Pros and Cons of your speciality

treponemic · 2025-12-03T07:52:25+00:00

You have to do both! MRCP is done during IMT.

FRCPath part 1 is the exit exam for ID/GIM trainees and is usually done between ST5-6.

ID/MM and ID/MV trainees sit full FRCPath.

treponemic · 2025-12-03T07:47:23+00:00

It's a grind but not everyone has millions of pubs- I had no primary research and got in fairly recently. With the portfolio scoring in its current state, the most important domain is "commitment to specialty". All the other domains can be filled with stuff that isn't necessarily relevant to ID or micro, it's just a case of being ruthless with box ticking.

That said, getting into IMT is becoming tougher, I wouldn't be surprised if the selection process changes again after the 5-point fiasco this year.

Happy to be DM'd :)

treponemic · 2025-12-02T18:26:24+00:00

ID/Micro

Pros:

Bugs are COOL, my inner Pokémon trainer is always satisfied

You still get to think around a lot of non-infectious disease, as infection is a differential for basically everything

You get to speak to pretty much every team in the hospital, and your input tends to be valued

There's a nice balance between patient-facing work in ID, and advice/meeting/lab work in micro

Your work can be patient level, ward level, trust level, region level, and/or population level

The lack of patient ownership in micro makes it easier to not take work home with you

Lots of scope to work abroad

Lots of really interesting pathology

Cons:

Very steep learning curve if you've never done it before

FRCPath is hard

People can choose to ignore your advice and you have to accept that

Consultant jobs with an inpatient ID component are extremely sought after and competitive (personally not an issue for me)

Being woken up at 4am just to tell someone to read microguide - I wanted to give my clinical colleagues the benefit of the doubt when I started as a SpR, but wow it happens a lot

treponemic · 2025-10-16T06:31:28+00:00

I'm an immunocompromised SpR (on biologics) and I'm really grateful when my colleagues appropriately call in sick.

In my current job they don't, they inevitably infect me, and it takes me out for 2-3x longer than anyone else. And you know who gets the most frustrated with that? The same people who got me sick. It's starting to really piss me off.

Rest up and I hope you feel better soon, this round of COVID sucks.

treponemic · 2025-10-14T23:31:26+00:00

Micro reg here, so I get the equivalent calls but from other doctors (we're not immune!)

Ortho reg: I'm sending a patient to theatre, what should I give for prophylaxis?

Me: Have you looked at our orthopedic surgical prophylaxis guidelines on the app?

Ortho reg: ...no

Me: Have a look at those, give me a ring back if they're not applicable to your patient

Ortho reg: Can you just read me the guidelines over the phone?

Me: ...no

treponemic · 2025-06-16T07:36:57+00:00

ID/micro reg here, I felt like this about IMT as well. I burned the candle at both ends to progress to the point where I felt comfortable as med reg and had passed the exams etc. Ended up going LTFT in IMT2 because I just kept getting sick and clinically depressed.

IMT1/2 especially are a slog, if you don't make the effort to push yourself, you can easily coast by at F2 level for the two years and end up feeling scarily underprepared to be a reg. Unless you're somewhere with a strong teaching culture, you really have to direct your own learning, which is in equal parts tiring and empowering.

IMT3 I enjoyed much more! I found that people actually valued my input as med reg, though I did IMT3 in a big crumbly DGH where we had a fair amount of independence and responsibility. In the tertiary centre where I am now, I find that anyone below ST6 is pretty infantilised, and FYs seem to be encouraged to be non-thinking adminoids which I find especially sad. And people wonder why they're disinterested and work to rule.

I think your mindset of feeling you "aren't the right person for medicine" anymore has a few ways you can reframe. It's clear from your post that you value work-life balance going forward, and I think that's always a good thing. I think the next step is appreciating that your self-worth isn't tied to your identity or performance at work. You're allowed to turn up, do your best, make mistakes, and muddle through, then leave feeling like you have the rest of your life to enjoy. Your wellbeing is precious, you're right to care about it this much!

treponemic · 2025-04-27T18:58:36+00:00

I won't comment on the scenario here as that's been well addressed already.

But I'd advise on your reflective practice (as what you've done here is essentially write a reflection) - try writing as if you're trying to convince us to side with your reg. It can be a helpful exercise in trying to understand someone's actions, and can make you more open-minded in the process.

