Genito-Urinary Medicine (GUM)

The Specialty

Genito-Urinary Medicine involves the investigation and management of sexually transmitted infections and HIV. 

The West Midlands GUM Training website (updated 6.8.14)

Introduction to Genito-urinary (GU ) Medicine

Genito-Urinary Medicine (GUM) 

Genito-Urinary Medicine involves the diagnosis and care of patients who have sexually transmitted infections (STI) and HIV. It also includes provision of sexual health advice, contraceptive care, the management of genital skin abnormalities, provision of post exposure prophylaxis after sexual exposure to HIV (PEPSE), screening and counselling for blood borne viruses, sexual dysfunction and psychosexual medicine. The specialty also provides partner notification for individuals with STI in a structured manner. 

The specialty is mainly based in out-patient settings in an open access arrangement; i.e. GP referral is not required for access to the services. It includes community-based integrated sexual health services for provision of contraception and management of STI and HIV clinics. HIV services also include provision of in-patient care for HIV infected patients. There are outreach services for special groups, for example, sex workers, drug users, HIV testing services for men who have sex with men and for African-born individuals. The specialty provides extensive experience in working with peer-led and voluntary organisations. 

HIV medicine is mostly provided in out-patient services and involves lifetime management of infection in people living with HIV, including their in-patient care. Training in HIV medicine involves recognition and management of AIDS- related morbidities, management of individuals infected with HIV with a complex susceptibility profile for antiretroviral drugs, drug interactions with non-related medicines, and common chronic illnesses. Working in HIV medicine provides extensive opportunities to work with different topics of general medicine. 

There is a strong public health component in the specialty that requires close collaboration with Public Health England (PHE). The specialty regularly provides PHE with a number of surveillance data on STI and HIV. As a result, there are numerous opportunities for research projects.

The key components of GU Medicine 

• Good communication is vital; obtaining sexual history, counselling for STI and HIV, discussion of high risk sexual behaviour and the offer of support for its management. Trainees in GU Medicine will gain confidence in communicating complex medical consultations to their patients in a clear and fluent manner. 

• Ample patient contact; the specialty is mainly delivered in out-patient settings that are open access to the public and provide excellent opportunities for the management of patients from a wide demographic:age, gender, ethnicity and sex group. 

• A varied range of clinical presentations that make each case unique: duration of presentations may range between acute and long-standing. Some of the presentations can be diagnosed and managed effectively on the same day. Some of the patients will require long-term follow-up management. 

• The specialty benefits from effective multidisciplinary team-working and collaboration. The team typically comprises doctors, health advisors, nurses, social workers, pharmacists and community workers. 

• We utilise the techniques of motivational interviewing as an approach to help patients overcome problems with partner notification and reduce high risk sexual behaviour. 

• Working with people who have issues related to sexually transmitted infection, contraception, psychosocial and child protection. • Satisfying outcomes: diagnosis and treatment of some patients with acute presentation on the same day and use of problem-solving approaches to manage patients effectively. 

• Long-term relationships with HIV patients who require regular follow-up appointments that provide training in management of chronic illnesses. • Opportunity to develop professionally and become expert in a sub-specialty area. 

• Good work-life balance: GU Medicine is a family-friendly medical specialty where a good balance is possible. 

• Audit and research; the specialty has a strong link with research. There are six monthly journals on the topics of STI and HIV and one on the topic of contraception in the UK that provide plenty of opportunities for publication of audit and research projects. The specialty has close links with the universities of Birmingham, Keele and Warwick for stronger academic support of research projects. 

• Teaching opportunities; regular teaching sessions for medical students, Foundation doctors, nurses, and colleagues of other disciplines. Opportunities for development of teaching skills.

Working in GU Medicine 

If you are considering a career as a GUM Physician, it is essential that you enjoy patient contact, multi-disciplinary team-working and possess and utilise good communication skills. 

It is important to feel comfortable broaching sensitive issues (such as sex and contraception); that you have good interpersonal skills and be non-intimidating and non-judgmental towards your patients. 

You are expected to have completed the MRCP examination too.

The region 

The West Midlands ranges from Staffordshire in the north to Warwickshire and Herefordshire in the south. In between these areas lie the cities of Birmingham and Coventry and the towns of the Black Country. 

