Genitourinary medicine (GUM) is a dynamic, fun specialty which provides care for all aspects of sexual health and HIV medicine. It is mostly outpatient based but does include inpatient care of HIV infection.
It is a patient-centred specialty which encompasses disciplines from general medicine, virology, microbiology, dermatology, gynaecology and public health, creating a unique and rewarding career. In many centres the specialty is combined with contraceptive services to offer a holistic service for patients.
It can also include more specialised services such as young people's clinics, genital dermatoses, sexual dysfunction, psychosexual medicine and outreach services for sex workers and drug users.
The specialty is evolving to accommodate the requirements of a modern sexual health and HIV service, both in terms of curriculum review and managing commissioning change, with the patient needs at the forefront of training and workforce planning.
There is also a public health element to the specialty with the need to perform partner notification (contact tracing), and to collect and report surveillance data nationally in order to detect changing trends of infections.
GUM - trainee characteristics
The nature of genitourinary medicine requires trainees who are:
- excellent communicators
- team players
- adaptable, given the evolving nature of the specialty
- not easily embarrassed, with a good sense of humour!
Working/training in an ST3 GUM post
The day-to-day work of a GUM physician varies, depending on sub-specialty and setting, and ranges from managing acute presentations of STIs, sexual assault assessment and post-exposure prophylaxis for HIV in addition to routine reproductive and sexual healthcare provision and the long-term management of chronic HIV infection.
There are also more specialist services, such as psychosexual medicine, adolescent clinics and genital dermatology, as well as sex worker and drug user outreach services.
Entry into Genitourinary Medicine training is possible following successful completion of both a foundation programme and a core training programme. There are two core training programmes for Genitourinary Medicine training:
- Core Medical Training (CMT) / Internal medicine training (IMT)
- Acute Care Common Stem - Acute Medicine (ACCS-AM)
Emphasis on social factors and community-based care
As many of our patients come from socially deprived, vulnerable and under-represented populations, there is also a real emphasis on social circumstances and emotional well-being. Confidentiality and safeguarding are extremely important elements of our specialty.
Traditionally, GUM clinics were hospital based; however most of the newer integrated sexual health and contraception services are now community-based with spoke site clinics and out-reach services to enable easier access for the local communities they serve and improved engagement with hard-to-reach groups. HIV inpatient care continues to be provided in acute settings.
Inter-disciplinary work and work-life balance
- The specialty provides ample opportunity for interdisciplinary working with sexual and reproductive health, infectious diseases, diagnostics specialties and public health; the latter being a key element of the specialty with regards to partner notification and disease surveillance.
- GUM physicians work alongside the ever-increasing multidisciplinary team, including professionals from various disciplines - primarily nurses, health advisers, general practitioners, pharmacists, clinical psychologists, safeguarding teams, school nurses and other allied professionals.
- GUM has limited on-call, thus allowing for a better work-life balance; although there are some opportunities to participate in acute medical or HIV on-call rotas, or in specialist sexual health work, such as sexual assault and outreach clinics.
Future training proposals
The specialty is aligned with Group 1 acute medical care specialties in the Shape of Training proposals, with dual accreditation in General Internal Medicine as well as GUM. This will ensure that CCT holders are competent to practice independently at consultant level in both GUM and General Internal Medicine. This will increase the scope of career posts to which GUM trainees will be able to apply, to include those with an acute care component in addition to Integrated Sexual Health and community based posts. Entry will follow completion of the 3 year Internal Medicine Training (IMT) programme, and the first intake of trainees on the dual accreditation pathway is anticipated to be in August 2022.
- GUM has achieved high scores for satisfaction in the annual GMC trainee survey, and most trainees feel prepared for consultant posts after the four-year training programme.
- The curriculum was revised in 2016 and is delivered through a variety of learning experiences, including work-based learning and on-the-job supervision.
- Out-of-programme attachments have been encouraged, and a number of trainees pursue HIV care abroad or higher degrees.
A day in the life of an ST5 GUM registrar...
To give an indication of what you can expect from time in a GUM post, we asked an ST5 trainee to describe a common day for them.
- Today is Monday so I start with our HIV multidisciplinary meeting at 9am in our HIV hospital base.
- This multidisciplinary meeting is attended by the GUM consultants, registrars, specialist nurses, sexual health advisers, virologists, psychiatrists and counsellors, as well as some cakes or biscuits!
- We review each of the patients coming to clinic over the next week and discuss difficult management or, more often that not, challenging social circumstances.
- Clinic starts later in the morning and my first patient is indeed a challenge - a newly diagnosed lady from Africa who has been trafficked to the UK and doesn't speak any English.
- The consultation is challenging, especially with a translator; however, after an hour or so we make some progress and link her in with social work, TARA and the Red Cross.
- My next patient is a gentleman who wishes to start a family with his HIV-negative wife. We discuss all the options and make a referral for fertility assessment.
- After this I see a patient who has not attended for three years. He's short of breath with oral candida, so I arrange admission to our ward for further assessment with just enough time to make our STI diagnostics group meeting.
- This group is attended by public health and virology colleagues to review local STI trends and new diagnostic tests, and attending really helps in appreciating the GUM specialty as a whole.
Community sexual health clinic
- In the afternoon I'm based in one of our community hubs with two specialist nurses for the sexual health clinic.
- As our service is fully integrated, the afternoon is as varied as always, including gonorrhoea-diagnosed by onsite microscopy, emergency IUD fitting, PEP for HIV after a condom break, post-menopausal bleeding as well as a prolonged discussion with the partner of a patient recently diagnosed with herpes simplex.
