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Scottish Medical Training

Scotland - the home of medical excellence

Speciality: Genitourinary Medicine

Programme Description
GMC Reference: SES/421

Why choose this programme

Genitourinary Medicine (GUM) is the specialty that informs the prevention and management of sexually transmitted infections (STIs) including HIV.
The core elements of the specialty are the clinical management of STIs and HIV/AIDS, surveillance and reporting, the prevention of morbidity and mortality due to STIs & HIV by initiating treatment, partner notification and behavioural
change. 


GUM physicians are required to have specialist skills in the delivery of HIV & GUM services, clinical governance, public health, epidemiology and the provision of contraception. The specialty of genitourinary medicine has a strong multidisciplinary team ethos and requires excellent communication skills. Close liaison is required with microbiology and virology, the specialties of acute medicine, obstetrics and gynaecology, sexual and reproductive health, paediatrics, dermatology, accident and emergency, public health departments and mental health services.


The work of the specialist includes management of young people, refugees, psychosexual disorders and people who have been sexually assaulted. HIV care involves management of complex antiretroviral treatments, drug interactions,
understanding of antiretroviral drug resistance patterns, treatment side effects and co-infection of HIV with hepatitis or tuberculosis. As the field is rapidly evolving it is expected that trainees will actively participate in research and audit.


This programme based in Scotland offers the full range and depth of specialty experience with trainees principally based in Glasgow or Edinburgh. There is close working with colleagues in sexual and reproductive health to provide integrated services which provide holistic care. There is good access to internal and external training events and IT/library support. The International HIV drug therapy conference is held every other year in Glasgow.


The Scottish programme provides a positive work-life balance with limited out-of-hours commitments and access to both urban and rural settings.
The UK specialty association for GUM is the British Association for Sexual Health and HIV (BASHH). Prospective candidates can find further information of interest here 

"Life as a GU registrar is incredibly varied and you can expect to see a range of clinical presentations throughout the working day. There is a high level of patient interaction and consultations can be complicated by social, psychological and ethical issues as well as the physical presentation. Often you can provide adequate management in one visit which is very satisfying and great for the patient!"

Becky Hussey, ST3 in Genitourinary Medicine

 

Research, audit, teaching and management opportunities

The Genitourinary Medicine (GUM) Training Programme is managed nationally across Scotland and offers the full range and depth of specialty experience. Trainees are based principally in Glasgow or Edinburgh. The programme is co-ordinated by the South East Deanery

Genitourinary Medicine (GUM) is the medical specialty which delivers care in all aspects of sexual health and HIV medicine. There is a focus on sexually transmitted infections (STIs), but as the public can attend directly without being referred, patients with other conditions (such as genital skin problems) are frequently seen. Examples of other sexual health presentations include sexual assault, prophylaxis following sexual exposure to HIV, and acute STIs causing genital ulcers and discharge.

The majority of patients with STIs are generally in their teens or twenties and so do not have multiple chronic medical conditions, and can often be cured. Some people who are well and asymptomatic may simply be attending for a check up. People with HIV are often older and remain under medical follow-up for many years.

In the past, GUM clinics were often housed in large hospitals, but there has been a move into community settings which have smaller hubs to provide better local access. Examples in Scotland include the Sandy ford in Glasgow, on Sauchiehall Street and at the recently refurbished ChalmersHospital in Edinburgh. HIV care has continued within acute hospital sites to ensure access to diagnostic imaging, laboratories, pharmacy and in-patient beds if required. Therefore GUM physicians often work on more than one geographical site.

Like many specialties GUM may change in the near future according to the Shape of Training Review. It is possible there will be an increased commitment to Acute Medicine/General Internal Medicine and there will be clarity about these changes over the coming couple of years. Whilst uncertainty is always difficult to live with it’s probably best viewed as an opportunity to train with increased opportunity for a broad ranging career post CCT (CST?).

What areas of medicine does GUM link to?

