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

2 Specialties Metabolic medicineof Health (DH), which define the facilities, servicesand treatment that should be available for patients.Education and trainingEducation and training are important aspects of the workof MM physicians who teach and train medical students,qualified doctors in many disciplines, nurses and laboratoryscientists. The training curriculum for MM 1 reflectsthe need to support the development and maintenanceof skills and acquisition of knowledge required for proficiencyin the investigation, diagnosis and management ofall five MM domains, together with generic competenciesnecessary to support good medical practice.Mentoring and appraisal of medical staff andother professional staffAll MM physicians undergo annual appraisal. Thosewith a management role will often act as appraisers intheir organisation. Consultants will also assist with theappraisal and assessment of medical trainees.Continuing professional developmentA minimum five-year requirement of 250 CPD credits isrequired, calculated on a five-year rolling cycle, where onecredit usually equates to one hour of educational activity.Clinical governanceA MM physician has a defined role in clinicalgovernance arrangements having responsibility for thequality of the results issued by the clinical biochemistrylaboratory. Mechanisms include participation ininternal quality control and external quality assuranceschemes and attainment of recognised accreditation.Research – clinical studies and basic scienceMM physicians are encouraged to undertakehigh-quality clinical studies and basic science researcheither individually or in collaboration with academicand scientific colleagues.Local management dutiesMM consultants can be clinical directors or hold otherleadership or management roles within a NHS trust.Specialty and national guidelinesThere are guidelines pertinent to laboratory and clinicalaspects of all the MM domains. Some of these are fromspecialty societies, eg Disorders of nutrition guidelines for themanagement of patient with a short bowel, availablefrom the Small Bowel and Nutrition Committee ofthe British Society of Gastroenterology. 2 A consensus document for the diagnosis andmanagement of patients with IMD, available fromthe NSPKU. 3Guidelines from NICE include those for nutritionsupport, obesity, diabetes, cardiovascular riskassessment and lipid management and familialhypercholesterolaemia. 4Specialty and national auditAudit is carried out within the domains of MM viaspecialist societies such as the Association for ClinicalBiochemistry (www.acb.org.uk). Relevant nationalaudits include the National Clinical Audit of theManagement of Familial Hypercholesterolaemia, 5 andthe National Diabetes Audit 6 which is considered to bethe largest clinical audit in the world.Quality tools and frameworksFor the laboratory aspects of the service, accreditation 7and benchmarking exercises, such as the nationalpathology benchmarking service, 8 provide measurablequality standards. For the clinical aspects of MM,national service frameworks have been developed fordiabetes and coronary heart disease. 96 Clinical work of consultantsHow a consultant works in this specialtyThere is considerable variation between consultants.Those with laboratory duties may spend the equivalentof a day a week as duty biochemist with front-lineresponsibility for clinical validation of results andtroubleshooting of analytical problems and additionaltime on the development of laboratory services. Thosetrained in general internal medicine are likely to haveadditional clinical duties on the wards and mayundertake general medical outpatient clinics.Inpatient workThere is variation in the amount and type of inpatientwork according to the domains of specialist interest ofMM physicians. Typical duties might include: nutrition ward round for 15 patients, 2–3 hours general medical, IMD or nutrition MDT meeting todiscuss complex patients, 1–2 hours IMD ward round for those admitted forinvestigation and more complex patients admittedwith acute metabolic problems, 2–3 hoursC○ Royal College of Physicians 2013 169