INFECTIOUS DISEASES
HIGHER SPECIALIST TRAINING PROGRAMME
MALTA
APRIL 2011
INTRODUCTION
Training in Infectious Diseases provides a generic programme for specialists who may
practice in a variety of infection related disciplines for example tropical medicine, HIV
medicine, infection control and aspects of public health medicine.
SELECTION for and ACCESS to the TRAINING
Teachers and training institutions or other responsible bodies select and appoint trainees in
accordance with the established selection procedure.
ENTRY REQUIREMENTS
 Registration with the Medical Council Malta.
 Certificate of Completion of Basic Specialty Training in General Medicine
DURATION of TRAINING
A minimum of 4 years postgraduate training is required, in addition to at least a minimum of 2
years must be in General Internal Medicine which forms the “common trunk”. The common
trrunk should be completed before embarking on the specialist training (this 2 year period is
subsequent to the compulsory post qualification training internship otherwise known as the
Foundation Programme).
Infectious Diseases training should thus not be less than four years full-time or equivalent
TRAINING CENTRE
Training shall take place in an institution or group of institutions which together offer the
trainee practice in the full range of the specialty. They must have an intensive care unit and
other specialties must also be represented (particularly the medical specialties and surgery)
so as to provide an opportunity for inter-specialty consultation. They must have access to a
full range of microbiological, biochemical, haematological and imaging investigations and fulfil
other criteria that the Association of Physicians may, from time to time, determine.
TRAINING PROGRAMME, TRAINING LOG-BOOK
General Description of Higher Medical Training for Infectious Diseases: (These requirements
are in addition to the general principles for Higher Specialist Training as described in the
document Specialist Training Programmes in Adult Medical Specialties issued by the Medical
Specialists Accreditation Committee).
The training programme will include agreed periods undertaken in the management of
unselected community acquired infection(s) and the management of imported infection, both
as in patient and out patient, and hospital acquired infection. Attachment to a Medical
Microbiology/Clinical Virology department is also necessary during the training to enable the
trainee to acquire the ability to use the laboratory appropriately and to interpret data
originating from the Clinical Microbiology laboratory. Involvement in the management of
immuno-compromised patients (for example HIV infection, transplant patients, patients with
infected prostheses) and a period of involvement in an Intensive Care Unit will be obligatory.
Research will be regarded as an integral component within the training programme. It is
recognised that in some countries infectious diseases is practised with clinical responsibility
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for patients in a ward and in others it may be more on a consultation basis but the underlying
principles included in this training programme should be relevant to both styles of training.
KNOWLEDGE-BASED ASSESSMENT
In order to be awarded the CCST at the end of training, the trainee should be in possession
of specialty certificate awarded by the Federation of Royal Colleges of the UK and the
relevant speciality society or the UEMS speciality certificate or an equivalent qualification
recognized by the Association of Physicians of Malta.
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THE CURRICULUM
Community Acquired Infection and hospital acquired infection:
Involvement in management (clinical assessment, investigation, diagnosis, treatment and
follow up) of unselected patients suffering from infections, preferably predominantly
community acquired, and imported infection(s) forms a central theme within the training
programme.
Typical examples would be community acquired pneumonia, MRSA infections, vector-borne
diseases such as leishmaniasis, typhus and leptospirosis.
Consult experience should be obtained during this period e.g. in other hospital associated
infections such as surgical infections, intensive-care related infections, orthopaedic infections,
device related infections and infection in immune compromised patients.
At least 3 years should usually be spent in an approved post which meets the above
requirements of the curriculum. It must include both inpatient and out patient care. (A
maximum of one year of training outside the European Community at a recognised training
centre approved prior to the period of training by the specialist national authority will be
acceptable).
ORGAN-SPECIFIC INFECTIONS
The trainee is expected to have extensive experience in the diagnosis and management of
the following organ-specific infections
Pneumonias and other respiratory infections
Endocarditis (native/prosthetic)
Joint and bone infection
Skin and soft tissue infection
Central Nervous System infections: Meningitis/Encephalitis
Urinary tract infections
Infectious diarrhea
Complicated intra-abdominal infections
PYREXIA OF UNKNOWN ORIGIN (PUO)
Training in the management of patients suffering from PUO must be given during the training
period. The trainee is expected to be well-experienced in the management of such patients.
HIV/AIDS
Experience in HIV/AIDS must form part of the training programme and may require rotation to
a unit possessing a high component of suitable patients or to a dedicated HIV unit if it cannot
be provided in the primary ID training centre.
Cross specialty infections including tuberculosis and viral hepatitis
Experience in the management of cross speciality infections such as tuberculosis and viral
hepatitis (including B and C) must be part of the training programme.