GUM physicians work closely with colleagues in reproductive health (formerly family planning) who have a background in gynaecology. In Scotland, most services are delivered as 'integrated sexual health' with care for both STIs and contraception being delivered at the same time. There is also an emphasis on social aspects as many patients are drawn from vulnerable populations. HIV care is provided with close working links with other medical specialties, notably with colleagues in Infectious Diseases, but also with a range of other medical specialties given the multi-system impact of HIV. There is close liaison with obstetricians for pregnant women living with HIV to prevent mother to child transmission.

GUM also works closely with Public Health specialists as there is an emphasis on prevention. Much of the STI caseload is effectively applied virology or microbiology, and so there are strong links with laboratory based specialties. GUM has strong tradition of multidisciplinary team working. Many nurses have prescribing and clinical competencies so they can see patients without the need to refer to a doctor. There are also team members who specialise in partner notification and laboratory staff. Many GUM physicians have formal leadership/director responsibilities.

"I like our patients and the more informal setting of a community GUM clinic which I think helps to break down barriers to communication. I like the variety of the job with elements of various disciplines - medicine, ID, dermatology, gynaecology, public health - and the more holistic approach than I had with patients in other specialties."

- Graham Leslie, ST6 in Genitourinary Medicine

What personal attributes would make someone well suited for this specialty?

You shouldn't work in GUM if you don't like talking to people about sex. You need to be non-judgemental, be able to maintain confidentiality and have excellent communication skills. Being a team-player is essential and having a sense of humour is recommended as you will hear some pretty interesting stories.

What are the best aspects of the job?

GUM is one of the few specialties where you can actually cure some patients after a single visit. HIV is a treatable condition with an almost normal life expectancy now. Because of co-morbidities, you need to know how to manage a range of medical conditions such as renal and cardiovascular risk. It's gratifying seeing patients' self-esteem improve by reducing stigma by offering an explanation of what has happened, especially if it has affected their personal relationships.

There is limited on-call requirement. Most trainees work workdays and finish by 5-6 pm without duties on weekends, which is usually a welcome break after a few years on-take. However there are opportunities to participate in acute medical rotas or specialist sexual health work such as sexual assault or outreach clinics.

The sociable hours help to create a more relaxed working environment, with readily available consultants and senior colleagues who are happy to provide advice and help. Many sexual health services use electronic patient records which include results processing and prescribing, so there is less time spent chasing bits of paper.

"One of the best things about being a GUM doctor is that you may be the first person someone has spoken to about a problem that has been on their mind for a long time. You feel in a privileged position to be the person they spoke to. It is also satisfying that you are usually able to provide immediate reassurance or solutions to the problem, so that they can go away with the weight of the world taken off their shoulders."

- Gillian Fraser, ST4 in Genitourinary Medicine

What are the worst aspects of the job?

Not all medical colleagues appreciate the complexity of the specialty and the large numbers of patients seen. You still get the jokes about not wanting to shake hands with a "clap doctor" or jibes about only being good enough to work in a "VD clinic". There is also not a strong patient voice as people tend not to want to write to politicians or collect donations because they've had genital warts or herpes. However, it can be interesting at dinner parties when you explain what you do for a living.

What are the hours like? How competitive is it?

In general it is much less stressful than acute medical specialties. As with any job, the work intensity varies but is normally manageable. GUM gets high scores for overall general satisfaction in the annual GMC trainee survey. Most trainees readily achieve consultant status. There are about 400 GUM consultants in the UK. The specialty training programme lasts four years, but many registrars take time for out of programme experience, often outside Europe.

I'd like to have a family - what kind of impact would this have?

As much of GUM is based in out-patients, it is relatively easy to adjust rotas for men and women who wish to work less than full-time or who require flexibility week by week for caring commitments. Equally, given the non-judgemental nature of the specialty, there are a significant number of staff who are "out" having same sex partners. Bullying or discrimination is uncommon. Gender and ethnicity balance of the GUM medical workforce reflects that of the wider population.

