Medical Specialties

Acute Medicine remains a relatively new specialty within Northern Ireland, focusing on the initial assessment and management of acutely ill medical patients presenting to hospital and providing high quality ambulatory care as well as leadership and management of the Acute Medical Unit (AMU).

Excellent organisational and communication skills especially whilst under pressure together with an enquiring mind and a commitment to providing holistic patient-centred care are the key attributes of a Consultant in Acute Medicine.

Click the link to view the Chemical Pathology Pages of the Royal College of Pathologists Website

Clinical Genetics is an increasingly attractive career option for Trainees from a wide variety of backgrounds.  It has long been considered as an off-shoot of Paediatrics but in fact a large proportion of referrals are now for adults and the specialty is very keen to attract Trainees with a background in Adult Medicine.  In recent years there has been a huge expansion in the area of Cancer Genetics.

The speciality of Clinical Genetics is concerned with the diagnosis of inherited disease and birth defects, the estimation of genetic risks and the counselling of family members.  Clinical Geneticists work very closely with Genetic Counsellors and Clinical Scientists.  Clinical Genetics does not involve actual laboratory work (apart from some training requirements or periods of research) but is very much involved with the interpretation of laboratory results and the implications for families.  Communication skills are therefore very important.

Most of the work is carried out in out-patient clinics and Clinical Geneticists do not usually have inpatient beds.

Training Programme Details

Clinical oncology is the non-surgical management of malignant disease, using both radiotherapy and systemic therapy (chemotherapy, hormone therapy and biological agents).

Managing cancer in all its various forms requires an enquiring mind, a secure general medical background, good practical skills and a real commitment to patient care.

Training Programme Details

The Department of Therapeutics and Pharmacology QUB, in conjunction with its clinical unit at BCH, offers posts approved both for training in Clinical Pharmacology and GIM.  Specialist clinics dealing with Heart Failure, Hypertension and Diabetes are also part of the Clinical Training.

The Department has a very active Clinical Research Programme, at present mainly in Cardiovascular and Diabetes Research.

There are good research facilities for studies in Clinical Neuropharmacology. Clinical and research experience can be obtained simultaneously.

Opportunities exist for involvement of Trainees in short-term research projects or work for an MD or PLD.

This relates to trainees in the first common period of Specialty Training between Foundation Training Year 2 and recruitment into ST3. It is a generic spread of the discipline of medicine and the first step in training within the School of Medicine.

CMT programmes are designed to deliver core training in General Internal Medicine (GIM) and Acute Internal Medicine (AIM) by acquisition of knowledge and skills as assessed by the workplace-based assessments (WPBA) and the MRCP(UK).  Programmes are usually for two years and are broad based consisting of four to six placements in medical specialties. These placements over the two years must include direct involvement in the acute medical take. Trainees completing core training will have a solid platform of GIM and AIM from which they can continue into Specialty Training.

The curriculum for CMT was reviewed and rewritten in August 2009 to:

• Meet the GMC’s 6 new standards as detailed in their Standards for Curricula and Assessment systems
• Keep up to date with medical advances and changes in the service and training
• Incorporate the framework documents produced by the Academy of Medical Royal Colleges (AoMRC) detailing Common, Medical Leadership and Health inequality competencies
• Include 5 new assessment methods (Acute Care Assessment Tool, Case based Discussion, Patient Survey, Teaching Observation and Audit Assessment).

Training Programme Details

Click the link to visit the JRCPTB Website

Dermatology offers a unique but competitive career choice.  Historically and practically it is based in general medicine.  Indeed the first physicians were essentially dermatologists before the stethoscope, the cardiogram, radiology and blood tests allowed the emergence of the internist.  Modern dermatologists are specialists in a whole gamut of cutaneous afflictions (there are several thousand named dermatoses) reflecting the whole spectrum of pathology to which the human organism is prey, inflammatory, infectious, neoplastic and degenerative.  Dermatologists must have sufficient competency in acute and general medicine and in skin surgery to allow them to care for their patients, adult and children, in a holistic way, developing a special appreciation of the impact of skin disease on an individual and on society.

Dermatologists are expected to practice only in the specialty and there is no provision either in training or career posts for a Physician with a special interest in Dermatology.

Dual Accreditation

Many consultant physicians practice general internal medicine in addition to their medical specialty, and many patients are cared for under the umbrella of general internal medicine. These include the full range of adults admitted as emergencies with acute medical problems, ranging from the young fit person with a severe acute illness, to the frail elderly with multiple disorders. Patients with problems that are not clearly within the remit of a particular medical specialty are referred to outpatient clinics for the opinion of a general physician.

Nearly all trainees following the GIM curriculum to CCT will be doing so in parallel with training in another medical specialty. The GIM curriculum defines the competencies needed for the award of a CCT in general internal medicine, which are needed to allow participation at a senior level on the acute medical take, and to provide advice on the investigation and management of inpatients and outpatients with acute and chronic medical problems.

Dual CCT Trainees who wish to achieve a CCT in both GIM and another specialty must have applied for and successfully entered a training programme which was advertised openly as a dual training programme. Trainees will need to achieve the Competencies, with assessment evidence, as described in both the other specialty and GIM curricula. Individual assessments may provide evidence towards competencies from both curricula. On successful completition of the training programme and assessments for both specialties, as outlined in the relevant GMC approved curricula, the trainee will achieve two CCT’s, one in GIM and one in another medical speciality.

For further information, go to https://www.jrcptb.org.uk/specialties/general-internal-medicine-gim

Geriatric Medicine involves dealing with acute medical emergencies in the older person, general and specialist inpatient and outpatient rehabilitation, and an element of respite and continuing care.

Further information can be found on the following link - British Geriatric Society. 

