Internal Medicine

Cardiology deals with diseases of the heart and circulatory system.

Pathological processes in the vascular tree can arise as a consequence of dysfunction in other systems. The pathological processes involved, the physical impact of these conditions, and their psychosocial effects must be thoroughly understood.

Cardiology sits on the cusp between medicine and surgery. There are a lot of practical aspects to the specialty so cardiologists require good hand-eye coordination as well as good decision making skills.

Cardiology has a rich and rapidly evolving evidence base. Developments in the specialty have led to sub-specialisation is areas such as cardiac ultrasound, electrophysiology, adult congenital heart disease, or preventive cardiology. Your interest in sub-specialty topics will be facilitated during training.

Training in Cardiology is completed in two stages:

• Basic Specialist Training in General Internal Medicine (or an equivalent programme) – Two years
• Higher Specialist Training in Cardiology – Six years

Our Higher Specialist Training programme in Cardiology offers Dual Training, which is additional training in General Internal Medicine.

Download Cardiology HST Curriculum 2022 (PDF, 1.2MB)

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Clinical Pharmacology and Therapeutics is about improving patient care through the safe and effective use of medicines and the evaluation of new therapies. Specialists in Clinical Pharmacology and Therapeutics (CPT) promote rational and cost-effective prescribing. They have expert knowledge of drug licensing, pharmacoeconomics and pharmacovigilance.

Clinical Pharmacology and Therapeutics is underpinned by the basic science of pharmacology, with added focus on the application of pharmacological principles and methods in the real world. It has a broad scope, from the discovery of new target molecules, to the effects of drug usage in whole populations.

Clinical pharmacologists work in a variety of settings in academia, industry and government. In the laboratory setting they study biomarkers, pharmacokinetics, drug metabolism and genetics. In the office setting they design and evaluate clinical trials, create and implement regulation guidelines for drug use, and look at drug utilisation on local and global scales. In the clinical setting they work directly with patients, participate in experimental studies, and investigate adverse reactions and interactions.

Doctors in this specialty generally combine their work with another specialty such as Cardiology, Stroke Medicine, Internal Medicine or Geriatric Medicine. Our Higher Specialist Training Programme in Clinical Pharmacology and Therapeutics was introduced in 1997. There are currently 8-10 practicing clinical pharmacologists in Ireland.

Training in Clinical Pharmacology and Therapeutics is completed in two stages:

• Basic Specialist Training in General Internal Medicine (or an equivalent programme) – Two years
• Higher Specialist Training in Clinical Pharmacology and Therapeutics – Four years

Our Higher Specialist Training programme in Clinical Pharmacology and Therapeutics offers Dual Training, which is additional training in General Internal Medicine.

Download Clinical Pharmacology and Therapeutics HST curriculum 2021 (PDF, 800KB)

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Clinical Genetics deals with the diagnosis and management of inherited disorders and birth defects. It is an exciting, rapidly evolving specialty at the cutting edge of medicine.

Clinical geneticists must continually take account of new discoveries that alter clinical practice. They have an important role to play in public education and debates about ethical issues arising from new developments in the clinical application of genetic knowledge.

Clinical geneticists generally work in multidisciplinary regional genetic centres in close collaboration with laboratory scientists, clinical co-workers (genetic counsellors) and academic colleagues. Doctors in this specialty need a wide range of clinical skills, as genetic disorders can affect people of all ages and involve all body systems. Communication skills are particularly important, as the clinical geneticist must explain complex concepts and genetic test results to families so that they can make informed decision and choose an appropriate course of action.

Our Higher Specialist Training programme includes training in Clinical Biochemical Genetics, which deals with inborn errors of metabolism and the diagnosis, genetic counselling and management of patients with inherited metabolic diseases. Training in Clinical Genetics is completed in two stages:

• Basic Specialist Training in General Internal Medicine (or an equivalent programme) – Two years
• Higher Specialist Training in Clinical Genetics – Four years

Download Clinical Genetics HST curriculum 2022 (PDF, 773KB)

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What do clinical geneticists actually do?
They see individuals and families at risk of inherited disorders. They take their family tree, examine the individual and discuss the disorder. They also assess children and adults to help make diagnoses in suspected genetic disorders.

