Education and training
The JRCPTB curriculum in genitourinary medicine sets out the requirements for a certificate of completion of training (CCT). Trainees should be equipped with the competencies needed to participate at a senior level in the provision of GUM (including HIV) and contraception services, surveillance and reporting of sexually transmitted and HIV infections, clinical governance, public health and epidemiology.
The Academy of Medical Royal Colleges (AoMRC) has produced a cost of training document setting out the mandatory costs of training involved in college enrolment fees, examination costs and GMC fees. Published in October 2017, it has been compiled to help pre-specialty doctors make fully informed career selections, with a clear understanding of the mandatory costs of their future training pathway.
The British Association for Sexual Health and HIV (BASHH), the specialist society, works with the Specialist Advisory Committee (SAC) in GUM to support the delivery of the curriculum. The SAC, training programme directors (TPDs) and educational supervisors work to ensure trainees have adequate training opportunities and support external placements.
BASHH, in conjunction with Health Education England (HEE) and the Federation of the Royal Colleges of Physicians, has developed eHIV-STI, an e-learning resource which covers the sexual health and HIV (GUM) curriculum. BASHH runs a 10-day modular course that covers the curriculum for the specialty certificate examination (SCE) for trainees. Trainees are also encouraged to participate in all specialty educational events. In addition a 2-day meeting is run each year specifically for doctors in training, covering a mix of clinical and non-clinical topics.
BASHH introduced a mentoring scheme in 2009 to support GUM physicians during their transition from trainee to consultant. The scheme has received very positive feedback from newly appointed consultants and has expanded to merge with BHIVA to include doctors working mainly in HIV medicine and specialty and associate specialist doctors. Mentors are experienced consultants and SAS doctors who have had specific training. The mentoring period offered is 18 months.
Supporting other specialties
The educational development of physicians and HCPs working in other areas is supported through a number of initiatives led by BASHH, including:
- the eHIV-STI e-learning resource covering the GUM curriculum, available free to all NHS employees.
- multidisciplinary courses covering the skills and competencies to deliver sexual healthcare, from the novice to the specialist. These also include competency assessment at various levels. The STI foundation and intermediate levels are especially developed for clinicians working in primary care and fields allied to GUM, eg prisons, sexual and reproductive healthcare and pharmacists.
- educational expertise for the delivery of training by overseeing or running bespoke trainer packages.
Ongoing training in GIM
All trainees are required to have ongoing training in general internal medicine (GIM) relating to the care of HIV-infected patients, as well as patients with viral hepatitis and STIs that can cause systemic disease eg syphilis. This is organised in a variety of ways and may include attachments in specialist outpatient or inpatient services. In some regions GUM trainees at ST3 contribute to the GIM on-call rota but this is the exception.
GUM training and the new internal medicine curriculum
In line with the proposed new internal medicine curriculum, the GUM SAC is supportive of GUM trainees spending:
- 3 months of the first year of specialty training participating in acute unselected take as part of the ‘fourth year’ in internal medicine
- a proposed extra third year in core medical training.
This would require educational supervision outside GUM and deliver educational value towards competencies in practice such as managing the acute unselected take over a standard shift and procedural skills. What is unclear at present is how to best integrate enhanced internal medicine ‘generalism’ without losing or diluting essential specialist competencies in STIs, HIV and contraception.
The GUM SAC view, supported by trainees and colleagues outside the SAC, is to develop dual accreditation with a joint CCT in GUM and internal medicine. It will be essential to ensure there is sufficient acute take experience during the 4 years to maintain and develop procedural competencies and to be perceived by peers as physicians capable of delivering the acute take. This may result in GUM trainees participating regularly in the acute unselected take, outpatient clinics and ward work. Trainees would bring relevant specialist knowledge to any HIV/GUM patients that presented to the acute take or to acute-based specialties, including those in obstetrics and gynaecology and surgical practice.
Continuing professional development
The specialty supports the clinical and professional development of consultant physicians in a variety of ways. BASHH runs four scientific meetings a year on key developments and issues for the specialty. These are free to attend and available online for colleagues unable to attend in person. Special interest groups are responsible for leading on development of educational materials, meetings and training needs analyses within their specialist areas. In addition, there is an annual BASHH conference and a number of workshops based on needs assessments. BHIVA runs two annual meetings. There is an annual planning process and 3–5 yearly rolling plans for the delivery of specialist areas of education to avoid duplication and overlap between content and timings of planned meetings.
BASHH supports a regional network through its clinical governance committee. These regional groups host local meetings providing educational and networking opportunities. As a small specialty BASHH has a network of mentors, who support newly appointed consultants, as detailed above.