Our Specialties

Obstetrics and Gynecology

Our specialties

We offer training in 25 specialties. Here you can find out more about these specialties and what they involve.

A

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:

  1. Basic Specialist Training in General Internal Medicine (or an equivalent programme) – Two years
  2. 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.

Read more about Higher Specialist Training in Cardiology (PDF)

A

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:

  1. Basic Specialist Training in General Internal Medicine (or an equivalent programme) – Two years
  2. Higher Specialist Training in Chemical Pathology – Five years

Read more about Higher Specialist Training in Chemical Pathology (PDF)

A

Clinical Microbiology deals with the prevention, diagnosis and treatment of human diseases caused by microorganisms including bacteria, fungi, parasites and viruses. It includes the study of microbial pathogenesis and epidemiology and is related to the study of disease pathology and immunology. It is a specialty that encompasses both the laboratory diagnostic aspects and prevention and clinical management of microbial diseases.

Training in Clinical Microbiology is completed in two stages:

  1. Basic Specialist Training in General Internal Medicine (or an equivalent programme) – Two years
  2. Higher Specialist Training in Clinical Microbiology – Five years

Read more about Higher Specialist Training in Clinical Microbiology (PDF).

A

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 utilization 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:

  1. Basic Specialist Training in General Internal Medicine (or an equivalent programme) – Two years
  2. 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.

Read more about Higher Specialist Training in Clinical Pharmacology and Therapeutics (PDF). 

A

 

What is Clinical Genetics?

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:

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

Read more about Higher Specialist Training in Clinical Genetics (PDF).

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 are the qualities or personal attributes needed 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 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."

A

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:

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

Read more about Higher Specialist Training in Dermatology (PDF).

A

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 (i.e. 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:

  1. Basic Specialist Training in General Internal Medicine (or an equivalent programme) – Two years
  2. 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.

Read more about Higher Specialist Training in Endocrinology and Diabetes Mellitus (PDF).

A

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:

  1. Basic Specialist Training in General Internal Medicine (or an equivalent programme) – Two years
  2. Higher Specialist Training in Gastroenterology – Four years

Read more about Higher Specialist Training in Gastroenterology (PDF). 

A

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:

  • Cardiology
  • Clinical Pharmacology and Therapeutics
  • Clinical Genetics
  • Dermatology
  • Endocrinology and Diabetes Mellitus
  • Gastroenterology
  • Genitourinary Medicine
  • Geriatric Medicine
  • Infectious Diseases
  • Medical Oncology
  • Nephrology
  • Neurology
  • Palliative Medicine
  • Rehabilitation Medicine
  • Respiratory Medicine
  • Rheumatology

Generally speaking, if you want to pursue a career in one of the above specialties, you will need to complete two stages of training:

  • Basic Specialist Training in General Internal Medicine – Two years
  • Higher Specialist Training in your chosen specialty – Four to six years

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):

  • Cardiology
  • Clinical Pharmacology and Therapeutics
  • Endocrinology and Diabetes Mellitus
  • Gastroenterology
  • Geriatric Medicine
  • Infectious Diseases
  • Nephrology
  • Respiratory Medicine
  • Rheumatology

Dual Training is of considerable benefit to doctors in the above specialties due to the type of the patients they encounter.

A

Paediatrics deals with the prevention, diagnosis and treatment of medical conditions affecting infants, children, and adolescents, from birth to age 18.

Paediatricians diagnose and treat specific health issues, diseases and disorders related to the various stages of growth and development. They work very closely with the patient and their family.

Paediatricians working in general hospitals in Ireland mainly practice General Paediatrics. A General Paediatrician must be competent in the prevention, diagnosis and management of a wide range of diseases. They must be able to deal with the acute presentation of illness affecting one or more organ systems at the same time.

Paediatricians in tertiary children’s hospitals (e.g. Our Lady’s Children’s Hospital Crumlin) tend to have a specific subspecialty interest, such as Paediatric Immunology or Paediatric Metabolic Medicine.

Neonatology, a subspecialty of Paediatrics, deals with the medical care of newborn infants, especially the ill or premature newborn infant. It is usually practiced in neonatal intensive care units (NICUs).

