A career in Respiratory Medicine is hugely varied involving the management of fascinating clinical presentations, ranging from the acutely unwell patient with severe infection or respiratory failure through to understanding the pathophysiology of someone with unexplained breathlessness. Respiratory physicians are known in all hospitals as being dynamic individuals who truly live by the adage of putting the patient at the heart of all that we do whilst also being committed teachers and managers. Our work is further varied by looking after patients spanning all age groups, for example younger patients with asthma, cystic fibrosis or pulmonary arterial hypertension through the ages to older individuals with airways disease or lung cancer.
With around one third of all acute medical admissions being due to respiratory problems, a career in respiratory medicine can put you at the centre of the management of some of the sickest patients in the hospital. Managing a patient as they come through the doors of the emergency department with severe pneumonia, type 2 respiratory failure requiring immediate treatment with non-invasive ventilation through to thrombolysing someone with a high risk pulmonary embolism can be both challenging and rewarding. Respiratory physicians also have strong working relationships with the Intensive Care Unit and are often asked to provide opinions on patients. In fact, there is an opportunity for Respiratory Intensive Care Medicine training.
However, many respiratory physicians choose to also manage chronic diseases with their work focusing more in the outpatient setting. Patients being referred to general respiratory clinics offer the opportunity to stretch your diagnostic skills and often require excellent history taking and clinical examination skills in order to instigate appropriate investigations. One major area of this work is understanding the physiology of the patient sitting in front of you. Respiratory physicians therefore develop a very logical way of unpicking presentations culminating in focused investigations including cross sectional imaging, bronchoscopy, pleural intervention, right heart catheterisation, echocardiography and lung function testing, all of which respiratory physicians take pride in interpreting themselves in conjunction with other relevant colleagues. Respiratory diseases often lend themselves to well established treatments and it is a joy to see patients improve following an accurate diagnosis. We also have several diseases that lend themselves to subspecialty care with bronchiectasis, interstitial lung disease, sleep medicine, occupational medicine and pulmonary vascular diseases to name a few. All these areas have seen recent significant advances in terms of treatments with prognoses improving year on year.
Respiratory physicians often undertake various practical procedures including thoracic ultrasound, bronchoscopy, endobronchial ultrasound and thoracoscopy. Huge advances in these techniques have been witnessed in recent years with several improvements not only in diagnosis but also therapeutic manoeuvres including endobronchial stenting for strictures, endobronchial ultrasound to aid diagnosis of lung cancer, thermoplasty for the treatment of asthma, insertion of indwelling pleural catheters as well as the advent of medical thoracoscopy. There is no doubt that this is an area that will continue to expand in the future.
Respiratory physicians are, in general, team players and the work that we do naturally involves integrating with other specialties in particular radiologists, oncologists, thoracic surgeons, palliative care, histopathologists, physiotherapist and of course, general practitioners and practice nurses. We work closely with multi-disciplinary colleagues. Respiratory Physicians have also embraced integrated care models benefiting patients with chronic respiratory conditions and through this drive closer working between primary and secondary care.
Finally, respiratory physicians have a strong history of advancing our understanding of disease through bench to bedside research. We embrace basic science, translational and clinical research and as a result our work is focused on providing evidence based care. Respiratory physicians also tend to be enthusiastic educators and as such trainees are encouraged to take time out of clinical training programme to gain experience in research, management and leadership techniques or gain further qualifications in delivering teaching.
A career in Respiratory Medicine will, without doubt, give you a different experience every day whilst providing you with a lifelong enjoyment of investigative clinical medicine, procedures, interaction with other specialties and the joy of seeing patients respond to treatment.
Entry into Respiratory Medicine training is possible following completion of the Internal Medicine Training. Trainees will need to obtain the MRCP to enter Higher Specialist Training in Respiratory Medicine at ST4 level.
A new curriculum for dual training in Respiratory Medicine and Internal Medicine was implemented in August 2022. Trainees already in training in 2022 will need to transfer to the new curriculum unless in their final year of training. Please see our transition page for further information.
A webinar detailing the changes is also available on the British Thoracic Society's website here.
The curriculum for each specialty defines the process of training and the capabilities needed for the award of a certificate of completion of training (CCT). The curriculum includes the assessment system for measuring trainees’ progress, comprising workplace based assessment and knowledge based assessment. Information on the Specialty Certificate Examination (SCE) in Respiratory Medicine can be found on the MRCP(UK) website.
A new curriculum has been approved by the GMC and implemented in August 2022.
The previous curriculum for Respiratory Medicine appears below. Earlier versions of the curriculum are no longer available online but copies can be requested from firstname.lastname@example.org.
The ARCP decision aid for each specialty defines the targets that have to be achieved for a satisfactory ARCP outcome at the end of each training year. This is the ARCP decision aid for the new 2022 curriculum:
The decison aid below should be used for trainees remaining on the previous curriculum.
The SAC has produced the following guide for training programme directors, supervisors and trainees to support the implementation of the new curriculum.
The guidance below provides information on the minimum training requirements for acquiring competencies in pulmonary hypertension, lung transplantation and cystic fibrosis in the 2010 curriculum.