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


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


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


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


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


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)


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*


VIROLOGIST


VIROLOGISTFOUNDATION EQUIVALENT + RELEVANT POST-GRAD DEGREE

ST5CCT*

BMT1 BMT2 ST1 ST2 ST3 ST4 ST5 ST6CCT*


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?