Medical Training in Chemical Pathology
Chemical pathology is a subspecialty of medicine with two slightly different qualifications depending on the training route. The two main training routes are either straight in after a foundation year training for chemical pathology alone or after an additional 2 years of core medical training (CMT) with achievement of full MRCP status (Membership of Royal College of Physicians) for chemical pathology with metabolic medicine (comparable to microbiology and microbiology with infectious disease options). Metabolic medicine posts are more numerous and could be considered the preferred route as the extra medical training will only inform later practice plus give the candidate more job flexibility. There is an alternative route as a subspecialty of general internal medicine (GIM) but this will not be discussed here as laboratory competencies do not form a part of the training, only the clinical areas.
The five main clinical areas in which clinic and ward round experience is required are:
- Inborn errors of metabolism (IMD)
- Diabetes mellitus
- Nutrition (including TPN) and obesity
- Lipidology and cardiovascular risk
- Metabolic bone disease
This is shared by the GIM training route. IMD is mostly dealt with in specialist paediatric centres and care of children co-ordinated by paediatricians. You will be exposed to this however your main role is in the care of adults who have survived with IMD plus advise clinicians who are caring for children or adults with these conditions.
You work with all clinical groups to give advice, develop services and potentially also in the management and investigation of certain patients. Commonly most of your work is done with endocrinology, where you may oversee dynamic function tests and help in the development and interpretation of hormone assays.
The laboratory component is heavier than haematology practice but most biochemistry departments differ from haematology by the addition of clinical scientists to the team. Clinical scientists have a scientific background but sit the same FRCPath exams being trained in both analytical and clinical aspects of laboratory practice. This strengthens the expertise of the team and provides much assistance with both training and practice of laboratory work.
Training is usually based in the department rather than the deanery as there are only a few trainees. Common competencies in endocrinology, clinical science and paediatrics means that other specialty training opportunities can be utilised. Over the 5.5 years (with an extra 6 month grace period) you must achieve work-place based assessments (separate e-portfolio designed for pathology trainees), a defined number of clinics/ward rounds in the five main areas and full FRCPath (Fellow of Royal College of Pathologists). There is variety between deaneries but posts are often unbanded with any on-call duty being laboratory based. Due to the nature of the day to day work, part-time training and academic or other extra-curricula activities are easy to integrate into training.
Recruitment for chemical pathology with metabolic medicine is organised nationally, the venue of which changes each year. For the last couple of years places have been unfilled and very few people apply with applicant to place ratio in the order of 1:1 (varies year to year).
Resources for further information:
Recruitment information: http://www.st3recruitment.org.uk/specialties/metabolic-medicine
Page on RCPath website with person specification and curricula: http://www.rcpath.org/training-education/specialty-training/chemical-pathology.htm
(This page is maintained by the ACB Education Committee)