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In this article, Dr Sarah Schoeman, co-chair of the Royal College of Physicians Genitourinary Medicine (GUM) Speciality Advisory Committee, interviews Dr Khine Phyu and Dr Michael (Mikey) Ewens to discuss their experience in becoming the first dually trained and accredited consultants in GUM/General Internal Medicine (GIM) in the UK.
Sarah: Why did you decide to pursue dual rather than single accreditation?
Khine: During the early stages of GUM training, I became aware of the clinical diversity of GUM, for example, the ageing HIV population with complex comorbidities and polypharmacy and the systemic involvement that characterises many sexually transmitted infections (STIs). I also realised the importance of multidisciplinary interactions. This motivated me to maintain my GIM skills and knowledge, and to pursue dual training.
Mikey: I recognised the significant benefits of having GUM-trained physicians on the acute/general medical wards. For example, being able to identify systemic presentations of STIs such as syphilis, sexually transmitted enteric infections and STI-related reactive arthritis. I also wanted to feel confident in providing comprehensive comorbidity management for patients with HIV.
Sarah: What proved to be the most challenging aspect of dual training?
Mikey: Maintaining a balance between attending to training needs and service provision proved difficult. Appropriately, the new dual-training curriculum is integrated throughout the 4 years of training. A flexible, individualised approach is key to ensuring adequate training and a good work–life balance. (Of note, Mikey and Khine completed their GIM training through extended additional training time towards the end of their training programme).
Khine: Organising my working week to meet the needs of both GUM and GIM competencies was challenging, but definitely achievable. One of the strengths of GUM is the abundance of opportunities it offers for acquiring essential generic skills required in dual training. Training in two different specialties is challenging, but it is also exciting and motivating.
Sarah: What has proved to be the most rewarding aspect of dual training?
Khine: We have acquired numerous new and transferable skills and gained greater confidence in managing chronic medical conditions.
Mikey: An added bonus has been the opportunity to forge valuable friendships and alliances within other specialties.
Sarah: Please describe your first day in GIM as a GUM/GIM consultant. (figure 1 captures this first day. online supplemental file 1 published with written permission from Mikey and Khine.)
Supplemental material
Photo of Mikey and Khine on their first day in General Internal Medicine (GIM) as dually accredited consultants in Genitourinary Medicine/GIM.
Khine: I began with a personal introduction as not many were anticipating the presence of a GUM consultant on the general medical ward. My background in an outpatient-based specialty proved valuable in conducting a thorough and individualised ward round in a timely manner. Leading the ward round and providing bedside teaching for the junior doctors in attendance was very rewarding.
Mikey: The day was exciting and nerve-wracking at the same time! I worked on Same Day Emergency Care, where the model of delivering senior care is similar to that of GUM, and this played to my strengths. I ensured the Rheumatology trainee was able to diagnose chlamydia in a patient with reactive arthritis and diagnosed HIV in a patient with metastatic cancer.
Sarah: Where do you see yourself in 5 years’ time?
Khine: It is still early days, but I believe I will still be working in both GUM and GIM and supporting the development of dually accrediting GUM/GIM trainees.
Mikey: I will be definitely working in both GUM and GIM, helping support continuous improvement of both departments, including expanding pre-exposure prophylaxis services and enhancing support to those who are not currently receiving HIV care in a manner that aligns with their needs and preferences. I also hope to hold specialty-specific national roles.
Sarah: What are your top tips for dually accrediting trainees?
Khine:
Begin each training year by crafting a comprehensive personal development plan and engage in discussions with both your GUM and GIM educational supervisors. Clearly outline your priority achievements.
Attend GIM teaching sessions and conferences. These are not mere ‘tick box’ exercises but very helpful learning resources.
Mikey:
Book your courses early! Particularly the Advanced Life Support course as the waiting list can be long.
Enjoy the training experience and absorb as much knowledge as possible. Share the fantastic expertise and additional skills that come with being a GUM doctor with colleagues in other specialty teams.
Closing statement
Sarah: As demonstrated by Mikey and Khine in this interview, the benefits of dual GUM/GIM training are multiple. As well as improving the future management of people living with HIV and enabling earlier diagnosis and better management of STIs in our hospitals, dual-trained GUM/GIM consultants also have additional skills and more career choice/options than single-accredited colleagues. Dual GUM/GIM training, therefore, benefits both patients and clinicians.
Ethics statements
Patient consent for publication
Ethics approval
Not applicable.
Footnotes
Handling editor Anna Maria Geretti
Contributors DR suggested the interview. SAS wrote the interview questions. ME and KP wrote their responses to the interview questions. All authors were involved in reviewing and editing the article. SAS submitted the article.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Commissioned; internally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.