Select Committee on Science and Technology Minutes of Evidence

Further information from Dr Derrick Crook and Dr Robert C Spencer

"How does the epidemiologists/CCDCs training fit into the joint training between microbiology and infectious disease?"

Response by Dr Derrick Crook

  The epidemiologists/CCDCs training does not fit into the Joint training scheme officially. The Joint RCP/RCPath committee on ID and Clinical Micro discussed a proposition to merge epidemiolgists/CCDCs training into the newly created Joint ID/Clinical Microbiology and Virology training. This proposition was never taken further.

  However, joint trainees are eligible to apply for posts as epidemiologists or CCDC's (eg Dr Kyle Knox has just been appointed a CCDC in Oxford and is completing joint ID/Micro training). I believe that the appointment of jointly trained people to epidemiolgists/CCDCs posts will be a very positive development. It is clear; however, that the training curriculum of both ID and Clinical Micro and Virology would benefit from a substantial increase in the emphasis on training and experience in epidemiology, management of outbreaks, statistics and a formal understanding of evidence based medicine. These aspects are poorly developed in both training schemes.

  Were the joint training enhanced to emphasize epidemiology, this would provide a better background for people who wished to go down the track of an epidemiolgists/CCDC. It would also reassure the Faculty of Public Health, the HPA and DOH that better training was being offered to the ideal candidates for CCDC posts.

  One attractive advantage of the changes arising from the creation of the HPA is the opportunity to look at remolding PHL training slots by turning them into joint training posts which could have an emphasis on epidemiology. This would need to be addressed early, for example before April 2003 when irreversible changes may already have been made to PHL training posts.

  A practical way of achieving this could be as follows:

  1.  Persuade the colleges to enhance epidemiology and outbreak training in the Joint ID/Clin Micro training.

  2.  Establish an HPA sponsored fellowship programme that aimed at building a cadre of infection experts and future leaders trained in epidemiology.

  3.  The fellowships could consist of the following:

    (a)  Competitive entry with a proposal for training and research project. This could be based on the same criteria as getting a Wellcome or MRC training fellowship. It could be open to anyone wishing to follow joint ID/Micro training (could include established trainees).

    (b)  Joint training in ID/Clinical microbiology (five years or less depending on the candidate's experience).

    (c)  Funded research fellowship of three years including salary and consumables investigating a subject of relevance to the HPA (eg i. the transmission of campylobacter using sequence based molecular epidemiology of the organism or ii. the burden and economic cost of Norwalk outbreaks).

    (d)  Elective opportunities during clinical and laboratory training to gain training at CDSC, HPA reference units or overseas centres such as the CDC, Atlanta.

  These fellowships could be based at any academic centre of excellence in England or Wales and would need to be developed jointly with HPA.

  In the long-term it would be very helpful was the committee able to encourage an abbreviation in the training required for Joint ID/Clinical Microbiology and Virology training from six years to five years training (one year of research counts). Also to encourage the RCPath to simplify the exit exam away from the recently implemented three part exam running over three years to a single easy to administer exit exam. These practical changes will make the joint training even more attractive to high caliber candidates than the current scheme. Hopefully the anticipated changes planned by the government for re-organising medical training would be a good time to implement such changes.

Response by Dr Robert C Spencer

  In reply to your question re CCDC training etc, in Bristol we have an arrangement whereby SpRs in Public Health Medicine spend some time in our Laboratory and the SpRs in Medical Microbiology spend some time with the local Health protection Unit (CCDCs)

  At a recent CBRN training day for CCDCs/PH for London and the East, 50 per cent of the audience of 50 said they had had laboratory exposure and 100 per cent of these considered it a very useful secondment. If their lady/lordships feel that something more formal should be in place, I will be happy to bring it to the attention of the Royal College of Pathologists.

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