Many of the disorders are rare and the clinical geneticist must try and provide information about the disorder, new treatments and give recurrence risks. They discuss options in terms of avoidance of recurrence in any future pregnancies. They have to know who is coming to clinic in advance and "work them up" so that they know what is available in terms of testing and where in the world they need to send blood samples for testing. A lot of the work-up occurs post-clinic. They often need to discuss cases including radiology with colleagues internationally. This involves entering data on secure websites to seek opinions etc. They need to liaise with foreign and local labs to order what tests need to be done and where the sample needs to go to.

What qualities or personal attributes do you need to be a good clinical geneticist?
You need to be inquisitive, to have an interest in the thorough investigation of a family. You need to be prepared to go back and request post-mortems, review of old historic patient records, radiology etc, all with the aim of confirming diagnoses or helping someone identify the likely cause of a family's problems. You need to be prepared to do many pubmed searches etc. You also need to be empathetic and non-judgemental. Increasingly, doctors in this specialty need to learn to be competent in bioinformatics. They also need to be part of multidisciplinary teams and help colleagues with the interpretation of genetic test results, particularly with the advent of next generation sequencing.

We asked a clinical geneticist: What are the pros and cons of a career in clinical genetics?
"The pros would be: Interesting career, never boring. You have to keep on top of science. You cannot keep still And the cons: As a specialty, clinical genetics is a misunderstood by healthcare managers who do not understand the value of prevention. It is difficult to measure the cost savings from prevention so all preventative specialties have been hardest hit by the austerity measures. This translates into: Workload is enormous and support very poor… But it’s still worth it."

Dermatology deals with the structure, functions and appearance of the skin, hair, nails and mucous membranes (mouth and genitalia), and the impacts on these of primary and systemic diseases.

Skin, the largest organ in the human body, can be affected by over 2,000 diseases. Besides the pathological processes involved and the physical impact of these conditions, the psycho-social effects must also be understood. Diseases affecting skin and hair can have a serious impact on a patient’s appearance, comfort, and psychological well-being. A dermatologist is in a position to drastically improve a patient’s quality of life, which brings enormous job satisfaction.

Dermatologists have at their disposal, a huge variety of treatments to manage a tremendous number of diseases, including novel immunomodulatory drugs, phototherapies, laser treatments and cryotherapy.

Dermatologists can develop subspecialty interests such as paediatric dermatology or occupational dermatoses.

Mainly an outpatient specialty with a less demanding on-call workload, dermatology offers wide clinical variety and a good work-life balance.

Training in dermatology is completed in two stages:

• Basic Specialist Training in General Internal Medicine (or an equivalent programme) – Two years
• Higher Specialist Training in Dermatology – Five years

Download Dermatology HST curriculum 2022 (PDF, 1.2KB)

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Endocrinology deals with diseases affecting the endocrine glands. This includes thyroid disease, adrenal disease, reproductive endocrinology, growth disorders, calcium disorders, pituitary disease, water metabolism and pituitary disease in traumatic brain injury.

Endocrinologists need excellent communication and leadership skills. They must coordinate and maintain multidisciplinary networks for managing endocrine diseases and diabetes mellitus; for example, arranging monthly multidisciplinary meetings with surgery, radiotherapy, pathology and radiology for thyroid cancer. The very nature of endocrine diseases (for example, their impact on other organs and systems in the body) means that an endocrinologist must also be a skillful general physician.

