Medicine Feilds

The need for qualified microbiologists continues to grow, both for basic research and practical applications. Many microbes have yet to be discovered. In addition, microbiologists are still studying how the known microbes function. As a result, the field of microbiology has virtually unlimited potential.

Microbiologists are needed across many industries, including in academic, technology, industrial and environmental organizations. Several career paths exist for individuals interested in studying microbes, or using microbiology techniques in their daily job activities.Much depends upon the chosen career path, including the degree and training required, the positions available, salary and job outlook, and work environment.

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Those considering a career in a microbiology, or a related field, will benefit from investigating the options before committing to a specific degree program. Microbiologists Microbiologists are scientists who study microbes, organisms too small to be seen with the naked eye. They also study how microbes interact with their environment. This includes examining how they cause disease and affect the health of plants, humans and other animals.Immunology — the study of how human health is affected by microbes — is an example of this type of specialization.

Some microbiologists may focus on studying one specific type of microbe. For example, bacteriologists study bacteria, and virologists study viruses. Or they may study practical applications of microbiology, such as biotechnology, medical microbiology or industrial microbiology. A degree in microbiology does not always mean that you have to work in a laboratory. Some microbiologists teach at universities and other schools. Those with an interest in journalism can obtain a job as a science writer.Microbiologists can also combine their education and experience with other degrees, such as law or business. They may find mostly office-based positions in legal, legislative or corporate environments.

Microbiology Job Activities In spite of the broad range of specialities available in microbiology, many positions have similar job activities. Microbiologists, in general, examine microbes using a variety of tools, such as microscopes. They may use other equipment, including gas chromatographs, electrophoresis gels, fluorescent cell sorters and various incubators.Some laboratories may use toxic chemicals or dyes when working with microbes. Microbiologists collect samples from the environment, including people, plants, animals and field locations. They also grow the microbes from the samples, and use standard laboratory techniques to isolate specific microbes. Microbiologists may also observe the effect of microbes on their environment or other organisms. This is especially true of medical microbiology, which examines the role of microbes in human health.

Microbiology Employers and Microbiology Work Environment.Microbiologists work for a variety of employers, including the federal government, state and county health departments, and academic institutions. They may also be employed by pharmaceutical companies, biotechnology firms, food and beverage industries, and manufacturing companies. Many microbiologists conduct research in laboratories, as well as work in offices, where they write up the results of their experiments.

Academic microbiologists often teach classes, in addition to conducting their own research. Microbiologists, especially those who carry out research, collaborate with other scientists.They sometimes supervise more inexperienced scientists and students working in their laboratory. Environmental and medical microbiologists, as well as other kinds, may collect samples in the field. Because microbes are found throughout the world, this fieldwork can be carried out in challenging and remote locations. Microbiologists working in the field have to be able to survive with difficult living conditions.

Microbiology Education The education required to work as a microbiologist depends upon the position.Degrees range from a high school education to a doctorate degree. Most microbiologists have at least a bachelor’s degree in microbiology, or a related science. Some microbiology laboratory technician positions, especially in medical laboratories, are open to individuals with a high school diploma or an associate’s degree.

A higher degree, of course, will allow you to work in more challenging positions, with higher salaries. Microbiologists who conduct independent research need to have at least a master’s degree, and often a doctorate degree for academic positions.As part of the degree, these programs offer students the opportunity to take part in research, either as part of an existing project, or their own unique study. The coursework provides a broad overview of science and microbiology topics. Students may specialize in one or more areas, both in their courses and in their laboratory research experiences. Microbiology Salary and Job Outlook The job outlook and salary for microbiologists varies with the degree and industry. The average salary for microbiologists was $64,350 in 2008, according to the Bureau of Labor Statistics.

Salaries ranged from $38,240 for those with bachelor’s degrees to more than $111,300 for those doctorate degrees. The average salary of microbiologists working for the federal government was $97,264 in 2009. The number of positions available for microbiologists is expected to grow faster than average.

This will vary with the degree and industry. Those with doctorate degrees will face competition for academic research positions. The number of available positions is partially affected by the amount of funding available for research, which often comes from the federal government. Bio-chemistry Careers in BiochemistryBiochemistry BIOCHEMISTRY involves studying the chemistry of living things such as substances, compounds and processes. Biochemists combine the fields of microbiology, cell biology, genetics, chemistry, cell biology, and physics in their day-to-day work or experiments.

They get into the most, minute characteristics of organisms, and their biological processes. They may be identifying the way in which DNA, which carries the genetic information, is transferred between cells and can be manipulated. Biochemistry finds application in clinical and forensic science and in the food and pharmacological industries.Biochemists are contributing to advances in a wide variety of areas, including health, agriculture and the environment. The screening of unborn babies for disease and investigation of possible cures for illnesses such as cancer and AIDS are possible due to progress in the biochemical understanding of disease The work environment could be the government, private sector, laboratories, hospitals, universities, and other educational and research institutions. USEFUL ATTRIBUTES Problem-solving, research and analytical skills, and curiosity are important traits for future biochemists.Good oral and written communication skills are critical as many scientists work as part of a team, write research papers or proposals, and have contact with clients or customers with nonscience backgrounds.

Observational, planning, team work, organisational, and computational skills are important for all scientists, including biochemists. EDUCATION Start with science in plus two/equivalent with Physics, Chemistry, Biology and Maths for future career in Biochemistry. Although some universities do offer biochemistry during graduation, post graduation really establishes you as a biochemist.MSc Biochemistry is offered in more than forty universities.

