD, DOPS, MSF 1,3

In preparing to break bad news:

• Sets aside sufficient uninterrupted time

• Chooses an appropriate private environment and ensures that there will be no unplanned disturbances

• Has sufficient information regarding prognosis and treatment

• Ensures the individual has appropriate support if desired

• Structures the interview

• Is honest, factual, realistic and empathic

CbD, DOPS, MSF 1,3

Is aware of relevant guidance documents CbD 1

Structures the interview:

• Sets the scene

• Establishes understanding

• Discusses diagnosis, implications, treatment, prognosis and subsequent care

CbD 1,3

Behaviours

Take leadership in breaking bad news CbD, DOPS, MSF 1

Respects the different ways people react to bad news CbD, DOPS, MSF 1

Ensures appropriate recognition and management of the impact of breaking bad news on the doctor

CbD, DOPS, MSF 1

1.14 Complaints and Medical Error

To recognise causes of error and to learn from them, and to realise the importance of honesty and effective apology and to take a leadership role in the handling of complaints


GMP

Describes the local complaints procedure CbD, MSF 1

Recognises factors likely to lead to complaints (poor communication, dishonesty, clinical errors, adverse clinical outcomes etc)

CbD, MSF 1

Outlines the principles of an effective apology CbD, MSF 1

Identifies sources of help and support for patients and doctors when a complaint is made about self or a colleague

CbD, MSF 1

Skills

Contributes to processes whereby complaints are reviewed and learned from

CbD, DOPS, MSF 1

Explains comprehensibly to the patient the events leading up to a medical error or serious untoward incident, and sources of support for patients and their relatives

CbD, DOPS, MSF 1,3

Recognises when something has gone wrong and identifies appropriate staff with whom to communicate this

CbD, DOPS, MSF 1


Delivers an appropriate apology and explanation CbD, DOPS, MSF 1,3,4

Distinguishes between system and individual errors (personal and organisational)

CbD, DOPS, MSF 1

Shows ability to learn from previous errors CbD, DOPS, MSF 1

Behaviours

Takes leadership over complaint issues CbD, DOPS, MSF 1

Adopts behaviour likely to prevent causes for complaints CbD, DOPS, MSF 1,3

Deals appropriately with concerned or dissatisfied patients or relatives CbD, DOPS, MSF 1

Acts with honesty and sensitivity in a non-confrontational manner CbD, DOPS, MSF 1

Acts with honesty and sensitivity in a non-confrontational manner CbD, DOPS, MSF 1

Recognises the impact of complaints and medical error on staff, patients and the National Health Service

CbD, DOPS, MSF 1

Contributes to a fair and transparent culture around complaints and errors CbD, DOPS, MSF 1

Recognises the rights of patients, family members and carers to make a complaint

CbD, DOPS, MSF 1,4

Recognises the impact of a complaint upon self and seeks appropriate help and support

CbD, DOPS, MSF 1,4

1.15 Communication with colleagues and cooperation

To recognise and accept the responsibilities and role of the doctor in relation to other healthcare professionals

To communicate succinctly and effectively with other professionals as appropriate


GMP

Understands the section in "Good Medical Practice" on Working with Colleagues, in particular:

CbD, MSF 1

States the roles played by all members of a multi-disciplinary team CbD, MSF 1

States the features of good team dynamics CbD, MSF 1

States the principles of effective inter-professional collaboration to optimise patient, or population, care

CbD, MSF 1

Understands the principles of confidentiality that provide boundaries to communication

CbD, MSF 1

Acts with appropriate knowledge of professional and ethical conduct in challenging situations

Cb 1

Knows techniques to manage anger and aggression in self and colleagues

CbD 1

Knows personal responsibilities when managing physical and/or mental ill health in self and colleagues

CbD 1

Skills

Communicates accurately, clearly, promptly and comprehensively with relevant colleagues by means appropriate to the urgency of a situation (telephone, email, letter etc), especially where responsibility for a patient's care is transferred

CbD, mini-CEX 1,3

Utilises the expertise of the whole multi-disciplinary team as appropriate, ensuring when delegating responsibility that appropriate supervision is



maintained

Communicates effectively with administrative bodies and support organisations


Employs behavioural management skills with colleagues to prevent and resolve conflict and enhance collaboration


Behaviours

Shows awareness of the importance of, and takes part in multi-disciplinary teamwork, including adoption of a leadership role when appropriate but also recognising where others are better equipped to lead


Fosters a supportive and respectful environment where there is open and transparent communication between all team members


Ensures appropriate confidentiality is maintained during communication with any member of the team


Recognises the need for a healthy work/life balance for the entire team, but takes any personal leave only after giving appropriate notice to ensure that cover is in place


Accepts additional duties in situations of unavoidable and unpredictable absence of colleagues ensuring that the best interests of the patient are paramount

CbD, MSF 1

1.16 Health Promotion and Public Health

To work with individuals and communities to reduce ill health, remove inequalities in healthcare provision and improve the general health of a community.


GMP

Understands the factors which influence the incidence and prevalence of common conditions

CbD, mini-CEX 1

Understands the factors which influence health and illness – psychological, biological, social, cultural and economic especially poverty and unemployment

CbD, mini-CEX

1

Understands the influence of lifestyle on health and the factors that influence an individual to change their lifestyle

CbD, mini-CEX 1

Understands the influence of culture and beliefs on patients perceptions of health

CbD, mini-CEX 1

Understands the purpose of screening programmes and knows in outline the common programmes available within the UK

CbD, mini-CEX 1

Understands the positive and negative effects of screening on the individual

CbD, mini-CEX 1

Understands the possible positive and negative implications of health promotion activities (e.g. immunisation)

CbD, mini-CEX 1

Understands the relationship between the health of an individual and that of a community and vice versa

CbD, mini-CEX 1

Knows key local concerns about health of communities such as smoking and obesity and the potential determinants

CbD, mini-CEX 1

Understands the role of other agencies and factors including the impact of globalisation in increasing disease and in protecting and promoting health

CbD, mini-CEX 1

Demonstrates knowledge of the determinants of health worldwide and strategies to influence policy relating to health issues including the impact

CbD, mini-CEX 1


of the developed world strategies on the third world

Outlines the major causes of global morbidity and mortality and effective, affordable interventions to reduce these

CbD, mini-CEX 1

Recalls the effect of addictive and self harming behaviours, especially substance misuse and gambling, on personal and community health and poverty

CbD, mini-CEX 1

Skills

Identifies opportunities to prevent ill health and disease in patients CbD, mini-CEX, PS 1,2

Identifies opportunities to promote changes in lifestyle and other actions which will positively improve health and/or disease outcomes.

CbD, mini-CEX 1,2

Identifies the interaction between mental, physical and social wellbeing in relation to health.

CbD, mini-CEX 1

Counsels patients appropriately on the benefits and risks of screening and health promotion activities


Identifies patient’s ideas, concerns and health beliefs regarding screening and health promotions programmes and is capable of responding appropriately

mini-CEX, CbD 1,3

Works collaboratively with other agencies to improve the health of communities

CbD, mini-CEX 1

Behaviours

Engages in effective team-working around the improvement of health CbD, MSF 1,3

Encourages where appropriate screening to facilitate early intervention CbD 1

Seeks out and utilises opportunities for health promotion and disease prevention

CbD 1

1.17 Environmental Protection and Emergency Planning

To understand the relationship of the physical environment to health

To be able to identify situations where environmental exposure may be the cause of ill health and to relate to emergency planning arrangements both in relation to environmental matters and other issues in clinical practice


GMP

Understands in outline the mechanisms by which environmental chemicals have an impact on human health

CbD 1

Understands in outline the mechanisms by which adverse chemical exposure can be mitigated (decontamination, specific antidotes)

CbD, mini-CEX 1

Knows the potential sources of information and guidance to manage a case of chemical etc exposure. (including local, regional and national sources)

CbD 1

Understands the principles of emergency planning CbD 1

Knows in outline the emergency plan for health care organisation they currently work for and specifically knows their duties and responsibilities within the plan

CbD 1

Skills

Recognises the potential for chemical or other hazardous environmental exposure in relation to an individual patient.

CbD

1,2


Manages patients in an appropriate manner according to guidance CbD, mini-CEX 1,2

Appropriately performs duties and tasks when required in accordance with Trust emergency plans

CbD

1,3

Behaviours

Actively engages in emergency planning arrangements including exercises in accordance with Trust plans

CbD, MSF 2,3

Openly considers the possibility of chemical or environmental exposure in clinical work

CbD, MSF 1,2

1.18 Principles of Medical Ethics and Confidentiality

To know, understand and apply appropriately the principles, guidance and laws regarding medical ethics and confidentiality


GMP

Demonstrates knowledge of the principles of medical ethics CbD, mini-CEX 1

Outlines and follows the guidance given by the GMC on confidentiality CbD, mini-CEX 1

Defines the provisions of the Data Protection Act and Freedom of Information Act

CbD, mini-CEX 1

Defines the principles of Information Governance CbD, mini-CEX 1

Defines the role of the Caldicott Guardian and Information Governance lead within an institution, and outline the process of attaining Caldicott approval for audit or research

CbD, mini-CEX 1,4

Outlines situations where patient consent, while desirable, is not required for disclosure e.g. serious communicable diseases, public interest

CbD, mini-CEX 1,4

Outlines the procedures for seeking a patient’s consent for disclosure of identifiable information

CbD, mini-CEX 1

Recalls the obligations for confidentiality following a patient’s death CbD, mini-CEX 1,4

Defines the standards of practice defined by the GMC when deciding to withhold or withdraw life-prolonging treatment

CbD, mini-CEX 1

Knows the role and legal standing of advance directives CbD, mini-CEX 1

Outlines the principles of the Mental Capacity Act CbD, mini-CEX 1

Skills

Uses and shares information with the highest regard for confidentiality, and encourages such behaviour in other members of the team

CbD, mini-CEX, MSF 1,2,3

Recognises the problems posed by disclosure in the public interest, without the patient’s consent


Recognises the factors influencing ethical decision making: including religion, personal and moral beliefs, cultural practices


Uses and promotes strategies to ensure that confidentiality is maintained, for example anonymisation

CbD 1

Counsels patients on the need for information distribution within members of the immediate healthcare team

CbD, MSF 1,3

Counsels patients, family, carers and advocates tactfully and effectively when making decisions about resuscitation status, and withholding or withdrawing treatment



Behaviours

Encourages informed ethical reflection in others CbD, MSF 1

Shows willingness to seek advice of peers, legal bodies, and the GMC in the event of ethical dilemmas over disclosure and confidentiality


Respects patient’s requests for information not to be shared, unless this puts the patient, or others, at risk of harm


Shows willingness to share information about care with patients unless they have expressed a wish not to receive such information

CbD, mini-CEX 1,3

Shows willingness to seek the opinion of others when making decisions about resuscitation status, and withholding or withdrawing treatment


1.19 Obtaining of Consent

To understand the necessity of obtaining valid consent from the patient, and when and how to obtain it


GMP

Outlines the guidance given by the GMC on consent, in particular: CbD, MSF 1

Understands that consent is a process that may culminate in, but is not limited to, the completion of a consent form

CbD, MSF 1

Understands the particular importance of considering the patient's level of understanding and mental state (and also that of the parents, relatives or carers when appropriate) and how this may impair their capacity for informed consent

CbD, MSF 1

Understands the social and cultural issues that might affect consent CbD, MSF 1

Skills

Presents all information to patients (and carers) in a format they understand, checking understanding and allowing time for reflection on the decision to give consent


Provides a balanced view of all care options CbD, mini-CEX, PS 1,3,4

Behaviours

Respects a patient’s rights of autonomy even in situations where their decision might put them at risk of harm

CbD, mini-CEX, PS 1

Keeps within the scope of authority given by a competent patient CbD, mini-CEX, PS 1

Provides all information relevant to proposed care or treatment in a competent patient

CbD, mini-CEX 1,3,4

Seeks consent for procedures within own capabilities

Shows willingness to seek advance directives

CbD, mini-CEX 1,3

Shows willingness to obtain a second opinion, senior opinion, and legal advice in difficult situations of consent or capacity


Informs patients and seeks alternative care where personal, moral or religious belief prevents a usual professional action



1.20 Legal Framework for Practice

To understand the legal framework within which healthcare is provided in the UK and/or devolved administrations in order to ensure that personal clinical practice is always provided in line with this legal framework.


