Entry into the infection specialties is at ST3 level after achievement of IMT2 or IMT3 and MRCP (or equivalent). The first two years of infection training are the same for all trainees who are required to complete combined infection training (CIT). During this time a trainee rotates through the different infection specialties and completes FRCPath Part 1 (Combined Infection Certificate Examination) to enter higher specialist training.
In higher specialist training (HST) trainees will complete further rotations in specialties which can include medical microbiology, medical virology, infectious diseases and general internal medicine. Medical microbiology and medical virology trainees will sit FRCPath Part 2 during HST. The majority of trainees in the East of England dual accredit becoming specialised in two disciplines although there are posts for medical microbiology and medical virology alone.
You choose your higher specialty training accreditation (ID/GIM, ID/MM, ID/MV, MM, MV) when you apply for your ST3 number not when you complete CIT. Changing accreditation at a later date requires re-applying for a new national training number.
For the first two years, you’ll complete Combined Infection Training (CIT), which gives baseline experience and knowledge in each of infectious diseases, virology and microbiology. During CIT, you will be required by the curriculum to attend specific training at different work placements totalling:
Six months of clinical microbiology training associated with a diagnostic laboratory
Six months of clinical virology training associated with a diagnostic laboratory
Six months of appropriate infection related clinics where the major focus is managing patients with infection. A combination of clinics could include HIV clinics, general ID clinics, travel clinics or GUM clinics
Six months of clinical inpatient care of patients with infection.
In the East of England region, training is separated into three specialties, with the six month block of clinics integrated throughout the two years. Typically you will have six months of infectious diseases experience, four months of medical virology experience and twelve months of medical microbiology experience. A number of trainees in the East of England region, are part of an academic training programme and will have academic rotations built in to their CIT programme (please see research link for further information)
During CIT you will be required to make an attempt at passing the FRCPath Part 1 exam. There are weekly teaching sessions covering the CIT curriculum over a two year period which help prepare you for this and there are multiple other resources available locally and nationally including Learn Infection from the British Infection Association (BIA).
All infectious diseases placements are undertaken at Addenbrooke’s Hospital. The rotation includes a combination of ward work, referrals work and general infectious diseases clinics. You will also be given your own cohort of HIV patients during this time. Infectious diseases trainees are expected to care for their cohort throughout their training (including HST) allowing them to build strong relationships over years.
For microbiology experience, the Cambridge trainees will undertake a placement at Addenbrooke’s hospital and will also be given the opportunity to work at one of the local district general hospitals to gain further experience in other settings. Rotations are typically undertaken at Watford General Hospital or Colchester Hospital and may be up to 6 months per rotation. Norfolk and Norwich trainees will undertake all their microbiology in Norwich. During the microbiology rotation you will get experience in infection control and infection consultations, which include in person reviews of staphylococcus aureus bacteraemia patients, fungaemia patients and multiple microbiology ward rounds / multidisciplinary team meetings.
The Cambridge virology placements are all undertaken in the Public Health England Laboratory in Cambridge. The Norfolk & Norwich placements are undertaken in the Norwich Virology laboratory. Both may have the opportunity for short placements at the other site to gain experience. There is also opportunity to experience short placements in PHE Colindale and with field epidemiologists and the health protection team.
Infectious diseases is a broad and fascinating specialty which offers the opportunity to see a wide range of patients with many presentations. It combines detailed history taking, clinical acumen, laboratory techniques and careful selection of investigations to make diagnoses and treat patients.
In the East of England all inpatient infectious diseases is based in Addenbrooke’s hospital in Cambridge which is the regional tertiary centre. You will manage a range of complex conditions including community acquired infections, returning travellers, TB, HIV, bone and joint infections and multi-drug resistant infections amongst many others.
Out-patient work includes reviewing patients with pyrexia of unknown origin, travel-related conditions, specialist clinics in HIV, TB, viral hepatitis and bone and joint infections. There is also an out-patient antimicrobial therapy (OPAT) service which runs 7 days a week allowing a wide range of experience.
As the regional centre the referrals registrar gives telephone advice for the whole of the East of England and frequently reviews patients in ambulatory care, the emergency department and any patients with pyrexia of unknown origin. As Addenbrooke’s is a large tertiary centre with every specialty the range of patients seen is vast, ranging from neurosurgical complications to immunosuppressed patients post bone marrow transplant.
There is a strong tradition of research and a large proportion of trainees go on to complete research projects including PhDs during their training. The infectious diseases team is very supportive in assisting with applications for funding and for time out of training to complete research.
Medical microbiology is a rapidly changing specialty which involves all aspects of infection. Traditionally it was seen as a laboratory-based job with interpretation of results and providing telephone advice to clinicians. However, increasingly it is far more clinical and diverse. There are multiple opportunities for consults, specifically staphylococcus aureus and candida bacteraemias. There are multiple MDTs and specialist infection-focused ward rounds ICU (including daily rounds on the adult intensive care units and neurocritical care unit; and twice weekly rounds with neonatal and paediatric critical care , haematology, diabetic foot and transplant (liver, renal and multivisceral) services which trainees can attend.
There is ample opportunity to learn the laboratory techniques critical to understanding microbiology with daily bench rounds to discuss findings with biomedical scientists and review culture results. The teams in the East of England are very supportive of their trainees and encourage participation in lab activities. Trainees are also encouraged to partake in antimicrobial stewardship and infection control activities.
There is significant overlap with other infection specialties, specifically infectious disease and many trainees dual train in both specialties.
There is a strong tradition of research and a large proportion of trainees go on to complete research projects including PhDs during their training. The microbiology team is very supportive in assisting with applications for funding and for time out of training to complete research.
Within medical microbiology you will also sit FRCPath Part 2 to attain full Fellowship of the Royal College of Pathologists and there is support from the department, including mock exams, to help you with this.
Clinical virology is a broad and fascinating specialty which, similar to microbiology, sits at the interface between laboratory and clinical medicine alongside research and management of infection control.
Clinical virology allows an opportunity to be involved in a mix of clinical work including the diagnosis of viruses and management of chronic viral infections e.g. HIV, hepatitis B and C as well as congenital and perinatal infections and latent viral infections within immunocompromised patients, particularly transplant recipients. There is also much work on emerging pathogens which requires virology expertise with a direct link to public health organisations.
Addenbrooke’s is attached to the PHE laboratory which is the referral laboratory for the region. It deals with all virology enquiries from the East of England and processing many samples including those for transplants. There is also the opportunity for virology trainees to train in other centres including Norwich and other PHE laboratories at Colindale and work with the Health protection team and field epidemiologist departments within PHE to gain more experience.
There is a strong research interest in the department and a large proportion of trainees go on to complete research projects including PhDs during their training. The virology team is very supportive in assisting with applications for funding and for time out of training to complete research.
Within medical virology you will also sit FRCPath Part 2 to attain full Fellowship of the Royal College of Pathologists and there is support from the department, including mock exams, to help you with this.