As a paediatrician you could be working in:

  • General paediatric units seeing a wide range of conditions affecting children
  • Community-based settings managing long-term care of children and young people
  • Highly specialised units working in a wide range of sub-specialties such as neonatal medicine

Is paediatrics for you? Are you:

  • Committed to promoting the welfare of children?
  • Able to be patient, senstive and empathetic?
  • Approachable and diplomatic?
  • comfortable with an informal and flexible environment?
  • good at communicating with a wide range of people?
  • someone who thrives in a team situation?
  • fun-loving with a good sense of humour?

Training in General Paediatrics is completed in two stages:

  1. Basic Specialist Training in Paediatrics (or an equivalent programme) – Two years
  2. Higher Specialist Training in General Paediatrics – Five years

Read more about Higher Specialist Training in General Paediatrics (PDF).

A

What is Genitourinary Medicine?

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: 

  1. Basic Specialist Training in General Internal Medicine (or an equivalent programme) - Two years
  2. Higher Specialist Training in Genito-Urinary Medicine - Four years

Read more about Higher Specialist Training in Genitourinary Medicine (PDF)

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 marginalized 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."

A

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: 

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

Read more about Higher Specialist Training in Geriatric Medicine (PDF)

 

A

What is haematology?

The study of blood has fascinated people since the beginning of time. The Greek physician Hippocrates (460–370 BC) believed too much or too little blood along with three other body humors (yellow bile, black bile and phlegm) could be responsible for human emotions and behaviours.

Nowadays, the study of blood more widely known as haematology, is a unique specialty within the Faculty of Pathology at RCPI. It has equally important clinical and laboratory commitments.  Currently there are 54 Consultant haematologists and 22 specialist registrars in training working in Ireland.

 Patients attending the haematology service encompass a diverse group of people with benign and malignant medical conditions; this provides many sub-specialties which can appeal to a large number of people. There are adult and paediatric clinical haematology specialties and within these, there are sub-specialty areas of interest including haemostasis and thrombosis; red cell disorders; obstetric haematology; malignant haematology including leukaemia, lymphoma, myeloma and transplantation. More recently some haematologists are becoming laboratory specialists, spending more time in the laboratory than on the ward. This area too has sub-specialties including transfusion, coagulation, and molecular diagnostics.

Training Haematology is completed in two stages: 

  1. Basic Specialist Training in General Internal Medicine (or an equivalent programme) - Two years
  2. Higher Specialist Training in Haematology - Five years

Read more about Higher Specialist Training in Haematology (PDF)

Further down the career path, the diversity of the patients and advances in molecular medicine and its application to patient care remain interesting. The clinical aspect is busy, requiring a lot of general medical knowledge. Patients often have serious illnesses which are potentially life threatening (e.g. leukaemia, sickle cell disease, haemophilia). The clinic provides constant challenges and lots of opportunities for interactions with other specialists and with general practice.

 The longevity of the relationship with patients and their families is very rewarding and the direct translation of scientific medicine into patient care makes haematology an evolving modern specialty. There are abundant research possibilities across the sub-specialties. Many trainees go abroad to the Canada, the United States and the United Kingdom during the later years of training or at the completion of training to dedicate some research time to a sub-specialty. The integration of research and clinical work continues to develop, but can be a tricky balance.

What do haematologists actually do?

Most haematologists rotate between their clinical and laboratory responsibilities while simultaneously having a regular outpatient clinic and day ward service. During clinical time, haematologists look after in-patients with haematological conditions, with a ward round two to three times per week. They review patients at a multi- disciplinary team (MDT) meeting and attend a haematopathology review meeting once weekly. Depending on the sub-specialty, they may need to attend other dedicated meetings. They often work closely with a specialist nurse and specialist trainee.

During laboratory time, haematologists review bone marrow aspirates and trephines to establish a diagnosis or evaluate a response to treatment. Haematology uses specialist tests such as flow cytometry, FISH or PCR to look for a disease defining profile or examine for minimal residual disease after treatment. The bringing together of specialist tests with traditional microscope based morphology findings into a comprehensive result requires working closely with specialist clinical scientists and our colleagues in histopathology.

Haematologists also see consultations from other hospital teams on patients with a laboratory haematological abnormality, a radiological image suspicious of a haematological malignancy, an unexplained bleeding or clotting problem and try to  determine the correct diagnosis and if necessary assist in planning treatment.

Are you interested in this specialty?

