Genitourinary Medicine Trainees Research Articles

Higher specialty training in genitourinary medicine: A curriculum competencies-based approach.

Specialty trainees in genitourinary medicine (GUM) are required to attain competencies described in the GUM higher specialty training curriculum by the end of their training, but learning opportunities available may conflict with service delivery needs. In response to poor feedback on trainee satisfaction surveys, a four-year modular training programme was developed to achieve a curriculum competencies-based approach to training. We evaluated the clinical opportunities of the new programme to determine: (1) Whether opportunity cost of training to service delivery is justifiable; (2) Which competencies are inadequately addressed by direct clinical opportunities alone and (3) Trainee satisfaction. Local faculty and trainees assessed the 'usefulness' of the new modular programme to meet each curriculum competence. The annual General Medical Council (GMC) national training survey assessed trainee satisfaction. The clinical opportunities provided by the modular training programme were sufficiently useful for attaining many competencies. Trainee satisfaction as captured by the GMC survey improved from two reds pre- to nine greens post-intervention on a background of rising clinical activity in the department. The curriculum competencies-based approach to training offers an objective way to balance training with service provision and led to an improvement in GMC survey satisfaction.

P069 What impact has tendering had on trainees? The Results of a National Survey of Trainees and Newly Appointed Consultants by BASHH Trainees Collaborative for Audit, Research and Quality Improvement Projects

Background/introduction In April 2013, local authorities gained responsibility for commissioning services for sexual health in England. With many services going to tender and resultant change in services or service provider, there is anecdotal evidence that this has impacted on the education, training and morale of genitourinary medicine (GUM) trainees. Aim(s)/objectives To evaluate the impact of tendering on GUM trainees. Methods An electronic survey designed by the British Association for Sexual Health and HIV Trainees’ Collaborative for Audit, Research and Quality Improvement Projects (T-CARQ) was distributed to GUM trainees and newly appointed consultants. Results 82 individuals responded, (74% GUM trainees, 25% newly appointed consultants, 1% Locum appointed for Service). 63% (45/72) had experience of training within a service which was being tendered. Of these, 59% (24/41) felt their training was not considered and 20% (8/41) felt that it was. 44% (18/41) felt adequately supported. 30% (12/40) reported active participation in the tendering process. On a scale of 0 (no impact) to 5 (major impact), the median score for impact of tendering on training was 2. The positive/negative impact of tendering on different training elements was rated; other than management experience the overall impact on all parameters was negative namely morale, senior support and education. Discussion/conclusion This survey describes the variable impact of service tendering on GUM training. Our recommendations for maintaining training standards despite tendering include: actively involving trainees and education partners, inclusion of specialist GUM training in service specifications, development of guidance for commissioners and services for the management of GUM training within tendering.

P162 Why are core medical trainees not applying for genitourinary medicine?

Background/introduction Applications for higher speciality training in genitourinary medicine (GUM) have decreased dramatically in recent years leaving a number of unfilled posts. The reasons for this are unknown. Methods We produced an anonymous electronic survey for CMTs which was distributed to all deaneries in the UK. Survey questions included the advantages/disadvantages of a career in GUM and main barriers to application. A specific question was asked regarding the impact that the Shape of Training review (SOT) would have on the perceived attractiveness of a career in GUM. Results 100 CMTs responded, 51 CT1s and 49 CT2s. 35/100 were considering or applying for GUM and 17/100 may be. 61/100 gave reasons as to why they were not applying: 28% (17/61) interested in another speciality, 33% (20/61) no previous exposure, 21% (13/61) no interest, 20% (12/61) too specialist, and 3% (2/61) were uncertain of speciality future. The main advantage of GUM was an attractive work/life balance 44% (32/73). When specifically asked about the SOT implementation and likelihood of applying for GUM, 94/100 responded. 27% (25/94) were more likely to apply and for 36% (34/94) it made no difference. However of those applying/considering or maybe considering GUM (n = 52); 31% (16/52) would be less likely to apply and 27% (14/52) would apply but not if SOT is implemented. Discussion/conclusion This survey demonstrates that a significant proportion of CMTs are not considering GUM due to lack of exposure to the specialty. The SOT review is likely to significantly impact on GUM training, possibly deterring trainees currently considering applying but potentially also attracting other trainees who may not previously have considered it.

