Dr Karen Devine, ST4
One-line ‘definition’ of specialty

The diagnosis and management of any infection from tropical to hospital-acquired infections.

Brief run-down of training programme content and duration

Five years from ST3. In total, this is comprised of two years of general medicine and three years of infectious disease (ID) training. The three years of ID training should include general ID, HIV and hepatitis, travel medicine, microbiology, virology, sexual health and a short stint in the Intensive Treatment Unit (ITU). There are proposed plans to change training in ID. These plans include a common infection stem for all ID, microbiology and virology trainees. Trainees would then divide into their chosen speciality for the final three years.

Exam requirements:

Exit exam.

Other requirements

Completion of the Eportfolio and an annual review of competence progression (ARCP) at the end of every year of the five-year training programme is essential, as is the attendance at general medical training days throughout the year. It is preferable to have both the Diploma of Tropical Medicine and Hygiene (DTMH) and the Diploma of HIV. There are no specialist practical skills required.

Opportunities/expectations for out of programme/research

There is plenty of opportunity for research including PhDs, MDs and MScs (for example in medical education). However, these are not built into training time. You must apply within your first four years for an out of programme (OOP) experience. Research can be conducted within or outside the UK providing the deanery is satisfied that it constitutes a proper educational experience.

A day in the life of a Registrar/Consultant

Quite often a day can include being on-call for infectious diseases whilst doing a clinic and managing some sick patients on the ward. Being on-call you can expect questions and referrals from GPs and other specialties about anything from advice on investigating fever in the returning traveller to what to do about a monkey bite. You generally start the day with a handover from the nurses about any problems with patients overnight and review the patient if necessary. Discuss the plan for the patients with the Senior House Officer (SHO) who will do the ward round that day and arrange to meet up for a board round after your clinic. Start your general ID clinic which regularly includes patients with hepatitis B, pyrexia of unknown origin (PUO), extrapulmonary tuberculosis (TB), schistosomiasis and HIV. Go back to the ward to get an update on the patients from the SHO and attend the multi-disciplinary team (MDT) meeting. Review any GP referrals or patients referred from the Assessment and Rehabilitation Unit (ARU). Finally, if you have time, read the paper for journal club or prepare your presentation for the unit meeting before going home.

Pros and Cons of working in this specialty


  • If you enjoy all aspects of medicine and don’t want to limit yourself to just one system and if you want to cure a large number of your patients, ID is for you
  • Your patients are fascinating and come from several different countries and cultures
  • Some diagnoses such as HIV offer you the chance to form long-term clinical relationships with your patients, deal with ethical and difficult social issues, work within a multi-disciplinary team (MDT) and become familiar with aspects of medicine others find daunting such as drug resistance, interactions and pharmacokinetics


  • If you want to spend some of your week doing procedures, ID doesn’t really offer this unless this includes sticking a needle into a palpable mass to get some pus
  • Not so much a ‘con’ than a false belief; a UK ID training programme does not mean you rotate through various tropical destinations
How this specialty differs to others and what made me choose it

Infectious diseases and care of the elderly are really the only specialties which are truly multi-systemic. The draw of ID is that you can cure most of your patients. New and known infections are constantly evolving which challenges you to keep your knowledge up-to-date and offers a rich seam of research possibilities. You develop a knowledge of the likely causative microbes and patterns of resistance to choose a safe and appropriate empirical antibiotic regime and not just accept tazocin as a panacea. Infectious diseases is also the interface of public health, microbiology, sexual health, tropical medicine and virology. Therefore clinical presentation varies widely and management often depends on working with various other specialties. However, the best thing about ID are the patients who are often incredibly engaging and offer you insights into different cultures and customs that stimulate your interests inside and outside medicine.

Tips for success in applying for this specialty

Try to do an ID SHO post in your rotation. If this is not possible, take the opportunity in another specialty to focus on the infections side. For example, attend the TB clinic when in respiratory, do an audit of patients getting an HIV test diagnosed with lymphoma when doing haematology or spend your ‘taster’ week on an ID unit. There are always friendly ID Registrars who are happy to advise on audit possibilities and Consultants who have those rare cases that are in need of writing up for a case report submission. You can also do the DTMH in Glasgow as an evening course.

For more information

British HIV Association

London School of Hygiene and Tropical Medicines (Diploma in Tropical Medicine and Hygiene)

British Journal of Medicine (careers article)