The clinical immunologist is involved in the investigation, diagnosis and management of a wide range of conditions, from immune deficiencies, allergic disease, auto inflammatory conditions and some autoimmune conditions.

The role also requires expertise in the management and governance of the laboratory service. It is the diverse nature of the role of the clinical immunologist that makes it such an interesting job.  To do the job, the clinical immunologist must have good clinical and diagnostic skills, and the incentive to keep up to date with such a rapidly expanding spectrum of disease.

The Regional Immunology Service for Northern Ireland is based in the Royal Victoria Hospital site.  The service provides outpatient clinics, a dedicated day Hospital for investigation and treatment of patients with immunological or allergic disease, and a regional laboratory providing immunology tests for the province.

The specialty of Infectious Diseases, although small in comparison to the system-based specialties, provides the opportunity of a career ranging from challenging and constantly varied clinical management to intellectually stimulating frontier research into diseases of worldwide importance.

The specialty has encompassed the requirements of a clearly objective based training curriculum and offers training programmes ranging from pure Infectious Diseases to combined training in Infectious disease and General medicine, Infectious disease and Medical microbiology, and Infectious disease, Tropical medicine and General medicine.

This specialty includes both bacteriology and virology. The Medical Microbiologist is involved in the science of laboratory diagnosis of infection, clinical investigation of infections, prevention and control of cross-infection and management of problems associated with antibiotic resistant microorganisms.

Click the link to view the Medical Microbiology Pages of the Royal College of Pathologists Website

This specialty focuses on the systemic treatment of cancer patients using a variety of approaches including Cytotoxic Agents, Hormones, Immunotherapy, Gene Targeted Therapies and Bone Marrow Transplantation. Medical Oncologists primarily treat solid tumours arising from various sites, and work as part of a multidisciplinary team that includes Surgical Oncologists, Radiation Oncologists and Palliative Care Physicians. The specialty offers distinctive access to academic medicine and is actively involved in cancer clinical trials and translational scientific research.

A career in medical oncology will provide a rewarding opportunity to be at the forefront of the delivery of innovative systemic anti-cancer therapy to patients, through an ethos of holistic, evidence-based care.

Occupational Medicine is concerned with protecting and maintaining health in the workplace. Doctors in Occupational Medicine may work as a member of an Occupational Health team directing policy on occupational health matters. They also help employers to comply with their statutory requirements and may be involved in first-aid, health surveillance and statutory and non-statutory examinations.

In many organisations they are actively involved in health promotion. Most major public and private organisations provide a comprehensive occupational health service headed by Occupational Physicians. In Northern Ireland in 1998 there were 19 doctors practising as full time Occupational Physicians.

Posts in occupational medicine vary from part-time involvement of GPs to whole time posts in larger organisations. Salary scales in the UK, dependent on qualifications, responsibility and seniority, are recommended by the BMA and in Ireland by the Irish Society of Occupational Medicine.

Paediatric cardiology has traditionally included care of patients of all ages with congenital heart disease. Many of these patients require lifelong follow up, leading to a most rewarding, close and long term relationship with patients and their families.

Higher medical training in paediatric cardiology has maintained its openness to trainees from either a paediatric or an adult medicine background, although a solid basis of both paediatrics and cardiology (adult or paediatric) is essential for entry into specialist training.

Skill requirements for training in congenital cardiology have gradually become less rigid, but paediatric or medical experience up to the level of achievement of MRCPCH or MRCP remains essential.

Perhaps the most important attribute of any budding paediatric cardiologist is highly developed skill in communication.

Palliative Medicine remains a shortage specialty and there are good prospects for Trainees wishing to specialise.

At present there are 6 approved Registrar posts in Northern Ireland, distributed between the Northern Ireland Hospice, the Marie Curie Centre, Belfast City Hospital and Royal Victoria Hospital.

Leading a cross-section of organisations and individuals, public health consultants strive to realise ways of making our communities and our environments healthier, and more capable of providing us with what we need for optimal health. Leaders in public health must be diverse in their capabilities: creative in their ability to visualise change, meticulous and organised in making it happen, and then monitoring the results. They take on the challenge of extremely varied and often unpredictable workloads. Timescales for getting projects up and running can be long and require a great deal of negotiation, but a good public health consultant will be able to handle the challenge of this, providing the leadership and management skills necessary to see projects through to completion. They seldom, if ever, work on one project at a time, and must also be able to respond to emergencies as they arise.

To do the job, they must have a broad understanding of all the factors that contribute to health, the structure of healthcare systems and services, current government policy, and how to effectively interpret available data. Are able to evaluate evidence to devise and implement strategies to improve and protect health, and to improve health services. Public Health Consultants are both tough negotiators and simultaneously possess good powers of persuasion to get the community, other stakeholder organisations and politicians to agree and work effectively towards common goals.

Some consultants will become experts in a specific area of public health, while others will find that their job incorporates a cross-section of public health activities and/or research. However, their work usually falls within one or all of the following three domains: improving health, protecting health or improving health services.

Those who have completed their training are currently eligible to apply for posts in the Public Health Agency, in the Department of Health, for academic Public Health posts in the university. As health services structures change there be opportunities in other organisations in the future.

In Northern Ireland the number of consultant vacancies is approximately balanced to the number of suitably qualified candidates.

Training Programme Details

Rehabilitation Medicine is in most instances practiced full time, although can be practiced in conjunction with other specialties including Rheumatology, Neurology and Geriatric Medicine.

This involves the acute management of severely ill patients with Connective Tissue Disease, Auto-immune conditions and Vasculitis and also the medical treatment and rehabilitation of potentially disabling Musculoskeletal disorders. During the period of attachment to Rheumatology, practical experience and tuition are offered in special diagnostic and therapeutic methods, including Joint and Soft Tissue Injection currently in use in the province.