Advantages of living and working in the West Midlands 

• Diverse populations: the West Midlands is a region of contrasts with urban and rural areas facing different challenges. The urban areas in the West Midlands are densely populated and have a younger age profile with a higher proportion of young people under 16 than in any other region in England. Rural populations are typically older. The West Midlands has the largest non-white population outside London and has large numbers of asylum seekers and refugees. All of these factors contribute to diverse clinical presentations in mixed populations, ensuring that trainees will see a wide spectrum of clinical disease and gain a huge amount of experience in working with varied patient groups with different needs 

• Well-located in the heart of England 

• Hugely accessible: good travel links to other cities. The West Midlands is atthe centre of the national rail and road network making it easy to reach other parts of the county in two hours. There is also an international airport • Plenty of open space: Birmingham has more parks than any other European city 

 • Many areas of outstanding natural beauty • Developing cultural and creative industry 

 • Lively night-life in the city centres 

 • Large city centre shopping malls

The Training Programme 

Duration: The GUM training programme is four years long. 

 • The regional GU Medicine training centres: There are currently nine training posts in the region. Each trainee is based at one of the main training centres in Birmingham (Whittall Street Clinic, Queen Elizabeth Hospital Birmingham, Heartlands Hospital) for at least two of the four years. The remaining 1-2 years are spent at one of the other training centres (Coventry, Wolverhampton or Stoke). 

Content of the programme: Consistent with the training curriculum, in the first two years of training, trainees usually participate in 5-7 weekly GUM clinics and one HIV clinic to gain experience in the basics of GU and HIV medicine. During the last two years of training there is more focus on HIV medicine and more specialised GUM clinics and trainees often work in fewer weekly clinics so that they can focus on their research projects. Trainees are also expected to complete a block of inpatient HIV care for at least six months, although how this is provided will vary according to the training centre you are working in. During the four years, trainees are expected to obtain a number of certificates; Diploma in GU Medicine, Diploma for the Faculty of Sexual and Reproductive Health, and Diploma in HIV Medicine. They are also expected to gain competencies in insertion and removal of long-acting reversible forms of contraception. These skills can be gained at the local contraception clinics. Throughout the training programme, presentation at regional and national meetings, through poster and oral media, is encouraged. There are many opportunities to teach undergraduates, postgraduates and peers. 

Regional Training Programme: Trainees are expected to attend and contribute towards the monthly regional training programme for GU Medicine, which rotates between all of the centres. The regional training closely adheres to the 2014 GU Medicine curriculum. 

Mandatory examinations, qualifications and courses: 

 o Examinations: The diploma in GU Medicine examination is usually taken in the second year (ST4) and the diploma in HIV examination, which equates to an exit exam, should be taken during the fourth year (ST6) of the programme. Please click on the Society of Apothecaries link for further details. 

o Contraception qualifications: The diploma of the Faculty of Sexual and Reproductive Healthcare is mandatory and consists of online and practical training. Trainees are also expected to gain the letters of competence for insertion and removal of long-acting reversible contraception. Please click on the FSRH link for further details. 

o Courses: There are several mandatory courses that are laid out on the JRCPTB GUM curriculum. Please click on the JRCPTB link for further details. 

On call: Trainees are expected to participate in the on-call rota at their main centre of training. The on-call may be purely for HIV inpatient care and GUM advice, or general infectious disease, depending on the centre. The frequency of on-call varies between centres but is typically approximately 1:5. There is no resident night-duty at any of the training centres but trainees may be called in the night for advice.  

Career development opportunities: Many opportunities are available and it is widely encouraged for trainees to participate in the following: 

o Teaching: regular and frequent teaching of medical students, GP and other specialty trainees, nurses and postgraduate doctors 

 o Research: HIV is a fast-moving field in research and there is always new knowledge to keep up-to-date with o Audit: all trainees are expected to regularly engage in audit 

o International, national and regional conferences: attendance at and participation in oral presentations, case presentations and poster presentations 

o Trainee representative roles – regional and national level, to develop leadership skills and gain experience working on committees.

A typical week in years 1-2 comprises: 

GUM clinics: 5-7 

HIV clinic: 1 

HIV multidisciplinary team meeting: discussion of inpatients, HIV resistance cases and complicated out-patient cases 

Departmental meeting/teaching: 1 

CPD session: 2 

 On call: 1-2 (9am-9pm, non-residential)

Supervision, Appraisal and Assessment 

Educational supervisor: Each trainee has an educational supervisor at each of their training centres, whom they meet at least quarterly. 

ARCP: Trainees will have an ARCP at least annually (depending on individual requirements). Assessment of competencies will include annual review of the regular workplace-based assessments (mini-clinical evaluation exercise (mini-CEX), case-based discussion (CbD) and multi-source feedback (MSF)) that all trainees engage in throughout their training.

Key GUM contacts 

Dr Sarah Barrett 

HSTC chair and LTFT training advisor 

 sarah.barrett@heartofengland.nhs.uk 

Dr Ria Daly 

HSTC Trainee Rep for GU Medicine 

Ria.daly@heartofengland.nhs.uk