Immuno-compromised patients:
The training programme must include experience in the management of opportunistic
infection(s) in immunocompromised patients such as neutropenic hosts, transplant patients,
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congenital immune deficiencies as well as those compromised by illness such as diabetes
mellitus and infected prosthetic devices.
Medical Microbiology:
Experience in Medical Microbiology is essential. It is envisaged that attachment, collaborative
research, and/or direct involvement in these disciplines will be necessary.
An attachment will typically be between 2-3 months (flexible timing may be allowed), and
should ideally be organised in the first year of training.
Intensive Care:
A period of attachment to and a period providing consults to an Intensive Care Unit to gain
experience in the management of these patients must form part of the training programme. A
period spent in this environment should provide additional experience in the prevention and
treatment of nosocomial infection and sepsis.
This period of attachment is expected to be from 2-4 weeks and should ideally be done
during the second year of training.
SEPSIS
A firm grasp of the pathogenesis, diagnosis and management of the sepsis syndrome is
considered very important
Control of Infection:
Experience in the prevention and control of community and healthcare related infections or
hospital outbreaks e.g. MRSA, SRSV is important.
Epidemiology and Public Health Medicine
A period of interface with these disciplines is regarded as desirable and will enable the
trainee to become familiar with the principles and practicalities of immunisation and
vaccination, investigation and control of notifiable diseases and community outbreaks.
Research:
Training to develop a basic understanding and ability in clinical and/or laboratory research
methodology is essential. Supervised research or further formal postgraduate training, is
encouraged.
The trainee will be expected to publish at least one manuscript in an international, peer
reviewed journal. During the training, the trainee is also expected to initiate and participate in
at least 2 Clinical Audits pertaining to the local Infectious Disease practice.
Tropical Medicine
To enhance their training in tropical medicine the following would be considered valuable and
desirable:
1. Attendance at a tropical medicine training course at one of the internationally
approved centres such as those leading to the Diploma in Tropical Medicine and
Hygiene or equivalent or
2. A twelve month period in a recognised training centre in the tropics or a period of
experience in an approved parasitological laboratory may be considered.
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Post-graduate Qualifications
Other post-graduate qualifications will be considered valuable after discussion a priori (before
committing to any specific course or examination) with the Infectious Disease Lead Trainer/s.
Diseases of travel:
The training must include aspects of prevention of travel associated diseases as well as the
regular clinical assessment, diagnosis and management of travel related infections. If this
training cannot be provided at the primary training centre, the experience must be obtained
elsewhere.
VIRAL HAEMORRHAGIC FEVERS (VHFS)
A clear understanding of the management of VHFs, the strict infection control measures and
public health implications must form part of the training programme.
Bioterrorism
An understanding of the issues related to the clinical presentation, early recognition,
epidemiology and management and control of infections which could potentially be
deliberately released into a community for example, smallpox, anthrax, plague, botulism and
tularaemia.
Sexually Transmitted Diseases (STD)
An understanding of the basic principles of STD as they relate to infectious diseases is
desirable.
This may include a short period of attachment to the Genito-urinary Clinic of between 1-2
weeks.
Antimicrobial Chemotherapy
Knowledge of the issues relating to optimal use of antimicrobial chemotherapy including an
understanding of the pharmacokinetics and principles of prevention, mechanisms of
resistance and management of antimicrobial resistance must be obtained during the training.
Practical Skills to be acquired by completion of infectious diseases training:
The underlying objective is to produce an individual who can function independently at
specialist level by the end of training. Requirements can be summarised as follows:
i.
ii.
iii.
iv.
v.
vi.
vii.
Appropriate management of an emergency admission suffering from severe infection.
Competence in acute assessment of patients suffering from infections and the day-to-day
care of patients suffering from severe infections and its sequelae.
Management of severe infection in an ICU setting.
Management of patients with imported infections - e.g. malaria.
Care of immuno-compromised patients - including neutropenic and those with HIV
infection/AIDS. It is essential that the trainee must develop the skill to effectively use and
monitor combination antiviral regimes.
Management of nosocomial infections, with knowledge of infection control, and
appropriate liaison with laboratory services.
Practical knowledge of common clinical diagnostic procedures
It is also essential that the trainee be:
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a. Regularly involved in under-graduate and post-graduate teaching.
b. Involved in audit and quality control relating to the speciality.
c. Conversant with clinical pharmacological aspects of and appropriate use of antimicrobial
chemotherapy (where possible with involvement with the Antibiotic Sub-Committee).
d. Conversant with aspects of infection control (where possible by being co-opted onto the
Infection Control Committee).
e. Aware of resource management implications related to practice in the speciality.
f. Able to lead a multidisciplinary team in the clinical setting.
