The Role Of A Medical Microbiologist Or Virologist
Medical microbiologists and virologists direct the prevention, diagnosis and treatment of infectious diseases, with viral infections being the focus of medical virologists’ work. Medical microbiology and virology are pathology specialties.
A medical microbiologists or virologists job is to provide a consultancy service to clinical colleagues regarding care of patients with suspected infection. They advise on the most suitable samples to collect and identify the causative agent by microscopic examination, biochemical and molecular tests and analysis of the results(1).
They recommend treatment and monitor patients subsequent to its administration. In conjunction with supervisory roles in diagnostic laboratories, medical microbiologists contribute to public health strategies. They are engaged in minimising antibiotic resistance by constructing guidance on appropriate prescribing for a range of diseases and promoting patient adherence to treatment regimens.
They collaborate with hospital infection control teams and estates departments to reduce the spread of nosocomial infections. Additionally, medical microbiologists monitor patterns of infectious disease incidence in the community and globally.
Virology is a small specialty. Virologists diagnose viral infections and advise clinical colleagues on antiviral treatments. They have direct involvement in the care of patients with chronic infections, for example, HIV and hepatitis(1) Virologists also have public health roles.
This includes studying antiviral drug resistance, advising on immunisation strategies and collaborating with hospital infection control teams to minimise transmission of hospital-acquired infections. Virologists work to identify and combat global health issues resultant of viruses.
In 2017, women comprised 55% and 46% of the medical microbiology and virology workforce in England respectively.2 Utilisation of skills, for example, communication, inquisitiveness, flexibility, and multidisciplinary teamwork alongside, for example, biomedical scientists, infection control nurses and other doctor are key to these specialties.
Increasingly, in conjunction with working in diagnostic laboratories, medical microbiologists and virologists assume clinical roles in outpatient clinics, hospital wards and intensive care units. There is also growing expectation for 24-hour service provision. Additionally, the future of these specialties is likely to feature centralised and automated working models(3).
A Typical Week
The regular workload of medical microbiologists and virologists comprises reporting, electronically or via telephone or ward visits, on cultures that have become positive, visiting intensive care units and other hospital specialties, for example, paediatrics and haematology that frequently care for patients with infections and responding to telephone enquiries from clinical colleagues(4).
Other activities include multidisciplinary meetings, for case discussions and devising antibiotic, infection control and emergency policies, leading laboratory operations and investigating outbreaks.
On-call duties are rare and are often conducted remotely. Examples of on-call cases are emergency admissions with septic shock and overnight deterioration of patients in intensive care units(4).
The Route To Medical Microbiology Or Virology
The first stage in the medical microbiology and virology training route, after two years of foundation training, is three years of general medical training. General medical training can be Internal Medicine Training (IMT) stage 1 or Acute Care Common Stem (ACCS).
Application to these is through a form that examines, for example, core competence, clinical reference, and details of achievement in various areas – and an interview. Both programmes feature rotations across a variety of medical specialties; ACCS facilitates increased focus on acute medicine, emergency medicine, anaesthetics and critical care medicine in the initial two years.
Trainees must pass the Member of the Royal College of Physicians of the United Kingdom (MRCP (UK)) examination prior to progressing to the next stage of training, namely Combined Infection Training (CIT). In 2019, the competition ratio for CIT ST3 was 2.22.5 The CIT curriculum has a duration of two years and aims to equip trainees with rudimental clinical and laboratory principles in medical microbiology, virology, infection prevention and control and infectious diseases(3).
Trainees experience six months of each of: clinical microbiology and virology training based in a diagnostic laboratory, clinical infection consultancy, a selection of infection reed clinics and clinical management of inpatients with infection. Trainees are assessed by the Fellow of the Royal College of Pathologists (FRCPath) Part 1 examination in Infection. Here, the route to medical microbiology and virology diverges.
Higher specialty training in medical microbiology has a duration of two years. This is advanced training in medical microbiology that comprises infection prevention and control and clinical therapeutics of infection(3). Subsequently, trainees attempt the FRCPath Part 2 examination in Medical Microbiology.
