We offer training in 29 specialties. Here you can find out more about these specialties and what they involve.
Remember, before you undertake Higher Specialist Training, generally speaking you must complete Basic Specialist Training (BST) in a relevant specialty.
Training bodies are supported and funded by HSE NDTP.
2018 Basic Specialist Training curricula:
Chemical Pathology involves detecting changes in a wide range of substances in blood and body fluids (electrolytes, enzymes and proteins) in association with many diseases. It also involves detecting and measuring tumour (cancer) markers, hormones, poisons and both therapeutic and illicit drugs.
The largest part of a Chemical Pathologist's day is typically spent in clinical liaison: advising other doctors about the appropriate tests for the investigation of a particular clinical problem, the interpretation of results and follow-up, and the effect of interferences e.g. by therapeutic drugs on test results.
Evaluation of new technologies and the development of new tests is an ongoing process in Chemical Pathology. This applies particularly to areas that are now opening up, such as the use of molecular biology techniques in diagnostic tests. Specialist areas of interest include such topics as inherited metabolic diseases, trace metals and environmental monitoring, drugs of abuse, and nutrition.
Training in Chemical Pathology is completed in two stages:
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:
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.
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.
"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 health care 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."
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 e.g. 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:
General Internal Medicine deals with the prevention, diagnosis and treatment of adult diseases. Doctors specialising in General Internal Medicine are known as physicians.
Physicians need expert knowledge of a wide range of common acute disorders due to the type of patients they encounter. They often have to manage seriously ill patients with undifferentiated or multi-system disease processes.
The vast majority of physicians have a subspecialty interest in diseases affecting particular organs or organ systems. In Ireland there are 16 General Internal Medicine subspecialties:
Generally speaking, if you want to pursue a career in one of the above specialties, you will need to complete two stages of training:
You should read the entry requirements for Higher Specialist Training in your preferred specialty carefully. You will find this information in the Higher Specialist Training curriculum for that specialty, available on this web page.
We do not offer Higher Specialist Training in General Internal Medicine, however the following specialties offer ‘Dual Training’ in Higher Specialist Training, which means that you complete additional training in General Internal Medicine (e.g. participating in acute unselected medical take):
Dual Training is of considerable benefit to doctors in the above specialties due to the type of the patients they encounter.
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 Genito-Urinary Medicine is completed in two stages:
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 & in the patients’ 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:
Training Haematology is completed in two stages:
The three main aspects of this specialty are diagnostic histopathology, cytopathology and autopsies.
Diagnostic histopathology involves making diagnoses based on the microscopic examination of tissues removed during various operative interventions and procedures such as endoscopy, biopsy or resections. The biopsy or surgical specimen is processed and histological sections are placed onto glass slides.
Cytopathology deals with diseases on the cellular level. A common application of cytopathology is the smear test, used to detect precancerous cervical lesions and prevent cervical cancer.
A histopathologist also conducts postmortem examination of the body to determine the cause of death (autopsy).
Training in Histopathology is completed in two stages:
Training in Immunology is completed in two stages:
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:
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:
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:
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.
Neuropathology is the study of disease of nervous system tissue, usually in the form of either small surgical biopsies or whole-body autopsies. Neuropathologists usually work in a department of anatomic pathology, but work closely with the clinical disciplines of neurology, and neurosurgery, which often depend on neuropathology for a diagnosis. Neuropathology also relates to forensic pathology because brain disease or brain injury can be related to cause of death. Neuropathology should not be confused with neuropathy, which refers to disorders of the nerves themselves (usually in the peripheral nervous system). Neuropathology plays a key role in characterising the pathogenesis of neurodegenerative diseases including forms of neurodegeneration with brain iron accumulation.
The HST Neuropathology curriculum was developed in 2015 with the Neuropathologists in Ireland, Dr Francesca Brett, Dr Niamh Bermingham and Dr Jane Cryan.
Trainees in Higher Specialist Training can approach a career as a Neuropathologist in one of two ways:
In circumstances where a trainee has, following a successful Aptitude Assessment, spent two years in Histopathology at BST level, the second of these two years may be assessed for equivalence to a Year 1 programme of Higher Specialist Training. This evaluation will be made at annual assessments.
Obstetrics and Gynaecology is concerned with women’s health – before, during and after the reproductive years.
Doctors in this specialty provide medical and surgical care to women and have specialist expertise in pregnancy, childbirth, fertility, family planning and disorders of the female reproductive system.
It provides a good mix of medical and surgical skills and one can really follow a life from cradle to the grave. It is a field at the cutting edge of medicine and so always throws up ethical considerations.
Obstetrics focuses on childbirth, providing pre-natal care and pregnancy support along with post-partum care. Gynaecology focuses on the health of the female reproductive system including the diagnosis and treatment of disorders and diseases. Combined training in both Obstetrics and Gynaecology is important because these specialties often overlap.