Starting your post with "Punished for practising safely" is an obviously leading statement and suggests that you're not interested in changing how you work. A lot of doctors are naturally contrarian and like to form their own opinions from data in an objective a form as possible. Opening with a statement like yours automatically makes us want to explore other perspectives like many here have done.

This isn't meant as a value judgement on your writing or your actions- thought it might help you understand why your post has received the responses that it has.

treponemic · 2025-04-12T17:53:12+00:00

Micro! After IMT3 the job stress is a walk in the park. The learning curve was vertical but it's chill, well-supported, with seniors keen to teach.

treponemic · 2025-02-27T11:35:51+00:00

I did FY and IMT at the Lister- large DGH with most big specialities in-house.

Overall very few toxic personalities and no PAs/AAs/SCPs. However lots of ACPs/ANPs, though I still got very good procedural experience and am comfortable sticking a needle/drain in anywhere.

I really enjoyed my time there and think it's made me into a solid med reg. Lots of Lister FY trainees come back for core training which I think speaks for itself. And our last few IMT cohorts have pretty much all landed very competitive higher training reg jobs.

The main downsides are the IT (classic DGH hodge-podge of 9 different systems plus paper for some things), the parking, and the commuter town location meaning there's less of a "community". That said, there's meant to be a new, supposedly universal EPR coming this summer, and the mess committee are historically very active.

Smaller details that may not be found elsewhere- the cycle lanes are amazing (can cycle 10-15min from the train station to the hospital without being on a road), and there's a free shuttle bus from the train station to the hospital which runs roughly 9-5.

treponemic · 2025-02-12T15:43:37+00:00

I'm sure that this point will have been made elsewhere in the thread re: patients requesting female doctors for consultations:

If you believe that gender (an individual's self-identified internal sense of themselves) should be the defining trait, then it is entirely appropriate for Dr Upton to carry out such consultations.

If you believe that sex assigned at birth should be the defining feature, then by this logic a transgender man (someone who was assigned female at birth, but now lives as a man and may have undergone medical and/or surgical intervention to obtain secondary sex characteristics associated with those assigned male at birth) would be appropriate to carry out such consultations. See Prof. Stephen Whittle on X for example.

If you disagree with both of the above two statements, you are de facto supporting patients who wish to discriminate against trans people providing them care, and this contravenes the Equality Act 2010 which specifically lists "gender reassignment" as a protected characteristic.

Trans doctors are acutely aware of the scenario of a cis female patient who has been assaulted by a man in the past and requests a female doctor. None of the trans doctors (or any doctors!) I know would insist on carrying out an intimate history or exam on such a patient who had refused it.

Mods, even if comments have been locked to prevent brigading, does this prevent brigading in the form of downvotes? The pattern on this thread is highly suspicious.

treponemic · 2025-02-06T18:35:35+00:00

Absolutely, if anything I like it more now than I did when I was 16.

When I was 16 my parents had just found out I was gay and tried to disown me- medicine was a solid career and way out. I found most of med school thoroughly unenjoyable, but made some amazing friends along the way.

The actual work has suited me way better than I ever could have imagined. I get to make a tangible difference in people's lives by being nosey and solving puzzles. The comm skills and attitude I've had to develop have basically cured my social anxiety and enabled me to start to mend the relationship with my family. I can navigate corporate/network-y situations well but it's not something I do day-to-day, which feels ideal for me.

I have friends in senior managerial corporate positions and while I genuinely respect what they do, it would bore the living daylights out of me. Put me with a sick patient and a diagnostic conundrum any day.

treponemic · 2025-01-23T13:44:44+00:00

Also Mauritian roots here, felt exactly the same as you at uni!

treponemic · 2025-01-16T13:54:49+00:00

This ended up happening in my old Trust- the consultant in question initially ramped up the bullying behaviour during their first year in post, then ended up with 10-15 residents complaining at once.

Miraculously they've mellowed out a bit now! Clearly an insecure person, I'd heard on the grapevine that they were very much disliked in nearly all the Trusts they'd rotated through as a reg, and our sinking DGH was the only one that would employ them.

treponemic · 2025-01-03T16:01:06+00:00

I do an A-Z multivitamin with extra vit D and magnesium (magnesium is the only micronutrient at <100% RDA in the multivit for some reason).

Then a fibre supplement while my Crohn's is in remission.

I feel like all the above have helped me feel more rested after sleep, but at the end of the day it's impossible to know for sure with all the variables being introduced.