Entry into the specialty:

After completion of the two-year Foundation programme, trainees who wish to pursue a career in GUM need to follow a two-year core programme in acute medicine and pass the MRCP(UK). It is no longer possible to gain entry to the GUM programme with the MRCOG or MRCP part 1 only. There is competitive entry to GUM ST3 posts. There then follows a four-year programme in higher specialist training, which leads to a Certificate of Completion of Training (CCT).


Learning experiences:

There was a major revision and update of the GUM curriculum in 2010. Details are available on the JRCPTB website (see link at end). The curriculum is delivered through a variety of learning experiences, mostly by work-based learning and on-the-job supervision. The first two years concentrate on core GUM and HIV clinical competencies. This includes blocks mainly spent providing care for HIV out-patients and in-patients. In years 3 and 4, there is a greater emphasis on medical management & leadership, public health and wider aspects of integrated sexual health, including contraception. Trainees undertake specific training attachments in dermatology, gynaecology, infection and laboratory based diagnostics. Some trainees may wish to undertake additional training in clinical infection. Others may wish to pursue a concentrated period of research.

Assessment:

There are two methods of assessment: performance (workplace- based) and knowledge-based. Workplace-based assessment includes use of the Mini-Clinical Evaluation Exercise (Mini-CEX), case-based discussion (CbD) and DOPS for diagnostic and management skills. Multisource feedback is undertaken twice during the training programme. The e-portfolio is used as documentation and for annual reviews.

What exams will I have to sit and when?

There are 3 knowledge-based assessments that need to be passed during the 2010 GUM curriculum. Knowledge of GUM is assessed by the examination for the Diploma in Genitourinary Medicine (DipGUM) which is administered by the Society of Apothecaries, London. This needs to be passed by the end of ST4 (year 2) to progress to ST5. Trainees need to pass the DFSRH (Diploma of the Faculty of Sexual and Reproductive Health) by the end of ST5 and the DipHIV (Diploma of HIV) by the end of ST6.

What can I do during my degree and foundation training that might improve my chances of getting into this specialty?

Speak to existing trainees and consultants. Find out how sexual health services are delivered locally. There is a wealth of information on the internet, so use the following websites to get started. It also helps if you can show an interest in GUM by participating in Special Study Components (SSC) or projects whilst a student or coming for tasters or attending relevant training days during foundation. Finally, don't forget to get a life. Volunteering or being really good at something outside medicine is not to be underestimated.

Where is the training delivered?
This programme involves placements in some or all of these Health Boards and hospitals:

Gartnavel General, Glasgow, Royal Infirmary of Edinburgh, Western General Hospital, Edinburgh, Sandyford Clinic, Glasgow, Lauriston Building, Edinburgh

Mainly based at;

Sandyford Services, Glasgow

Brownlee Centre, Gartnavel General Hospital, Glasgow

Chalmers Hospital, Edinburgh

Western General Hospital, Edinburgh.

Various attachments in acute and community-based sites to support the delivery of the curriculum.




Contacts and Useful Links
Programme Type Deanery based or National: National
Administration office West of Scotland
Lead Dean / Director Professor Alastair McLellan
Responsible Associate Postgraduate Dean or Assistant Director (GP) Dr D Farquhar
Specialty or Sub-specialty Specialty or Sub-specialty: Specialty
Date of GMC recent approval August 2010
Associated Royal College - Faculty
Joint Royal Colleges of Physicians Training Board (web site)
Curriculum and Associated Assessment System https://www.gmc-uk.org/education/standards-guidance-and-curricula/curricula/genitourinary-medicine-curriculum
Programme Administrator: Named Programme Administrator: Christine Ferguson
Address: NHS Education for Scotland, Third Floor, 2 Central Quay, 89 Hydepark Street, Glasgow, G3 8BW
Tel: 0141 223 1528
Email: Christine.Ferguson@nes.scot.nhs.uk
Programme Director Programme Director Name: Dr Fiona Fargie
Address: The Sandyford, Glasgow
Tel:
Email: Fiona.fargie@nhs.net
Quality of Training Quality Management

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