GMP

Knows that all decisions and actions must be in the best interests of the patient

CbD, mini-CEX 1

Understands the legislative framework within which healthcare is provided in the UK and/or devolved administrations – in particular death certification and the role of the Coroner/Procurator Fiscal; child protection legislation; mental health legislation (including powers to detain a patient and giving emergency treatment against a patient’s will under common law); advanced directives and living Wills; withdrawing and withholding treatment; decisions regarding resuscitation of patients; surrogate decision making; organ donation and retention; communicable disease notification; medical risk and driving; Data Protection and Freedom of Information Acts; provision of continuing care and community nursing care by a local authorities.

CbD, mini-CEX 1,2

Is familiar with disability and other equality legislation CbD, mini-CEX 1,2

Understands the differences between health related legislation in the four countries of the UK

CbD 1

States sources of medical legal information CbD, mini-CEX 1

Understands disciplinary processes in relation to medical malpractice CbD, mini-CEX, MSF 1

Understands the role of the medical practitioner in relation to personal health and substance misuse, including understanding the procedure to be followed when such abuse is suspected


Skills

Cooperates with other agencies with regard to legal requirements – including reporting to the Coroner’s/Procurator Officer, the Police or the proper officer of the local authority in relevant circumstances

CbD, mini-CEX 1

Prepares appropriate medical legal statements for submission to the Coroner’s Court, Procurator Fiscal, Fatal Accident Inquiry and other legal proceedings and be prepared to present such material in court

CbD, MSF 1

Incorporates legal principles into day to day practice CbD, mini-CEX 1

Practices and promotes accurate documentation within clinical practice CbD, mini-CEX 1,3

Behaviour

Shows willingness to seek advice from employer, appropriate legal bodies (including defence societies), and the GMC on medico-legal matters

CbD, mini-CEX, MSF 1, 3

Promotes informed reflection on legal issues by members of the team CbD, mini-CEX, MSF 1,3

Demonstrates that all decisions and actions must be in the best interests of the patient



1.21 Ethical Research

To be equipped to ensure that research is undertaken using relevant ethical guidelines.


GMP

Outlines the GMC guidance on good practice in research CbD 1

Knows about local and national research guidelines CbD 1

Knows the principles of research governance

Outlines the differences between audit and research

AA, CbD, mini-CEX 1

Describes how clinical guidelines are produced CbD 1

Demonstrates a knowledge of research principles CbD, mini-CEX 1

Outlines the principles of formulating a research question and designing a project

CbD, mini-CEX 1

Comprehends the principal qualitative, quantitative, bio-statistical and epidemiological research methods

CbD 1

Outlines sources of research funding CbD 1

Skills

Uses critical appraisal skills and applies these when reading literature CbD 1

Demonstrates the ability to write a scientific paper CbD 1

Applies for appropriate ethical research approval CbD 1

Demonstrates the use of literature databases CbD 1

Demonstrates good verbal and written presentations skills CbD, DOPS 1

Understands the difference between population-based assessment and unit-based studies and be able to evaluate outcomes for epidemiological work

CbD 1

Behaviour

Follows guidelines on ethical conduct in research and consent for research

CbD 1

Shows willingness to encourage and take part in research CbD 1

1.22 Evidence and Guidelines

To learn to make the optimal use of current best evidence in making decisions about the care of patients.

To develop the ability to construct evidence based guidelines and protocols in relation to medical practise


GMP

Outlines the principles of critical appraisal CbD 1

Knows the advantages and disadvantages of different study methodologies (quantitative and qualitative) for different types of questions

CbD 1

Outlines levels of evidence and quality of evidence CbD 1

Knows how to apply statistics in scientific medical practice CbD 1

Understands the use and differences between the basic measures of risk CbD 1


and uncertainty

Describes the role and limitations of evidence in the development of clinical guidelines and protocols

CbD 1

Understands the processes that result in nationally applicable guidelines (eg NICE and SIGN)

CbD 1

Skills

Searches medical literature with relevant tools including PubMed, Medline, Cochrane reviews and the internet

CbD 1

Appraises retrieved evidence to address a clinical question CbD 1

Applies conclusions from critical appraisal into clinical care CbD 1

Contributes to the construction, review and updating of local (and national) guidelines of good practice using the principles of evidence based medicine

CbD 1

Behaviours

Aims for best clinical practice (clinical effectiveness) at all times, as informed by evidence based medicine

CbD, mini-CEX 1

Recognises knowledge gaps and keeps a logbook of clinical questions CbD, mini-CEX 1

Keeps up to date with national reviews, key new relevant research, and guidelines of practice (e.g. NICE and SIGN)

CbD 1

Recognises the common need to practise outside clinical guidelines CbD, mini-CEX 1

Communicates risk information, and risk-benefit trade-offs in ways appropriate for individual patients

CbD, mini-CEX

Encourage discussion amongst colleagues on evidence-based practice CbD, mini-CEX, MSF 1

1.23 Audit

To learn how to audit clinical practice and to apply the findings appropriately to complete the audit cycle.


GMP

Understands the different methods of obtaining data for audit including patient feedback questionnaires, hospital sources and national reference data

AA, CbD 1

Understands the role of audit (improving patient care and services, risk management etc)

AA, CbD 1

Understands the steps involved in completing the audit cycle AA, CbD 1

Describes the working and uses of national and local databases used for audit such as specialty data collection systems, cancer registries etc. and for reporting and learning from clinical incidents and near misses in the UK

AA, CbD 1

Skills

Designs, implements and completes audit cycles AA, CbD 1,2

Contributes to local and national audit projects as appropriate (e.g. NCEPOD, SASM)

AA, CbD 1,2

Supports audit by junior medical trainees and within the multi-disciplinary team

AA, CbD 1,2

Behaviours


Recognises the need for audit in clinical practice to promote standard setting and quality assurance

AA, CbD 1,2

1.24 Teaching and Training

To teach a variety of different audiences in a variety of different ways.

To assess the quality of the teaching.

To plan and deliver a training programme with appropriate assessments.

To supervise, teach and mentor learners (trainees) in a work setting.


GMP

Describes relevant educational theories and principles

Outlines adult learning principles relevant to medical education:

CbD 1

Demonstrates knowledge of relevant literature relevant to developments and challenges in medical education and other sectors

CbD 1

Outlines the structure of an effective appraisal interview CbD 1

Defines the roles to the various bodies involved in medical education and other sectors

Recalls learning methods and effective learning objectives and outcomes

Describes the differences between learning objectives and outcomes

CbD 1

Differentiates between appraisal and assessment and performance review and aware of the need for both

Differentiates between formative and summative assessment and define their role in medical education

Outlines the structure of the effective appraisal review

CbD 1

Outlines the role of workplace-based assessments, the assessment tools in use, their relationship to course learning outcomes, the factors that influence their selection and the need for monitoring evaluation

CbD 1

Outlines the appropriate local course of action to assist a trainee experiencing difficulty in making progress within their training programme

CbD 1

Skills

Critically evaluates relevant educational literature

Varies teaching formats and stimuli, appropriate to the situation and the audience

CbD 1

Provides effective and appropriate feedback after teaching, and promotes learner reflection

CbD, MSF, TO 1

Conducts developmental conversations as appropriate eg: appraisal, supervision, mentoring

CbD, MSF 1

Demonstrates effective lecture, presentation, small group and bed side teaching sessions

CbD, MSF 1,3

Provides appropriate career support, or refers trainee to an alternative effective source of career information

CbD, MSF, TO 1,3

Participates in strategies aimed at improving patient education e.g. talking at support group meetings

CbD, MSF 1

Leads departmental teaching programmes including journal clubs CbD, TO 1

Recognises the trainee in difficulty and take appropriate action including where relevant referral to other services

CbD, TO 1


Is able to identify and plan learning activities in the workplace CbD 1

Contributes to educational research or projects eg: through the development of research ideas of data/information gathering. Is able to manage personal time and resources effectively to the benefit of the educational faculty and the need of the learners

CbD, TO 1

Factors in safeguards to protect the patient when teaching and training is being conducted using patients

CbD 1

Behaviour

Maintains the dignity and safety of patients at all times in discharging educational duties

CbD, MSF 1,4

Recognises the importance of the role of the physician as an educator within the multi-professional healthcare team and uses medical education to enhance the care of patients

CbD, MSF 1

Balances the needs of service delivery with education CbD, MSF 1

Demonstrates willingness to teach trainees and other health and social workers in a variety of settings to maximise effective communication and practical skills and to improve patient care

CbD, MSF 1

Demonstrates consideration for learners including their emotional, physical and psychological well being with their development needs. Acts to endure equality of opportunity for students, trainees, staff and professional colleagues

CbD, MSF 1

Encourages discussions with colleagues in clinical settings to colleagues to share knowledge and understanding

CbD, MSF, TO 1,3

Maintains honesty and objectivity during appraisal and assessment CbD, MSF 1

Shows willingness to participate in workplace-based assessments and demonstrates a clear understanding of their purpose

CbD, MSF 1

Shows willingness to take up formal training as a trainer and respond to feedback obtained after teaching sessions

CbD, MSF, TO 1,3

Demonstrates willingness to become involved in the wider medical education activities and fosters an enthusiasm for medical education activity in others

CbD, MSF, TO 1

Recognises the importance of personal development as a role model to guide trainees in aspects of good professional behaviour

CbD, MSF, TO 1

Demonstrates willingness to advance own educational capability through continuous learning

CbD, MSF 1

Acts to enhance and improve educational provision through evaluation of own practice

CbD, MSF 1

Contributes to educational policy and development at local or national levels

CbD, MSF 1


1.25 Personal Behaviour

To acquire and nurture behaviours that will enable the trainee to become a senior leader able to deal with complex situations and difficult behaviours and attitudes

To learn how to work increasingly effectively with many teams to put the quality and safety of patient care as a prime objective

To demonstrate the attributes of someone who is trusted to be able to manage complex human, legal and ethical problems

To strive to be someone who is trusted and known to act fairly in all situations


GMP

Recalls and build upon the competences defined in the Foundation Programme Curriculum


Outlines the main methods of ethical reasoning: casuistry, ontology and consequential


Is familiar with the overall approach of value based practice and how this relates to ethics, law and decision-making


Defines the concept of modern medical professionalism CbD 1

Outlines the relevance of professional bodies (Royal Colleges, NHSMEE , GMC, Postgraduate Dean, BMA, specialist societies, medical defence societies etc)

CbD 1

Skills

Practises with professionalism including:

• Integrity

• Compassion

• Altruism

• A view to continuous improvement

• Aspiration to excellence

• Respect of cultural and ethnic diversity

• Regard to the principles of equity


1,2,3,4

Works in partnership with patients and members of the wider healthcare team


Liaises with colleagues to plan and implement work rotas MSF 3

Promotes awareness of the doctor’s role in utilising healthcare resources optimally and within defined resource constraints


Recognises and responds appropriately to unprofessional behaviour in others

CbD 1

Provides specialist support to hospital and community based services if appropriate and permitted

CbD, MSF 1

Handles enquiries from the press and other media effectively CbD, DOPS 1,3

Behaviour

Recognises personal beliefs and biases and understands their impact on the delivery of health services


Appropriately refers patients where personal beliefs and biases could impact upon professional practice

Uses all healthcare resources prudently and appropriately CbD, mini-CEX 1,2


Improves clinical leadership and management skill CbD, mini-CEX 1

Recognises situations when it is appropriate to involve professional and regulatory bodies

