Speciality: Genitourinary Medicine
Why choose this programme
What is Genitourinary Medicine?
Genitourinary Medicine (GUM) is the medical specialty which delivers care in all aspects of sexual health and HIV medicine. The core elements of the specialty is the deterrence of morbidity and mortality due to sexually transmitted infections (STIs) & HIV, by undertaking prevention interventions, surveillance and reporting, clinical management of disease and partner notification.
GUM physicians are required to have specialist skills in the delivery of HIV & sexual health services, including for high risk and vulnerable populations, such as young people, LGBTQ+ individuals, refugees, intravenous drug using individuals, commercial sex workers and incarcerated prisoners. People attending GUM services can sometimes have complex psychosocial problems, or have difficulty accessing health care. However, the majority of patients with STIs are generally younger, do not have multiple chronic medical conditions and can often be cured.
HIV care involves the understanding of antiretroviral drug resistance patterns and management of complex antiretroviral treatments, including drug interactions and treatment side effects. Some patients with HIV continue to be diagnosed late, presenting with rare opportunistic infections and malignancies. However, the majority of individuals with HIV are now living longer and HIV physicians have an important general medical role to play in the management of patient frailty, multi-morbidity and polypharmacy.
GUM clinicians also require a strong grounding in a number of other skills, including public health, clinical governance, quality improvement and clinical leadership.
The UK specialty association for GU Medicine is the British Association for Sexual Health and HIV (BASHH). Prospective applicants can find further information of interest at Love Gum Resources | British Association for Sexual Health and HIV (bashh.org)
Why choose this programme?
A career in Genitourinary Medicine offers a fulfilling mixture of being able to immediately cure a significant proportion of patients and also allowing management of chronic specialist condition, in the guise of HIV.
HIV care provision requires a sound grasp of general medicine, for managing multimorbidity, as well as rare opportunistic infections and malignancy. Individuals with HIV usually remain under care at the same service for many years, allowing the forging of strong doctor-patient relationships.
Even in shorter consultations, clinicians can do much to improve patients’ psychological wellbeing and sexual relationships, by explaining sexual ill health and reducing stigma. As discussed, sexual ill health is frequently more common in already marginalised and vulnerable groups and it can be very personally rewarding to make a difference for such individuals. GUM physicians have a considerable public health role, in the prevention, early detection, effective treatment and prevention of onward transmission of sexually transmitted infections (STIs) and blood borne viruses.
GU medicine as a career allows the opportunity to develop various specialist skills and interests, for example, in the management of genital dermatoses, psychosexual dysfunction, sexual assault referral services, gender identity services, outreach services, safeguarding of minors and vulnerable adults, etc.
The sociable hours and out-patient nature of GU medicine help to create a more relaxed working environment, with consultants and senior colleagues readily available to provide advice and support. The limited evening/ out of hours commitments of the specialty also enable a beneficial long-term work-life balance.
Below are a sample of quotes from Scottish trainees about what attracted them to the specialty:
I love the combination of infectious diseases, women's health and public health. I don't think any other specialities offer the same level of clinical patient-facing time while also being involved in public health interventions at a very high level where real changes can be made.’
‘I always had an interest in sexual health. I also felt there was still stigma and judgement of people and their sex life and I wanted to be part of the effort to improve this culture. I worked as a general medical registrar for a few years and maintaining some general medicine in my day to day practice was appealing.’
‘A typical day in GUM includes an urgent care clinic, which is often fast paced, where you can see anything from a young healthy person with gonorrhoea to a complex neurosyphilis needing hospital admission; and a specialist clinic such as HIV care, genital dermatology or PrEP.’
‘It is incredibly rewarding to provide care to marginalised groups of people who may not seek healthcare anywhere else.’
The GU Medicine team
Genitourinary Medicine has strong tradition of multidisciplinary team working, with nurse practitioners and clinical nurse specialists playing a significant role within services. Many specialist nurses have prescribing and clinical competencies, allowing them to see patients without the need to refer to a doctor. There are also team members (health advisors) who specialise in partner notification. The specialist HIV team commonly includes clinical pharmacists, clinical psychologists, psychiatrists and dieticians, in addition to medical and nursing staff.
GUM and HIV services have close liaison with the laboratory team, as well as the specialties of acute medicine, infectious diseases, obstetrics and gynaecology, sexual and reproductive health, paediatrics, dermatology, public health and mental health services.
GUM in Scotland
The Genitourinary Medicine Training Programme is managed nationally across Scotland and offers the full range and depth of specialty experience. The programme is co-ordinated by the South East Deanery. Trainees are based principally at the Glasgow or Edinburgh training units. Both the Glasgow and Edinburgh GUM teams work very closely with colleagues in the sexual and reproductive health specialty to provide integrated services, which also carries benefits in terms of training opportunities for trainees. There is good access to internal and external training events. The International HIV drug therapy conference is held every other year in Glasgow.