P191 Survey of genital dermatology training amongst genitourinary medicine (GUM) specialist registrars

Introduction There has been no recent review of genital dermatology (GD) training for GUM trainees. The 2010 GUM specialist registrar curriculum states specific learning objectives that trainees should meet by CCT. Aim In order to evaluate and improve training, the BASHH GD Special Interest Group (SIG) conducted an online survey to assess specialist registrar training in GD. Methods The survey was designed through Survey Monkey and cascaded to trainees across the UK in 2014. Results 42 trainees responded, representing several deaneries (50% London) and grades. 68% of trainees receive GD training through adhoc clinical teaching; 85% through formal lectures. 26%, 32%, 37% have attended specialist GD clincs by gynaecologist, GUM physician, dermatologist respectively. Mean confidence in managing specific conditions varied from 5 (vulval pain syndromes) to 7.5 (fungal infections) (1–10 confidence scale). 47% were ≥7/10 confident in topical steriod use (1–10 confidence scale). Independently able to perform procedures: 21% punch biopsies, 63% fungal scrapings, 15% curettage. 50% of trainees are satisfied with GD training with 69% feeling they will be adequately trained by CCT. 58% would like a formal qualification in GD to be available. Discussion Training in GD is variable with mixed confidence in diagnosis, treatment and practical procedures. Many trainees feel training could be improved with requests for a formalised attachment, formal qualification and greater training in practical procedures. The BASHH GD SIG, in liaison with BASHH, aims to optimise GD training for registrars. Plans for improved resources are in progress, including a practical skills course and e-learning.

Genitourinary Medicine trainees’ experience and training needs in the management of patients disclosing sexual violence

The British Association for Sexual Health and HIV (BASHH) Sexual Violence group assessed the level of confidence of Genitourinary Medicine (GUM) trainees in managing patients disclosing sexual violence using an online survey. Twenty-eight percent of current UK GUM trainees responded. The results demonstrated wide variation in trainees' experience and confidence in managing these patients, which was dependent on the patient type, as well as the gender of the trainee and the number of years' experience the trainee had in the specialty. There were also differences in the reported availability of training in this specialist area. Regular accessible training in identification and management of patients disclosing sexual violence is recommended for GUM trainees.

P2.148 Uptake and Evaluation of an Electronic Learning Tool For Sexually Transmitted Infections and HIV

Background An elearning tool: eHIV-STI was developed by the British Association for Sexual Health and HIV (BASHH), the Royal Colleges of Physicians (RCP) and e-Learning for Healthcare. The first sessions went live in February 2010 and the project was completed in December 2011 with 141 sessions. eHIV-STI covers the knowledge component of the UK Genitourinary Medicine (GUM) training curriculum, from introductory to advanced STI and HIV knowledge required for practise as a specialist. It also acts a refresher for established consultants and has been approved by the RCP for external CPD, supporting revalidation. It is available free to all clinical staff in the NHS. Introductory sessions have been embedded in STI training for non specialists, and for GUM trainees, since 2012, sessions are used to complement national specialist courses, delivering some knowledge in advance by allowing the face to face sessions to deal with more complex issues. Methods Using reports generated within the learning management system we undertook detailed analysis of usage of the tool since its introduction, by clinician type, sessions accessed, and evaluation of sessions, as well as collating more specific feedback from trainees using it as an adjunct to training courses. Results The number of registered users has risen steadily since 2010 to 10217 individual users accessing sessions 104857 times by the end of 2012. The majority of GUM trainees and consultants are registered users, but additionally it is used extensively across the health service including 2341 nurses, 1122 newly qualified doctors and 1259 general practitioners. Evaluation of the material ranges from 4.3 to 4.6 out of 5 for content, presentation, interactivity, and self assessment. Conclusion eHIV-STI has rapidly become a very well used and evaluated learning tool for clinicians working in the fields of sexual health and HIV and in allied areas.

GUM trainees and workforce planning

Workforce planning is an inexact science. Crucial information such as consultant retirement plans and the actions of trusts in developing new posts, refilling vacancies and reconfiguring services in the face of financial pressures are unknowns. ‘Liberating the NHS’1 is likely to result in far-reaching consequences for the genitourinary medicine (GUM) workforce. Pension changes may result in more immediate workforce implications. Other variables such as ‘community working’, new commissioning arrangements, development of other specialties and actions of devolved nations will take time to impact. From the Health Protection Agency's 2010 data the number of sexually transmitted infections diagnosed in UK GUM clinics is 30% higher than a decade ago and the total number of services provided by clinics are four times higher than in 2001.2 The increasing workload has not resulted in equivalent GUM consultant expansion in the last 10 years. The 2010 Royal College of Physicians (RCP) data show a 5.4% increase from 2009 to 391 consultants. The RCP consultant census provides consultant workforce data and in 2009 was completed by only 45% …

