Clinical Virology
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Transcript of Clinical Virology
Clinical Microbiology and Virology
Hugo Ludlam, Microbiology CATT Chair
Goura Kudesia, Virology CATT Chair
February 22nd 2006
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
Where Are We Now?
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
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
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
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)
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
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?
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
New Medical Microbiology Curriculum
6-12 months training in Virology At least one month pre part 1 exam
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.
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
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
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
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 methodology…There
should be active involvement with research
projects throughout HST”
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
Post Part -1Virology Core Curriculum
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 aspectsManagementHealth and safetyUnderstanding Research and DevelopmentPublic 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)
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.
Issues Arising……..
On-Call funding/need for, duration of Optional Modules
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
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
OREvidence in portfolio of achieving the required competencies by another route
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
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
Appraisal and Assessment
On going workplace based assessment and feed back
Future
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?
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
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
Run Through Training Model
Allows experience assessment of competencies Issue of NTNs Credit for previous experience Time out for research
F1 F2
BMT1#
BMT1 BMT2 ST1 ST2 ST3
CONSULTANT MEDICAL MICROBIOLOGIST/
VIROLOGISTFOUNDATION EQUIVALENT
ST1 ST2 ST3 ST4
ST1 ST2 ST3 ST4 ST5 CCT*
ST4
CCT*
CONSULTANT MEDICAL MICROBIOLOGIST/
VIROLOGIST
CONSULTANT MEDICAL MICROBIOLOGIST/
VIROLOGISTFOUNDATION EQUIVALENT + RELEVANT POST-GRAD DEGREE
ST5CCT*
BMT1 BMT2 ST1 ST2 ST3 ST4 ST5 ST6CCT*
CONSULTANT MEDICAL MICROBIOLOGIST/
VIROLOGIST/ ID
# BMT or equivalent clinical trainingCCT* 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
MEDICAL MICROBIOLOGY AND VIROLOGY – proposed minimum training time 5 yearsMEDICAL 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)
THE ROYAL COLLEGE OF PATHOLOGISTSIMPLEMENTING RUN THROUGH TRAINING
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
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
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.
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.
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….
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?