Why are the curriculum changes taking place?

The Shape of Training (SoT) review was launched in 2012. It’s report was published in October 2013 and recommended a reform of postgraduate training of all doctors to ensure it is more patient focused, more general (especially in the early years) and has more flexibility of career structure. This fits with HIV being a chronic, treatable condition with an increasing burden of medical comorbidities in an ageing cohort. A further driver for change was the GMC review of the curricula and assessment standards, which led to the GMC’s report ‘Excellence by design: standards for postgraduate curricula’ in May 2017’. It concluded that all new postgraduate curricula should be revised from 2020 and that the large number of detailed curriculum competencies should be replaced by fewer higher level learning outcomes known as capabilities in practice (CiPs). Curricula must also incorporate Generic Professional Capabilities (GPCs) to ensure that the patient is at the centre of any consultation and decision making.

What does the current Genitourinary medicine (GUM) curriculum train you in?

The 2016 updated curriculum offers training in: investigation, diagnosis and management of acute and chronic sexually transmitted infections (STIs) and blood-bourne viruses (BBVs) ie HIV and Hepatitis, in cis and trans men and women including non-binary individuals, contraception, HIV in-patient, out-patient and on-call management including management of HIV in pregnancy, adolescents, hepatitis co-infection, TB co-infection, Antiretroviral Therapy (ART), psycho-social aspects and sexual and reproductive health in HIV. In addition, it offers training in managing sexual health in specific groups such as men who have sex with men (MSM), children, young people and prisoners. There is also training in Obstetrics & Gynaecology, Dermatology, epidemiology and public health competencies relevant to GUM, sexual dysfunction, sexual assault, pre- and post- exposure prophylaxis for HIV, research methods, teaching, management and leadership skills.

What are the main differences between the current GUM curriculum and the new one?

a) Dual accreditation with Internal Medicine (IM) 

b) The use of CiPs to help doctors to better understand what is expected of them in their training programme to enable reliable, holistic decisions to be made about their suitability to progress. The large number of detailed competencies in the 2016 curriculum will be replaced by the eight specialty CiPs below:

  • Managing patients with non-complex GUM health presentations in out-patient or community settings
  • Managing patients with complex GUM/contraception presentations in a specialist out-patient or community setting
  • Providing specialist care for individuals living with HIV in an out-patient or community setting
  • Providing specialist care for individuals with diagnosed HIV/AIDS in a hospital in-patient setting
  • Delivering interventions to prevent transmission of HIV, other BBVs and STIs
  • Supporting early detection of STIs and HIV in all settings
  • Safeguarding of public health and delivering sexual health/HIV services and information for specific populations in a range of settings
  • Ability to successfully lead, manage and work with specialist service commissioning in acute and community settings

c) Updated public health and epidemiology section

d) Requirement for punch biopsy procedural skill to be recommended rather than mandatory

e) Obtaining the DFSRH and letters of competence in intrauterine techniques (LoC IUT) and subdermal contraceptive implants (SDI) to become recommended not mandatory requirements

Who is eligible to apply for the new GUM/IM training pathway?

Genitourinary medicine is a group 1 specialty and will be entered following selection at ST4, on completion of three years of Internal Medicine (IM) stage 1 or Acute Care Common Stem – Acute Medicine/Internal Medicine (ACCS-AM/ACCS-IM) with full MRCP(UK). Trainees who have sat MRCP PACES, where the outcome is not yet confirmed, can apply and receive a proleptic offer (one which they can only take up if they pass the MRCP(UK) examination). A trainee would then dual train with the GUM and IM stage 2 curricula for four years before achieving a dual CCT in GUM and IM (see Fig 1below).
Fig. 1. The training pathway for GUM/IM and achievement of CCT

How much time will need to be spent training in IM as part of the new GUM curriculum?

An indicative 12 months of IM training is required in the new curriculum. This will be integrated flexibly within the specialty training programme although it is likely that at least three months of IM will need to be completed in the final year of training. Some GUM programmes will choose to run this as a separate year whilst others will integrate it within the specialty training. It is expected that some HIV in-patient and outpatient experience can count towards IM training. GUM and IM stage 2 training will most likely include supporting the acute specialty take in addition to the acute unselected take.

