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A career in Chemical Pathology/Metabolic Medicine
The provision of an analytical service for biochemical tests both in the laboratory and at the “point of care” by the patients side gives consultants “the best of both worlds” in many ways. A chemical pathologist’s job is never boring, and a working week will always provide you with opportunities to grow into your interests as you progress through training.
Typical duties for chemical pathologists involve laboratory management and duty biochemist shifts where the addition of clinical interpretation and the ‘authorisation’ of results from routine and specialist laboratory tests, provide a service to other clinicians. Direct clinical care is also provided in both inpatient and outpatient settings within one or more of five main clinical areas which are:
- lipids,
- diabetes,
- inborn errors of metabolism,
- metabolic bone disease and
- nutrition
Key skills and personal attributes
Chemical pathologists, like many other pathology disciplines, are able to draw on a range of skills that can be applied in both the laboratory and clinical setting. Breadth of clinical knowledge, as well as ability to gain depth into specialist areas, are skills that you develop over time as clinical queries you deal with come from a number of different sources in the field of medicine. Personal attributes include:
- Ability to work in a multidisciplinary team which includes a range of colleagues, both clinical in and out of the department, and scientific with BMS’s and clinical scientists
- Ability to work independently and prepared to work behind the scenes
- Good management and interpersonal skills given the need to be a senior individual within the laboratory multi-disciplinary team
- Ability to manage risk appropriately and give advice confidently to other clinicians and patients based on the interpretation of biochemistry test results
- Compassion and ability to give personalised clinical care to individuals with a range of chronic conditions, including some which will have been present since childhood
Overview of Chemical Pathology training
Under the Royal College of Pathologists, Chemical Pathology training has undergone a curriculum change live from 2021. All trainees now enter Chemical Pathology speciality training following completion of a core training period such as Internal Medicine Training (IMT) (but other core training programmes are allowed) and completion of MRCP/similar postgraduate diploma.
Training duration is 5 years with CCT or CESR (CP) awarded in chemical pathology following evidence of:
- satisfactory completion of the chemical pathology curriculum and the minimum training period
- satisfactory outcomes in the requisite number of workplace-based assessments (including multi-source feedback)
- FRCPath by examination (see figure 2)
- Acquisition of Annual Review of Competence Progression (ARCP) outcome 6.
Figure 2. FRCPath examinations
The curriculum requires training to be undertaken both in the laboratory and in clinical settings. As most disease processes, whether occurring in premature neonates or in the very elderly, involve changes in body chemistry, the scope of chemical pathology covers the whole of medicine. There are some areas in which knowledge of the underlying biochemistry is particularly relevant, and trainees will be expected to attain capabilities to provide direct clinical care to patients in the following five areas, which comprised the former subspecialty of metabolic medicine:
- nutrition
- inborn errors of metabolism in adults
- cardiovascular risk management and disorders of lipid metabolism
- disorders of calcium and bone metabolism
- diabetes mellitus
Most chemical pathologists provide direct clinical care to patients in at least one of these areas (for example, leading clinical services for lipid clinics or nutrition), or contribute to clinical services in other areas such as endocrinology or toxicology. Full details on the new curriculum can be found here.