If you think you might be interested in Haematology, consider all the haematological results in your existing patients. Read the blood film reports and get involved in the haematology consult, go and visit the laboratory and look at the patient’s blood film. Watch a registrar do a bone marrow exam and if at all possible, go and look at it in the laboratory with them.

If you have a patient with an abnormal coagulation test, follow it up with the haematology team, ask questions and read when you go home. Talk to your local haematology team, find out when they meet and try and go to an MDT. 

Senior house officers should try and do an audit with a haematology subject and if possible try and present at local or national haematology meeting. Check out these websites for more information and upcoming events (HAI (www.haematologyireland.ie) and  LFI (www.lfi.ie).

How should Trainees prepare for an SPR interview for this specialty?

You need to pass the MRCPI or an equivalent exam. Completion of a recent ALS (advanced life support) course is recommended. A comprehensive but succinct CV with visible haematology experience is important. It is preferable that experience is more than three months but not essential.

An additional year in haematology after Basic Specialist Training is an advantage and desirable but not essential. Experience of audit is essential and some knowledge of research with publications is an advantage. Published case reports are worth credit, and publications of any kind are well regarded.

It’s a good idea to have read some peer reviewed papers on recent haematology literature, for example in the New England Journal of Medicine, the British Medical Journal or the Irish Journal of Medical Science.

Speak with haematolology trainees in your hospital and ask them what's topical in haematology and what questions they were asked at interview. It is also important to be aware of the wider health care system. You should be familiar with any new national initiatives and policies to address current national medical issues including cancer. 

We asked a Haematologist - What are the pros and cons of a career in Haematology?

"The pros would be

  • Acquisition of new skills including microscopy and haematopathology
  • Longevity of relationship with patients and their families makes this specialty very rewarding
  • The diverse range of sub-specialties in clinical and laboratory medicine offers multiple and varied career opportunities
  • Haematology places an emphasis on teamwork with other skilled individuals, e.g. pathologists, clinical nurse specialists and palliative care
  • There are many opportunities to travel and obtain sub-specialty experience
  • The blend of research with clinical work allows direct translation of science into the clinic
  • New technology is continuously embraced in the specialty and leads to changes in patient management

The cons would be

  • More Exams! Completion of the FRCPath during Higher Specialist Training is required
  • On-call can be onerous as many patients can have life threatening complications at presentations and during treatment
  • The longevity of the relationship with patients can mean that the bad news can affect you personally
  • New technology has led to multiple new diagnostic and therapeutic options; the challenge for haematologists is to chose wisely
  • Lifelong learning is challenging in a broad and fast moving specialty

 Haematology is a specialty with a diverse group of patients and a fascinating link with the laboratory. It is at the forefront of molecular medicine and new technologies are changing the clinical interaction year on year."

A

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:

  1. Basic Specialist Training in Histopathology (or an equivalent programme) - Two years
  2. Higher Specialist Training in Histopathology - Four to Five years

Read more about Higher Specialist Training in Histopathology (PDF)

A

What is Immunology?

The immune system is involved in every branch of medicine. Clinical Immunology is an integrated Clinical and Laboratory specialty, in which Specialists apply a detailed understanding of the immune system to a wide variety of clinical problems. Clinical immunologists are involved in assessing and managing patients, as well as running immunology laboratories.

Clinical Immunologists see and assess patients with possible or diagnosed immunodeficiency and allergy. Additionally, they are likely to be involved with patients with complex autoimmune disease, autoinflammatory conditions and other rare diseases, and assessment of patients where the diagnosis is elusive.

Consultants take responsibility for running laboratories in which tests are processed to diagnose and monitor patients with immunodeficiency, autoimmune disease and allergies. In some hospitals, immunologists may also be involved in providing a transplant immunology service, where tests for transplant work-up, transplantation and post-transplant monitoring are performed.

Clinical Immunology is a rapidly evolving discipline, with new disorders being reported every few weeks – it never gets boring! Clinical work is highly variable as immunology interfaces with every aspect of medicine. Having both clinical and laboratory facilities and expertise, together with collaborations around the world allows you move from the bedside to the bench, and back to the bedside.

