Nephrology foundation year posts (FY1 and FY2) and core medical training (CMT) and passed the Membership of the Royal College of Physicians (MRCP) exam before competing for a National Training Number (NTN) in renal medicine. The typical subspecialty training is five years and leads to a Certificate of Completion of Training (CCT) in both renal medicine and general (internal) medicine. Subspecialty trainees often interrupt their clinical training to obtain research degrees (MD/PhD). Nephrology training can be accomplished through one of two routes. The first pathway is through an internal medicine pathway leading to an Internal Medicine/Nephrology specialty, and sometimes known as
Four Organs work, each tone sounds almost in sequence. A continuous maraca beat serves as a rhythmic framework. Reich describes the piece as "the longest V–I cadence in the history of Western Music," the V and I chords being contained within the one chord. "You'll find the chord in Debussy and Thelonious Monk – the tonic on top and the dominant on the bottom." He has cited the music of Pérotin and other twelfth and thirteenth century composers as suggesting the technique of note augmentation used in "Four Organs". For performances of the piece, Reich recommended using electronic organs with as plain