Most endocrinologists look after medical inpatients and participate in the acute medical take, offering expertise in areas such as hypoglycaemia, glycaemic control in patients in intensive care and coronary care units, managing diabetic ketoacidosis, and adrenal or pituitary crises. Thanks to advances in the specialty, endocrinology is based mainly in the outpatient department and sees patients from adolescence to old age. There is an increasing trend to develop specialised, multidisciplinary clinics - for example, obstetric medical, or diabetic foot.

New therapeutic avenues are opening up as molecular biology unlocks many of the mysteries of endocrine disease. Doctors who complete Higher Specialist Training in Endocrinology and Diabetes Mellitus may later wish to subspecialise in endocrinology or diabetes mellitus. Training in endocrinology and diabetes mellitus is completed in two stages:

• Basic Specialist Training in General Internal Medicine (or an equivalent programme) – Two years
• Higher Specialist Training in Endocrinology and Diabetes Mellitus – Four years (Five years with Dual Training)

Our Higher Specialist Training programme in Endocrinology and Diabetes Mellitus offers Dual Training, which is additional training in General Internal Medicine.

Download Endocrinology and Diabetes Mellitus curriculum 2021 (PDF, 892KB)

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Gastroenterology is the study of diseases involving the digestive tract, liver and pancreas, which include chronic inflammatory bowel disease, autoimmune conditions involving the liver and pancreas, functional bowel disorders, coeliac disease, dysmotility disorders, GI cancers and many more.

Besides the theory behind GI disease, gastroenterologists spend a significant proportion of their time performing procedures ranging from basic diagnostic endoscopies including gastroscopies and colonoscopies to both diagnostic and therapeutic procedures including enodscopic ultrasound, ERCP (endoscopic retrograde cholangiopancreatopgraphy), double balloon enteroscopy and more advance interventional luminal endoscopy.

Within the specialty there is considerable scope for sub-specialisation, for example, hepatology (viral Hepatology, transplant Hepatology), luminal gastroenterology, functional disease, interventional endoscopy and pancreaticobiliary medicine with significant opportunity for research.

Training in gastroenterology is completed in two stages:

• Basic Specialist Training in General Internal Medicine (or an equivalent programme) – Two years
• Higher Specialist Training in Gastroenterology – Five years

Download Gastroenterology HST curriculum 2022 (PDF, 1.8MB).

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Genitourinary Medicine (GUM) is a varied specialty primarily related to the treatment and prevention of sexually transmitted infections (STIs).

A large part of the work is involved in the clinical management of patients with HIV infection at all stages of disease, including inpatient management. The work involves a number of non-infectious medical genital problems such as dermatoses. A number of GUM departments also offer other sexual health services such as contraception, colposcopy (for the diagnosis and treatment of cervical dysplasia) and sexual dysfunction.

Doctors in this specialty work closely with colleagues in public health medicine, infectious diseases, clinical microbiology and obstetrics/gynaecology. They also work with marginalised groups for whom they frequently advocate as they may not have a voice of their own. Doctors in this specialty see lots of younger people. It is very rewarding to see patients (particularly our HIV positive patients) respond quickly to treatment. Also, as a specialty, GUM is fast changing and never boring. There are loads of research opportunities.Training in genitourinary medicine is completed in two stages:

• Basic Specialist Training in General Internal Medicine (or an equivalent programme) - Two years
• Higher Specialist Training in Genitourinary Medicine - Four years

Download Genitourinary Medicine HST curriculum 2022 (PDF, 1MB)

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What are the qualities or personal attributes needed to be a good consultant in Genitourinary Medicine?

Being a good communicator is essential. You need to be non judgemental – lots of the people we look after are from marginalised groups and often heavily stigmatised against within society. You also need to take on a role of advocacy for the many marginalised groups that you see.

We asked a consultant in this specialty – what are the pros and cons of a career in GUM?

