Clinical Microbiology and Virology

1. Clinical Microbiology and Virology Hugo Ludlam, Microbiology CATT Chair Goura Kudesia, Virology CATT Chair February 22nd 2006

2. A Journey • Where are we now? • Where would we like to be? • Where will we actually be? • Evolution, not revolution • What will our profession be doing in 5 years time? • Managing Change • Defending and improving our service

3. Where Are We Now?

4. Medical Microbiology and Virology Core Curriculum • Same entry criteria for both • Shared Pre-Part 1 MRCPath core curriculum • Common MRCPath part 1 examination • Separate pre-part 2 MRCPath core curriculum • Separate MRCpath part 2 examination • Common generic portfolio • CCT in Medical Microbiology and Virology

5. Important Documents • At the College Website… • MM&V in foundation training • New Curriculum for Higher Specialist Training • Training and Learning Record for HST • On-line Training Portfolio • Exam Regulations and specimen questions • JCHPT Handbook

6. Specialist Registrar Training • Current Entry Criteria – Medical Microbiology • Two years of General Professional Training with normally MRCP or equivalent (Mandatory for Joint Training) • Not less than 6 months in a specialty with heavy infection load such as ID • One year as SHO in Medical Microbiology and/or Virology • May also include 6 months training in Infectious Diseases

7. Specialist Registrar Training • Overseas Doctors seeking Specialist Training • Clinical Observers • Honorary SHO • Entry to F2 year – “places available” • Basic Specialist Training (SHO) • Higher Specialist Training (SpR)

8. Specialist Registrar Training • Overseas Doctors’ routes in to training • Honorary (unpaid) SHO • 3+ month contract • RCPath sponsorship for GMC registration • Patient contact • Learn by doing • Pay Back • Recognition of training

9. Specialist Registrar Training • Overseas Doctors seeking SpR posts • RCPath certificate of equivalence of basic specialist (SHO) training • Deaneries now insisting on this before short listing for SpR appointment • Unpaid posts?

10. New Medical Microbiology Curriculum • Developed 2002-2005 • Approved by STA September 2005, approval adapted by PMETB • Structured, knowledge and skill based • Pre Part 1 MRCPath • Post Part 1 MRCPath • Generic • Assessments • Workplace based • Formal - examination • RCPath Specialist Advisors in Microbiology and Virology • Deanery Programme Directors, STC

11. New Medical Microbiology Curriculum • 6-12 months training in Virology • At least one month pre part 1 exam

12. New Medical Microbiology Curriculum • TEACHING/LEARNING METHODS • Trainees have a service provision role and it is recognised that a large component of training can occur as an apprenticeship, provided appropriate supervision is available. • Normally, 60–80% of training would be by in-service training. • It should be with a readily available consultant, well supervised, with the appropriate content, have a broad exposure and include laboratory issues.

13. Pre-Part 1 Curriculum • Approximately 12 months period, common with Virology • A period of Core / Foundation Training • Basic understanding of: • Biology • Host pathogen relationships • Laboratory Safety • Basic principles of diagnosis, clinical syndromes, treatment and prevention • Infection control and sterilisation/disinfection • For many trainees this represents their first exposure to laboratory medicine • Begins with 3-4 months supervised introduction to laboratory infection/clinical microbiology

14. Pre-Part 1Curriculum New MRCPath Path 1 examination • Spring 2003 – first sitting • Joint MRCPath part 1 examination with Medical Microbiology • 3 hours MCQ and extended choice questions • First summative assessment • Trainee assessed for suitability at end of first year of training • Sat at 12-18 months • Trainee can progress despite failure if satisfactory RITA, but must obtain for CCT

15. Post Part 1 Curriculum • Microbiology and Virology • Approximately 3.5 years CCT (Medical Microbiology and virology) • Rotation • “should gain 0.5-2 years DGH experience” • exposure to management issues • Core Modules • Laboratory aspects of Microbiology • Knowledge of Health and Safety • Clinical Skills (Diagnosis and Management of Infection • Specialist Areas • Virology, Health Protection and Epidemiology, • Parasitology, Mycology • Out-of-hours – 1 in 5 to 1 in 10, throughout training • Management • What’s gone • Recommendation for post-graduate courses e.g. MSc • Major Research component