CbD, mini-CEX 1

Acts as a leader, mentor, educator and role model CbD, mini-CEX, MSF 1

Reviews competences defined in the Foundation programme:

• Deals with inappropriate patient and family behaviour

• Respects the rights of children, elderly, people with physical, mental, learning or communication difficulties

• Adopts an approach to eliminate discrimination against patients from diverse backgrounds including age, gender, race, culture, disability, spirituality and sexuality

• Places needs of patients above own convenience

• Behaves with honesty and probity

• Acts with honesty and sensitivity in a non-confrontational manner

CbD, mini-CEX 1

Accepts mentoring as a positive contribution to promote personal professional development

Participates in professional regulation and professional development


Takes part in 360 degree feedback as part of appraisal CbD, MSF 1,2,4

Promotes the right for equity of access to healthcare CbD, mini-CEX 1

Demonstrates reliability and accessibility throughout the healthcare team CbD, mini-CEX, MSF 1

1.26 Management and NHS Structure

Understand the structure of the NHS and the management of local healthcare systems in order to be able to participate fully in managing healthcare provision

Knowledge Assessment

Methods

GMP

Understands the guidance given on management and doctors by the GMC

CbD 1

Understands the local structure of NHS systems recognising the potential differences between the four countries of the UK

CbD 1

Recalls the range of agencies that can provide care and support in and out of hospital, and how they can be accessed

CbD 1

Understands the structure and function of healthcare systems as they apply to your specialty

CbD 1

Understands the consistent debates and changes that occur in the NHS including the political, social, technical, economic, organisational and professional aspects that can impact on provision of service

CbD 1

Understands the importance of local demographic, socio-economic and health data and the use to improve system performance

CbD 1

Understands the principles of:

• Clinical coding

• European Working Time Regulations including rest provisions

• National Service Frameworks

• Health regulatory agencies (e.g., NICE, Scottish Government)

• NHS Structure and relationships

• NHS finance and budgeting

CbD, mini-CEX 1


• Consultant contract and the contracting process

• Resource allocation

• The role of the Independent sector as providers of healthcare

• Patient and public involvement processes and role

Understands the principles of recruitment and appointment procedures CbD 1

Skills

Participates in managerial meetings CbD 1

Works with stakeholders to create and sustain a patient-centred service CbD, mini-CEX 1

Employs new technologies appropriately, including information technology CbD, mini-CEX 1

Conducts an assessment of the community needs for specific health improvement measures

CbD, mini-CEX 1

Behaviour

Recognises the importance of equitable allocation of healthcare resources and of commissioning

CbD 1,2

Recognises the role of doctors as active participants in healthcare systems

CbD, mini-CEX 1,2

Responds appropriately to health service objectives and targets and take part in the development of services

CbD, mini-CEX 1,2

Recognises the role of patients and carers as active participants in healthcare systems and service planning


Takes an active role in promoting the best use of healthcare resources CbD 1

Shows willingness to improve leadership and managerial skills (e.g. management courses) and engage in leadership and management of the service

CbD, MSF 1


2. Medical Leadership and Management The Medical Leadership Competency Framework, developed by the Academy of Medical Royal Colleges and the NHS Institute for Innovation and Improvement, has informed the inclusion of leadership competencies in this curriculum. The Framework identified possible assessment methods, but in reviewing these we identified a need for more specific methods. JRCPTB and the RCP Education Department has established a working group to develop and evaluate leadership assessment methods. These may include variants of CbD and ACAT, as well as the Case Conference Assessment Tool currently being piloted.

2.1 Personal Qualities

To identify personal strengths, limitations and the impact of personal behaviour and to be able to change this in the light of feedback and reflection

Knowledge

Assessment Methods

GMP

Demonstrates different methods of obtaining feedback CbD, MSF 1

Demonstrates awareness of personal values and principles and how these may differ from those of other individuals and groups

1,3,4

Realises the importance of best practice transparency and consistency 1

Skills

Maintains and routinely practices critical self awareness, including being able to discuss strengths and weaknesses with supervisor and recognising external influences and changing behaviour accordingly

1

Uses assessment, appraisal, complaints and other feedback to discuss and develop an understanding of personal development needs

1.3

Identifies personal strengths and weaknesses MSF 1,3

Organises and manages workload effectively and flexibly CbD, MSF 1,3

Behaviours

Recognising and showing respect for diversity and differences in others 1

Shows commitment to continuing professional development which involves seeking training and self development opportunities, learning from colleagues and accepting criticism

1,3

Demonstrate self management: organising and managing themselves while taking account of the needs and priorities of others.

CbD, PS 3

2.2 Working with Others

To adopt a team approach, acknowledging and appreciating efforts, contributions and compromises. To continue to recognise the common purpose of the team and respect the decisions of its members

Knowledge

Assessment Methods

GMP

Demonstrates a wide range of leadership styles and approaches and the applicability to different situations and people

MSF 1

Skills

Enables individuals, groups and agencies to implement plans and make decisions

1,3

Assesses and appraises of more junior clinical colleagues or students 1,3


Builds and maintains relationships by listening, supporting others, gaining trust and showing understanding

MSF 3

Shows willingness to act as a leader, mentor, educator and role model 3

Behaviours

Shows recognition of a team approach, respecting colleagues, including non-medical professionals

1,3

2.3 Managing Services

To support team members to develop their roles and responsibilities and continue to review performance of team members to ensure that planned service outcomes are met

Knowledge

Assessment Methods

GMP

Demonstrates knowledge of relevant legislation and HR policies 1

Shows knowledge of the duties, rights and responsibilities of an employer and co-worker

1

Demonstrates knowledge of individual performance review 1

Comprehends the roles, competences and capabilities of other professionals and support workers

1,3,4

States the role of audit (improving patient care and services, risk management etc).

1

States the steps involved in completing the audit cycle 1

Skills

Continues to contribute towards staff development and training, including mentoring, supervision and appraisal

1,3

Is able to write a job description, including person specification and short listing criteria

1

Contributes to the development of an organisational response to emerging health policy.

1

Behaviours

Commitment to good communication whilst also inspiring confidence and trust

1,3

Managing resources: knowing what resources are available and using influence to ensure that resources are used efficiently and safely

1

Managing people: providing direction, reviewing performance and motivating others

1,3

Managing performance: holding self and others accountable for service outcomes.

1,3


2.4 Improving Services

To ensure patient safety at all times, continue to encourage innovation and facilitate transformation

Knowledge

Assessment Methods

GMP

Demonstrates knowledge of risk management issues and risk management tools

1,2

Demonstrates understanding of how healthcare governance influences patient care

1

Demonstrates knowledge of a variety of methodologies for developing creative solutions to improving services

1,2

Recalls principles of risk assessment and management 1,2

Identifies risk management guidance such as safe prescribing, sharps disposal, needle stick injury

1,2

Skills

Reports clinical incidents . 1,2

Assesses and manages risk to patients 2

Monitors the quality of equipment and safety of the environment relevant to the specialty

1,2

Ensures the correct and safe use of medical equipment, ensuring faulty equipment is reported appropriately

2

Questions existing practice in order to improve the services 1,2

Behaviours

Seeks advice and or assistance whenever concerned about patient safety 1,2,3

Supports colleagues to voice new ideas and is open minded to new thoughts

1,3

2.5 Setting Direction

To be able to identify contexts for change and make decisions

Knowledge

Assessment Methods

GMP

Demonstrates knowledge of the functions and responsibilities of national bodies, College and faculties, representatives, regulatory bodies

1

Demonstrates effective communication strategies within organisations 1

Skills

The ability to discuss the local, national and UK health priorities and how they impact on the delivery of health care relevant to the specialty

. 1

Is able to run committee meetings and work collegiately and collaboratively with a wide range of people outside the immediate clinical setting

1,3

Behaviours

Willingness to articulate strategic ideas and use effective influencing skills 1,3

Willingness to participate in decision making processes beyond the immediate clinical care setting

1,3


Applies knowledge and evidence to construct an evidence-based challenge to systems and processes in order to identify opportunities for service improvements

1

Makes decisions: integrates values with evidence to inform decisions 1,3


3. Content of learning

3.1 Fundamental Immunology

The trainee will acquire a sound knowledge of Fundamental Immunology required to underpin clinical and laboratory practice

Knowledge

Assessment Methods

GMP

Core body of knowledge in fundamental immunology:

• Cells of the immune system

• Cytokines,chemokines and other inflammatory mediators including lipid mediators

• Phagocytic cells and their function

• Antibody mediated immunity

• Complement system

• Cell-mediated immunity

• Innate immunity

• Regulation of the immune system

• Hypersensitivity mechanisms

• Pathogenesis of immunodeficiency

• Pathogenesis of allergic diseases

• Immunological tolerance and the pathogenesis of autoimmunity

• Immunobiology of transplant rejection and its prevention

• Classification and biology of malignancies of the lymphoid system

• Scientific basis of allergen immunotherapy

• Scientific basis of immunoprophylaxis

• Scientific basis of therapy for primary immunodeficiency

• Scientific basis of immunosuppressive and immunomodulatory therapy

• New developments in therapy of immunodeficiency

FRCPath, CbD 1

Skills

Ability to integrate knowledge of fundamental immunology to understand the patho-physiology, including the genetic and molecular basis of (a) immunodeficiency diseases, (b) autoimmune / rheumatic disease and systemic vasculitides, (c) allergic disease

FRCPath, CbD 1

Behaviours

Recognise vital importance of fundamental immunology to practice as a clinical immunologist

FRCPath 1


3.2 Primary and Secondary Immunodeficiency Diseases

The trainee will acquire and be able to apply a comprehensive body of knowledge relating to the clinical presentation, investigation and management of patients with primary and secondary immunodeficiency diseases

Knowledge

Assessment Methods

GMP

The skills and knowledge required to:

assess and manage patients with congenital and acquired immunodeficiency – including antibody and cell mediated defects, complement deficiency, C1 inhibitor deficiency and neutrophil defects, at a consultant level.(Use report of IUIS Scientific Committee : Bonilla FA,Geha RS.Update on primary immunodeficiency diseases.J Allergy Clin Immunol 2006;117:S 435-441)

FRCPath, CbD 1,2,3

Skills

Eliciting a relevant focused history in the context of immunodeficiency to guide clinical examination and formulation of differential diagnoses.

Mini-CEX, CbD 1

Physical examination – to perform a targeted and relevant clinical examination and link findings to the history to establish diagnosis(es) and formulate a management plan.

Mini-CEX, CbD 1

Selection of appropriate laboratory and ancillary investigations FRCPath, CbD, Mini-CEX

1,3

Formulating differential diagnoses FRCPath, CbD, Mini-CEX

1

Decision making and Clinical Reasoning – develops the ability to formulate a diagnostic and therapeutic plan based on integration of laboratory results and current guidelines on management of immunodeficiency.

FRCPath, CbD 1

Therapeutic Interventions – to prescribe, review and monitor therapeutic interventions relevant to the management of immunodeficiencies.

FRCPath, CbD, Mini-CEX

1,2

Understand putative mechanisms of action of various immunological therapies including immunoprophylaxis

FRCPath, CbD 1

Have a working knowledge of the evidence base for the use of various immunological therapies including immunoprophylaxis

FRCPath, CbD 1

Be able to explain the indications for the use of these therapies including immunoprophylaxis

FRCPath, CbD 1

Be able to explain adverse effects associated with individual therapies and immunoprophylaxis

FRCPath, CbD 1

Behaviours

Recognise importance of understanding immunopathogenesis to devise therapeutic options in these disorders

FRCPath, CbD 1,2

Recognise importance of understanding genetic basis of immunodeficiencies and the importance of genetic counselling in disease prevention

FRCPath, CbD 1,3

As the primary physician for patients with immunodeficiencies, recognise importance of patient and service advocacy in leading and developing clinical and laboratory services for this group of patients.