"The pros would be: GUM is interesting, never dull with lots of opportunities to teach and do research. The people working in GUM and allied specialties are also great – this is true in Ireland and beyond. We have a great international network working in the area. And the cons: career prospects in Ireland are uncertain, with only two permanent publicly appointed consultants in GUM. The launch (and subsequent ongoing implementation) of the first national sexual health strategy in October 2015, may improve this. Also the fact that it is only recognised as a specialty in a small number of European countries."

Geriatric Medicine is the branch of medicine that focuses on health care of older people. It aims to promote health and to prevent and treat diseases and disabilities in older adults.

A trainee in geriatric medicine should develop expertise the clinical, rehabilitative, preventive, and social aspects of illness in the older adult. Specific expertise should be gained in the comprehensive assessment and management of older people with acute and chronic illness in a wide variety of clinical settings – in hospital, at the out-patients department, in an ambulatory care setting, in continuing long-term care and in the patient's own home.

This group of highly trained and experienced geriatricians are experts at managing the complex care of older adults, and they work closely with other physician specialists to achieve the best results for each patient.

Our geriatricians act as liaisons between patients and their loved ones, their medical teams, and their nursing homes or senior living communities. They keep everybody in the loop concerning treatment plans, day-to-day progress, and any necessary follow-up arrangements.

Training in geriatric medicine is completed in two stages:

• Basic Specialist Training in General Internal Medicine (or an equivalent programme) - Two years
• Higher Specialist Training in Geriatric Medicine - Four years

Download Geriatric Medicine HST curriculum 2022 (PDF, 903KB)

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Infectious Diseases is a clinical specialty of internal medicine focusing on the assessment, diagnosis and management of acute and chronic infections. Besides these specialty specific elements, trainees in infectious diseases must also acquire certain core competencies which are essential for good medical practice. These comprise the generic components of the curriculum.

Training in Infectious Diseases is completed in two stages:

• Basic Specialist Training in General Internal Medicine (or an equivalent programme) - Two years
• Higher Specialist Training in Infectious Diseases - Four years

Download Infectious Diseases HST curriculum 2022 (PDF, 1.3MB)

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Medical Oncology is a medical discipline rather than surgical, and focuses on developing expertise in the management of cancer patients.

The management of care should be based on well-established standards and should ensure that the patient is cared for as a whole person. This care involves clinical and other investigations, management of the complications of the disease and its treatment and the provision of appropriate emotional, social and psychological support for patients and their families.

The medical oncologist is an essential member of the cancer team and is frequently the central figure in the provision of total care for the cancer patient in the multidisciplinary setting.

Training in medical oncology is completed in two stages:

• Basic Specialist Training in General Internal Medicine (or an equivalent programmes) - Two years
• Higher Specialist Training in Medical Oncology - Four years

Download Medical Oncology HST curriculum 2022 (PDF, 803KB)

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Nephrology is a predominantly clinical specialty dealing with diseases of the kidneys as they affect people of all ages.

Besides the pathophysiological processes involved and the physical impact of each condition, psycho-social effects must also be understood. The potential benefits and risks of specific treatments must be learned and experience gained in the multi-disciplinary approach to management of patients with kidney disease.

The physician may later wish to may develop subspecialty expertise in areas such as transplantation, obstetric medicine, vasculitis, etc so it is important that an interest in such topics can be facilitated during training.

Training in nephrology is completed in two stages:

• Basic Specialist Training in General Internal Medicine (or an equivalent programme) - Two years
• Higher Specialist Training in Nephrology - Five years

Download Nephrology HST curriculum 2021 (PDF, 929KB)

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Neurology is the branch of medicine concerned with the study and treatment of disorders of the nervous system. The nervous system is a complex, sophisticated system that regulates and coordinates body activities. It has two major divisions:

• Central nervous system: the brain and spinal cord
• Peripheral nervous system: all other neural elements, such as eyes, ears, skin, and other "sensory receptors"

A doctor who specialises in neurology is called a neurologist. The neurologist treats disorders that affect the brain, spinal cord, and nerves, such as:

