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How is the PENG Clinical Update Course structured?

The course runs over 7 months. It starts with pre coursework in March, has a 4-day residential course in June and ends with submission of post coursework in September. The residential course is a series of lectures followed by workshops during which delegates and tutors work through clinical scenarios regarding nutritional assessment, interpretation of fluid and electrolyte status, estimating requirements, critical appraisal, enteral and parenteral nutrition. The course concludes with a master’s level 20 credit module assessment. Please consider the points outlined below before applying for the course:

  • Do you have adequate clinical experience to be able to contribute to the workshop discussions?
  • Have you identified differences between your practice and those of your colleagues and would like to know the latest evidence?
  • Are you interested in improving your critical appraisal skills to improve your understanding of the literature and develop your clinical practice or formulate policies and procedures in your Trust?
  • Do you want to develop your anthropometric skills to perform a through nutritional assessment?
  • Are you struggling to assess and interpret fluid and electrolyte balance?
  • Do your patients experience complications of artificial nutrition and you are not sure of the best evidence based practice to help them?
  • Are you keen to complete a Masters assignment?

What next?

If after reading this, you feel that the time is right for you to attend the course then we look forward to receiving your application and together work towards ensuring best practice when providing artificial nutrition support for patients.

Additional PENG Clinical Update Course 2024/25

An additional PENG clinical update course is being run during the 24/25 academic year. This will be a blended learning course with 3 days virtual delivery (Monday 13th – Wednesday 15th January 2025) as well as a 1 day practical clinical skills day held in Birmingham (Monday 20th January 2025).

The virtual days will run 9am-5pm and the clinical skills day will be 10am-4:30pm

Delegates are required to complete pre coursework prior to attending (available from: 4th November 2024, submission deadline Midday 13th December approx 35 learning hours) Following attendance of the course, delegates are required to complete a post course assignment (Deadline 14th April). On successful completion delegates will be awarded with 20 masters credits from Queen Margaret University, Edinburgh.

As the course is a 20 masters level credit module there is an expectation that you will participate in a notional 200 learning hours. This time is divided between pre-course work (a notional 35 hours of learning), on course learning (a notional 28 hours of learning), post course work and self-directed learning (together equate to a notional 137 hours of learning). You are expected to complete all aspects of the course including the pre and post course work, the asynchronous lectures and attend all timetabled sessions.

To apply please visit

PENG Clinical Update Course 2023

Clinical Update 2023

Clinical update 2023 for ePENlines by Alison Culkin, Course lead, St Mark’s Hospital

Another fantastic clinical update was held at Queen Margaret’s University in Edinburgh in June with 80 delegates in attendance. This was the first time back face to face due to the covid-19 pandemic after the course was run virtually in 2021.

Please see below some of the feedback below - Click on the blue panels below to view the comments.

Better than any lecture I had back at uni, summarising things really nicely!!”

This was the most useful lecture, in my opinion. Critical appraisal is not a skill I learned when I studied at QMU for my undergrad and the lecture was very informative and relevant given the final assignment will include a critical appraisal”

Although we had attempted to take some of these measurements with our patients in our pre-course work I found this very helpful to have a practical session to be able to discuss others experience of using these measures with their patients. The tutor support and knowledge in this area were also particularly helpful”

Very helpful to do this, I particularly liked the BIA as this is something I had never done before and it was useful to compare the results of the hand-to-hand with the foot-to-foot and whole body equipment”

For further details, please see video on the PENG website. We hope Dietitians will collect data to provide future evidence of what is happening in clinical practice.

It was great to further my understanding of these biological process and consolidate my knowledge in this critical area of nutrition. The slides were clear and easy to understand”

V. Good lecture which I feel has influenced my future practise”

Very helpful to consolidate and apply critical appraisal learning and skills. Particularly as critical appraisal is something I struggle with”

This was so important and useful - I really benefitted from speaking with other delegates and discussing a sample paper as this is what I'll need to do for my final assignment”

So much information to take back to practice! Especially the interrelationship between the electrolytes”

I found this very helpful to consider the practical aspects of management of fluid and electrolyte status and it was very relevant to my practice”

I really liked the incorporation of the clinical scenarios to try to put the information provided into practice and discuss during the lecture. I found it very helpful”

This workshop made the content of the previous 2 presentations make sense! It tied things together really well and utilised some team working too”

It was really helpful to practice with some case studies and I felt more confident about my ability to put my learning into practice after this workshop”

Adults who lack the capacity to consent which can be found here and is a must read for all dietitians.

