Consultant physicians working with patients - Royal College of ...

2 Specialties Infectious diseases and tropical medicineMentoring and appraisal of medicaland other staffAll infectious diseases physicians undergo annualappraisal through their trusts or universities, or both. Inaddition, many take on management roles and thereforethey often act as appraisers for their organisations. Theyalso help with assessments and appraisals of traineesand other staff.Continuing professional developmentAll physicians take part in continuing professionaldevelopment (CPD) activities locally, nationally andinternationally through the CPD scheme. Many, if notall, contribute by providing teaching and training forothers to contribute to their CPD. There is a minimumrequirement for consultants to achieve an average (overfive years) of 50 hours of CPD annually.Clinical governancePhysicians in infectious diseases understand the needfor good clinical governance. Through organisationssuch as the British Infection Association (BIA), theBritish HIV Association (BHIVA), the British Society ofAntimicrobial Chemotherapy (BSAC), the Royal Societyof Tropical Medicine and in collaboration with theRoyal College of Pathologists (RCPath), physiciansdevelop guidelines (eg management of meningitis, feverin returning travellers and SARS) and help toimplement these locally. Through the RCP, infectiousdisease physicians have key roles on the JointCommittee on Infection and Tropical Medicine. Allphysicians will undergo appraisal.Research – clinical and basic scienceCompared to most medical specialties, a largeproportion of physicians in this specialty have academicappointments. At least half are academics (up to 80% ofthose in tropical medicine have academicappointments) and contribute significantly to researchnationally and internationally. Research varies frombasic science, often virological or immunological,through to clinical science and clinical trial work.British tropical medicine continues to have a highinternational profile in subjects as diverse as malaria,HIV, TB, dengue fever and rickettsial diseases.Local management dutiesMost infectious diseases physicians play an active role inlocal management, either as clinical leads or serving oncommittees for infection control. Most have taken onclinical directorships and some have become medicaldirectors of trusts. Most will have managementresponsibilities relating to MDTs.Specialty and national guidelinesInfectious diseases physicians and their professionalsocieties help to formulate and comment on guidelinesfrom the National Institute for Health and CareExcellence (NICE), the RCP and other organisations.Manyindividualshaveservedoncommitteestoformulate guidelines such as those dealing withmeningitis, TB and HIV. These have been published byBIS, BHIVA and other organisations.Specialty and national auditInfectious diseases physicians routinely take part innational audits organised by the HPA, BHIVA andothers, and contribute to the surveillance of infections.In addition, they are involved in the use of audit toassess clinical and other services in their own trusts.6 Clinical work of consultantsThe clinical work of infectious diseases consultantsincludes the following: Inpatient work: most infectious diseases physiciansare responsible for the care of acute admissions withinfection-related problems. A typical physicianwould be responsible for 500–600 admissions perannum. Outpatient work: outpatients is an important facetof the physician’s work and increasingly involves thecare of those with HIV and hepatitis virusinfections. A physician would be expected to see1,000–1,200 outpatients per year. Specialist procedures: infectious diseases is not aprocedure-based specialty but physicians often haveto deal with occupational exposure to blood-bornepathogens in healthcare workers and sort outpost-exposure prophylaxis for HIV exposures.However, an important ‘procedure’ is the need toprovide timely consultations to other services toprovide the best infection care. Consultation work isan important part of the infectious diseasesphysician’s workload. Specialist on call: most physicians will take part in aregular on-call rota for infectious diseases. Due tothe acute nature of the specialty this often requiresthe presence of the physician in the hospital out ofhours and involves weekend ward rounds. Mostphysicians would expect to be part of an on-call rotaof one in three or less.C○ Royal College of Physicians 2013 149