• Cerebrovascular disease, such as stroke
• Demyelinating diseases of the central nervous system, such as multiple sclerosis
• Headache disorders
• Infections of the brain and peripheral nervous system
• Movement disorders, such as Parkinson's disease
• Neurodegenerative disorders, such as Alzheimer's disease, Parkinson's disease, and Amyotrophic Lateral Sclerosis (Lou Gehrig's disease)
• Seizure disorders, such as epilepsy
• Spinal cord disorders
• Speech and language disorders

Neurologists do not perform surgery. If one of their patients requires surgery, they refer them to a neurosurgeon.

Trainees in neurology must take responsibility for seeing new patients, undertake ward consultations, and operate at a level of responsibility which would prepare him/her for practice as an autonomous consultant neurologist. The trainee should undertake three outpatient clinics weekly throughout the training period. This may be reduced to two, but never routinely increased to four. New patients should be seen throughout the training period under suitable supervision in outpatients and the consultant trainer should review ward consultations directly with the trainee.

Supervision should be particularly close during the first one or two years. Particularly experienced trainees may undertake the running of an outpatient clinic on their own without direct consultant supervision. The trainee must be involved in the day-to-day care of neurological patients, supervise their clerking and investigation, and be responsible for organisation and dictation of discharge summaries. The trainee must have experience in organising an inpatient waiting list, counselling patients and their relatives and communicating with GPs.

Training in neurology is completed in two stages:

• Basic Specialist Training in General Internal Medicine (or an equivalent programme) - Two years
• Higher Specialist Training in Neurology - Four years

Download Neurology HST curriculum 2022 (PDF, 1.2MB)

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Palliative Medicine is the branch of medicine involved in the treatment of patients with life-limiting disease for whom the focus of care is to optimise their quality of life through expert symptom management and psychological, social and spiritual support. Palliative medicine specialists may work in hospital, in the community and in specialist palliative care units.

Palliative medicine specialists provide care directly to patients with complex needs related to life-limiting disease, and support other doctors in providing care for patients with life-limiting illnesses with non-complex palliative care needs. The aim of specialist training is to understand and promote the role of palliative medicine, develop and lead services and involve the patients at the centre of this service.

Palliative care focuses on relief of the pain, symptoms and stress of serious illness. The goal of palliative care is to help people live more comfortably and to provide the best possible quality of life for patients and their families.

Palliative care is offered to patients who are terminally ill, those who are managing a complex, chronic condition, and patients who are focused on recovery. It can be offered in conjunction with curative medical care and all other appropriate forms of medical treatment.

Training in palliative medicine is completed in two stages:

• Basic Specialist Training in General Internal Medicine (or an equivalent programme) - Two years
• Higher Specialist Training in Palliative Medicine - Four years

Download Palliative Medicine HST curriculum 2022 (PDF, 943KB)

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Pharmaceutical Medicine is the medical specialty that encompasses the discovery, development, evaluation and licensing of medicines together with their appropriate marketing and ongoing monitoring of their safety in clinical practice (lifecycle management of medicines).

Medical practitioners who work as pharmaceutical physicians undertake these activities in many different areas within the healthcare system and allied services including clinical trial units, academic departments, contract research organisations, national agencies, such as the Heath Products Regulatory Authority (formally the Irish Medicines Board), NSAI or National Medicines Information Centre in Ireland as well as the pharmaceutical industry.

Although the majority of pharmaceutical physicians (with the possible exception of those undertaking clinical trials) have no direct contact with patients, they are required to be fully registered with the Medical Council of Ireland in order to fulfil their duties. Pharmaceutical physicians are involved in activities on a daily basis (for example, evaluating ongoing safety with medicines in practice and promoting evidence-based prescribing) to reduce medication errors, maximise patient benefit and minimise harm with use of medicines.