This session was incredibly powerful and really resonated with me. It generated a lot of discussion between all of us following the presentation and has really made me consider my practice and that of the rest of my team”

This was a hidden gem - I didn't realise we would have a lecture on this and the presenter was heartfelt and passionate about the subject. I felt it was an overlooked area of study and particularly useful for my community caseload”

Really enjoyed practising how to insert and NG and a bridle. Visualising it has really helped to improve my understanding. Useful to look as gastrostomy tubes and pH testing too. Wouldn't change anything about this workshop”

Great opportunity to "have a go" at tube changes. Very insightful to do the pH checks and consider this for nursing staff”

The British Intestinal Failure Alliance (BIFA) have published guidelines on the diagnosis and treatment of catheter related bloodstream infections which can be found here

Thoroughly enjoyed this. Great images of access routes and all well presented in a logical order”

I found it really useful to discuss the different routes for PN as my trust tends to just use PICC lines and I currently have limited experience in PN. I felt it broadened my knowledge”

Really useful at building my confidence with PN - felt enthusiastic to get more stuck in with this at work now! I really enjoyed this - I felt it was pitched at a level that I could understand (I have never worked with PN) and how it would be possible to upskill in this area”

I really liked being able to see and understand the PN bags. I really appreciated getting information from the tutors and my classmates who do have some experience in this area”

The workshops really helped to generate discussion and I learnt a lot by hearing about the experience of others”

Very enjoyable and highlighting the importance of our profession and igniting some fire in my dietetic brain for going back to work”

Really engaging and good to pull everything from the week together. Looking at the bigger picture and thinking about what we can each do individually with outcomes to demonstrate our worth”

Very knowledgeable and friendly people; willing to help and answer queries; inspirational collection of RDs!”

An incredibly knowledgeable, approachable and helpful team!”

Absolutely amazing course, I would highly recommend to everyone! I am feeling a lot more confident in my own practice, extremely motivated and more knowledgeable. Thoroughly enjoyed!!”

It was such an amazing week and I learned so much, am excited to feed back to my team and implement my learning at work. Thank you all”

Useful to take time out of the working day to reflect on my practice and consider how I (and the team) need to do things differently (as currently we don't use enough anthropometry in our monitoring)”

It was useful to consider my own practice and consider possible barriers I was facing with my current patient group prior to attending the course”

I thought the course was fantastic. Originally I had thought that I would have preferred it all to be virtual but I actually got the most out of the group discussion, the workshops and the networking so I think maybe a combination of virtual and face to face would be helpful”

Delegates were asked to write on a postcard a pledge of what they would take back to their workplace and this will be sent back to them once they have submitted their post coursework in September.

Meanwhile the tutors will be reviewing the evaluations and thinking about the clinical update 2024. We are also looking for new tutors. Please check out the PENG website for details or email me

PENG Clinical Update Course – Tutors Wanted

Are you passionate about nutrition support and education? Would you like to join a team of tutors on an award winning course? The PENG clinical update is looking for new tutors to join the team.

Find out more

PENG Virtual Clinical Update Course 2021

PENG Clinical Update Course April 2021 went virtual - please see below some of the feedback

For the first time the PENG clinical update course was run virtually this year due to the Covid-19 pandemic. The course remained similar with a mixture of pre coursework and 4 taught days over 2 weeks. Delegates were able to watch pre-recorded lectures followed by a question-and-answer session together with other delegates and the tutor team. The workshops occurred in small tutor groups during which delegates and tutors worked through clinical scenarios regarding nutritional assessment, interpretation of fluid and electrolyte status, estimating requirements, critical appraisal, enteral and parenteral nutrition. The course concludes with a master’s level 20 credit module assessment focussing on the critical appraisal of a research paper and a literature review on the effects of nutrition support. All went smoothly with the exception of an international issue with MS teams for a short time. Thank you to the tutors for all their hard work in running this course virtually and thanks to the delegates for lots of lively discussions.

