A Specialist Registrar’s View of Infection specialities

Updated Nov 2006

Infectious Diseases / General Internal Medicine / Tropical Medicine

Infectious Diseases and Tropical Medicine is a particularly diverse speciality, encompassing a variety of disciplines from acute medicine through to epidemiology and molecular medicine. Scientific advances ensure that diagnostic technology and treatments are constantly changing and new pathogens are regularly being recognised, making it a challenging and dynamic speciality. Globalisation, international travel and migration has meant that Infectious Diseases has become even more important.

The training programme lasts for five years combined with general internal medicine, plus an additional year if you wish to gain an accreditation in Tropical Medicine. As a trainee, you are exposed to all aspects of infection, spending at least 12 months in the management of unselected community acquired infections and imported infections. Further time is allocated to the management of immunocompromised patients (including those with HIV/AIDS) and you will also be attached to a medical microbiology department. Periods may also be spent in epidemiology, public health, genitourinary medicine and intensive care. Research opportunities, both clinical and laboratory, are widespread and participation in research is actively encouraged.

The main drawback of this exciting and challenging speciality at present is the limited number of consultant posts in the UK, with little of the promised expansion having occurred.

Infectious Diseases & Microbiology

There is increasing demand for doctors who have broad experience in both clinical and laboratory medicine. In providing a broad base of training in clinical infectious diseases and in medical microbiology, joint training in ID/micro importantly provides more options and flexibility at the other end of training when applying for consultant jobs.

The training scheme runs for six years. The exact structure of the scheme varies slightly between and within centres, but often begins with two years in medical microbiology/virology after which time Part 1 MRCPath is usually taken. Following that, two years of clinical infectious diseases is undertaken, just as described above under ID training, and incorporates the in and outpatient care of patients with community acquired infections, imported infections and immunocompromised patients. Some schemes (eg Oxford) also incorporate a period of 6 months of general internal medicine with unselected medical take. One year of related research may count towards the full 6 years’ training, and is encouraged. The final year will usually comprise 6 months of medical microbiology after which Part 2 of MRCPath is taken, and six months of clinical ID. There is usually time during the scheme to carry out short ‘electives’ to increase experience in certain areas, for example, HIV medicine, public health and GUM depending on individual training needs and interests. The structure may change slightly for MMC, but is likely to stick broadly to this outline.

Only time will tell where joint trainees will end up as consultants. However, if you want the excitement of a career in infection combined with the challenges of the laboratory together with wider job opportunities, this may be a good option.

Medical Microbiology

A career in medical microbiology requires a diverse range of skills, from an expert knowledge of laboratory microbiology to good clinical skills. In liaising between the laboratory and the wards, you can contribute significantly to direct patient care across all ages and all specialities in the hospital. You will also provide an important source of advice for GPs, and at times, you will work with Public Health. Clinical liaison may take the form of telephone advice, direct referrals from the wards, reviews in response to positive microbiological specimens, or regular ward rounds, for instance in intensive care, on the transplant ward or in Haematology.

From a laboratory point of view, training is designed to provide the skills required to carry out the tests you ask of the Microbiology Laboratory Scientific Officers, and these practical competencies are tested in Part 2 of the MRCPath which is taken towards the end of your training. Working as part of the infection control team is taking an increasingly important and high profile role in all hospitals, and is likely to continue to do so.

The training scheme has traditionally been four years, with Part 1 MRCPath usually being taken after Year 1 or 2, and Part 2 after Year 3 or 4. Entry into the new MMC scheme is set to be straight after the Foundation Year 2, and may well be longer. Some schemes have allowed trainees to complete a part time MSc in Microbiology alongside training, though how this will work with MMC is not certain. The good news is that there is no shortage of consultant posts at present, with significant vacancies across the country.

Genitourinary Medicine

Genitourinary medicine has many differences from the other medical specialities. It is a mainly outpatient based speciality with most time spent in clinics, although there is a period of inpatient HIV care. There is dual entry via either the MRCP route, or alternatively via the MRCOG route (although one year of medical experience is required including emergency medical “take” commitments). There are few medical emergencies to deal with, although patients presenting with HIV-related illnesses can sometimes be extremely unwell and perhaps more complicated than the usual cases encountered on the average medical “take”.

The speciality focuses on the management and investigation of sexually transmitted infections and HIV. However, there are opportunities to undertake more specialised services including young people’s clinics, sexual dysfunction clinics and outreach clinics for commercial sex workers. As the speciality deals with sensitive issues surrounding sex, it is important to be non-judgemental and comfortable in discussing these issues.

Training is four years and usually includes a period of inpatient HIV care. There are also options for spending a period of secondment in a specialist infectious diseases unit.

Public Health

Public health training is five years. Shortly after entry into a training scheme, trainees usually enrol in a course of study that will lead to the qualification of Diploma or Masters in Public Health. You can enter into a training scheme via a medical route or from a background other than medicine.

See Faculty of Public Health website for more information.