16. Post Part 1 Curriculum Microbiology Curricula and Research • Virology Curriculum - 3 months obligatory • Joint ID/Micro Curriculum - 1 year Clinical/Lab Project • OldMicrobiology Curriculum – Research was the • major component in the last 2 years and the old • part 2 exam • New Microbiology Curriculum – Very little left! • Aims of Curriculum - “understand research” • Part 2 Curriculum - “may include additional • modules such as research” • Generic HST: “encouraged to undertake and • understand research methodology…There • should be active involvement with research • projects throughout HST”

17. Post Part 1 Curriculum • Research • Fundamental to our practice • There is time to do it in the 20-40% of time away from learning ‘on the clinical’ • Blocks of time are best • Careful supervision to ensure success • Can also step out of SpR training and count 12 months of research towards CCT, extra 6 if clinical duties are included • When to step out? Ideally, before start HST, or just after part 1 exam

18. Post Part -1Virology Core Curriculum

19. Post Part 1 Curriculum- Virology • Virology Specific • Approximately 3.5 years CCT (Medical Microbiology and virology) • Core Modules • Out-of-hours • Basic Virology • Clinical Virology Laboratory Techniques Medical/Clinical aspects Management Health and safety Understanding Research and Development Public Health and epidemiology • Optional Modules • Clinical Attachment • Supra-regional attachment • Bacteriology attachment • Exotic and Dangerous virus infections • Attachment to another virology centre (to consolidate experience)

20. New Medical Microbiology Curriculum • TEACHING/LEARNING METHODS • Trainees have a service provision role and it is recognised that a large component of training can occur as an apprenticeship, provided appropriate supervision is available. • Normally, 60–80% of training would be by in-service training. • It should be with a readily available consultant, well supervised, with the appropriate content, have a broad exposure and include laboratory issues.

21. Issues Arising…….. • On-Call funding/need for, duration of • Optional Modules

22. Generic : Based on GMC Good Medical Practice Guidelines. • Good Clinical Care • Communications Skills • Maintaining Good Practice • Maintaining Trust • Working with Colleagues • Team-working and Leadership • Research • Clinical Governance

23. Generic Curriculum : Role of Deaneries……. ALL Higher Specialist Trainees required to reach the specified competencies irrespective of Specialty being trained in. Therefore Many Deaneries now offering generic courses (mandatory) for attendance prior to issue of RITA G OR Evidence in portfolio of achieving the required competencies by another route

24. Post Part 1 Curriculum- Formal Assessment Separate (Virology specific) MRCPath part 2 examination- to be taken after at least 3 years of HST in virology • Portfolio of assignments (for each of the core components). Must be submitted for approval 4 months prior to closing date for part 2. Candidates may sit the part 2 only when approved.Some Flexibility for those trainees who sat their part 1 in 2003 • Written • Practical First sitting- 2006/07

25. Appraisal and Assessment Meetings with Supervisor Construct and review written Annual Training Plan Frequent informal, Formal 3-monthly meetings RITAs Penultimate Year Assessment - coming MRCPath part 2 examination Examined against the curriculum Do Trainee and Trainer know what’s in it? Bioterror Critical appraisal skills (of a paper) Trainees do least well in this

26. Appraisal and Assessment • On going workplace based assessment and feed back

27. Future

28. Modernising Medical Careers (MMC) • Foundation Year 1 • Foundation Year 2 (‘SHO’ Year) • 4 month MM&V attachment • should count towards CCT • Compensates for loss of Microbiology SHO posts • Affects HST (SpR) entry criteria • SHO in MM route - gone • ‘MRCP’ route – how many will have this?