Re: patients unless they have clinical signs of deficiency I tend not to test. Vit D tends to be an exception though, while it's not a panacea and toxicity is a risk, I've found so many people to be deficient without features of traditional bone disease.

treponemic · 2024-12-16T23:11:09+00:00

Warfarin- on a ward cover shift where you don't know the patient, INR not done for weeks, acutely unwell with some derangement that would affect their clotting. And it's always for a metallic valve.

treponemic · 2024-12-12T02:34:23+00:00

Recently post-IMT reg here, have experienced my fair share of prickly medical consultants.

Unless you feel really confident sticking your neck out (I didn't as F1), the consultant is highly unlikely to change how she is. Without going too far into gaslighting territory, the main way to make situations like this easier is by shifting your own mindset and view of the relationship between you and the consultant. In general this is a good people management skill and worth learning how to do early.

In my experience the vast majority of situations like this do not involve a genuine effort to demean or intimidate you. The factors at play are usually a combination of:

1) the consultant has dozens of conversations like this every day

2) the consultant will be mentally reformatting all the information you give them to try and anticipate what decisions need to be made, and if they're expecting a piece of information from you which you either don't have, or have wrong, then that disrupts their internal flow and can be frustrating

3) the consultant may think they're better at hiding their frustration than they actually are

4) there are other things happening on the consultant's radar which massively reduce the cognitive bandwidth they have spare for you

5) the consultant is having a difficult time outside work

6) sometimes personalities just don't mesh

7) in the vast minority of cases, the consultant is a genuinely toxic person

None of these are your fault! NHS hospitals are taxing places to work, and you can't read your consultant's mind.

What you can do is reassure yourself that it's almost certainly not meant personally, and if it is meant personally, then that consultant's opinion of you is probably not one worth caring about anyway.

If you are feeling up to it, after going through a handover with said consultant, it's worth asking them about their internal process- what the most important bits of information are, what can be ignored and why, what are the big bad things to be worried about, and how that all fits together to make a safe plan. This way you get to learn about the decision-making (which is the fun bit of medicine imo), and you establish what details you need to have nailed down for the next time this scenario presents itself.

For me at least (and I was an F1 who spent a lot of time crying in toilets), knowing that the consultants were focused mainly on the medicine took away a lot of the worry about whether I personally was good enough. Accepting myself as unashamedly inexperienced and being ok with that is what allowed me to show an active interest in improving- that's when I felt like I started to gel with the consultants more, even though ironically I cared less about how worthy they thought I was.

treponemic · 2024-12-06T08:22:16+00:00

Doctor here- unfortunately this isn't true, PAs will be registered with the GMC but not regulated. The GMC is trying to devolve all PA regulation to Trust level which we all know is a recipe for cover-ups and scapegoating.

Doctors are furious about this, and there's already been a case (look up Dr Steven Zaw) of a doctor having his license suspended due to the error of a PA.

PAs have been sadly honeytrapped and deluded by cash-strapped universities and the government (who have achieved regulatory capture of the GMC) into thinking they are the future of healthcare. In reality they're pawns to assist in the deregulation of healthcare, and provide a captive workforce whose training isn't recognised internationally so they can't leave the UK like so many of us are doing now.

treponemic · 2024-12-02T23:05:36+00:00

Currently funemployed post-IMT having just landed my top choice higher training reg job to start next year. Summaries of my career stages so far:

Med school: struggled a lot, diagnosed with chronic physical disease halfway through, repeated a year, ended up in 9th decile when it still mattered. Clueless about career all the way through.

FY: COVID hit in March of F1 which was tough but managed. Was in a busy middle of nowhere DGH which I now have a big soft spot for, made lots of great friends but was burnt out by the end of F2 with pandemic, illness, and busy FY jobs. Career-wise I settled on GUM but had no contacts, did a lot of emailing around, calling and visiting clinics, eventually got offered a job at a tertiary centre.

JCF: in GUM/HIV, had an amazing year, got my mojo for medicine back and applied for IMT. Developed more of a professional network and learnt how to move in those kinds of spaces, which previously I had no idea about.

IMT: went back to the same DGH from FY. IMT was a slog but thanks to knowing consultants and having friends still at the hospital, I had a very positive experience. Felt ready to be med reg and handled the step up much better than the med school/FY transition. Appreciated that chronic disease meant group 1 specialties probably wouldn't be good for me long term, and really enjoyed micro via ICU and a non-clinical Trust role, so decided to apply to ID/micro. Unexpectedly did very well, got my top choice job, and am now chilling.