Young persons clinic
- Later in the day the young persons clinic starts with its usual added complexities. I see a 14-year-old with a history of liver transplant for contraception advice, as well as a group of 12-year-old boys asking for condoms with the usual jokes and giggles...
- At the end of the clinic I see a vulnerable 12-year-old girl who discloses her excessive drinking and sexual contact, at which point I discuss her case with our specialist young persons consultant, and subsequently social work.
End of the day...almost
- My normal day is supposed to finish here, at 5pm; however, I also participate in our Sexual Assault Referral Centre on-calls, and today am on call from 5pm till 9am the next morning. I just hope it's a quiet night!
Yorkshire & Humber training in GUM
Training in GUM is dual-centred, with one programme in the South locality based in Sheffield (TPD is Dr Gillian Dilke-Wing) and one programme in the West/East locality based in Leeds and York (TPD is Dr Sarah Schoeman). Both programmes share a common Specialty Training Committee and ARCP arrangements, and there is a co-ordinated programme of well-received regional training days across the Yorks & Humber, East Midlands and Northern Deaneries.
Sheffield training programme
·There are currently 5 registrar training numbers based at the Royal Hallamshire Hospital in Sheffield. The service sits with the Infectious Diseases unit to form the Academic Directorate of Communicable Diseases, and provides training to junior doctors from CMT, GP and Foundation programmes as well as Higher Specialty Training. All aspects of curriculum training (including SRH and HIV) are available locally and mostly on the Central Hospitals site, along with research and teaching opportunities.
·There is currently no regular on-call commitment for GUM registrars except during two 4-month attachments with the ID service, when trainees participate in ID only on-call on an approximately 1 in 10 basis. There are usually opportunities for locum work in ID or general medicine if desired.
·The Sheffield Sexual Health Service is currently out to tender (autumn/winter 2018/9) and the location of aspects of training may change as a result of this process. In addition, the two GUM and ID HIV services are integrating into a single unit to provide joined-up outpatient HIV care to the wider Sheffield population, with ID retaining inpatient responsibility.
Leeds/York training programme
- There are currently 7 registrar training numbers in the Leeds/York training programme 5 of which are based in Leeds and 2 of which are based in York each year. Trainees joining this programme usually spend one of their first two years of training in York and the remaining three years in Leeds.
- Leeds trainees work in the integrated sexual health service – Leeds Sexual Health (which is provided by Leeds Teaching Hospital (LTHT), Leeds Community Health Care Trust and Yorkshire MESMAC in a consortia) and the HIV out-patient service (which is provided by LTHT).
- Leeds Sexual Health is an extremely busy service with a city-centre hub and several spoke site clinics across the city which provides integrated sexual health care to the population of Leeds.
- The LTHT HIV out-patient service is an integrated GUM and ID service based in the Leeds General Infirmary and closely located to the Leeds Sexual Health Service (~10 minutes walk). It is the largest HIV unit in Yorkshire and one of the largest in the country providing HIV treatment and care to ~2,200 people living with HIV across Leeds, Wakefield and Dewsbury.
- HIV in-patient care for the West Yorkshire region is provided by the LTHT ID team on ward J20 at St. James’ University Hospital.
- The GUM department sits within LTHT’s Emergency and Specialty Medicine Clinical Service Unit and provides undergraduate and nurse training as well as postgraduate training to junior doctors from CMT and Foundation, GPs and Higher Specialty Training programmes.
- York trainees are employed by York Teaching Hospital NHS Foundation Trust and are based in a community setting at Monkgate Health Centre. This forms the centre for the integrated sexual health service (ISHS) and HIV outpatient services across York and North Yorkshire. For HIV patient care, York is in a regional network with Hull, with whom there are video linked regional MDTs twice a month and regular educational events. HIV related inpatients are managed in conjunction with the ID unit at Castlehill Hospital, Hull with patient transfer if required. ISHS provide the full range of level 3 services for GUM and SRH with good opportunities to train in implant and IUC procedures. There is no regular on call commitment during this year in York but there are usually opportunities for locum work in general medicine at York or Leeds if desired and occasionally gaps on the Leeds GUM/ID rota for which locum cover is required. There are good opportunities to be involved in training HYMS medical students, hospital doctors and GPs.
- All aspects of curriculum training (including SRH and HIV) are available locally in Leeds and/or York along with excellent teaching and research opportunities across the West/East locality.
- The Leeds GUM trainees contribute to a 1:8 ID on-call rota. This is mainly based on the ID ward at SJUH but occasionally requires the need to see out-lying patients across LTHT. This on-call rota is well supported by the ID consultant team who are used to having GUM trainees on their ST ID on-call rota and provides excellent additional training experience in HIV & ID medicine. There is currently no on-call commitment for the one year our trainees spend in York but optional locum opportunities mostly in general medicine or A&E are usually available in Leeds or York. Our Leeds trainees also do two 4 month ward blocks on the ID ward usually during their second and fourth years of training during which time they are ward based 3 days a week and LSH/HIV clinic/teaching 2 days a week.
- Throughout the 4 year training programme in Leeds/York we hold weekly ~1.5 hour GUM consultant supervised ST teaching sessions.
- Academic post - Development of a new shared Academic Clinical Fellow post between York & Leeds is currently being explored.
Further information on the specialty
For further information on the specialty and on the curriculum covered can be found on the JRCPTB site.