During infectious diseases training, the trainee must:
1. Be competent to supervise work and training of staff undergoing general professional
training (common trunk general internal medicine), and to contribute to the training of
those in the earlier stages of infectious diseases training.
2. Have understanding of clinical and/or laboratory research methods.
3. Have been exposed to ‘management’. This should include attendance at agreed courses
and committee experience.
4. Be familiar with administrative duties relevant to modern consultant practice in the
speciality.
5. Be aware of the importance of involvement in continuing medical education (CME) and
utilisation of resources for this purpose.
6. Actively contribute towards the improvement in systems of patient-care and safety, and in
health-care management.
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THE TRAINING PROGRAMME
Infectious diseases training for any individual trainee must be co-ordinated by an individual
person or body. There should be a training programme with a regular formal review for the
trainee on a minimum of an annual basis.
The ID Training Programme shall be based on the Curriculum outlined in this document.
JOINT TRAINING WITH GENERAL INTERNAL MEDICINE:
This may be undertaken and will have to be in accordance with guidelines produced by the
National Authorities to meet European requirements.
LOG-BOOK AND GENERAL CONDITIONS
A log-book will be kept with details concerning experience gained which must be signed by
the appropriate supervisor(s). (Appendix 1)
A Clinical Supervisor shall be assigned for an ideal period of one year after which the trainee
shall rotate to another Clinical Supervisor. The role of the Clinical Supervisor is primarily that
of monitoring and supporting the trainee’s day to day clinical and professional work
An appraisal shall be carried out at intervals of 6 months (minimum) or ad hoc as necessary
at the discretion of the Clinical Supervisor. At these appraisal meetings, a review of the
logbook will also be done. The Appraisal form in Appendix 2 will be used and filed in the
trainee’s logbook. Any Ad hoc meetings with the Clinical Supervisor may be recorded in the
Clinical Supervisor’s Ad hoc meeting form (Appendix 3)
In addition, the trainee shall have an Educational Supervisor. The role of the Educational
Supervisor is primarily that of monitoring and supporting the trainee’s Educational
Programme and progress.
A meeting with the Educational Supervisor shall be carried out at intervals of 6 months
(minimum) or as necessary at the discretion of the Educational Supervisor. At these Review
meetings, the educational programme and progress of the trainee may be discussed along
with any other relevant matters.The Educational Supervisor Review Meeting form in
Appendix 4 will be used and filed in the trainee’s logbook.
Communication between the Clinical and Educational Supervisors may be done if any
relevant information regarding the trainee’s clinical, and educational progress needs to be
shared with the interest of the trainee and patient safety in mind.
It will be the onus of the trainee to approach the Clinical and Educational Supervisor to
organise the regular meetings as well as the ad hoc meetings when necessary. The Clinical
and Educational Supervisors may however also themselves call an ad hoc meeting as
necessary.
All meeting encounters will be recorded in the Meeting Encounters form (Appendix 5) and
filed in the trainee’s logbook.
ANNUAL REVIEW OF PROGRESSION
An Annual Review of Progression will be done by an Annual Review of Progression Board.
The Board will consist of the Clinical and Educational Supervisors as well as an External
Reviewer. The logbook will be reviewed and achievements noted. Recommendations for
progress or otherwise in the Infectious diseases Programme will be made, as well as
recommendations for further development if necessary.
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Any difficulties with progression will be referred to the Training Committee. In addition, the
Training Committee will be undertaking a separate review, based on Supervisor Appraisals
and other assessments as necessary.
TRAINING BOARD IN THE EU/EFTA
Trainees should have the opportunity to be trained in recognised training institutions in other
UEMS member countries during their training with prior approval by the Specialist Advisory
Committee.
TEACHER/TRAINEE RATIO
The ratio between the number of qualified Infectious Diseases physicians in the teaching staff
and the number of trainees should provide for adequate close personal monitoring of the
trainee during his/her training and provide adequate exposure of the trainee to the training.
This ratio should be no less than 1:1.
OVERSEAS TRAINING
A period of training in an approved overseas training centre is encouraged and highly
desirable.
EDUCATIONAL ACTIVITIES
Attendance at weekly Journal Club meetings is expected. Other teaching activities will be
actively encouraged.
CONFERENCES
Attending of Infectious diseases related conferences is encouraged and desirable at least
once every year.