Post-coital bleeding in young women: the role of genitourinary medicine

Recently published Department of Health (DoH) guidelines and National Health Service Cervical Screening Programme guidelines recommend referral to a genitourinary (GU) medicine or sexual health clinic as part of the management pathway for young women with post-coital bleeding (PCB). The objectives of this questionnaire study were to ascertain whether GU medicine practitioners agreed with these recommendations and to assess which skills were considered necessary regarding the diagnosis and management of cervical pathology in departments of GU medicine and sexual health and also, therefore, in training in the specialty. The majority of respondents considered it important to check for cervical infection in determining the cause of PCB, but few GU medicine practitioners now perform colposcopy and many consider themselves insufficiently trained to assess the cervix in more detail. Since the colposcope is the optimal tool for examining the anogenital tract, we suggest that colposcopy, in its broadest sense, should be reconsidered as an essential part of GU medicine training.

Training in genitourinary medicine from the specialist registrar's point of view: opportunities and facilities available across the UK and plans for future working.

In recent years training for specialist registrars (SpRs) in GU medicine has undergone a number of changes. In addition, the speciality in general is undergoing modernization and change and issues of workforce planning and consultant job availability have been of particular importance to SpRs. In March 2003 a postal survey of SpRs in the UK was undertaken to evaluate training, future career plans and working patterns. A 59% (69/117) response rate was achieved and overall most SpRs expressed satisfaction with their training. However, a number of concerns were raised with aspects of training, which are discussed in this paper. Nearly half of SpRs will consider working part time in the future and almost two-thirds are interested in job sharing. This is the first survey of its kind in GU medicine and the results are informative to all involved with SpR training programmes and workforce planning in the speciality.

Level 2 genitourinary medicine training and ongoing supervision -- how we can all benefit.

An innovative six-month, two sessions a week, funded clinical attachment programme was devised and introduced for practical training and experience to meet the demands and requirements of those wishing practical experience and training in genitourinary medicine. This has been generated by interest from previous theoretical teaching and as a desire to provide Level 2 services in the community. To date four doctors have completed this training with excellent mutual evaluation and a recognition by all involved, including commissioners, of the importance of maintaining a regular formal session while providing Level 2 community sexual health services. To be formally recognized improved evaluation, standardization and certification are required. However, if pursued, this package with continuing specialist links should prove beneficial to all involved and with the current epidemic of sexually transmitted infections will improve and enhance available services.

Margaret Joan Godley, frcog, dip ven

Maggie Godley died peacefully at home on 24 January 2000. She was found to have disseminated ovarian cancer in October 1997, and endured extensive surgery and chemotherapy with typical no-nonsense...

The clinical load of HIV and AIDS for genitourinary physicians.

We aimed to investigate the extent of genitourinary medicine (GUM) involvement in the clinical management of HIV. A questionnaire survey was conducted on GUM consultants in the UK and the Irish Republic. Clinics were divided into teaching hospitals (THs) undertaking both undergraduate and postgraduate training in GUM, non-teaching training (NTT) centres undertaking specialist training only and non-teaching (NT) centres. Information was obtained on 241 of the 250 consultants on the Royal College of Physician's GUM Committee's records from 117 GUM clinics (including all THs and NTT centres). Four (1 TH and 2 NTT centres) GUM clinics did not see HIV-positive patients, 62 saw 10-99 patients, 18 reported 100-999 and 4 with over 1000 patients attending in 1996. Thirty-five per cent of the 55 THs and NTT centres had over 100 HIV patients. Consultants were involved in the outpatient care of HIV patients in 99.5% and GUM trainees in 85.5% clinics. Overall 47 clinics have their own inpatient HIV beds and 176 consultants (73%) had full (100) or significant (76) input to inpatient HIV management. Only 29% of THs and 12.5% of NTT centres had none or minor input into HIV care. HIV inpatient on-call commitment by the GUM trainees was reported by 64% of training centres. GUM services provide a major input into outpatient and inpatient care of HIV-infected patients in the UK.

Should training in colposcopy be obligatory in higher specialist training in genitourinary medicine?

Should training in colposcopy be obligatory in higher specialist training in genitourinary medicine?