Click on the titles to view the comments.

I found it convenient to be able to do the lectures in my own time. Lectures uploaded in a timely manner ahead of the taught days to allow for pre-reading and printing.”

Really helpful to have time to look through lectures myself, to pause and go back to listen to something again - the online format was great in this way.”

There are definite advantages to online learning such as reduced travel, time to pause a lecture and check something you don't understand.”

I liked the fact that the course was spread over 2 weeks (made it easier on my workload and did not feel drained after teaching days).”

I appreciated the possibility to watch the lectures when convenient for me and be able to re watch certain lectures if needed. I think that the online delivery had certainly quite a few advantages (more flexibility, easier to attend if you are having family commitments)”

Despite being online it was really engaging. Of course would have preferred to be in Edinburgh but the online delivery of the course was great. Good to be able to rewind lectures and re watch in own time.”

Really liked it being on MS teams. I found having access to the lectures in advance gave me more time to work through them and look at the links or suggestions the tutors made before the Q&A/workshops which better helped my understanding. It also helped keep me focused as I could watch some lectures over the weekend and it avoided me getting fatigued throughout the course days. I also liked it being broken up over 2 weeks as after week one when I was back at work I put some of the elements of the lectures into practice and allowed more time for those lectures and workshops to sink in and to read further on those before learning more topics the following week.”

I had reservation attending this course remotely this year. However, I was pleased that the lectures where pre-recorded, thus allowing me to watch as many time possible, this would not have been possible face to face.”

I enjoyed this course being delivered virtually as it enabled me to watch and replay lectures in my own time and environment.”

I found watching the lectures in my own time was really helpful and allowed flexibility for my day e.g. if I needed to attend a work meeting.”

Critical evaluation is something you do at a basic level in day to day practice however really looking at this skill in depth is something I hadn't done since university. It was very useful getting back into it and what it means to effectively evaluate what we do rather than going through the motions - allowing us to critique why we are doing what we are doing and is there something better we could be doing.”

This allowed me to get into the right frame of mind ahead of the course and gave me a chance to receive feedback on how I can improve and meet the expectations for the course.”

By completing this work and receiving constructive feedback from my tutor has given me the opportunity to identify key skills that I need to improve on such as critical appraisal and completing work to MSc standard.”

Absolutely outstanding lecture!!! I can’t stress enough how useful I found this lecture, as someone who struggles with critical appraisal it was so simple to understand yet was so thorough. This really set me up for the rest of the course and helped with my critical thinking. I appreciated the way the content was delivered and I have learnt so much from this session.”

Learned lots from this, really enjoyed the descriptions / practicalities and evidence for each part. Interesting to hear about the developing evidence in assessing body composition.”

Very interesting and has made me reflect upon my practice that perhaps my team and I are too cautious with refeeding management and it would be good to discuss this as a team and audit our practice based on Rhys' lectures and the new ASPEN guidelines. I also liked the interaction in the lecture, giving us time to think about scenarios.”

I found this lecture really interesting and it was explained really well. I also really enjoyed the interaction/ asking delegates to vote regarding their practice and what their trust does. Good use of case studies.”

I liked the critical appraisal aspect - helped to imbed skills learnt from the previous lecture ”

Really interesting lecture and I felt I learnt a lot from the session. Very knowledgeable presenter. Really enjoyed the attention to detail. Thank you for a great recap on acid based balance, definitely highlighted areas that I will be reflecting on to improve my practise. Found this very helpful with the detail in which everything was explained. Feel more confident looking at/interpreting blood gases and biochemistry. I found it useful to discuss what the recommendations were and how it applied in a hospital setting e.g. guidance on iv fluids. Case studies were really good.”

