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
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
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
(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
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.