Entry into the specialty
After completion of Foundation Year (FY) training, trainees who wish to pursue a career in GU Medicine need to complete the three year internal medicine training (IMT) stage-1 programme, including successfully passing MRCP (UK). Following this, prospective trainees need to participate in a competitive application process to gain entry to the four-year higher specialty dual-training programme in Genitourinary medicine & General Internal medicine (GIM). At the completion of this programme, trainees will be awarded Certificate of Completion of Training (CCT) in both specialities.
Learning experiences and examinations
A new curriculum was published in 2022. 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 assessment and on-the-job supervision. The first two years concentrate on core GUM and HIV clinical competencies. This includes periods spent providing care for HIV out-patients and in-patients. In years 3 and 4, there is a greater emphasis on specialist aspects of sexual healthcare, complex HIV care, medical management & leadership and public health. During speciality training, trainees undertake specific training attachments in dermatology, obstetrics and gynaecology and laboratory-based diagnostics. There are two knowledge-based assessments that are mandatory for GUM CCT: the Diploma in Genitourinary Medicine (required by the end of ST7) and the Diploma of HIV Medicine (required by the end of ST7).
General Internal Medicine training is provided as blocks throughout the higher specialist training programme and total a minimum of 12 months within the four year programme.
What personal attributes would make someone well suited for the speciality?
Conversations with patients are often of an intimate nature, so you should like talking to people and not be embarrassed discussing sex. Clinicians in the speciality require to have excellent communication skills and open and non-judgemental attitudes. Being a team-player is essential and having a sense of humour is also recommended as you can hear some pretty remarkable stories!
What can I do during my degree and general training to improve my chances of getting into the specialty?
Speak to existing trainees and consultants and find out how sexual health services are delivered locally. As a student, consider undertaking a project or Special Study Module in GU Medicine. If already an FY or IMT trainee, attend any relevant training days and organise a ‘GUM taster’ period. You can also consider contacting your local GU department to enquire about any research or quality improvement projects that you can become involved in.
There is a wealth of information on the internet, use the following websites to get started:
Join/follow Student and Trainee Association for Sexual Health and HIV (STASHH). (They also have a mentoring scheme available for individuals interested in joining the specialty). Students and Pre-specialty doctors - STASHH | British Association for Sexual Health and HIV (bashh.org)
Watch the Love GUM videos on BASHH website Love Gum Resources | British Association for Sexual Health and HIV (bashh.org)
Research
The Edinburgh and Glasgow GUM services have well recognised profiles in supporting research into HIV and STI treatment and prevention, leading and participating in national and international studies. Trainees are encouraged to take an active role in research, of which there are many opportunities, and out of programme research periods are supported.
Audit/quality improvement
National standards of care for STI treatment and prevention and people living with HIV are available and regularly updated. Both the Edinburgh and Glasgow sexual health services have a strong commitment to service development, improvement and review and trainees will be expected to participate in these activities as part of their training.
Teaching
As a GUM specialist you will be committed to providing high quality sexual health education to many different groups, including members of other health care professions or third sector. Trainees are encouraged to participate in a spectrum or undergraduate teaching activities, including bedside teaching, small group tutorials, delivery of lectures, examining and supervision of student projects. NHS Lothian delivers a formally accredited Clinical Educator Programme.
Management and leadership
There is ample opportunity to become an active member of national organisations BASHH and BHIVA. Many GUM physicians have formal leadership/director responsibilities at local and national level. Trainees are supported and encouraged to take on management and leadership responsibilities during their specialist training.
Gartnavel General, Glasgow, Royal Infirmary of Edinburgh, Western General Hospital, Edinburgh, Sandyford Clinic, Glasgow, Chalmers Centre, Edinburgh
GU training in Scotland is mainly based at the Chalmers Sexual Centre in Edinburgh or at the Sandyford Services in Glasgow. Trainees also respectively rotate to the Infectious Diseases Unit, Western General Hospital, Edinburgh or the Infectious Diseases Unit, Queen Elizabeth Hospital and Brownlee Centre, Gartnavel General Hospital in Glasgow as part of their HIV training.
Trainees are required to rotate into acute medicine specialties at their training site (South East or West of Scotland) for undertaking their GIM training.
| Programme Type | Deanery based or National: National |
| Administration office | West of Scotland |
| Lead Dean / Director | Professor Adam Hill |
| Responsible Associate Postgraduate Dean or Assistant Director (GP) | Dr Jane Rimer |
| 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.jrcptb.org.uk/sites/default/files/Genitourinary%20Medicine%202022%20Curriculum%20FINAL.pdf |
| Programme Administrator: |
Named Programme Administrator:
Sarah McNeil
Address: NHS Education for Scotland, Third Floor, 2 Central Quay, 89 Hydepark Street, Glasgow, G3 8BW Tel: Email: Sarah.McNeil@nhs.scot |
| Programme Director |
Programme Director Name: Imali Fernando Address: Chalmers Sexual Health Clinic 2a Chalmers Street EDINBURGH EH3 9es Tel: 0131-536-2098 Email: Imali.Fernando@nhslothian.scot.nhs.uk |
| Quality of Training | Quality Management |