I found this workshop very useful to help be better understand this topic. Loved the case studies Learnt so much Great to have a practical session to put the theory learnt into practise. Enjoyed the case study and working together as a group. It was good to see that other dietitians practice in a similar to me and come up with similar intervention rationales. Great to grasp what was taught and putting into practice. Having someone to go through the workshop questions and answering any other questions as they came up was very helpful in increasing my understanding”

I found this lecture really useful as it helped explain the new guidelines. This really helped me understand the pocket guide and more about critical appraisal. It was interesting to see the body of evidence for the rationale behind the requirements.”

Really good session - nice to bounce ideas off each other and learn from other peoples practice. Really enjoyed going through the case study with the group and devising what interventions we do in our practice and our rationale. I have been using these new PENG guidelines in my practice since they were published, but I now feel more confident to use them. In particular, referring to the Mifflin St Jeor equation for patients.”

Really interesting to learn about the new technology for pH. A well composed lecture that has increased my knowledge further in the area of dietetics.”

Excellent presentation. I really enjoyed this presentation, thought provoking, challenging rationales for choosing certain feeds etc. Really engaging lecture delivered really well,
great content and good recap on certain areas. Really enjoyed the section on fibre,
a lot of food for thought for practice. Eye opening to see the difference in fibre and protein sources in feeds. This will change my practice when thinking about poor tolerance and changing formulas.”

Very applicable to my work as I have a big home EN caseload - useful to talk through practices in different areas. Great informed discussions in my group. Really interesting to hear different perspectives. The workshops provide good consolidation of the previous lectures, great to have practical case studies and scenarios to work through, always learn a lot in these sessions. Good to put learning into practice and discuss different ways of doing things.”

Thought provoking, challenging why we choose certain routes including timings. Great presentation with clinical examples. Really enjoyed the style of delivery. Detailed presentation delivered excellently just the right amount of content given the time, it didn't feel rushed. Really valued the critical appraisal section. Great to have some case scenarios and examples imbedded into the lecture, particularly loved the focus in the surgical and ITU areas. Enjoyed the scenarios - found these helpful in relating to my work. Found where the presentation looked at the guidelines and research and how this is applied to current practice really insightful.”

Excellent presentation - PN is not relevant to my role however interesting to know about. Information explained well and provided me to further develop my knowledge of PN (limited experience).”

Excellent presentation - PN is not relevant to my role however I really enjoyed these presentations and found the biochemistry aspects and discussions regarding weight expectations particular useful. Very good at capturing the pertinent points. The presentation was also at a good pace and broken into 2 parts to give a natural break for the brain. Overall it was really useful to get an idea of considerations that are needed to be taken into account in PN. Enjoyed the slides on how much adjustments are clinically significant. Really enjoyed the part on micronutrients as this is an area I was hoping to get some guidance on, glad there is resources within the presentation to read further. Found it helpful to see the investigations you should look into or consider if appropriate before making big changes to nutritional regimens. Interesting to hear all the causes for abnormal LFTs.”

Really good to work out fluid and electrolyte requirements for the PN case study, adding in for fluid losses and also choosing a bag. I spoke with a colleague locally about how PN is managed in our hospital and this really helped me to put into perspective what would be a viable PN option for this patient in my area. Also good to hear questions and experiences of others in the group. Really enjoyed.”

I have been blown away by the knowledge of the teaching team and feel I have gained so much from the course already. The tutors have made it an enjoyable learning experience without the fear of asking silly questions, it has been a nurturing environment. Thank you for a great programme and being so helpful in answering questions in the Q&A. I have got so much out of this course, it has renewed my enthusiasm in my practice and critical thinking. Excellent course; most clinically valuable training courses I've ever been on. An essential for any clinician working in enteral and/or parental nutrition however it would be extremely useful for all dietitians.”

Clinical Update Free Place Winners

2020 Winners

  • Grace Owen – London area
  • Evelyn Umukoro – Epsom and St. Helier University Hospital NHS Trust
  • Jon Lawrence – Northampton
  • Amy Altenberg – Brighton
  • Naomi Westran – Royal Surrey County Hospital

2019 free place winners

2019 Winners

Congratulations to the PENG members who won a place at the 2019 PENG Clinical Update Course.

Back row: Aisling Phelan and Jack Chilton

Front row: Ellie Barlow, Kirsty Wood and Hollie Cornick