FRCPath 1,3

Recognise importance of obtaining valid consent from the patient for treatment with immunoglobulin and therapeutic monoclonal antibodies

CbD, DOPS 1,2,3


Recognise importance of making optimal use of current best evidence in making decisions about immunoglobulin replacement and treatment with therapeutic monoclonal antibodies

CbD 1,2

Recognise the need for audit of clinical practice in immunodeficiency to promote standard setting and quality assurance

AA, CbD 1,2

3.3 Systemic Autoimmune Rheumatic Disease and Systemic Vasculitides

The trainee will acquire and be able to apply a comprehensive body of knowledge relating to the clinical presentation, investigation and management of patients with systemic autoimmune rheumatic disease and systemic vasculitides

Knowledge

Assessment Methods

GMP

Core body of knowledge required to recognise, investigate and manage patients (in liaison with rheumatologists or relevant organ-based specialist) with systemic lupus erythematosus, scleroderma, inflammatory myositis, Wegener’s granulomatosis, microscopic polyangiitis, cryoglobulinaemic vasculitis, giant cell arteritis, Takayasu’s arteritis, polyarteritis nodosa and Henoch-Schonlein purpura and auto-inflammatory syndromes

FRCPath, CbD 1,3

Evidence –base for the various therapeutic options (conventional immunosuppressive agents, biologics) available to treat these patients

FRCPath, CbD 1,2

Skills

History taking - eliciting a relevant focused history in the context of suspected systemic autoimmune rheumatic disease and systemic vasculitides to guide clinical examination and formulation of differential diagnoses


1

Physical examination - to perform a targeted and relevant clinical examination and link findings to the history to establish diagnosis(es) and formulate a management plan.


1


1,3


1

Decision making and Clinical Reasoning – develops the ability to formulate a diagnostic and therapeutic plan based on integration of laboratory results and current guidelines on management of systemic autoimmune rheumatic disease and systemic vasculitides

FRCPath, CbD 1

Ability to apply knowledge of therapeutic options to select the most appropriate treatment for an individual patient

FRCPath, CbD 1

Behaviours


FRCPath, CbD 1

Recognise importance of service leadership in providing a diagnostic immunology laboratory service for patients with autoimmune diseases

FRCPath 1,3

Recognise importance of obtaining valid consent from the patient for treatment with immunosuppressive therapy and therapeutic monoclonal antibodies

CbD, DOPS 1,2,3

Recognise importance of making optimal use of current best evidence in making decisions about immunosuppressive therapy and treatment with therapeutic monoclonal antibodies

CbD 1,2


Appreciate need for close monitoring of patients to prevent/minimise adverse effects of therapy

FRCPath, CbD 1,2

Recognise the need for audit of clinical practice in autoimmune rheumatic diseases and systemic vasculitides to promote standard setting and quality assurance

AA, CbD 1,2

3.4 Allergic Diseases

The trainee will acquire and be able to apply a comprehensive body of knowledge relating to the clinical presentation, investigation and management of patients with allergic diseases of all degrees of severity

Knowledge

Assessment Methods

GMP

Core body of knowledge required to recognise, investigate and manage patients with allergic diseases of all degrees of severity including food and aero allergy, insect venom allergy, drug allergy, anaesthetic allergy, latex allergy, anaphylaxis, anaphylactoid reactions, urticaria, non-hereditary angioedema, mastocytosis

FRCPath, CbD 1

Evidence –base for the various therapeutic options to treat these patients, including anti-histamines, steroids and allergen-immunotherapy (desensitization therapy)

FRCPath, CbD 1,2

Skills

History taking - eliciting a relevant focused history in the context of suspected allergic disease to guide clinical examination and formulation of differential diagnoses


1,3

Physical examination - to perform a targeted and relevant clinical examination and link findings to the history to establish diagnosis(es) and formulate a management plan.


1


1,3

Skin testing FRCPath, CbD, Mini-CEX

1,3

Allergen immunotherapy FRCPath, CbD, DOPS, Mini-CEX

1,3

Challenge testing FRCPath, CbD, DOPS, Mini-CEX

Self-injectable adrenaline training FRCPath, CbD, DOPS, Mini-CEX

1,3


1

Ability to apply knowledge of therapeutic options to select the most appropriate treatment for an individual patient

FRCPath, CbD 1

Decision making and Clinical Reasoning – develops the ability to formulate a diagnostic and therapeutic plan based on integration of laboratory results and current guidelines on management of allergic diseases.

FRCPath, CbD 1

Behaviours


FRCPath, CbD 1

Recognise importance of obtaining valid consent from the patient for CbD, DOPS 1,2,3


desensitisation immunotherapy

Appreciate need for close monitoring of patients to prevent/minimise adverse effects of therapy

FRCPath, CbD 1,2

Recognise importance of making optimal use of current best evidence in making decisions about desensitisation immunotherapy,immunosuppressive therapy and treatment with therapeutic monoclonal antibodies

CbD 1,2

Recognise importance of service leadership in providing a diagnostic immunology service for patients with allergic diseases

FRCPath 1

Recognise the need for audit of clinical practice in allergy to promote standard setting and quality assurance

AA, CbD 1,2

3.5 Laboratory Immunology

The trainee will acquire and be able to apply a solid foundation of knowledge required to direct a diagnostic immunology laboratory at Consultant Level

Knowledge

Assessment Methods

GMP

The skills and knowledge essential for directing a diagnostic immunology laboratory at Consultant level

FRCPath 1,3

A sound knowledge of the principles of laboratory testing in diagnostic immunology

FRCPath 1

Be able to perform certain designated laboratory tests without supervision DOPS 1

Be able to select, interpret and provide clinical advice based on laboratory investigations as set out in the Laboratory Training Manual, relevant to the diagnosis, assessment and monitoring of patients with suspected immunodeficiency, allergy or autoimmunity.

FRCPath, CbD 1

Be fully conversant with the diagnostic utility and limitations of laboratory tests e.g. sensitivity, specificity, predictive values

FRCPath, CbD 1,2

Trainees will be able to explain the concept of Quality Assurance and Quality Control and apply these in practice as detailed in the Laboratory Manual and Training Record.

FRCPath 1,2

Skills

These are detailed in the laboratory manual and training record FRCPath, DOPS 1,2,3

Behaviours

Establishes close rapport and understanding with laboratory staff, users of the laboratory service and service managers

MSF 3

Appreciates integral importance of teamwork in running a diagnostic laboratory service

MSF 3

Recognise importance of service leadership in providing a diagnostic immunology laboratory service for patients with autoimmune disease, immunodeficiency and allergy.

FRCPath 2,3

Recognise the need for audit of laboratory practice in immunology to promote standard setting and quality assurance

AA, CbD 1,2


4 Learning and Teaching

4.1 The Training Programme

The organisation and delivery of postgraduate training is the statutory responsibility of the General Medical Council (GMC) which devolves responsibility for the local organisation and delivery of training to the deaneries. Each deanery oversees a “School of Medicine” which is comprised of the regional Specialty Training Committees (STCs) in each medical specialty. Responsibility for the organisation and delivery of specialty training in Immunology in each deanery is, therefore, the remit of the regional Immunology STC. Each STC has a Training Programme Director who coordinates the training programme in the specialty. Immunological diseases may have both adult and paediatric presentations. Collaborative training with paediatricians, particularly in relation to immunodeficiency will be undertaken. This will include a dedicated period of secondment to a recognised paediatric immunology centre where in-depth experience in the assessment and management of immunodeficient children will be obtained. The assessment and management of children with suspected severe combined immunodeficiency (SCID) will form an important component of this period of secondment. This will allow the trainee to develop the required skills essential for liaising with paediatric colleagues. The training programme is structured to deliver a solid grounding in fundamental immunology in ST3 and ST4 years whilst simultaneously enabling trainees to acquire Level 1 competencies in clinical and laboratory immunology. As trainees progress through ST5 and ST6, they will broaden their experience and understanding of applied clinical and diagnostic laboratory immunology, culminating with the completion of the FRCPath examination in immunology prior to completion of training at the end of ST7. In addition to paediatric immunology, it is recognised that trainees will require a period of secondment to other regional or national centres (typically 2-3 months) for acquisition of experience in those subject areas which may not be available in the local training programme e.g drug allergy, desensitisation immunotherapy. The sequence of training should ensure appropriate progression in experience and responsibility. The training to be provided at each training site is defined to ensure that, during the programme, the entire curriculum is covered and also that unnecessary duplication and educationally unrewarding experiences are avoided. However, the sequence of training should ideally be flexible enough to allow the trainee to develop a special interest.

4.2 Teaching and Learning Methods

The curriculum will be delivered through a variety of learning experiences. Trainees will learn from practice, clinical skills appropriate to their level of training and to their attachment within the department. Trainees will achieve the competencies described in the curriculum through a variety of learning methods. There will be a balance of different modes of learning from formal teaching programmes to experiential learning ‘on the job’. The proportion of time allocated to different learning methods may vary depending on the nature of the attachment within a rotation.


This section identifies the types of situations in which a trainee will learn. Learning with Peers - There are many opportunities for trainees to learn with their peers. Local postgraduate teaching opportunities allow trainees of varied levels of experience to come together for small group sessions. Examination preparation encourages the formation of self-help groups and learning sets. Work-based Experiential Learning - The content of work-based experiential learning is decided by the local faculty for education but includes active participation in:

• Immunology and Allergy clinics, including immunoglobulin infusion and desensitisation immunotherapy. After initial induction, trainees will review patients in outpatient clinics, under direct supervision. The degree of responsibility taken by the trainee will increase as competency increases. As experience and clinical competence increase trainees will assess ‘new’ and ‘review’ patients and present their findings to their clinical supervisor

• Depending on the stage of training, trainees will actively participate in connective tissue disease clinics

• Assessment of in-patients referred for immunological or allergy opinions. Every patient seen, on the ward or in out-patients, provides a learning opportunity, which will be enhanced by following the patient through the course of their illness: the experience of the evolution of patients’ problems over time is a critical part both of the diagnostic process as well as management. Patients seen should provide the basis for critical reading and reflection of clinical problems

• Consultant-led ward rounds. Every time a trainee observes another doctor, consultant or fellow trainee, seeing a patient or their relatives there is an opportunity for learning. Ward rounds should be led by a consultant and include feedback on clinical and decision-making skills

• Multi-disciplinary team meetings. There are many situations where clinical problems are discussed with clinicians in other disciplines. These provide excellent opportunities for observation of clinical reasoning

• Laboratory-based learning – trainees will undertake a range of immunological techniques as required by the curriculum, initially under supervision to be followed by independent performance when fully competent

• Management of common laboratory issues including assessment of new diagnostic tests, audit, troubleshooting and evaluation of data relating to quality assurance

Formal Postgraduate Teaching – The content of these sessions are determined by the local faculty of medical education and will be based on the curriculum. There are many opportunities throughout the year for formal teaching in the local postgraduate teaching sessions and at regional, national and international meetings. Many of these are organised by the Royal Colleges of Physicians, the Royal College of Pathologists, the Association of Clinical Pathologists, the British Society for Immunology and the British Society for Allergy and Clinical Immunology. Suggested activities include:

• A programme of formal bleep-free regular teaching sessions to cohorts of trainees (e.g. a weekly core training hour of teaching within a Trust)

• Case presentations

• Journal clubs

• Research and audit projects

• Lectures and small group teaching


• Grand Rounds

• Clinical skills demonstrations and teaching

• Critical appraisal and evidence based medicine and journal clubs

• Joint specialty meetings

• Attendance at national Immunology FRCPath training days (organised by the Association of Clinical Pathologists), which are designed to cover aspects of the training programme outlined in this curriculum.