29. Run Through SpR Training Model • Essentially what we already have in our new, current SpR model, but with new first year based on old SHO in MM/V and duration extended from 4.5 to 5 years • Intake from F2 or BMT • Time out for research

30. Modernising Medical Careers (MMC) Run Through Higher Specialist Training for MM & MM&ID Also For Clinical Virology & Clinical Virology & ID • Agreed by MM and Virology CATT • All Doctors enter at ST1 (~ old SHO year) • NTN (SpR) awarded at end of ST1, subject to satisfactory end of year assessment • Total duration of training extended to 5 years • MRCP? • MRCPath retained

32. Run Through Training Model • Allows experience • assessment of competencies • Issue of NTNs • Credit for previous experience • Time out for research

33. ST1 ST2 ST3 ST4 ST5 CCT* CONSULTANT MEDICAL MICROBIOLOGIST/ VIROLOGIST F1 F2 BMT1# ST1 ST2 ST3 ST4 ST5 CCT* CONSULTANT MEDICAL MICROBIOLOGIST/ VIROLOGIST FOUNDATION EQUIVALENT BMT1 BMT2 ST1 ST2 ST3 ST4CCT* CONSULTANT MEDICAL MICROBIOLOGIST/ VIROLOGIST FOUNDATION EQUIVALENT + RELEVANT POST-GRAD DEGREE BMT1 BMT2 ST1 ST2 ST3 ST4 ST5 ST6 CCT* CONSULTANT MEDICAL MICROBIOLOGIST/ VIROLOGIST/ ID THE ROYAL COLLEGE OF PATHOLOGISTS IMPLEMENTING RUN THROUGH TRAINING MEDICAL MICROBIOLOGY AND VIROLOGY – proposed minimum training time 5 years MEDICAL MICROBIOLOGY/VIROLOGY AND INFECTIOUS DISEASES – proposed minimum training time 6 years (to be agreed with RCP) Foundation training Specialist training leading to consultant post (or equivalent) • # BMT or equivalent clinical training • CCT* Relevant cross competencies from BMT 1 and 2 (or equivalent) or relevant postgraduate degree can be counted • towards up to one year of medical microbiology/virology training • All trainees must obtain Membership of the Royal College of Pathologists in order to be eligible for the award of the CCT F1 - Foundation Year 1 F2 - Foundation Year 2 BMT1 - Basic Medical Training Year 1 BMT2 - Basic Medical Training Year 2 ST - Specialist Training CCT - Certificate of Completion of Training

34. Run Through Training Model Cross competencies with other colleges • Medical Microbiology • Infectious Diseases • Virology • Most medical specialties • Virology • Infectious Diseases • Medical Microbiology • Genitourinary and HIV medicine • Most medical specialties

35. Current SpR Entry Requirements • 1. Applicants for higher specialist training (HST) in medical microbiology or virology must have completed a minimum of one year’s basic specialist training (BST) in microbiology or virology as a senior house officer (SHO). During this time, they should acquire • practical bench experience • and an introduction to: • clinical liaison • infection control • information technology. • This period may also include six months’ training in infectious diseases.

36. Current SpR Entry Requirements • 2. Applicants can acquire suitable general professional training, also at the SHO grade. Those who have undergone training in general medicine without experience in medical microbiology or virology should normally have obtained the MRCP (UK) or equivalent. During this period of training, it would be expected that not less than six months’ experience would be gained in one or more of the following: • infectious diseases • genitourinary medicine (including HIV) • paediatrics • oncology/haematology • transplantation medicine • chest medicine.

37. New SpR Entry Requirements • Competitive entry from F2 by assessment of aptitude for the specialty • If from BMT with relevant experience – this cannot count in the applicants favour • Once selected….

38. Conclusion • New Core Curriculum and Examination introduced • Further work is required to produce Medical Microbiologists and Virologists fit for the 21st Century. • Will Darwinian evolution apply to medically and scientifically qualified and dual-accredited Microbiologists and Virologists in competing for consultant posts? • Will the pace of change ever remit?