Genitourinary medicine

From August 2022, all genitourinary medicine higher specialty trainees will dual accredit in Genitourinary Medicine and Internal Medicine. This will be delivered in a blended approach to allow trainees to maintain and develop their skills in internal medicine, whilst becoming an expert in genitourinary and HIV medicine.

Genitourinary Medicine (GUM) is one of the most diverse, unique and advancing specialities, covering the prevention and management of sexually transmitted infections and HIV, and so much more.  

As a GUM trainee (and consultant) you can: 

• diagnose and treat conditions on the same day to managing long term chronic conditions;  
• take an active role in public health;  
• look after the cycle of life from adolescents to pregnant women and older patients;  
• specialise in various areas including psychosexual medicine, contraception, chronic genital problems including infections and dermatological conditions within sexual health;  
• manage the complexities HIV brings including opportunistic infections, HIV related and non-HIV related co-morbidities, antiretroviral drug resistance, adherence issues, largely in the outpatient setting but also inpatient setting; 
• manage key and vulnerable populations including young, sex workers and drug users, refugees, etc.  

Specialising in GUM not only provides the opportunity to work within a diverse multi-disciplinary team from specialist nurses, specialist pharmacists, health advisors, psychologists to peer support workers on a daily basis, but a diverse patient population group making communication skills, a non-judgemental attitude and empathetic nature ingrained for GUM physicians.  
 
Trainees are actively encouraged and supported throughout their training to undertake opportunities and develop in their career towards a consultant GUM physician. Out of programme experiences have included stints abroad in Africa, Asia, Middle East and Europe, training as sexual offences examiner, Public Health England fellowships, and furthering education qualifications, to name a few. Academic experiences are fostered through general training including service evaluation through QUIPS and audits, but formally through academic posts, with local, national and international collaborations always available. Strong links exists for trainees within the work of the British Association for Sexual Health and HIV, British HIV Association extending to a number of international organisations. As a consultant, it is easy to continue those interests above and beyond. 

Above all, GUM is a fun speciality, that will not only satisfy the clinical and psycho-social aspects of medicine from a generalist and specialist perspective, but provides a whole array of other opportunities while still being able to maintain a healthy work life balance!  

“One of the best things for me about working in GUM is that I really enjoy going to work every day; not many of my friends say that about their jobs in other careers." GUM trainee. 

GUM - trainee characteristics

• non-judgemental

• excellent communicators

• team players

• adaptability, given the evolving nature of the specialty

• not easily embarrassed, with a good sense of humour!

Working/training in an HST GUM post

The day-to-day work of a GUM physician varies, depending on sub-specialty and setting, and ranges from managing acute presentations of STIs, sexual assault assessment and post-exposure prophylaxis for HIV in addition to routine reproductive and sexual healthcare provision and the longterm management of chronic HIV infection.

There are also more specialist services, such as psychosexual medicine, adolescent clinics and genital dermatology, as well as sex worker and drug user outreach services.

Emphasis on social factors and community-based care

As many of our patients are drawn from vulnerable and under-represented populations, there is also a real emphasis on social circumstances and emotional health.

Traditionally, GUM clinics were based in hospital; however these are becoming increasingly community-based, so as to provide better local access, although HIV care has continued in acute settings.

Inter-disciplinary work and work-life balance

The specialty provides ample opportunity for interdisciplinary working with sexual and reproductive health, infectious diseases, diagnostics specialties and public health; the latter being a key element of the specialty with regards to partner notification and disease surveillance.

GUM physicians work alongside the ever-increasing multidisciplinary team, including professionals of various disciplines - primarily nurses, health advisers, general practitioners, pharmacists, school nurses and other allied professionals.

GUM is predominantly an out-patient specialty with limited on-call.  Dual accreditation in GUM and internal medicine will enable trainees to consider employment in a variety of settings including acute medicine, community hubs or in specialist sexual health work, such as sexual assault referral centres and outreach clinics. 

Trainee satisfaction

GUM has achieved high scores for satisfaction in the annual GMC trainee survey, and most trainees feel prepared for consultant posts after the four-year training programme.

The GMC accepted the revised GUM curriculum in 2021 and it will be implemented from August 2022.  The curriculum is delivered through a variety of learning experiences, including work-based learning and on-the-job supervision. 

Out-of-programme attachments have been encouraged, and a number of trainees pursue HIV care abroad or higher degrees. 

A day in the life of an ST5 GUM registrar...

To give an indication of what you can expect from time in a GUM post, we asked an ST5 trainee to describe a common day for them.

Morning meeting

Today is Monday so I start with our HIV multidisciplinary meeting at 9am in our HIV hospital base.

This multidisciplinary meeting is attended by the GUM consultants, registrars, specialist nurses, sexual health advisers, virologists, psychiatrists and counsellors, as well as some cakes or biscuits!

We review each of the patients coming to clinic over the next week and discuss difficult management or, more often than not, challenging social circumstances.

Clinic

Clinic starts later in the morning and my first patient is indeed a challenge - a newly diagnosed lady from Africa who has been trafficked to the UK and does not speak any English.

The consultation is challenging, especially with a translator; however, after an hour or so we make some progress and link her in with social work, TARA and the red cross.

My next patient is a gentleman who wishes to start a family with his HIV-negative wife. We discuss all the options and make a referral for fertility assessment.

After this I see a patient who has not attended for three years. He's short of breath with oral candida, so I arrange admission to our ward for further assessment with just enough time to make our STI diagnostics group meeting.

Diagnostics group

This group is attended by public health and virology colleagues to review local STI trends and new diagnostic tests, and attending really helps in appreciating the GUM specialty as a whole.

Community sexual health clinic

In the afternoon I'm based in one of our community hubs with two specialist nurses for the sexual health clinic.

As our service is fully integrated, the afternoon is as varied as always, including gonorrhoea-diagnosed by onsite microscopy, emergency IUD fitting, PEP for HIV after a condom break, post-menopausal bleeding as well as a prolonged discussion with the partner of a patient recently diagnosed with herpes simplex.

Young persons clinic

Later in the day the young persons clinic starts with its usual added complexities. I see a 14-year-old with a history of liver transplant for contraception advice, as well as a group of 12-year-old boys asking for condoms with the usual jokes and giggles...

At the end of the clinic I see a vulnerable 12-year-old girl who discloses her excessive drinking and sexual contact, at which point I discuss her case with our specialist young persons consultant, and subsequently social work.

End of the day...almost

My normal day is supposed to finish here, at 5pm; however, I also participate in our Sexual Assault Referral Centre on-calls, and today I am on call from 5pm till 9am the next morning. I just hope it's a quiet night!

Further information

• The British HIV Association (BHIVA)
• British Association for Sexual Health and HIV (BASHH)
• NHS health careers
• JRCPTB specialty page and curriculum
• ST4 GUM person specification