Independent Self-Directed Learning -Trainees will use this time in a variety of ways depending upon their stage of learning. Suggested activities include:

• Reading, including web-based material

• Maintenance of personal portfolio (self-assessment, reflective learning, personal development plan)

• Audit and research projects

• Reading journals

• Achieving personal learning goals beyond the essential, core curriculum Formal Study Courses - Time to be made available for formal courses is encouraged, subject to local conditions of service. Examples include management courses and communication courses. It is implicit that active participation in the above learning and teaching opportunities will enhance a trainee’s knowledge and skills which eventually translates in to a fully competent immunologist able to meet the needs of patients with a wide range of immune-mediated disease, including immunodeficiency, systemic autoimmune disease and serious allergy.

4.3 Research

Trainees who wish to acquire research competencies, in addition to those specified in their specialty curriculum, may undertake a research project as an ideal way of obtaining those competencies. For those in specialty training, one option to be considered is that of taking time out of programme to complete a specified project or research degree. Applications to research bodies, the deanery (via an OOPR form) and the JRCPTB (via a Research Application Form) are necessary steps, which are the responsibility of the trainee. The JRCPTB Research Application Form can be accessed via the JRCPTB website. It requires an estimate of the competencies that will be achieved and, once completed, it should be returned to JRCPTB together with a job description and an up to date CV. The JRCPTB will submit applications to the relevant SACs for review of the research content including an indicative assessment of the amount of clinical credit (competence acquisition) which might be achieved. This is likely to be influenced by the nature of the research (eg entirely laboratory-based or strong clinical commitment), as well as duration (eg 12 month Masters, 2-year MD, 3-Year PhD). On approval by the SAC, the JRCPTB will advise the trainee and the deanery of the decision. The deanery will make an application to the GMC for approval of the out of programme research. All applications for out of programme research must be prospectively approved. Upon completion of the research period the competencies achieved will be agreed by the OOP Supervisor, Educational Supervisor and communicated to the SAC, accessing the facilities available on the JRCPTB ePortfolio. The competencies achieved will determine the trainee’s position on return to programme; for example if an ST3 trainee obtains all ST4 competencies then 12 months will be recognised towards the minimum training time and the trainee will return to the programme at ST5. This would be corroborated by the subsequent ARCP.


This process is shown in the diagram below:

Funding will need to be identified for the duration of the research period. Trainees need not count research experience or its clinical component towards a CCT programme but must decide whether or not they wish it to be counted on application to the deanery and the JRCPTB. A maximum period of 3 years out of programme is allowed and the SACs will recognise up to 12 months towards the minimum training times.

4.4 Academic Training

For those contemplating an academic career path, there are now well-defined posts at all levels in the Integrated Academic Training Pathway (IATP) involving the National Institute for Health Research (NIHR) and the Academy of Medical Sciences (AMS). For full details see http://www.nccrcd.nhs.uk/intetacatrain and http://www.academicmedicine.ac.uk/uploads/A-pocket-guide.pdf. Academic trainees may wish to focus on education or research and are united by the target of a consultant-level post in a university and/or teaching hospital, typically starting as a senior lecturer and aiming to progress to readership and professor. A postgraduate degree will usually be essential (see “out of programme experience”) and academic mentorship is advised (see section 6.1). Academic competencies have been defined by the JRCPTB in association with AMS and the Colleges and modes of assessment have been incorporated in the latest edition of the Gold Guide (section 7, see http://www.jrcptb.org.uk/forms/Documents/GoldGuide2009.pdf). Academic integrated pathways to CCT are a) considered fulltime CCTs as the default position and b) are run through in nature. The academic programmes are CCT programmes and the time set for the CCT is the time set for academic trainees. If a trainee fails to achieve all the required competencies within the notional time period for the programme, this would be considered at the ARCP, and recommendations to allow completion of clinical training would be made (assuming other progress to be satisfactory) see the guidelines for monitoring training and progress http://www.academicmedicine.ac.uk/careersacademicmedicine.aspx. Extension of a

OOPR Applicant seeks approval from Deanery

Deanery grant time to go OOP

OOPR Applicant applies to JRCPTB for OOP approval

SAC decide on research content

OOPR Applicant obtains competencies whilst OOP

SAC decide how many competencies can be counted towards minimum training time

OOP applicant returns to programme at appropriate competency level


CCT date will be in proportion depending upon the nature of the research and will ensure full capture of the specialty outcomes set down by the Royal College and approved by GMC. All applications for research must be prospectively approved by the SAC and the regulator, see www.jrcptb.org.uk for details of the process.

5 Assessment

5.1 The Assessment System

The purpose of the assessment system is to:

• Enhance learning by providing formative assessment, enabling trainees to receive immediate feedback, measure their own performance and identify areas for development;

• Drive learning and enhance the training process by making it clear what is required of trainees and motivating them to ensure they receive suitable training and experience;

• Provide robust, summative evidence that trainees are meeting the curriculum standards during the training programme;

• Ensure trainees are acquiring competencies within the domains of Good Medical Practice;

• Assess trainees’ actual performance in the workplace;

• Ensure that trainees possess the essential underlying knowledge required for their specialty;

• Inform the Annual Review of Competence Progression (ARCP), identifying any requirements for targeted or additional training where necessary and facilitating decisions regarding progression through the training programme;

• Identify trainees who should be advised to consider changes of career direction. The integrated assessment system comprises a combination of workplace-based assessments and knowledge – based assessments. Individual assessment methods are described in more detail below. Workplace-based assessments will take place throughout the training programme to allow trainees to continually gather evidence of learning and to provide trainees with formative feedback. They are not individually summative but overall outcomes from a number of such assessments provide evidence for summative decision making. The number and range of these will ensure a reliable assessment of the training relevant to their stage of training and achieve coverage of the curriculum.

5.2 Assessment Blueprint

In the syllabus (3.3) the “Assessment Methods” shown are those that are appropriate as possible methods that could be used to assess each competency. It is not expected that all competencies will be assessed and that where they are assessed not every method will be used.

5.3 Assessment Methods

The following assessment methods are used in the integrated assessment system:

Examinations and Certificates

• The FRCPath examination in Immunology: Part I, Part II

• Advanced Life Support Certificate (ALS)


The FRCPath Examination in Immunology comprises two parts. The Part I examination comprises 2 written papers covering fundamental immunology and clinical problem-solving. The part I examination is designed to test a candidate’s grasp of fundamental immunology and ability to integrate knowledge and experience to critically evaluate clinical cases and laboratory results. The Part II examination is composed of a written component, an objective structured practical examination (OSPE), followed by an extended objective structured oral examination (OSOE). Successful completion of the FRCPath part II examination denotes that a candidate has reached the standard required for independent practice as a consultant immunologist. FRCPath examiners are appointed to the Panel of Examiners for a five year period. They will have been in a substantive post for at least five years and be actively involved in training and educational supervision and be undertaking continuous professional development. Examiners are required to undertake training in, and contribute to the ongoing development of, the examinations process. They are expected to examine a minimum number of times during the five year period as defined in the RCPath examination regulations. Their examining work can be in one or all of the examination components, as determined by the Chair of the Panel of Examiners. Information about the FRCPath, including guidance for candidates, is available on the Royal College of Pathologist’s website: http://www.rcpath.org/index.asp?PageID=114&SearchStr=frcpath .

Workplace-Based Assessments

• Multi-Source Feedback (MSF)

• mini-Clinical Evaluation Exercise (mini-CEX)

• Direct Observation of Procedural Skills (DOPS)

• Case-Based Discussion (CbD)

• Patient Survey (PS)

• Audit Assessment (AA)

• Teaching Observation (TO) These methods are described briefly below. More information about these methods including guidance for trainees and assessors is available in the ePortfolio and on the JRCPTB website www.jrcptb.org.uk. Workplace-based assessments should be recorded in the trainee’s ePortfolio. The workplace-based assessment methods include feedback opportunities as an integral part of the assessment process, this is explained in the guidance notes provided for the techniques. Multisource Feedback (MSF) This tool is a method of assessing generic skills such as communication, leadership, team working, reliability etc, across the domains of Good Medical Practice. This provides objective systematic collection and feedback of performance data on a trainee, derived from a number of colleagues. ‘Raters’ are individuals with whom the trainee works, and includes doctors, administration staff, and other allied professionals. The trainee will not see the individual responses by raters, feedback is given to the trainee by the Educational Supervisor. Mini-Clinical Evaluation Exercise (mini-CEX)


This tool evaluates a clinical encounter with a patient to provide an indication of competence in skills essential for good clinical care such as history taking, examination and clinical reasoning. The trainee receives immediate feedback to aid learning. The mini-CEX can be used at any time and in any setting when there is a trainee and patient interaction and an assessor is available. Direct Observation of Procedural Skills (DOPS) A DOPS is an assessment tool designed to assess the performance of a trainee in undertaking a practical procedure, against a structured checklist or standard operating procedure. The trainee receives immediate feedback to identify strengths and areas for development. Case based Discussion (CbD) The CbD assesses the performance of a trainee in their management of a patient to provide an indication of competence in areas such as clinical reasoning, decision-making and application of medical knowledge in relation to patient care. It also serves as a method to document conversations about, and presentations of, cases by trainees. The CbD should include discussion about a written record (such as written case notes, out-patient letter, discharge summary). A typical encounter might be when presenting newly referred patients in the out-patient department. Patient Survey (PS) Patient Survey address issues, including behaviour of the doctor and effectiveness of the consultation, which are important to patients. It is intended to assess the trainee’s performance in areas such as interpersonal skills, communication skills and professionalism by concentrating solely on their performance during one consultation. Audit Assessment Tool (AA) The Audit Assessment Tool is designed to assess a trainee’s competence in completing an audit. The Audit Assessment can be based on review of audit documentation OR on a presentation of the audit at a meeting. If possible the trainee should be assessed on the same audit by more than one assessor. Teaching Observation (TO) The Teaching Observation form is designed to provide structured, formative feedback to trainees on their competence at teaching. The Teaching Observation can be based on any instance of formalised teaching by the trainee who has been observed by the assessor. The process should be trainee-led (identifying appropriate teaching sessions and assessors).

5.4 Decisions on Progress (ARCP)

The Annual Review of Competence Progression (ARCP) is the formal method by which a trainee’s progression through her/his training programme is monitored and recorded. ARCP is not an assessment – it is the review of evidence of training and assessment. The ARCP process is described in A Reference Guide for Postgraduate Specialty Training in the UK (the “Gold Guide” – available from www.mmc.nhs.uk). Deaneries are responsible for organising and conducting ARCPs. The evidence to be reviewed by ARCP panels should be collected in the trainee’s ePortfolio. In each year of training, acquisition of knowledge and competencies relating to each of the main subject areas of the curriculum will be assessed by a combination of mini-CEX, DOPS, CbD, AA and TO. These methods of formative assessment will be complemented by summative assessment in the form of the FRCPath examination in


Immunology, which will be taken at defined points in the training programme – part I of the FRCPath will generally be taken at the end of ST4 or early in ST5 with part II being taken towards the end of ST6 or early in ST7. Successful completion of the FRCPath examination coupled with satisfactory progress through the ARCP process is essential pre-requisites for the award of a CCT in Immunology. The ARCP Decision Aid is included in section 5.5, giving details of the evidence required of trainees for submission to the ARCP panels. Each section of the syllabus outlines the knowledge, skills and behaviours that must be obtained by the trainee in order to successfully complete training. During their training, it is expected that the trainee will progress through three levels of competence, as outlined below:

Level 1: Introductory - The trainee has comprehensive understanding of principles and practices under direct supervision.

Level 2: Intermediate - The trainee has a good general knowledge and understanding of most principles and practices under indirect supervision. He/she should be able to deal with most of the day-to-day issues in a hospital immunology laboratory and outpatient clinic/ward to an adequate level but will still require consultant input with regard to complex management and clinical issues.