Will HIV inpatient care still be a requirement of the new GUM curriculum?

Yes. Although numbers of HIV in-patients are falling it is important that all those caring for HIV patients are able to assess when a patient needs referral for admission and to understand how HIV related conditions and AIDS defining illnesses are managed. We anticipate that the minimum time spent training in managing HIV in-patients will continue to be three months with some centres opting to provide their trainees with six months or more of in-patient exposure.

When is the new curriculum likely to be implemented?

The first entrants to the new IM stage 1 training were in August 2019, therefore the first cohort to complete three years of IM stage 1 and enter specialty ST4 training programmes will be in August 2022. The first cohort of GUM trainees to complete the four year training programme from ST4-7 and to dually accredit in both GUM and IM will be in August 2026. There will be no opt-out to drop either GUM or IM and obtain single accreditation although it should be easier to switch from one dually accredited specialty to another.

I am currently a trainee in GUM. Can I become dually accredited in IM?

There are two pathways for current trainees to obtain dual accreditation in GUM and general internal medicine (GIM):
  • completion of a Certificate of Completion of Training (CCT) in GUM and then starting another specialty programme, incorporating dual training with GIM, to gain outstanding competencies and claim credit for competencies already attained, or vice versa.
  • OR current trainees can seek to show equivalence to obtaining a GIM CCT via the Certificate of Eligibility for Specialist Registration (CESR) route. This involves further training in GIM and recognition of competencies already achieved. A mapping document has been produced to help with this.

What are the transition arrangements for the new curriculum? If I’m on the old curriculum beyond August 2022 will I need to change? And if so what additional competencies will I need?

Under current GMC regulations, trainees on the old curriculum will have to transfer to the new curriculum within two years of implementation, unless they are in their final year of training when the new curriculum goes live. However, if they do wish to switch to the new curriculum transition arrangements will be possible and will need to take account of the trainee’s stage of training and be cognisant of local service and training needs. We recommend that as trainees who will still be in programme after August 2024 are likely to need to transfer to dual training, it is advisable to maintain internal medicine capabilities acquired in CMT/ACCS-AM, if there is opportunity to do so. A detailed implementation plan for trainees during the transition period is yet to be finalised with the GMC and as soon as there are more details, these will be communicated.

Will there be any exit exams in the new curriculum?

GUM trainees will be expected to pass two knowledge based exams: the Diploma in Genitourinary medicine (Dip GUM) and the Diploma in HIV Medicine (Dip HIV), before they are awarded a CCT in GUM and IM under the new curriculum. The Diploma of the faculty of sexual and reproductive health (DFSRH) is recommended but will no longer be compulsory. There will be no exit exams. 

Is there going to be increased contraception training in the new GUM curriculum especially now that many services are providing integrated care?

DFSRH, LoC sub dermal implant (SDI) and IUD/IUS insertion, assessed by LoC IUT, will not be mandatory in the new curriculum but recommended if trainees wish to undertake them. Trainees will be expected to manage non-complex contraception presentations in out-patient or community settings as part of integrated sexual health services. Trainees wishing to gain competencies in more complex contraception, women’s health and scanning can apply to do this as an out of programme experience (OOPE) and each application will be assessed on a case by case basis by the local GUM training programme director. This training will not be a mandatory part of the new curriculum.

What is the difference between applying for GUM vs. community sexual and reproductive health (cSRH) training?

GUM is a physicianly specialty with a four year training programme, starting from ST4 (from 2022), which requires three years of IM stage 1 training and full MRCP(UK) for entry. By CCT trainees will be expected to have achieved the Dip GUM and Dip HIV. cSRH is a six year run through programme, starting at ST1, which trainees can apply for after completion of the second year Foundation Programme. CCT holders are expected to have passed the membership of the faculty of sexual and reproductive health (MFSRH) exam. The cSRH curriculum covers screening and management of non-complex STIs and offers training in all aspects of complex contraception and community gynaecology, including Termination of Pregnancy (TOP). GUM focusses on all aspects of complex STI and HIV care including training in non-complex contraception. Further details of current curricula can be found at www.fsrh.org.


I haven’t got any experience in GUM/HIV. Can I apply for a GUM training post?