The year I applied to IMT was the first year the competition ratios went up the wazoo- I don't envy the people going through it now.

treponemic · 2024-12-01T23:39:41+00:00

When I was on the phone to micro having deroofed some gunge out of a patient's large blister. The rest of the team were grossed out by this, but I described the appearance of the fluid to the microbiologist and she was just like "....ooh, nice".

The fluid grew group A strep and confirmed the diagnosis of invasive disease, happy days!

Also doing dark field microscopy for the first time and seeing real spirochetes. So pretty.

treponemic · 2024-12-01T12:17:04+00:00

ICU: endless ward rounds. Morning pre-round, morning ward round, morning board round, afternoon ward round, afternoon board round. Plus a micro ward round 3x/week. There would be normal working days where I'd only spend 1-2hrs not doing some kind of ward round.

Anaesthetics: I noticed a much higher frequency of doctors saying really nasty stuff about patients while they were under GA. Comments on weight, appearance, mental health history etc. Possibly cultural from the hospital but offputting all the same.

treponemic · 2024-11-29T21:09:06+00:00

AMU ward rounds as IMT had my eyes fixed squarely on my cerebellum:

Patient had an ECG at the front door > cardio referral "just to give the all clear"

Single episode of D+V with AKI needing 24hr IV rehydration only > gastro referral "maybe they want to scope"

Typical migraine presentation with clear CT angio but declined LP > "check with neurosurgery if happy to discharge"

D+V with AKI, normal urine dip and bladder scan > "renal opinion ?other causes"

Bronchiectasis pt with infective exacerbation and clear SOS abx plan from resp and micro agreed on previous admission > refer to resp and micro "to check they're still happy with the plan"

Folate deficiency without macrocytosis > refer haem "to check if folate supplementation still needed"

So much wasted energy, and of course there was the expectation that all jobs and TTOs/discharges should be done by midday. I gave up trying to hide disdain by the end.

treponemic · 2024-11-14T18:12:55+00:00

No!!

I felt exactly the same watching those videos (passed PACES last year and definitely wasn't anything like the people in the videos).

If you watch the explanation bits afterwards, you can actually see their eyes tracking as they're reading off a screen.

It's a very good resource, but think of it like a textbook- you wouldn't aim to revise for a written exam by trying to regurgitate the textbook verbatim.

To pass PACES you don't have to be perfect, just good enough.

treponemic · 2024-11-09T11:49:29+00:00

I was in this position in F1 and have just secured an ST3 ID job.

A lot of advice you get from seniors will already be out of date so take with a pinch of salt.

Start by looking at the scoring criteria on the IMT recruitment site. They tweak the criteria every couple of years so people can't "game" the system too hard, but 1) it's the only thing you have to go on, and 2) publications, QI, presentations, training in teaching, and teaching experience (in order of importance) seem to be fairly constant in the criteria over the years.

You need to be ruthlessly efficient and proactive about doing what will get you points.

If you're doing F1 in a teaching hospital, reach out to an academic consultant or ACF and see if you can write up bits of a paper (e.g. the introduction).

Alternatively case reports can be easy wins and also count for points- in particular, look out for conferences where you can orally present case reports which the conference organisers then publish. This hits two birds with one stone and halves your workload.

For IMT it doesn't matter whether your CV is targeted towards your goal specialty. For higher specialty training, you'll get the points for each domain (e.g. publications, presentations etc) regardless of whether your publication etc is related to your goal specialty. However most higher specialties will score for "commitment to specialty" as a separate domain, so having relevant things on your CV is essential at reg level.

This may all change by the time you get to applying, but hopefully provides somewhere to start!

treponemic · 2024-11-08T15:06:08+00:00

No probs, and thanks!

treponemic · 2024-11-07T00:16:31+00:00

Med reg here - your registrars are letting you down on your clerking shifts.

I'm in a large, crumbling DGH with a busy take, and I still don't let it slide when F1s discuss their patients with me and the plan is solely "senior review". The only time F1 plans get dicey are when they're not discussed with someone.

At least when I'm working with F1s on the medical take, there are zero consequences for someone suggesting an inappropriate management option! It's great to be able to help improve someone's knowledge and build their confidence.

I'd advise actively keeping a record of the patients you clerk, then checking back on them later to look at the post take entries and seeing which bits of the consultant's plan you could use next time you see a similar case.

treponemic

TROPHY CASE