Level 3: Independent - The trainee has an in-depth knowledge and understanding of principles. He/she should be competent to discuss and deal with the subject (or, where appropriate, perform the task/procedure), demonstrating a level of clinical or professional judgement commensurate with independent practice at consultant level. It is anticipated that a trainee at this level should have consultant input readily available at all times where required

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Immunology Oct 09 Page 53 of 94

5.5 ARCP Decision Aid - Minimal Standards Determining Satisfactory Progress

Immunology Specialist Training Curriculum topic ST3 ST4 ST5 ST6 ST7

Fundamental Immunology Level 1 competent Level 2 competent Level 2 competent Level 3 competent Level 3 competent

Primary immunodeficiency Level 1 competent Level 2 competent Level 2 competent Level 2 competent Level 3 competent

Autoimmune disease and systemic vasculitides

Level 1 competent Level 2 competent Level 2 competent Level 2 competent Level 3 competent

Allergic diseases Level 1 competent Level 2 competent Level 2 competent Level 2 competent Level 3 competent

Laboratory Immunology (see laboratory training manual and record)

Level 3 competent in all core areas of laboratory immunology

Audit assessment (AA) 1 completed project 1 completed project

Teaching observation (TO) episodes

1 1 1 1 1

Acquisition of common competencies (% by end of year) evidenced by above assessments

20% 40% 60% 80% 100%

ALS Valid Valid Valid Valid Valid

Examinations FRCPath part I FRCPath part II

MSF Satisfactory Satisfactory

Patient Survey Satisfactory Satisfactory

Minimum number of work place assessments (comprising a combination of mini-CEX, DOPS, ,CbD, AA and TO) ensuring coverage of the key subject areas of the curriculum

6 6 6 6 6

The above table serves as a guide to ARCP panels in assessing the progress of trainees in Immunology. The rate at which each individual trainee will acquire the necessary knowledge base in the 5 main subject areas of the curriculum (fundamental immunology, immunodeficiency, autoimmune disease, allergy and laboratory immunology) will inevitably vary. The incremental nature of acquisition of competencies (L1 to L3) is mapped against key learning outcomes as defined in the curriculum.It is meant to be interpreted flexibly and designed to ensure that the progress of trainees is measurable. While failure to achieve coverage of the precise proportion of the curriculum at the end of each year should not be seen as an insurmountable barrier to trainee progress, it is necessary for all trainees to achieve Level 3 competence across the curriculum and complete the FRCPath examination by the end of the training programme.


5.6 Penultimate Year Assessment (PYA)

The penultimate ARCP prior to the anticipated CCT date will include an external assessor from outside the training programme. JRCPTB and the deanery will coordinate the appointment of this assessor. This is known as “PYA”. Whilst the ARCP will be a review of evidence, the PYA will include a face to face component.

5.7 Complaints and Appeals

FRCPath Examinations A trainee who has taken any Royal College of Pathologists examination has the right of appeal if there is evidence of a procedural or administrative irregularity by the College or its contracted examination centres in the conduct or content of the examination that has adversely affected the trainee’s result. The appeals procedure is outlined in the Regulations and Guidelines for Membership Exams and Diplomas on the College website. The regulations and guidelines are reviewed annually, at which time the appeals procedure will automatically be reviewed. Appeals submitted on the grounds that a candidate seeks to challenge the professional or academic judgement of the examiners will not be considered and in no circumstances will the examination be re-marked. The principle underlying this is that the written papers and options are double blind marked and the reliability of the marking decisions in oral and practical assessments is greatest at the time of the initial examiners’ judgement. Subsequent review by different or senior examiners or by independent assessors cannot guarantee increased accuracy or reliability. Moreover, in the case of the oral and some practical assessments there is no residual physical evidence of the candidate’s performance, which could be revisited. Any appeal must be made by the trainee in writing to the Examinations Department within one month of issue of the examination result. The appeal will be considered by the Director of Examinations and Assessment, who will arrange an appropriate investigation of the appeal. This will include checking that no administrative, procedural, numerical, data transcription or computing errors have occurred, and that the declared result accurately reflects the judgement of the examiners. The Director may also ask the Chair of the Panel of Examiners for a report on the examination in question. Where a procedural irregularity is found the Director may authorise a refund of the examination fee or waiver of the fee to re-sit the relevant component of the examination. Only in exceptional circumstances, where it is clear that a paper has been overlooked or marks incorrectly totalled, will a fail mark be converted to a pass. There is a complaints procedure for all activities managed by the Examinations Department not directly linked to an outcome of an examination. The complaints procedure is available on the College website. The Examinations Manager is responsible for the complaints procedure and for maintaining a register of complaints detailing the nature of the complaint and the outcome. The register will be reviewed on a periodic basis by the Director of Examinations and Assessment who will aim to identify trends that indicate a need to review regulations and procedures. The Chair of the Panel of Examiners will also be advised of all complaints relating to the specialty. Candidates dissatisfied by the outcome of the examinations complaints procedure can take the matter further by going through the College’s complaints procedure and


referring the matter to the Chief Executive. Complaints referred to the Chief Executive are reviewed on a periodic basic by the College’s Executive Committee All workplace-based assessment methods incorporate direct feedback from the assessor to the trainee and the opportunity to discuss the outcome. If a trainee has a complaint about the outcome from a specific assessment this is their first opportunity to raise it. Appeals against decisions concerning in-year assessments will be handled at deanery level and deaneries are responsible for setting up and reviewing suitable processes. If a formal complaint about assessment is to be pursued this should be referred in the first instance to the chair of the Specialty Training Committee who is accountable to the regional deanery. Continuing concerns should be referred to the Associate Dean.

6 Supervision and Feedback

6.1 Supervision

All elements of work in training posts must be supervised with the level of supervision varying depending on the experience of the trainee and the clinical exposure and case mix undertaken. Outpatient and referral supervision must routinely include the opportunity to personally discuss all cases if required. As training progresses the trainee should have the opportunity for increasing autonomy, consistent with safe and effective care for the patient. Trainees will at all times have a named Educational Supervisor and Clinical Supervisor, responsible for overseeing their education. Given the small size of the specialty of Immunology, these roles have been combined into a single role of Educational Supervisor. The responsibilities of supervisors have been defined by GMC in the document “Operational Guide for the PMETB Quality Framework”. These definitions have been agreed with the National Association of Clinical Tutors, the Academy of Medical Royal Colleges and the Gold Guide team at MMC, and are reproduced below: Educational Supervisor A trainer who is selected and appropriately trained to be responsible for the overall supervision and management of a specified trainee’s educational progress during a training placement or series of placements. The Educational Supervisor is responsible for the trainee’s Educational Agreement. Clinical Supervisor A trainer who is selected and appropriately trained to be responsible for overseeing a specified trainee’s clinical work and providing constructive feedback during a training placement. Some training schemes appoint an Educational Supervisor for each placement. The roles of Clinical and Educational Supervisor may then be merged. Trainees will at all times have a named Educational Supervisor and Clinical Supervisor, responsible for overseeing their education. All trainers and educational supervisors will be consultants of at least 1years standing who will have undergone appropriate training to fulfil these roles, as determined by the local postgraduate deanery. The educational supervisor will be responsible for performing an induction appraisal soon after the trainee is appointed followed by 2 to 3 appraisals per year where developmental goals are agreed and previous goals reviewed. In co-ordinating training,the educational


supervisor will ensure that the curriculum is followed, write the supervisor’s report, provide feedback, communicate with other supervisors as required and support the under-performing trainee. The Educational Supervisor, when meeting with the trainee, should discuss issues of clinical governance, risk management and any report of any untoward clinical incidents involving the trainee. The Educational Supervisor should be part of the clinical specialty team. Thus if the clinical directorate (clinical director) have any concerns about the performance of the trainee, or there were issues of doctor or patient safety, these would be discussed with the Educational Supervisor. These processes, which are integral to trainee development, must not detract from the statutory duty of the trust to deliver effective clinical governance through its management systems. Opportunities for feedback to trainees about their performance will arise through the use of the workplace-based assessments, regular appraisal meetings with supervisors, other meetings and discussions with supervisors and colleagues, and feedback from ARCP. Deaneries will be responsible for ensuring that trainers and assessors are appropriately trained to undertake their educational responsibilities. Trainers and assessors will be expected to be fully conversant with the curriculum and assessment methods and work in conjunction with the SAC to deliver effective training.

6.2 Appraisal

A formal process of appraisals and reviews underpins training. This process ensures adequate supervision during training, provides continuity between posts and different supervisors and is one of the main ways of providing feedback to trainees. All appraisals should be recorded in the ePortfolio.

Induction Appraisal

The trainee and educational supervisor should have an appraisal meeting at the beginning of each post to review the trainee’s progress so far, agree learning objectives for the post ahead and identify the learning opportunities presented by the post. Reviewing progress through the curriculum will help trainees to compile an effective Personal Development Plan (PDP) of objectives for the upcoming post. This PDP should be agreed during the Induction Appraisal. The trainee and supervisor should also both sign the educational agreement in the e-portfolio at this time, recording their commitment to the training process.

Mid-point Review

This meeting between trainee and educational supervisor is mandatory (except when an attachment is shorter than 6 months), but is encouraged particularly if either the trainee or educational or clinical supervisor has training concerns or the trainee has been set specific targeted training objectives at their ARCP. At this meeting trainees should review their PDP with their supervisor using evidence from the e-portfolio. Workplace-based assessments and progress through the curriculum can be reviewed to ensure trainees are progressing satisfactorily, and attendance at educational events should also be reviewed. The PDP can be amended at this review.

End of Attachment Appraisal

Trainees should review the PDP and curriculum progress with their educational supervisor using evidence from the e-portfolio. Specific concerns may be highlighted from this appraisal. The end of attachment appraisal form should record the areas where further work is required to overcome any shortcomings. Further evidence of competence in certain areas


may be needed, such as planned workplace-based assessments, and this should be recorded. If there are significant concerns following the end of attachment appraisal then the programme director should be informed.

7 Managing Curriculum Implementation

7.1 Intended Use of Curriculum by Trainers and Trainees

This curriculum and ePortfolio are web-based documents which are available from the Joint Royal Colleges of Physicians Training Board (JRCPTB) website www.jrcptb.org.uk . The educational supervisors and trainers can access the up-to-date curriculum from the JRCPTB website and will be expected to use this as the basis of their discussion with trainees. Both trainers and trainees are expected to have a good knowledge of the curriculum and should use it as a guide for their training programme. Each trainee will engage with the curriculum by maintaining a portfolio. The trainee will use the curriculum to develop learning objectives and reflect on learning experiences. Development of the 2009 curriculum has been facilitated by a national educational workshop on the curriculum and assessment methods for educational supervisors and trainers held by the JRCPTB at the Royal College of Physicians on 26th June 2009. Local mechanisms for curriculum implementation will be overseen by the relevant schools of medicine under the aegis of postgraduate deaneries. Regular feedback from trainee representatives on the SAC in Immunology at JRCPTB, the SAC in Immunology at the Royal College of Pathologists and the Intercollegiate Joint Committee on Immunology and Allergy will ensure that trainees’ views on curriculum implementation are adequately represented.

7.2 Recording progress

On enrolling with JRCPTB trainees will be given access to the ePortfolio for Immunology (under development). The ePortfolio allows evidence to be built up to inform decisions on a trainee’s progress and provides tools to support trainees’ education and development. The trainee’s main responsibilities are to ensure the ePortfolio or relevant paper copies are kept up to date, arrange assessments and ensure they are recorded, prepare drafts of appraisal forms, maintain their personal development plan, record their reflections on learning and record their progress through the curriculum. The supervisor’s main responsibilities are to use ePortfolio or paper-based evidence such as outcomes of assessments, reflections and personal development plans to inform appraisal meetings. They are also expected to update the trainee’s record of progress through the curriculum, write end-of-attachment appraisals and supervisor’s reports. Trainees will be expected to document acquisition of laboratory immunology competencies by recording progress in the Laboratory Training Manual (Laboratory logbook).