OTHER REQUIREMENTS FOR TRAINEES
EXPERIENCE
To build up his/her experience the trainee should be involved in the management and
treatment of a sufficient number of in-patients and out-patients and perform a sufficient
number of the practical procedures relevant to the specialty which may not be provided by
other hospital professionals.
LANGUAGE
The trainee should have sufficient linguistic ability to communicate with patients and to study
international literature and to communicate with foreign colleagues. In some countries this
may be subject to a formal test.
HUMANISTIC SKILLS
The specialty of Infectious Diseases traverses all other specialties and inter-specialty
consultations make up a substantial part of the work load of ID physicians. Trainees are
therefore expected to have particularly good communication skills, be able to work in a team
without problems, and maintain excellent doctor-healthcare worker and doctor-patient
relationships.
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Appendix 1
LOGBOOK FOR INFECTIOUS DISEASES
KEY AREAS AND COMPETENCE
Malta Infectious diseases Training Programme
KEY AREAS OF INFECTIOUS DISEASES
Trainee’s name
CATEGORY
KEY POINTS
Community
acquired
infection
(Please refer to
Curriculum)
Approx number of inpatients
per month
Tropical
infectious
disease
Approx number of returning
travellers
per year
Travel
medicine
Approx number of travelrelated consultations per
year
HIV / AIDS
Approx number of HIV
inpatients seen
per month
Approx number of HIV
outpatient seen
per month
Approx number of
compromised
patients (excluding
transplant/HIV)
per month
YEAR
1
YEAR
2
YEAR
3
YEAR
4
Approx number of outpatients
per month
Compromised patients
(including transplant)
Hospital acquired
infection
Pyrexia of Unknown Origin
Approx number of transplant
per month
Approx number of hospital
acquired
infections per month (c. diff.,
pneumonia, UTI etc)
Approx number of patients
per year
Surgical infection
consults
Approx number of consults
(month)
Intensive care
Approximate number of
patients seen in Intensive
Care
Clinical Supervisor Initials
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Trainee’s name
Sepsis
Approx number of patients
per year
Medical
microbiology/
clinical virology
Approx time spent in
laboratory
aspects of infection (weeks)
Approximate number of cases
where you have decided
directly re antimicrobial
chemotherapy
Epidemiology and
Public Health
Approx time spent in activities
relating to this area (hours)
Genito urinary
medicine
Approx time spent in this
areas
(weeks)
Other (specify)
(eg journal club, case
presentation)
Other (specify)
Other (specify)
KEY AREAS OF INFECTIOUS DISEASES SIGN OFF
Trainee’s name
Clinical supervisor signature year 1
Educational supervisor signature year 1
Date
Clinical supervisor signature year 2
Educational supervisor signature year 2
Date
Clinical supervisor signature year 3
Educational supervisor signature year 3
Date
Clinical supervisor signature year 4
Educational supervisor signature year 4
Date
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LEVEL OF COMPETENCE
Trainee’s name
CATEGORY
KEY POINTS
YEAR
1
YEAR
2
YEAR
3
YEAR
4
KEY TO LEVEL
OF COMPETENCE:
1.lacks competence, needs basic
instruction
2.insufficient competence,
supervision essential
3.competent under supervision
4.fully competent and able to act
independently
Community
acquired infection
Please refer to
curriculum
Management of unselected
patients
with community acquired
infection
(inpatient)
Management of unselected
patients
with community acquired
infection
(outpatient)
Tropical infectious
diseases
Management of illness in the
returning traveller from the
tropics
Travel medicine
Principles & practice of
prevention of
travel related illness
Management of all aspects of
HIV
care - clinical
(including drug therapy)
Diagnosis & management of
infection
in compromised patients
including
transplant patients
Diagnosis & management of
hospital
acquired infection and
understanding
the principles of prevention
and
control
Understand principles of
diagnosis,
management and control of
surgical
infection
HIV / AIDS
Compromised
patients
Hospital acquired
infection
Surgical infection
Clinical Supervisor Initials
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LEVEL OF COMPETENCE SIGN OFF
Trainee’s name
Clinical supervisor signature year 1
Educational supervisor signature year 1
Date
Clinical supervisor signature year 2
Educational supervisor signature year 2
Date
Clinical supervisor signature year 3
Educational supervisor signature year 3
Date
Clinical supervisor signature year 4
Educational supervisor signature year 4
Date
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Appendix 2
Structured Trainee Appraisal Form – HST
Infectious Diseases Training Programme
Details of Trainee
Name & Surname: _________________________________________
I.D. Number: ________________________
Medical Council Registration Number: ______________________
Grade (circle one): HST1
HST2
HST3
HST4
Time period under assessment:
From (DD/MM/YY) ___________________ to
1
CLINICAL SKILLS AND UNSUITABLE
(DD/MM/YY) _____________________
SUITABLE
Unable
EXPERIENCE
comment
Poor
1.1
Fair
Satisfactory
Good
Clinical Skills
Clinical Knowledge
Technical/operative skill
Clinical judgement
Patients clinical records
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to
1.2 Do you have any concerns regarding the applicant’s
(a)
Overall clinical competence compared to other doctors at this level?