Working in women's health is a stimulating and rewarding career. Childbirth is an important event for any woman, and obstetricians are central to providing support and ensuring safety in maternity care. But Obstetrics & Gynaecology goes beyond just childbirth, and if you choose this career you'll be focusing on improving women's health at all stages of their lives.
Training in Obstetrics & Gynaecology is completed in two stages:
Occupational Medicine is a clinical medical specialty that deals with the interface between work and health. It is a small but long established specialty, both in Ireland and internationally.
Occupational physicians need to have a broad knowledge of clinical medicine. Typically, entrants to specialist training have already gained qualifications in General Internal Medicine, General Practice or another clinical field. They also need additional knowledge of basic science (e.g. noise exposure and effects on hearing, radiation exposure effects, toxicology), along with an awareness of legal issues pertaining to workplace safety and employment equality. A good understanding of how business works and what constitutes good management is essential. Occupational Medicine also has various subspecialties, such as Diving Medicine or Aviation Medicine.
Typically, medical students or doctors in postgraduate training come into contact with the occupational health department in the context of sharps injuries or hepatitis B immunization in a hospital setting. In fact, this is just one small area of the specialty. Occupational Medicine involves preventative programmes such as immunisations, health surveillance (e.g. audiology for noise exposure), rehabilitation of workers with an illness or disability, and advising organizations (governmental and business) on how to best optimize the health of their most important asset, their employees.
Occupational Physicians need to know how to “get to the bottom” of sometimes complex cases or issues. They must give decisive medical advice and be prepared to explain this medical advice to both the employee and the employer, while respecting confidentiality when dealing with the latter.
Specialist training in Occupational Medicine can be completed in Ireland on the Faculty of Occupational Medicine’s Higher Specialist Training programme. Career prospects are good, with specialists gaining employment in the public sector or the private sector. The lack of ‘on-call’ commitment facilitates a healthy work-life balance.
Your four-year programme will incorporate the following core elements:
You can receive up to 12 months’ credit for overseas training during HST in Occupational Medicine. The overseas post must offer an appropriate level of training and supervision and it must be prospectively approved by the Faculty of Occupational Medicine and the Irish Committee on Higher Medical Training.
Over the four years of your HST programme, you need to attend at least 800 occupational health clinics or equivalent (3.5 hours each). These clinics must include at least 100 sessions in a health service occupational health department.
Over the four years of your HST programme, you should carry out 20 industrial/worksite visits, covering a wide range of working environments. You should identify hazards and their assessment and control, and interact with safety officers, hygienists and environmental safety officers.
You are expected to see at least 400 occupational clinical cases each year. Cases should involve audiology, psychosocial, respiratory, dermatological, toxicological, rehabilitation, disability assessment and musculoskeletal conditions. Uncomplicated pre-employment assessments are not considered as cases.
You are expected to obtain knowledge and experience in other relevant specialties. This experience may be gained through personal reading, attendance at meetings or clinical attachment at outpatient clinics. Your trainer will help you identify which specialties you would benefit from.
Training in Occupational Medicine is completed in two stages:
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:
Public Health Medicine is about improving and protecting the health of the population, rather than treating individual patients. Public Health physicians have specialist knowledge of health protection, health service development and health improvement, as outlined in the table below.
Public Health Medicine reaches beyond the usual boundaries of the healthcare system. Doctors in this specialty work in national government agencies, local community and voluntary organisations.
Health Service Development
The Faculty's approach is that public health:
Specialists in Public Health Medicine operate a 24-hour Public Health Out Of Hours Service. This service provides national cover for the International Health Regulations (IHR), an Irish government commitment to the World Health Organisation and its Member States. The service also provides out of hours guidance on infectious disease control and outbreak management, for example in a crèche, hospital or nursing home.
To prepare for out of hours specialist cover, you will be required to participate in a health protection working hours on-call rota during HST. In the first two years of HST this is at the level of first or second responder on call during working hours under supervision of a Specialist in Public Health Medicine. In your third year you will be expected to take a lead in health protection incidents and investigations. In your final year you may work as acting Specialist on call. Out of hours work will be introduced in the coming year.
During HST, you need to become competent in each of the following aspects of Public Health Medicine. You need to record progress in achieving these competencies on a quarterly basis in a Competency Log, which must be scanned and uploaded to your ePortfolio
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:
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 2 years of clinical training; or with the same trainer for more than 1 year. The HST in Respiratory is 4 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:
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 4 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 e.g. in General (Internal) Medicine will require at least a fifth year of training.
Training in Rheumatology is completed in two stages:
Each specialty has a National Specialty Director (NSD) who actively leads the development and delivery of training in their specialty.
They are available to provide advice and career guidance relating to their specialty.
If you would like to get in touch with one of our NSDs, let us know by email to HST@rcpi.ie