Pharmaceutical physicians interact with other healthcare professionals on a regular basis - on medical information enquiries, in clinical trial activities, in preparing educational materials, including journal articles, textbooks, reference books, formularies, pharmacoeconomic assessments and e-learning materials – all of which encourage rational use of medicines in the interest of patient safety.

Pharmaceutical physicians from either the pharmaceutical industry or national agencies may also be called upon by the media to give guidance on drug-related events of public interest.

This training programme will provide the knowledge and competence for a doctor to be trained in all aspects of drug development, the regulation and safe use of medicines, and with good communication skills who will be able to assist healthcare professionals, as well as pharmacoeconomic and regulatory competent authorities in the rational use of medicines, in the interest of public health.

Download Pharmaceutical Medicine HST curriculum 2021 (PDF, 831KB)

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Rehabilitation Medicine is the branch of medicine that aims to enhance and restore functional ability and quality of life to those with physical impairments or disabilities.

Training in rehabilitation medicine requires expertise in a broad range of clinical skills, not only medical, but also psychological, technical and social. A sound knowledge and experience of the wide variety of disorders encountered is necessary together with skills to co-ordinate a range of medical and paramedical expertise, social agencies and personal support services.

Specialists in rehabilitation medicine work closely with allied specialties such as rheumatology, neurology, geriatric medicine and spinal injury.

Training in rehabilitation medicine is completed in two stages:

• Basic Specialist Training in General Internal Medicine (or an equivalent programme) - Two years
• Higher Specialist Training in Rehabilitation Medicine - Four years

Download Rehabilitation Medicine HST curriculum 2022 (PDF, 874KB)

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Respiratory Medicine is a clinical specialty dealing primarily with diseases of the lungs, but also their effects on other organs. Many diverse pathological processes are involved in producing such disorders and in addition to the common diseases such as asthma, chronic obstructive pulmonary disease (COPD) and carcinoma of the lung, many other inflammatory, infective and degenerative processes lead to a wide variety of diverse diseases.

The experience gained through rotation around different departments is recognised as an essential part of HST. A specialist registrar may not remain in the same unit for longer than two years of clinical training; or with the same trainer for more than one year. The HST in Respiratory is four years, one year of which may be gained from a period of full-time research. Those who wish to obtain dual certification in respiratory medicine and in general internal medicine will require at least a fifth year of training.

The training programme offered will provide opportunities to fulfil all the requirements of the curriculum of training for respiratory medicine programmes in accredited training hospitals.

Training in respiratory medicine is completed in two stages:

• Basic Specialist Training in General Internal Medicine (or an equivalent programme) - Two years
• Higher Specialist Training in Respiratory Medicine - Four years

Download Respiratory Medicine HST curriculum 2022 (PDF, 1.6MB)

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Rheumatology is a sub-specialty of internal medicine involving the diagnosis and treatment of rheumatic diseases. It incorporates the study of joints, soft tissues and related structures called connective tissues. Many rheumatic disorders are defined as ‘auto-immune’ conditions because the triggers for disease onset and maintenance are related to immune aberrations that identify ‘self’ proteins as foreign. Equally, newer and more sophisticated treatments use specific components of the immune system to mitigate the disease process.

A trainee in rheumatology must therefore have an in-depth knowledge of internal medicine, excellent general diagnostic skills, an aptitude for clinical analysis and an ability to work in a team environment with clinicians and health professionals from different specialties. Proficiency in joint and soft tissue aspiration and injection is also essential.

The duration of HST in Rheumatology is four years, one year of which may be gained from a period of full-time research. Those who wish to obtain dual certification in rheumatology and, for example, in general internal medicine will require at least a fifth year of training.

Training in rheumatology is completed in two stages:

• Basic Specialist Training in General Internal Medicine (or an equivalent programme) - Two years
• Higher Specialist Training in Rheumatology - Four years

Download Rheumatology HST curriculum 2021 (PDF, 879KB)

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