Combined Infection Training (CIT) is a two year, integrated laboratory and clinical training programme which includes medical microbiology and virology and infectious diseases. Entry is at ST3 following successful completion of Core Medical Training (CMT) or Acute Care Common Stem(ACCS) and the award of the MRCP. Trainees will then progress to separate CCTs in Medical Microbiology, Medical Virology, Infectious Diseases or a combined CCT in Medical Microbiology/Infectious Diseases or Infectious Diseases/General Internal Medicine . Please note that CIT is only delivered as part of run-through training for each of these options. The final option must be declared at the beginning of the CIT programme which will run through into the Higher Infection Training chosen.
The CIT curriculum was designed jointly by the Royal College of Pathologists and the Joint Royal College of Physicians Training Board (JRCPTB) and was approved by the GMC in April 2014 with an expected start date of August 2015.
The South West School of Pathology will continue to provide the revised 2010 curricula for current trainees not wishing to transfer to the new 2014 curricula. Feedback from the 2013 GMC trainee survey placed the microbiology training in Bristol at number 1 in the UK for trainee satisfaction.
The Severn PGME Combined Infection Training Programme
Trainees will work alongside each other gaining experience in the laboratory, ward round and bedside consultative service. Those who are training in CIT will be housed for 18 months of their training in the department of Infection Sciences, North Bristol NHS Trust (NBT) and will gain additional experience in bedside consultations and out-patient clinics. Six months of CIT training will be in the Infectious Diseases department under supervision of the ID physician at SouthmeadHospital, NBT or in the Respiratory Medicine department of the Royal United Hospital Bath (RUH) under the supervision of a respiratory/ID physician.
Those trainees going onto Higher Infection Training will complete their training in the departments outlined alongside those completing the 2010 curricula.
Severn Pathology Infection Sciences Department
Laboratory, bedside consultation and out-patient training will be delivered by the Severn Pathology Infection Sciences department for Medical Microbiology and Virology. The Infection Sciences department houses bacteriology for the cities of Bath and Bristol and surrounding areas and regional PHE virology for the South West of England. It is one of the largest diagnostic infection services in England. It also houses the national PHE mycology reference laboratory and national antibiotic reference laboratory alongside an active research division. Approx. 1m bacteriology samples and 560,000 virology samples are processed annually.
Extensive laboratory experience and daily consult services will be delivered with bedside consults by the medical microbiology and virology teams. By mid-2015 it will be one of the most automated bacteriology services in the UK with close links to Genetics in provision of molecular diagnostics. The hospitals served include 2 large teaching hospitals; University Hospitals Bristol and North Bristol NHS Trust, and District General Hospitals; Royal United Hospital, Bath and Weston General Hospital, Weston-Super-Mare as well as all the associated general practices and community services. The large hospitals provide regional; renal, haemato-oncology, cardiovascular/cardiac surgery, neurosurgery, burns, trauma, vascular and urology services as well as the usual general medical and surgical specialties and two very large ITUs. North Bristol NHS Trust houses the Infectious Diseases unit and the specialist HIV services. There is also a specialist eye hospital and the regional children’s hospital (paediatric ITU, neurosurgery and burns) with regional NICU services provided on both sites.
Trainees will gain wide experience of bedside consultations and ward rounds to the large Intensive Therapy Units of both North Bristol NHS Trust and University Hospitals Bristol which includes a busy paediatric ITU, as well as ward rounds to specialist units such as the renal unit, burns and plastics and neurosurgery. Ward rounds take place on a daily basis as do bedside consultations. There are nine microbiology consultants in the Infection Sciences department, two are joint ID/microbiology accredited, and four consultant virologists. In addition there is a senior clinical scientist in mycology and the number of trainees in the department as a whole varies between 10 and 12 making for a lively group of professionals specialised in infection.
Outpatient clinics will include regular orthopaedic infected joint clinics, diabetic foot clinics, spinal infection clinics, Staphylococcus aureus bacteraemia with ad hoc complex urology infection clinics provided by the medical microbiologists with relevant specialty teams. Infection prevention and control training will also be delivered and will include advice on decontamination of re-usable medical devices and antibiotic stewardship as well as outbreak and alert organism advice. The Infectious Diseases consultants will ensure experience in Infectious Diseases is gained in an in-patient setting and out-patient clinics in general ID, HIV, TB, hepatitis, and imported infections.
Infectious diseases inpatient experience
Infectious diseases training will be delivered at two sites, under the direct supervision of consultant physicians accredited in infectious diseases. At North Bristol NHS Trust (NBT), trainees will become experienced in the diagnosis and management of unselected community acquired infection, fever in returning travellers, fever of undetermined origin and the wide array of conditions that is expected to be covered during combined infection training in an inpatient and outpatient setting. The training in ID will be delivered by the ID specialists (one ID physician and two microbiologists who are ID and microbiology accredited), with training in HIV medicine delivered by the ID physician and 2 consultant immunologists. The ID team has 16 dedicated beds in 2 wards, within which are up to 5 HIV beds. There is a 6-bedded isolation suite with ventilated lobbied isolation cubicles where airborne infections such as TB, and influenza, etc., can be safely isolated.
The Respiratory Medicine department at the Royal United Hospital in Bath is fortunate in having a consultant who also has a CCT in Infectious Diseases and is able to provide supervision for in-patient infections associated with patients with Respiratory diseases. He has a particular interest in non-CF bronchiectasis and medical education, as well as a wide interest in respiratory-related sepsis. The Royal United Hospitals Bath Trust is a very large and busy district general hospital serving the city of Bath and surrounding area (some 0.5m population). The Respiratory Unit is situated in the main block of the RUH offering full integration of outpatients, inpatients, office space and lung function. There is a purpose built 33 bedded ward with a Respiratory High Care Unit. The ward is used for both general medical and respiratory patients, all of whom are under the care of six respiratory physicians. Trainee feedback from all grades has been good with repeated ‘green flags’ in the GMC National Trainee Survey (Specialty Induction 2012 & 2013)
Generic training opportunities
During their training all trainees will be encouraged to take part in an audit, quality improvement and/or research. All of the departments in this rotation are very active in research and development and there is a unique opportunity to be involved in research in a world leading centre for research in antimicrobial chemotherapy. Effective teaching is a very important part of the role of a Consultant and trainees will take part in a wide range of undergraduate, post-graduate and allied specialties teaching associated with the host Trusts and Universities of Bristol and the West of England.