Yes. Previous experience is desirable but not essential. Apply for national and/or local tasters, do a relevant course-online/in person to increase your understanding of the specialty and ask your local service if you can help complete an audit or quality improvement project relating to GUM or HIV.

Why is GUM recruitment so poor with a fill rate of 26% in 2019?

There are approximately 140 NTNs in the UK (42% in London), some of which have two trainees job sharing, of which 34 are not filled by specialty trainees. The JRCPTB State of Physicianly Recruitment report 2019 stated that GUM continues to have a low fill rate of 26% in 2019 (only 12 out of 46 vacant posts were filled in contrast to a fill rate of 59% in 2015 and 100% in 2013) and it appears that posts outside of London are harder to fill. This is mainly due to fragmentation of services due to split GUM/HIV commissioning, on-going reduction in funding to services from local authorities and uncertainties due to tendering. There are few actual vacancies as empty NTNs are often filled by specialty /trust grade/FY3/LAS doctors on a fixed term contract.

Will I be limited in my choice of location if I apply to train in GUM?

There are 140 National GUM NTNs across England, Scotland, Wales and Northern Ireland over a wide range of units of application, so you should not be limited in your choice of location. 42% of GUM NTNs are based in London. In 2019, two regions filled all available vacancies (Scotland and KSS, n=4). There were 46 posts available across 13 LETBs/Deaneries. 20/46 (43%) vacancies were based in London/KSS (46% in 2018); 6/20 (30%) of these were filled (41% in 2018, 92% in 2017) compared to 6/26 (23%) (25% in 2018) posts outside London; seven regions did not fill any of their available vacancies (Wessex, Wales, North East , North West, East of England, Thames Valley and South West Peninsula, n=14)

What certainty is there over a consultant career post CCT in the light of funding cuts to sexual health services?

In 2018 and 2019 the number of consultant posts advertised exceeded number of CCTs (2018: 18 CCTs vs.38 substantive (26 FT, 12 PT) and 18 locum consultant posts; 2019: 19 CCTs vs. 32 substantive posts (18 FT, 14 PT) and 20 locum consultant posts. Of the substantive posts, two were advertised as HIV only, the remainder a mix of ISH/HIV, GUM/HIV and SH/HIV. One of these posts in Scotland and 31 in England, of which 1/3rd were in Greater London.

Future of the specialty:

Would you recommend a career in GUM with current cuts to local authority funding meaning that services will be under pressure to meet local demands?

Public health England data suggests that several STIs, including Chlamydia, Herpes, Shigella, Syphilis (STS) and Gonorrhoea (GC), are increasing, with rates of STS & GC increasing by 165% and 250% over the last 10 years. Funding cuts and reduced access to sexual health services are therefore likely to have severe adverse effects on the Nation’s sexual health. The BASHH/THT ‘State of the Nation’ report published in February 2020, highlights the emerging crisis in STIs in England. BASHH continue to lobby with the government to prioritise funding for sexual health services, in addition to working on a new National strategy for sexual health and reproductive health, which was agreed by the government in the autumn of 2019. GUM physicians remain key in leading services which diagnose, treat and manage people with STIs, including HIV, making a career in GUM all the more rewarding at this critical time.

What is the future for current GUM consultants with no IM experience?

Current GUM consultants will be able to lead integrated services or work within acute trusts, providing GUM, SRH and HIV care. Depending on their expertise they may also be able to work in academia, clinical trials, sexual assault referral centres (SARCs) and in services providing Prison HIV and sexual healthcare, genital dermatology, women’s health, complex contraception, hepatology and public health. They will not be able to participate in the acute unselected medical take.

What will a consultant post look like for dually accredited trainees in GUM and IM?

Dual accreditation in GUM and IM will allow CCT holders the flexibility of applying for consultant posts in GUM, HIV, SRH and IM, to include participation in both specialty and acute take. Depending on experience, posts may also include academia, clinical trials, SARCs, Prison HIV and sexual healthcare, genital dermatology, women’s health, complex contraception, hepatology and public health. HIV outpatient services are currently not commissioned to provide general medical care to patients. This may change in the future as dually accredited doctors complete CCT and as our ageing HIV cohort develop an increasing number of medical comorbidities.