8 Curriculum Review and Updating The curriculum will remain under regular review as a standing item on the agenda for meetings of the SAC in Immunology at JRCPTB held 3 times a year. Trainee and lay representation on the committee will enable the SAC to respond to any issues raised by these groups. In addition to these meetings, the SAC will formally review the curriculum at its joint annual meeting with Regional Specialty Advisors. These meetings will ensure that the


curriculum remains relevant to current practice and that the SAC responds swiftly to advances in basic and applied immunological science which impact on the quality of care provided to patients with immune-mediated disease.

9 Equality and Diversity The Royal Colleges of Physicians will comply, and ensure compliance, with the requirements of equality and diversity legislation, such as the:

• Race Relations (Amendment) Act 2000

• Disability Discrimination Act 1995

• Human Rights Act 1998

• Employment Equality (Age) Regulation 2006

• Special Educational Needs and Disabilities Act 2001

• Data Protection Acts 1984 and 1998 The Federation of the Royal Colleges of Physicians believes that equality of opportunity is fundamental to the many and varied ways in which individuals become involved with the Colleges, either as members of staff and Officers; as advisers from the medical profession; as members of the Colleges' professional bodies or as doctors in training and examination candidates. Accordingly, it warmly welcomes contributors and applicants from as diverse a population as possible, and actively seeks to recruit people to all its activities regardless of race, religion, ethnic origin, disability, age, gender or sexual orientation. Deanery quality assurance will ensure that each training programme complies with the equality and diversity standards in postgraduate medical training as set by GMC. Compliance with anti-discriminatory practice will be assured through:

• monitoring of recruitment processes;

• ensuring all College representatives and Programme Directors have attended appropriate training sessions prior to appointment or within 12 months of taking up post;

• Deaneries must ensure that educational supervisors have had equality and diversity training (at least as an e learning module) every 3 years

• Deaneries must ensure that any specialist participating in trainee interview/appointments committees or processes has had equality and diversity training (at least as an e module) every 3 years.

• ensuring trainees have an appropriate, confidential and supportive route to report examples of inappropriate behaviour of a discriminatory nature. Deaneries and Programme Directors must ensure that on appointment trainees are made aware of the route in which inappropriate or discriminatory behaviour can be reported and supplied with contact names and numbers. Deaneries must also ensure contingency mechanisms are in place if trainees feel unhappy with the response or uncomfortable with the contact individual.

• monitoring of College Examinations;

• ensuring all assessments discriminate on objective and appropriate criteria and do not unfairly disadvantage trainees because of gender, ethnicity, sexual orientation or disability (other than that which would make it impossible to practise safely as a physician). All efforts shall be made to ensure the participation of people with a disability in training.

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10 Appendix A

Laboratory Training Manual and

Record for Specialty Registrars in

Immunology

60

NAME: NTN Number: LABORATORY ADDRESS: TELEPHONE NUMBER: EMAIL ADDRESS: PRINCIPAL LABORATORY SUPERVISOR’S NAME: START DATE: FINAL SUBMISSION DATE:

61

INTRODUCTION

This manual outlines the JRCPTB Laboratory Training program for trainees in Immunology. The Training Programme Director and consultant supervisor will be responsible for the continuous assessment of the trainee. This will be achieved by regular contact between the trainee and their supervisor to assess progress using the record made in their training manual. Sections in the training manual will be signed by the person supervising the training (BMS 1 or Higher, or Clinical Scientist of B Grade or Higher). The log book will be reviewed together with other relevant records like 360 degree assessments at ARCP meetings. Satisfactory completion of laboratory training will be assessed and certified at the PYA, as a mandatory part of the process. Differences exist in the type and size of individual training departments and secondments to other units may be necessary to achieve competence in some procedures. Training aims are for the trainee to gain an understanding of immunological mechanisms and apply this knowledge to the investigation and diagnosis of disease processes. The trainee will develop the expertise needed to advise on the application of laboratory investigations to diseases of the immune system, to interpret the results generated by such investigations, to be aware of the limitations of laboratory assays, to initiate appropriate research and development in diagnostic laboratory immunology and to understand the managerial organisation within the NHS. The Sections highlighted in bold italics are regarded as core areas with which the trainee is expected to be fully conversant and demonstrate a level of competence required for independent practice.

USE OF THE TRAINING MANUAL This manual covers the areas in which a trainee should gain experience over the 4-year training course. It provides a record of continuous assessment. The supervisor and trainee should indicate the dates on which the trainee has studied a topic and where relevant, the level of competence achieved. It is envisaged that a higher level will be assigned as more experience is gained. At present there is no standard way of electronically validating signatures. Therefore a printed certified version should be included in your portfolio for inspection at ARCP assessments. The training manual should be augmented with any additional information which will document the training received and the levels reached. The completed record of training will be used ultimately to assess the successful completion of the training.

The Manual is divided into sections Section 1 Laboratory Management Section 2 Analytical Techniques and Instrumentation Section 3 Interpretation of Immunology tests Section 4 Research and Development Section 5 Meetings attended Section 6 Presentations given

62

SECTION 1 LABORATORY MANAGEMENT

This section gives the trainee an insight into the functional organisation of a laboratory, a hospital and the National Health Service. The trainee should also understand the importance of quality assurance, clinical governance and Health and Safety aspects of laboratory management. An appreciation of the organisation of the analytical and reporting process should also be obtained. The understanding of theoretical aspects and practical experience should be recorded.

Management and Professional Structures Date Covered Comments

NHS Organisation and Management

Hospital Management Structure

Laboratory structure

63

Handling of Information Date Covered Comments

Initiation of request by clinician

Types of patient records: eg. Paper based, Electronic

Patient confidentiality and consent

Laboratory computer system

Use of a Personal Computer including common programmes (eg. Word Processing , database, Statistical analysis, Bibliography)

Data protection Act

Reporting of Results

Telephone Enquiries

64

Sample Handling Date

Covered Has reached level of competence required for independent practice

Comments

Specimen collection and transport

Transportation through the post

Sample handling and storage in laboratory

Disposal of clinical waste

High Risk Samples

Spillage and containment

65

Quality Assurance Date


Comments

The SOP

Document control

Sample requirements

Specimen identity checks

Determining Normal ranges

Internal quality control

External quality control

Quality assurance

QC interpretation

Laboratory accreditation: CPA

Statutory Registration of Laboratory Staff

Laboratory Audit

66

Health and Safety Date


Comments

The laboratory safety policy

Risk management

Health and safety at work act

Fire safety

Dealing with biological hazards in the laboratory

Disinfection and decontamination

Vaccination policy

Chemical hazards including COSHH

Mechanical hazards (including sharps)

Dealing with needle-stick injuries

Electrical hazards

Ionising radiation

Laser/UV hazards

Genetic manipulation policy

Incident handling

Waste disposal

Safe Storage of Chemicals

67

Basic Laboratory Management Date Covered Comments

Business planning

Bidding for new services/equipment

Finance control

Staffing and Personnel Issues

Disciplinary Procedures

Organising Research & Development

68

SECTION 2: ANALYTICAL TECHNIQUES AND INSTRUMENTATION / LABORATORY PROCEDURES The purpose of this section is to allow the trainee to become familiar with a range of techniques encountered in the Immunology laboratory and to gain an understanding of the assay principles and their application. For each entry in this section the competence of the trainee is assessed as follows:

• Level 0: Procedure unavailable in laboratory or opportunity for training not available.

• Level 1: Observed a demonstration.

• Level 2: Technique preformed under supervision and has a basic understanding of the theory behind the procedure and can rectify any problems that occur.

• Level 3: Technique performed without supervision and has a comprehensive understanding of the theoretical concepts and application of the assay.

• Level 4: Extensive experience of technique and where relevant, has a knowledge of the clinical interpretation of the results generated.

Wide experience rather than in-depth knowledge of a limited number of techniques should be aimed for (i.e. level 4 is not expected in all topics). Where essential procedures are unavailable, secondment to a laboratory performing those assays should be offered. This should be noted in the secondments section.

69

ANALYTICAL TECHNIQUES AND INSTRUMENTATION A. BASIC LABORATORY TECHNIQUES Operation of Basic Laboratory Equipment Level of

competence attained and date

Level of competence attained and date



Has reached level of competence required for independent practice

Liquid handling using Pipettes

Liquid handling using robotics

Balances

Centrifuges

pH meters, Concept of buffers

Water purification

Microscopy, types of microscopes

Preparation of sections for microscopy

Fixation and Embedding

Operation of Cryostats

Spectrophotometric and related techniques

(manual and automated equipment)

Visible and UV spectrophotometry

Nephelometry / Turbidimetry

Densitometry

Enzyme Linked immunosorbent assay and similar immunoassay techniques

Level and date

Level and date

Level and date

Level and date


Isotopic Techniques

Beta counters

Gamma counters

70

Radioimmunoassay

71

Gel Phase and Electrophoretic Techniques Level of






Radial immunodiffusion

Double diffusion

Zonal Electrophoresis

Immunoelectrophoresis

Polyacrylamide gel electrophoresis

Two-dimensional electrophoresis

Isoelectric focusing

Western blotting

Immunofixation

Capillary zone electrophoresis

Gel Staining Methods

Chromatographic Techniques

Column chromatography

Gel filtration

Ion-exchange chromatography

Affinity chromatography

72

Cellular and Tissue Immunology Level of






Tissue culture / aseptic technique

Cell and tissue storage

Viability assays

Cellular analysis including cell counting

Flow cytometry

Light/ Fluorescence Microscopy

73

Molecular Biology Level of






Principles of DNA extraction and DNA analysis

Restriction enzymes

DNA probes

Southern blotting

Polymerase chain reaction

Hybridisation techniques

Others: please specify below

74

B. SPECIFIC LABORATORY PROCEDURES Cellular Immunology Level of






Leucocyte separation techniques

• Lymphocytes

• Monocytes

• Neutrophils

Phagocyte functions

• NBT

• Flow cytometry

Cell proliferation assays and their applications

Flow cytometry, principles, practise, applications

Use of Flow cytometry for the diagnosis of Immunodeficiency

Broad principles of Diagnosis and classification of lymphoid neoplasms

75

MHC and Tissue Typing Level of






HLA typing

Cellular Assays

DNA techniques

Antibody screening

Principles of Tissue matching for Renal , Solid Organ and BM transplantation

Other techniques: Specify below

76

Protein Analysis Level of






Immunoglobulins (G, A, M, D, E)

Immunoglobulin fragments : Heavy chains, Light chains

Cryoglobulins

Methods for assessing specific antibody responses including limitations

Paraproteins

Beta 2 microglobulin

Immunoglobulin subclasses

Other proteins

Precipitins (avian, fungal)

Specific IgE

Tryptase

C-Reactive protein

77






Complement: C3, C4 Other components

Functional complement assays: CH50 \CH100 AP50\AP100

C3 nephritic factor

C1 inhibitor: Immunochemical and Functional

Cytokine detection

78

Autoantibody Analysis Level of






Rheumatoid factor

Antinuclear antibodies

Anti- ds.DNA antibodies

Extractable nuclear antigens: Ro, La, Sm, RNP, Jo1, Scl 70

Antineutrophil cytoplasmic antibodies :c-ANCA, p-ANCA Anti-MPO, PR3

Smooth Muscle antibodies

Glomerular basement membrane antibodies

Mitochondrial antibodies

Antibodies used to diagnose celiac disease

Gastric parietal cell antibodies

Intrinsic factor antibodies

Thyroid autoantibodies

Pancreatic islet cell antibodies

Steroid cell antibodies (adrenal, ovarian, testis)

Level and date

Level and date

Level and date

Level and date


Cardiolipin antibodies

Liver autoantibodies

• Neural auto-antibodies:

79

Cerebellar antibodies (Yo, Hu), Ganglioside antibodies,

• Glutamic acid decarboxylase antibodies,

• Myelin associated glycoprotein antibodies

80

Immunohistology






Analysis by immunofluorescence techniques

Principles of immunohistochemistry

Histology of the immune system

Renal disease

Skin disease

81

C. SECONDMENTS

Secondment site

Dates Comments including reason for secondment

82

SECTION 3 INTERPRETATION OF IMMUNOLOGY TESTS A Clinical Immunologist must be able to interpret laboratory results for communication to other clinical colleagues. The trainee is required to develop an understanding of how the immune system responds to different disease processes and how these changes can be used in the laboratory for monitoring and diagnosis. Essential to the interpretive process is an understanding of the assays performed and their limitations. The trainee should have a good knowledge of how patient reports are generated and when additional comments or telephone communication may be required. The immunologist should be to advise clinical colleagues on relevant tests for a given clinical situation. Sections below are provided for recording progress.

