What is sub-specialty training?
A growing trend towards specialisation has been noticeable in medicine in recent history, which has not always been welcomed. However, despite increasing calls from bodies like the RCP for a resurgence of the generalist and reviews of the shape of training underway there are certain areas of respiratory medicine where “Super” specialist training is still required. This is because these diseases are rare, complex or require a specific set of skills which cannot be easily achieved during general respiratory training. Yet a superior level of skills and knowledge may only be required by those wishing to work full time in a sub-specialist area.
The curriculum calls for all respiratory physicians to have a basic level of knowledge and exposure in these areas but until recently how these competencies were achieved varied between individuals and regions. Exposure to CF, Pulmonary Hypertension, Lung transplant and other sub-specialities depended on your rotation and the services available locally. Changes to the curriculum in 2015 have made it clearer what is required but it remains to be seen how easily this can be achieved for all trainees. More information is available here.
The aim of this section of the website is to help all trainees achieve the competencies they need in sub-specialist areas by bringing together the best resources available in person, online and in print. In this section more than any other we welcome your input regarding useful resources and feedback on how to achieve these new training requirements.
Why train in a sub-specialty?
Achieving these basic requirements provides only a brief snapshot of what can be some of the most complex and interesting areas of respiratory medicine. We hope that the resources provided here and combined experiences may help to inspire future generations of sub-specialists.
There are many different reasons why people choose to train in a sub-specialty. For many it is an encounter with a specific patient, an inspiring colleague or the impact of a talk at a training day or conference. For others it is because they are interested in the pathophysiology, research options or the challenge of working in a rarer field. In some cases it may be the technical challenge of a practical procedure or the differing models of care adopted in some specialist areas.
Although a return to generalism and the drive for service provision may be limiting exposure to some sub-specialist areas during general training; there will remain a need for sub-specialists in areas where therapeutic options are widening like Pulmonary Hypertension, where population size is increasing like CF or outcomes are improving like lung transplant.
What are the major sub-specialties?
From a curriculum point of view CF, PH and Lung transplant are the three major sub-specialties with clearly defined mandatory training requirements. These services are arranged into dedicated specialist centres and with relatively established “accepted models” for sub-specialist training. This often includes 12 months of a clinically based fellowship in a specialist centre and/or 2-3 years of research in the relevant area.
The curriculum also requires knowledge of the BOLD or Orphan lung diseases, HIV, genetic and developmental lung disease, occupational lung disease and neuromuscular diseases all of which could also be considered sub-specialist areas. The rise of practical procedures including interventional bronchoscopy, EBUS and thoracoscopy shows further growth in those developing additional sub-specialist skills but likely to be working in more general settings.
Initially we have focused on the sub-specialist areas highlighted by the recent curriculum changes but would welcome resources in any sub-specialist area – especially in those diseases perhaps only cared for by one national centre!