Training in Immunology

Training in Immunology is completed in two stages: 

  1. Basic Specialist Training in General Internal Medicine (or an equivalent programme) - Two years
  2. Higher Specialist Training in Immunology - Five years

Higher specialist training in Immunology takes 5 years, during which you will complete the FRCPath examination in Immunology. Trainees are encouraged to undertake a research based higher degree, one year of which can be counted towards HST training. During training, trainees gain experience in clinical and laboratory aspects of immunology, as well as laboratory management, accreditation, audit and governance.

Read more about Higher Specialist Training in Immunology (PDF)

How to make yourself competitive for HST in Immunology

Experience in related medical specialties (dermatology, infectious diseases, rheumatology, nephrology, neurology, haematology etc) is an advantage.

Undertaking audits or small research projects during your SHO years, particularly in an immunology related area of your specialty, shows initiative and interest.

 Try to gain some laboratory experience, particularly in a diagnostic laboratory.

Qualities and Personal Attributes you need to be a good Immunologist

  • Broad clinical knowledge and competence
  • Scientific approach to medicine and therapeutics
  • Up-to-date knowledge of immunobiology and ability to apply to clinical situations
  • Intellectual curiosity
  • Aptitude for multidisciplinary working
  • Excellent communication and influencing skills
  • Ability to simplify complex information for patients and non-specialists
  • Ability to deal with ambiguity, make and communicate pragmatic decisions
  • Interest in laboratory medicine and management
  • Interest in improving healthcare and service development
A

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: 

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

Read more about Higher Specialist Training in Infectious Diseases (PDF)

A

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: 

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

Read more about Higher Specialist Training in Medical Oncology

A

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: 

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

Read more about Higher Specialist Training in Nephrology

A

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

Read more about Higher Specialist Training in Neurology (PDF)

 

A

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: 

  1. Basic Specialist Training in Obstetrics & Gynaecology (or an equivalent programme) - Three years
  2. Higher Specialist Training in Obstetrics & Gynaecology - Five years

Read more about Higher Specialist Training in Obstetrics & Gynaecology (PDF)

A

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:

  • At least 18 months in an industrial sector (e.g. heavy and light industry, engineering, electronics, manufacturing, pharmaceutical, chemical, transport)
  • A minimum of one year in the service sector (e.g. healthcare, financial services, insurance, office environment)

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.

Occupational Health Clinics

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.

Workplace Assessments

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.

Clinical Cases

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.

Experience in other relevant specialties

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: 

  1. Basic Specialist Training in General Internal Medicine (or an equivalent programme) - Two years
  2. Higher Specialist Training in Occupational Medicine - Four years

Read more about Higher Specialist Training in Occupational Medicine (PDF)

A

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: 

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

Read more about Higher Specialist Training in Palliative Medicine

A

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.

Domains of Public Health Medicine

Health Protection

  • Disease and injury prevention
  • Communicable disease control
  • Protection from environmental hazards
  • Emergency planning

 Health Service Development

  • Health needs assessment
  • Service planning
  • Clinical governance and risk management
  • Efficiency (including value for money)
  • Audit and evaluation
  • Change management
  • Equity

Health Improvement

  • Health promotion
  • Reducing inequalities
  • Advocacy and socio-economic issues
  • Education
  • Lifestyles
  • Community development

The Faculty of Public Health's approach

The Faculty's approach is that public health:

  • adopts a population based approach to Public Health
  • emphasises collective responsibility for health, its protection and disease prevention
  • recognises the key role of the state, linked to a concern for the underlying socio-economic and wider determinants of health, as well as disease
  • emphasises partnerships with all those who contribute to the health of the population.

Public Health Out Of Hours Service

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.

Competencies for Higher Specialist Training

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

  • Applied epidemiology
  • Research
  • Knowledge management, including health intelligence
  • Health improvement
  • Communicable disease prevention, surveillance and control
  • Environmental Health
  • Emergency planning and response
  • Quality and safety in healthcare
  • Health economics
  • Public health communication and advocacy
  • Public health leadership and management
  • Health policy

Read more about Higher Specialist Training in Public Health Medicine (PDF)

A

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: 

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

Read more about Higher Specialist Training in Rehabilitation Medicine (PDF)

A

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: 

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

Read more about Higher Specialist Training in Respiratory Medicine (PDF)

A

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: 

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

Read more about Higher Specialist Training in Rheumatology (PDF)

Doctors explain why they love their specialty

National Specialty Directors

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