83

STATISTICAL METHODS USED FOR INTERPRETING LABORATORY DATA

Measures of central tendency Date Covered Comments

Parametric and non-parametric ways of comparing data

Sensitivity and specificity

prior and posterior probability

Negative and Positive Predictive Value

Receiver operated characteristic curves

Understanding of the impact of prior and posterior probability

Difference between performance of tests to screen for disease versus diagnosis

84

Interpretation of Laboratory Data Level of






Autoantibody tests

85







Protein tests

86







Cellular tests

87







Allergy tests

88

INTERPRETATION OF LABORATORY DATA Laboratory Investigations by Disease Level of






Immunodeficiency:

• Antibody deficiency

• Phagocyte

deficiency

• Defective Cell-mediated immunity

• Complement

deficiency

89

Laboratory Investigations by Disease






• Systemic Autoimmunity:

• Systemic lupus

erythematosus • Rheumatoid arthritis • Antiphospholipid

syndrome • Scleroderma • Sjögrens syndrome • Systemic vasculitis • Seronegative

spondyloarthropathies • Dermatomyositis

• Overlap syndromes

90






Allergy:

• Food allergy

• Inhalant allergy

• Drug allergy

• Skin prick testing

• Patch testing

• Heaf Test

• Anaphylaxis

Lymphoproliferative Disease

Myelomatosis

91

SECTION 4 - RESEARCH and DEVELOPMENT A. The Scientific Literature Dates Comments Journals

Multidisciplinary Immunological - Scientific Immunological - Medical

Library facilities

Medline and other Databases:

Searching Clinical databases Genetic Databases (eg.OMIM)

B. Research Technique Ethical issues and approval Hypothesis Background Aims and Objectives Methods Recording Results Handling the data Statistics Presentation Preparing a poster Preparing a talk Powerpoint Routes to publication Writing a paper Refereeing

92

C. The Funding of Research NHS research and development Charities - project grants Government funding A Research Grant Refereeing process

93

SECTION 5 - MEETINGS/ SEMINARS ATTENDED DATE DETAILS

94

SECTION 6 - PRESENTATIONS GIVEN DATE DETAILS

ANEXO V.2.- PROGRAMAS FORMATIVOS EN INMUNOLOGÍA CLÍNICA Y DE

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MED

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MED

/17

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LATT

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FETT

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Atti

med

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spec

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ento

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Infe

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r ed

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ges

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rico

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ti.

AP

Azi

enda

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vers

ità P

adov

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attie

infe

ttive

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/26

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LOG

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tti m

edic

i e sp

ecia

listic

i rel

ativ

i al

l'inq

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amen

to, a

llo st

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ed

alla

tera

pia

di

pazi

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con

mal

attie

imm

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d al

lerg

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aff

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ti a

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i Neu

rolo

gia.

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ecia

lizza

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ffia

ncan

do il

tuto

r ass

egna

to e

d ac

quis

endo

aut

onom

ia n

ella

ges

tione

dei

rico

vera

ti.

AP

Azi

enda

/ Uni

vers

ità P

adov

a:

Clin

ica

Neu

rolo

gica

4

TN

EU

RO

LO

GIA

(TIR

OC

INIO

)

ex N

EU

RO

LO

GIA

CA

RA

TT

ER

IZZA

NT

I A S

CE

LT

A D

EL

LO

ST

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EN

TE

TA

FD

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plin

e el

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e pe

r le

tipo

logi

e de

lla c

lass

eA

MB

ITO

CFU

TIP

O

MED

/09

MED

ICIN

A IN

TER

NA

Atti

med

ici e

spec

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tici r

elat

ivi

all'i

nqua

dram

ento

, allo

stud

io e

d al

la te

rapi

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pa

zien

ti co

n pa

tolo

gia

imm

unol

ogic

a

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ecia

lizza

ndo

dovr

à fr

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ntar

e co

n as

sidu

ità

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ie,

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lato

ri e

labo

rato

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stic

i del

re

parto

con

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vità

di a

llerg

olog

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d im

mun

olog

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clin

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cui è

ass

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do il

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st

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APE

Azi

enda

/ Uni

vers

ità P

adov

a:

Emat

olog

ia e

d Im

mun

olog

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Clin

ica

3T

IMM

UN

OL

OG

IA E

D

AL

LE

RG

OL

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LIN

ICA

2

ex IM

MU

NO

LO

GIA

CL

INIC

A 2

MED

/12

GA

STR

OEN

TER

OLO

GIA

Atti

med

ici e

spec

ialis

tici r

elat

ivi

all'i

nqua

dram

ento

, allo

stud

io e

d al

la te

rapi

a di

pa

zien

ti co

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alat

tie im

mun

olog

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affe

rent

i a

repa

rti d

i Gas

troen

tero

logi

a

Lo sp

ecia

lizza

ndo

dovr

à fr

eque

ntar

e co

n as

sidu

ità e

co

rsie

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ambu

lato

ri de

l rep

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di G

astro

ente

rolo

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cui è

ass

egna

to,

affia

ncan

do il

tuto

r ass

egna

to e

d ac

quis

endo

aut

onom

ia n

ella

ges

tione

dei

rico

vera

ti.

APE

Azi

enda

/ Uni

vers

ità P

adov

a:

Gas

troen

tero

logi

a, C

linic

a M

edic

a 5

1T

GA

STR

OE

NT

ER

OL

OG

IA E

D

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UN

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D

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LIN

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EN

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RO

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GIA

ED

IM

MU

NO

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GIA

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Inse

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lo sp

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ITA

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MED

/09

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Atti

med

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spec

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all'i

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stic

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vità

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olog

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d im

mun

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cui è

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do il

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isen

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osì c

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st

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i.

APO

Azi

enda

/ Uni

vers

ità P

adov

a:

Emat

olog

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d Im

mun

olog

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36T

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UN

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LIN

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ED

A

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MED

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MED

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ICIN

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TER

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Atti

med

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spec

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elat

ivi

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nqua

dram

ento

, allo

stud

io e

d al

la te

rapi

a di

pa

zien

ti co

n pa

tolo

gia

imm

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ogic

a

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ecia

lizza

ndo

dovr

à fr

eque

ntar

e co

n as

sidu

ità

cors

ie,

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lato

ri e

labo

rato

ri di

agno

stic

i del

re

parto

con

atti

vità

di a

llerg

olog

ia e

d im

mun

olog

ia

clin

ica

cui è

ass

egna

to,

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ncan

do il

tuto

r e

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isen

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estio

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zion

e de

gli e

sam

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st

alle

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ogic

i ed

imm

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ogic

i

APE

Azi

enda

/ Uni

vers

ità P

adov

a:

Emat

olog

ia e

d Im

mun

olog

ia

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ica

3T

IMM

UN

OL

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D

AL

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RG

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LIN

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3

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MU

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Alle

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AM

BIT

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MA

LATT

IE

DEL

L'A

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TO

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RIO

Inse

gnar

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MED

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MA

LATT

IE

DEL

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PPA

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TO

RES

PIR

ATO

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Inse

gnar

e al

lo sp

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MED

/13

END

OC

RIN

OLO

GIA

Atti

med

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spec

ialis

tici r

elat

ivi

all'i

nqua

dram

ento

, allo

stud

io e

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la te

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alat

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con

prob

lem

atic

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.

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ità e

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sseg

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il tu

tor

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cqui

send

o au

tono

mia

nel

la g

estio

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ei ri

cove

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APE

Azi

enda

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vers

ità P

adov

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Endo

crin

olog

ia, M

alat

tie d

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Met

abol

ism

o

1T

EN

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INO

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IM

MU

NO

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CL

INIC

A

MED

/15

MA

LATT

IE D

EL

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cqui

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Acq

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Acq

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IGIE

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Atti

med

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spec

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elat

ivi

all'i

nqua

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ento

, allo

stud

io e

d al

la te

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a od

alle

rgic

a.

Lo sp

ecia

lizza

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dovr

à fr

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n as

sidu

ità

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ie,

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lato

ri e

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rato

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stic

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re

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con

atti

vità

di a

llerg

olog

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d im

mun

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cui è

ass

egna

to,

affia

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do il

tuto

r e

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do a

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nel

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ei ri

cove

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bula

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li, c

osì c

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es

ecuz

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ferta

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gli e

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APO

Azi

enda

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vers

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Emat

olog

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mun

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Acq

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la

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Acq

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Acq

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TER

NA

Inse

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TER

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Atti

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stud

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d al

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rapi

a di

pa

zien

ti co

n pa

tolo

gia

imm

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ecia

lizza

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à fr

eque

ntar

e co

n as

sidu

ità

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ie,

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lato

ri e

labo

rato

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stic

i del

re

parto

con

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vità

di a

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olog

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d im

mun

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cui è

ass

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do il

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ferta

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e di

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st

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APE

Azi

enda

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vers

ità P

adov

a:

Emat

olog

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d Im

mun

olog

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IMM

UN

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D

AL

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RG

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4

ex IM

MU

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MED

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A IN

TER

NA

Inse

gnar

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lo sp

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MED

/14

NEF

RO

LOG

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sire

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inqu

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men

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ANEXO V.3 PROGRAMA DE FORMACIÓN EN INMUNOLOGÍA BÁSICA Y CLÍNICA DE ALEMANIA

ANEXO V.3 PROGRAMA DE FORMACIÓN EN INMUNOLOGÍA BÁSICA Y CLÍNICA DE ALEMANIA El programa de Formación en Inmunología Básica y Clínica de la Sociedad Alemana de Inmunología (DGfI) se encuentra en el link del correspondiente Website de la DGfI. http://dgfi.org/web/aus-und-fortbildung. En resumen, existe un programa que llaman "Academy in Immunology" el cual en esencia combina tres tipos de Training mediante Cursos: (i) uno "Basico" (para enseñar aspectos básicos de la inmunología actual; (ii) otro "Avanzado" (enseña conceptos avanzados de inmunología); y (iii) otro "Traslacional" (que provee información actualizada sobre aspectos de inmunología clínica que incluyen las terapias innovadoras). Además tienen establecido un Curriculum específico que provee un certificado como "Specialist in Immunology" ("Fach-Immunologe"), que implica Training en Inmunología Básica y Clínica durante varios años y que posteriormente se evalúa mediante un exámen oral. La Sociedad Alemana de Inmunología (DGfI) ha creado Centros para la Formación en Inmunología Clínica. Como indica el presidente de la DGfI en su carta, que se trascribe más abajo, este programa solo está disponible en el idioma alemán.

From: Kabelitz, Dietrich (Prof. Dr. med.) To: Fernandez Cruz Perez.Eduardo Subject: Letter of support form the German Society for Immunology (DGfI) Dear Professor Fernandez-Cruz, Please find attached a letter of support from the DGfI concerning your plans to establish a Training Program in Clinical Immunology in Spain. With best wishes, sincerely yours, Dieter Kabelitz President, German Society for Immunology Prof. Dr. Dieter Kabelitz Institute of Immunology UKS-H Campus Kiel Arnold-Heller-Str. 3 Haus 17 D-24105 Kiel Germany http://www.immunologie-kiel.uk-sh.de <http://www.immunologie-kiel.uk-sh.de/> the link to the corresponding website of our national society is as follows: http://dgfi.org/web/aus-und-fortbildung Unfortunately, it is currently available only in German language

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