Metabolic Medicine

In 2001, the Postgraduate Medical Education and Training Board gave approval for a training programme which would provide additional subspecialty recognition to programmes leading to a CCT (CCT) in Chemical Pathology or General Internal Medicine. A new training subcommittee was established, under the auspices of the JRCPTB, with membership drawn equally from the Royal College of Pathologists and the JRCPTB. This committee approves Regional programmes, and has developed the training record and other documentation necessary for both trainers and trainees.

What is the primary purpose of the specialty?

Metabolic Medicine can be defined as a group of overlapping areas of clinical practice with common dependence on detailed understanding of basic biochemistry and metabolism.   It therefore falls within the areas of expertise of both the physician and chemical pathologist.   Other training programmes do not adequately meet all requirements, particularly with respect to nutritional disorders and adult patients with inborn errors of metabolism (IEM).   The areas included are:

• Disorders of nutrition
• IEM
• Disorders of lipid metabolism and CV risk assessment
• Disorders of calcium metabolism and bone Diabetes
• Diabetes 

The main objectives of the Metabolic Medicine curriculum is to provide a scientific and clinical training for several areas of medicine which require greater knowledge of:

• Biochemistry, genetics and molecular biology than most organ-based specialities
• To develop the clinical training of Chemical Pathologists who wish to practice, predominantly on an outpatient basis, in these areas of medicine
• To support the academic progress and development of Metabolic Medicine This curriculum is set to the standards required by the JCHMT or Royal College of Pathologists and PMETB to ensure that trainees are fully prepared to lead a specialist clinical service in any of the five areas.

Choosing a career in Metabolic Medicine

Metabolic Medicine training with General Medicine is likely to be chosen by individuals with specific academic interests or those who wish to work with patients with inherited metabolic diseases. New drug treatments and better nutritional products for these individually rare conditions have resulted in improvements and changes to these individuals' prognosis. This developing field is very rewarding to work in and rapidly changing.
 
Trainees in Chemical Pathology can also gain subspecialty accreditation in Metabolic Medicine, and develop competencies to lead predominantly outpatient clinics in one or more of the clinical modalities of Metabolic Medicine. They would also be closely involved in laboratory work and usually lead the service. They would ensure the quality of laboratory results and guide clinicians to maximize the clinical benefits of laboratory tests in diagnosis, prognosis and monitoring.

For Chemical Pathology
The duration of training is determined by the time taken to achieve competencies, but at a minimum determined by the European Union of 7 years Detailed entry requirements and outline of training can be found in the Metabolic medicine Curriculum.

Due to regular revisions, arising from changes in the training environment and the requirements of the PMETB, the JRCPTB are currently running various curricula for trainees in each specialty.  All relevant curricula are listed at the bottom of this page under Documents.  Use the filter option on the right-hand side, together with the guidance notes below,  to help you select the correct document.  In summary:

• If you are a run-through (Specialty Registrar [StR]) trainee, you will follow the curricula tagged as ST3+

• If you are an ‘old style’ SpR, you are following the curricula tagged as SpR

• If you enrolled prior to 01/01/03, you will be following the original curricula which are no longer available for download, see note below

 
Competence Based Curricula and Assessment – StRs

PMETB has received the assessment system (blueprint and RITA/ARCP grid) for Metabolic Medicine and this has been approved.  

The assessment blueprints show the possible methods that can be used to assess each of the competences in the curriculum. Trainees and trainers should refer to the blueprints for guidance on the appropriate assessment methods for each aspect of the curriculum, and so plan the training programme according to the criteria set by the RITA Decision Aid. It is not expected that all competences will be assessed by all methods, rather that there will be a sampling of competences within a variety of settings, both within formal and workplace-based assessment, from which overall competence acquisition has to be determined.  RITA Decision Aids are not available for sub-specialties.

 Acute care common stem (Medicine) trainees will also follow the ACCS training manual.

Competence based curricula – SpR (for trainees enrolling after 1 Jan 2003)

The JCHMT introduced revised curricula for all the medical specialties together with a generic curriculum that applied to all trainees back in 2003. These are competence-based and set out the knowledge, skills and attitudes to be acquired by trainees before they may be awarded a CCT. 

Curricula (for trainees enrolling before 1 Jan 2003)