NO
(b)
Awareness and insight into knowing when it is necessary to seek advice?
NO
(c)
Ability to organise and prioritise problems?
NO
(d)
Manual dexterity
NO
YES, My concerns relate to:
...........................................……………………………………………………………………….
……………………………………………………………………………………………………….
……………………………………………………………………………………………………….
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2
ATTITUDE TO WORK UNSUITABLE
SUITABLE
Unable
AND TRAINING
comment
Poor
2.1
to
Fair
Satisfactory
Good
Willingness to learn
Contribution to the
department
Punctuality
Reliability
Self motivation
2.2 Do you have any concerns regarding the applicant’s
(a)
Enthusiasm to take responsibility for their training needs?
NO
(b)
Attendance or contribution at educational and audit meetings?
NO
(c)
Interest or ability in teaching juniors/peers?
NO
YES, My concerns relate to:
...........................................……………………………………………………………………….
……………………………………………………………………………………………………….
……………………………………………………………………………………………………….
3
PERSONALITY
UNSUITABLE
SUITABLE
Unable
comment
Poor
3.1
Fair
Satisfactory
Good
Ability to cope under
pressure
Honesty/Integrity
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to
3.2 Do you have any concerns regarding the applicant’s
(a)
Resilience-ability to cope with stressful situations?
NO
(b)
Awareness of ethical issues and individual responsibility?
NO
YES, My concerns relate to:
...........................................……………………………………………………………………….
……………………………………………………………………………………………………….
……………………………………………………………………………………………………….
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4
ATTITUDE TO OTHERS UNSUITABLE
SUITABLE
Unable
Skills in communication,
comment
co-operation and team
working
Poor
4.1
Fair
Satisfactory
Good
Patients
Relatives
Consultants
Peers
Other colleagues/staff
groups
4.2 Do you have any concerns regarding the applicant’s
(a)
Communication skills (clear, fluent and articulate in communication in English) NO
(b)
Ability to establish a good rapport with patients/relatives/colleagues etc?
NO
(c)
Ability to empathise & treat patients in a non-judgmental way?
NO
(d)
Ability to work as a member of a team
NO
YES, My concerns relate to:
...........................................……………………………………………………………………….
……………………………………………………………………………………………………….
……………………………………………………………………………………………………….
5 Disciplinary record / Fitness to Practice
Please give details of any existing disciplinary/fitness of practice record or outstanding
disciplinary/fitness to practice matter, together with the relevant details
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to
6 Sickness / Attendance record
Sickness while on your employment
Do you have any concerns about the applicants attendance
No. of days…………very rare!
NO
If yes give details of your concerns ………………………………………………………………………………..
…………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………
…
7 Summary
Using the strengths and weaknesses of the candidate please give any other information relevant to
the person specification and training programme.
Signature:
Name of Supervisor in Block Letters:
Date:
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Appendix 3
CLINICAL SUPERVISOR AD HOC MEETING
Infectious diseases HST Training Programme
Name of trainee
Date:
Name of Clinical Supervisor
Name of Educational Supervisor
Comments
State reason for meeting
Recommendations (state where special attention should be given in future attachments)
Signature of trainee
Signature of Clinical Supervisor
Date
YEAR OF SPECIALIST TRAINING (please circle) ONE/TWO/THREE/FOUR
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Appendix 4
EDUCATIONAL SUPERVISOR REVIEW MEETING
Infectious diseases HST Training Programme
Name of trainee
Date:
Regular / Ad hoc (circle as necessary)
Name of Clinical Supervisor
Name of Educational Supervisor
Comments
If Ad hoc, state reason for meeting:
Recommendations (state where special attention should be given in future attachments)
Signature of trainee
Signature of Educational Supervisor
Date
YEAR OF SPECIALIST TRAINING (please circle) ONE/TWO/THREE/FOUR
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Appendix 5
MEETING ENCOUNTERS FORM
Infectious diseases HST Training Programme
Name of trainee
Date:
YEAR OF DATE SUPERVISOR
TRAINING
(CLINICAL /
EDUCATIONAL)
MEETINGTYPE
(REGULAR / AD
HOC)
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SUPERVISOR
SIGNATURE
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