The beauty of Respiratory Medicine is its broad scope. There are many different primary pulmonary diseases, and the lung is also secondarly involved in many other systemic diseases. In addition, research areas are also diverse, encompassing both the clinical arena and basic immunology and molecular biology. Lung pathology is diverse and ranges from airways disease, to cancer to infective disease and inflammatory/vasculitic processes.
There is the opportunity to indulge one's yearning for practical procedures in the bronchoscopy list and for the high tech in the ITU, with which respiratory Medicine is developing closer links. This is definitely a specialty that truly can offer something for everyone.
Specialty Description
Respiratory Medicine is one of the two major specialties of acute General Internal Medicine (GIM). Approximately 30% of all acute admissions in GIM are for a primary respiratory problem - similar figures to Cardiology - and Respiratory Physicians are essential and major contributors to the acute medical take in all acute hospital trusts. Respiratory Medicine has a close relationship with Critical Care Medicine.
Most Respiratory Physicians supervise non-invasive ventilation in the support of patients with acute respiratory failure in the High Dependency Unit environment, and many have sessions helping to run Intensive Care services and expertise in the management of the Adult Respiratory Distress Syndrome. Respiratory Physicians have considerable technical skills. They undertake bronchoscopy (both diagnostic and, increasingly, interventional), pleural procedures (including pleural biopsy and chest drain insertion), medical thorascopy for the more invasive investigation of pleural effusion and non-invasive ventilation. They have considerable expertise in cardiopulmonary physiology and run lung function laboratories in most hospitals for the interpretation of complex lung function testing, a cornerstone of respiratory diagnosis.
In the outpatient setting, Respiratory Physicians run the services for lung cancer and tuberculosis in most Trusts. They are referred patients with a vast range of pulmonary and non-pulmonary conditions, the latter since the lung is involved in many non-pulmonary systemic conditions. A large percentage of their outpatient work involves the investigation, diagnosis and management of patients referred with the non-specific complaints of chest pain, cough and breathlessness of unknown cause such that most Respiratory Physicians have considerable expertise in dealing with diagnostic uncertainty. For this reason, they are often a port of call for other medical practitioners when there are other more general non-specific symptoms for which a diagnostic explanation is elusive.
They also run early discharge, hospital at home and pulmonary rehabilitation services for COPD and have considerable skill in the management of terminally ill patients. Some Respiratory Physicians run services for lung transplantation. Among specific disease areas that are the principal remit of Respiratory Physicians are a vast array of inherited (e.g. Cystic Fibrosis), congenital, infective (e.g. pneumonia, empyema, opportunist infection including transplant and HIV -related disorders, bronchiectasis, TB), inflammatory (e.g. eosinophilic lung disease, vasculitis, interstitial lung disease), vascular (e.g. pulmonary embolism, primary pulmonary hypertension), malignant (e.g. lung cancer, mesothelioma, mediastinal tumours), allergic, sleep-related, neuromuscular, and airway (asthma, COPD, obliterative bronchiolitis) diseases.
Competence Based Curricula and Assessment - StRs (for trainees who commenced training from 1 August 2007 to present)
There are two versions of curricula for this training period:
StRs who commenced training between 1st August 2007 and 3rd August 2010 will follow the 2007 version of their specialty curriculum and the 2007 Generic curriculum. Please see the 2007 Curriculum section of this webpage.
StRs who commenced training from 4th August 2010 onwards will use the 2010 version of their specialty curriculum. There is no need to follow the previously known ‘Generic curriculum' as this has now been embedded into the specialty curriculum. Please see the 2010 Curriculum section of this webpage.
The Joint Royal Colleges of Physicians Training Board (JRCPTB) is pleased to announce the 2010 Respiratory Medicine curriculum which has been reviewed and rewritten to:
- meet the GMC's 6 new standards as detailed in their Standards for Curricula and Assessment systems
- keep up to date with medical advances and changes in the service and training
- incorporate the framework documents produced by the Academy of Medical Royal Colleges (AoMRC) detailing Common, Medical Leadership and Health Inequality competencies
- include 5 new assessment methods (Acute Care Assessment Tool, Case based Discussion, Patient Survey, Teaching Observation and Audit Assessment).
This new curriculum has improved content, design and usability compared to its predecessors, and reflects a great deal of hard work and time expended by specialty curriculum groups. This curriculum will become the training manual for all trainees entering ST3 from 4th August 2010.
For further information on the 2010 curriculum it is recommended that you read the Quick Start Curriculum Guide.
If you have any queries or problems regarding the 2010 curriculum please email ptb@jrcptb.org.uk.
Core Training Programmes
Entry into Respiratory Medicine training is possible following successful completion of both a foundation programme and a core training programme.
There are 2 core training programmes for Respiratory Medicine training:
Assessment
The following methods are used as part of the integrated assessment system:
The assessment blueprint, which is embedded in the clinical syllabus, shows the possible methods that can be used to assess each of the competencies in the curriculum. Trainees and trainers should refer to the blueprint 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 ARCP Decision Aid. It is not expected that all competencies will be assessed by all methods, rather that there will be a sampling of competencies within a variety of settings, both within formal and workplace-based assessment, from which overall competence acquisition has to be determined.
The diagram below describes the training pathway:
Please view the 2010 curriculum for Respiratory Medicine for full details on the training routes and selection criteria.
Entry into Respiratory Medicine training is possible following successful completion of both a Foundation Programme and a core training programme.
Please view the 2007 curriculum for Respiratory Medicine for full details on the training routes and selection criteria.
Assessment
The assessment blueprints show the possible methods that can be used to assess each of the competencies 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 ARCP/RITA Decision Aid. It is not expected that all competencies will be assessed by all methods, rather that there will be a sampling of competencies within a variety of settings, both within formal and workplace-based assessment, from which overall competence acquisition has to be determined.
Further information on the various methods of assessment can be viewed in the Assessment section of this website.
The diagram below describes the training pathways in general terms.
Competence Based Curricula - SpR (for trainees who commenced training between 1 Jan 2003 and 31 July 2007)
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 - SpR (for trainees who commenced training before 1 Jan 2003)
The curricula for trainees enrolling pre 01/01/03 are no longer available on the website but can be obtained by request to ptb@jrcptb.org.uk.