Clinical Microbiology and Virology

1
Clinical Microbiology and Virology

• Hugo Ludlam, Microbiology CATT Chair
• Goura Kudesia, Virology CATT Chair
• February 22nd 2006

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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

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Where Are We Now?
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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

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Important Documents

• At the College Website
• MMV 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

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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

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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)

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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

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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?

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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

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New Medical Microbiology Curriculum

• 6-12 months training in Virology
• At least one month pre part 1 exam

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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, 6080 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.

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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

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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

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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
• Whats gone
• Recommendation for post-graduate courses e.g. MSc
• Major Research component

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Post Part 1 Curriculum

• Microbiology Curricula and Research
• Virology Curriculum - 3 months obligatory
• Joint ID/Micro Curriculum - 1 year Clinical/Lab
  Project
• Old Microbiology 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
  methodologyThere
• should be active involvement
  with research
• projects throughout HST

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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

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Post Part -1Virology Core Curriculum
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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

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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, 6080 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.

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Issues Arising..

• On-Call funding/need for, duration of
• Optional Modules

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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

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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

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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

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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 whats in it?
• Bioterror
• Critical appraisal skills (of a paper)
• Trainees do least well in this

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Appraisal and Assessment

• On going workplace based assessment and feed back

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Future
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Modernising Medical Careers (MMC)

• Foundation Year 1
• Foundation Year 2 (SHO Year)
• 4 month MMV 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?

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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

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Modernising Medical Careers (MMC)

• Run Through Higher Specialist Training
  for MM MMID 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

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Run Through Training Model

• Allows experience
• assessment of competencies
• Issue of NTNs
• Credit for previous experience
• Time out for research

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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
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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

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Current SpR Entry Requirements

• 1. Applicants for higher specialist training
  (HST) in medical microbiology or virology must
  have completed a minimum of one years 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.

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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.

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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.

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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?