Higher specialty training in virology is also a two-year course. It facilitates acquisition of a level of competence consistent with independent practice as a consultant. The curriculum features essentials of virology, viral diagnosis and clinical management and infection prevention and control.6 Trainees are assessed by the FRCPath Part 2 examination in Virology.
Formal training is concluded by attainment of a certificate of completion of training (CCT) that is issued by the General Medical Council. There is an option to specialise in infectious diseases and one of medical microbiology or virology(3). This adds an extra year to the higher specialty training period. Application for consultant jobs can be submitted six months prior to achievement of a CCT.
Medical students interested in medical microbiology or virology can attend conferences and choose relevant topics for student selected components. It is also possible to join the Royal College of Pathologists (RCPath) and the British Infection Association (BIA).
Foundation trainees should attempt to secure a full placement in the specialty of their interest. Alternatively, other modes of involvement can be explored by establishing contact with these departments. For foundation and core trainees, it may be beneficial to obtain research, teaching and management experiences.
There are no recognised subspecialties in medical microbiology and virology.
Many medical microbiologists and virologists conduct research; opportunities for research work in this field are very good(1). Research may comprise laboratory work or clinical trials.
NHS consultant salaries are the same for all specialties but vary between Scotland (highest), England, Northern Ireland, and Wales (lowest) and increase with service (up to 19 years). In 2020 the salary bands range from £77,779 to £109,849.6 Salaries can be further enhanced with NHS excellence awards.
There is only limited scope for private practice. JRSM reported in 2008 that the average private income for medical microbiologist and virologists was about 15% their NHS income, one of the lowest figures of any specialty.7
For more information on salaries within the NHS, please feel free to review The Complete Guide to NHS Pay.
Key organisations for medical microbiologists and virologists are the RCPath, the European Society of Clinical Microbiology and Infectious Diseases, the European Society for Virology, The Pathological Society of Great Britain and Ireland and the BIA.
The Federation of Infection Societies conference is one of the most important infection conferences globally. Some prominent journals in the field are Nature Reviews Microbiology, Clinical infectious Diseases and PLOS Pathogens.
Related Job Sources With BMJ Careers
More Complete Guides By BMJ Careers
Medical microbiology and virology (doctor)[Internet]. Health Careers. [cited 26 July 2020]. Available from: https://www.healthcareers.nhs.uk/exploreroles/doctors/roles-doctors/pathology/microbiology-and-virology-doctor
NHS Digital. Analysis of the representation of women across the hospital and community health services workforce [Internet]. NHS Digital; 2018 [cited 26 July 2020]. Available from: https://digital.nhs.uk/data-and-information/find-dataand-publications/supplementary-information/2018-supplementaryinformation-files/analysis-of-the-representation-of-women-across-the-hospitaland-community-health-services-workforce
Curriculum for Specialty Training in Medical Microbiology [Internet]. 2nd ed. General Medical Council; 2017 [cited 26 July 2020]. Available from: https://www.gmc-uk.org/education/standards-guidance-and-curricula/curricula/medical-microbiology-curriculum
Working life (MMV) [Internet]. Health Careers. [cited 26 July 2020]. Available from: https://www.healthcareers.nhs.uk/explore-roles/doctors/roles-doctors/pathology/microbiology-and-virology-doctor/working-life
Specialty Recruitment Competition Ratios 2019 [Internet]. Health Education England; 2020 [cited 26 July 2020]. Available from: https://specialtytraining.hee.nhs.uk/Portals/1/Competition%20Ratios%202019_1.pdf
Training in virology [Internet]. The Royal College of Pathologists. [cited 26 July 2020]. Available from: https://www.rcpath.org/discover-pathology/careers-in-pathology/train-to-work-in-pathology/training-in-virology.html
Morris S, Elliott B, Ma A, McConnachie A, Rice N, Skåtun D et al. Analysis of consultants’ NHS and private incomes in England in 2003/4. Journal of the Royal Society of Medicine [Internet]. 2008 [accessed 14 June 2020];101(7):372-380. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2442143/table/tbl3/