Professor Jonathan Edgeworth
Professor Michael Malim
Guy’s and St Thomas’ (GSTT) has pioneered the modernisation of UK infection services by integrating clinical microbiology and virology, infectious diseases (ID), infection prevention control and antimicrobial pharmacy in a single Directorate, which reports directly to the Board. The Directorate has consultants in ID general medicine, ID/microbiology, microbiology and virology that provide trainee supervision and mentorship. Trainees rotate between clinical posts in ID, microbiology & virology and specialist service provision in critical care and cancer & transplantation across both sites. There are opportunities to develop clinical research interests either on the St Thomas’ site, or discovery science leaning interests on the Guy’s site.
We tailor our programme to the needs of the trainees, with monthly training meetings, weekly teaching and seminar programmes, and consultant cover to allow trainees to attend external training days. The laboratory, translational research and video conferencing facility (CIDR), microbiology, virology, infectious diseases and infection control teams, are co-located to ensure optimal interdisciplinary working and support. Consequently, our infectious diseases/ microbiology (ID/M) specialist trainees gave our department highest marks as strong positive outlier in 2013 and 2014 GMC national training survey making us top London Trust for ID/microbiology training, and prompting a Deanery Best Practice visit in 2014.
We have ten trainees at GSTT at any one time rotating with other London hospitals. Trainees are specialising in ID/microbiology, ID/virology or ID/general medicine and rotate to GSTT in the course of their training programmes. There are two trainees attached to the virology service at any one time. ACFs join the same clinical rotation as other trainees with time in infectious diseases, acute medicine, general practice, microbiology and virology, and infection control, and also in specialist services including HIV, hepatitis and genitourinary medicine, transplantation and haemoncology, obstetrics and paediatrics. The Academic Clinical Lecturer (ACL) will spend the majority of their time in ID, virology or microbiology depending on their chosen sub-speciality interests.
Academic Clinical Fellows (ACFs) spend a single block of 6 months in research with the rest of their time undertaking clinical work and ACLs spend 50% of their time in research in 6-month blocks rotating from clinical training to research. Both ACFs and ACLs typically begin with a short clinical microbiology/ID attachment, to familiarise themselves with the broad range of clinical and laboratory services at GSTT and to facilitate participation in the Infection on-call Specialist Registrar rota. For all academic trainees, the guiding principle is to tailor training according to their remaining training requirements, and to facilitate development of their specific interests and career aspirations.
Training will also address the broader range of skills of a consultant including clinical audit and aspects of laboratory management including safety, quality control, and business case development. There will be an opportunity to undertake clinics in general ID, hepatitis or HIV. The ACFs and ACLs can also join the combined microbiology/virology on-call rota once they have completed their initial general microbiology/ID consult post, in rotation with other trainees.
The ACL will be encouraged to organise the weekly postgraduate education seminars, with particular focus on academic relevance, and contribute advice and direction to other trainees considering embarking on academic careers in conjunction with consultant colleagues. ACFs and ACLs will attend and participate in the weekly departmental postgraduate education seminars, case conference meetings, consultant-led taught bench rounds and weekly virology tutorials and case review sessions. They will also be supported to attend regional StR training days and participate in GSTT courses on relevant aspects of training such as management, good clinical practice and research ethics. An educational supervisor will be allocated with whom they will have regular meetings. During their six months laboratory/research blocks the ACL may continue their general HIV or HIV research clinic if that is appropriate to their academic development. There will also be a commitment to teaching medical students and junior doctors during this period.
Research projects may be based: 1) at Guy’s Hospital, where the focus is laboratory-based investigation of the dynamic interactions between viruses or bacteria and the human host using a raft of molecular genetic, cultured cell, biochemical, structural, bioinformatic, systems, animal model and/or cohort-based methodologies to study the principles that underpin pathogen replication and persistence, and the host immune response; 2) at St Thomas’ Hospital where translational research is embedded in clinical/ diagnostic service and focuses on pathogen genomics, anti-microbial resistance (AMR) and stewardship, healthcare-associated infections, fecal microbiome transplantation and vaccine trials; or 3) in close collaboration across the two sites as highlighted by a multitude of COVID-related projects addressing key areas such as diagnostics and viral variant recognition, transmission patterns, immune responses, correlates of disease outcome, community infection and surveillance, immunity, virus replication and long-term persistence. Project selection will be tailored to the research interests of the ACF/CL, in close consultation with Edgeworth and Malim.