You can opt for a Junior Research Fellowship after MSc by appearing for the UGCCSIR JRF/NET exam. This could lead to a lectureship and a career in research and development, consulting or allied work. Some medical colleges may offer MD Biochemistry open to MBBS graduates. Central Drug Research Institute, Industrial Toxicological Research Institute, National Botanical Research Institute, etc would offer scope for advanced studies and research. PROMINENT INSTITUTIONS *• Aligarh Muslim University, Aligarh (www.

amu. ac. in) * • All India Institute of Medical Sciences, New Delhi (www.

aiims. edu or www. aiims.

ac. in) * • University of Allahabad, Allahabad (www. auadmission. com) * • Banaras Hindu University, Varanasi (www.

bhu. ac. in) * • University of Delhi, Delhi (www.

du. ac. in) * • University of Lucknow, Lucknow (www. lkouniv. ac. in)Audiological Medicine Audiovestibular medicine is the medical specialty concerned with the diagnosis and management of hearing and balance disorders in adults and children.

It also involves the management of people with tinnitus, dysacuses (conditions where ordinary sounds produce discomfort or pain) and communication disorders.In children this will involve diagnosis, aetiological investigation and habilitation for those with permanent childhood hearing loss, speech disorders and balance problems. Most adult patients present with balance disorders, tinnitus or complex hearing problems. A broad general medical training allows for appropriate investigation and medical management of the wide variety of conditions – of peripheral otological, central nervous system and general medical origin – presenting with audiovestibular symptoms. These include genetic diseases, infections, inflammatory conditions, vasculitis and vasculopathy, and traumatic and metabolic disorders.Because a high proportion of patients, especially children, have significant comorbidities, and because of the wider impact of their condition, audiovestibular physicians work as part of multidisciplinary teams containing a wide variety of health, education, social work and voluntary professionals.

These include audiologists, vestibular rehabilitationists, tinnitus therapists, clinical, educational and family psychologists, otologists, speech and language therapists, educational audiologists, specialist social workers and teachers.Related RCP publications * Consultant physicians working with patients, fourth edition (2008) * Hearing and balance disorders (2008) Specialty training For information about specialty training in audiological medicine, please visit the Joint Royal Colleges of Physicians Postgraduate Training Board (JRCPTB) website. Specialist society * British Association of Audiological Physicians (BAAP) Clinical Radiology Radiology or medical imaging has made great advances in recent years, thanks to dramatic technical innovation.Rapid advances in computer technology have led to the routine clinical application of ultrasound scanning (1970s), computed tomography (CT) (1980s), magnetic resonance imaging (MRI) (1990s) and, most recently, positron emission tomography (PET) in its diagnostic arm.

Parallel advances in catheter, stent, coil, embolisation materials, and balloon technology have massively increased the central role of image guided intervention in patient management. The nature of the job The specialty of radiology requires a sound clinical background in order to work with colleagues in other medical disciplines.A radiologist should also know about the basic sciences related to the imaging and pathology of disease. Radiologists are essentially clinicians who use various imaging methods to reach their diagnoses. Originally, these methods all entailed the use of ionising radiation, but since the advent of ultrasound scanning and MRI this is no longer the case. In addition, with the evolution of interventional radiology and the continued improvements in imaging resolution, the radiologist has many more options in his or her therapeutic armoury.

Imaging now impacts on almost all medical specialties, from general practice through medicine, surgery, obstetrics, and orthopaedics to psychiatry. Such close links with other clinical specialties make the career choice popular. Most schemes are vastly oversubscribed—the Northern Ireland scheme has 10 applicants for every post. Pros and cons Pros * Structured training * Scope for a wide variety of interests * Good job opportunities Cons * Imposing entry criteria for applicants * More examinations Working practice of a clinical radiologist.The day to day work of a radiologist working in a tertiary referral centre with a particular specialist interest (for example, neuroimaging, paediatrics, nuclear medicine, or intervention) will be different from one who works in an area or district general hospital. Typically, however, a working week for a generalist would include barium work; cross sectional imaging such as CT, MRI, and ultra-sound scanning; nuclear medicine; intervention; and, of course, plain film reporting.

And that’s part of the attraction of this career—you see such a wide range of medicine in thetypical working day. It is, for example, routine to be thinking about cardiology, thoracic surgery, oncology, neurology, orthopaedics, accident and emergency, and general medicine in a single CT list. Patient contact While it was once true that radiology didn’t have as much clinical follow up as some other specialties, this is changing, particularly in the interventional subspecialties. In fact, with the exceptions of MRI and CT, we spend the day close to our patients—for example, when performing ultrasound scanning.As we watch the monitor, the patient watches us, looking intently for any verbal or non-verbal clue as to the nature of their condition. It is worth remembering that most of our patients are nervous, if not petrified, of what our tests may reveal. It is therefore helpful to be able to try to reduce a patient’s anxiety during an examination and, hopefully, reassure him or her at the end of it. Bladder x ray examination Credit: JOSH SHER/SPL Entry criteria Trainees should have two years’ clinical experience, at least one of which should be at postregistration level.

Many of the training schemes insist on trainees having passed part 1 of the examination for membership of the Royal College of Physicians, the Royal College of Surgeons, or the Royal College of Obstetricians and Gynaecologists or equivalent; it is not uncommon for training programmes to attract applicants with completed higher qualifications. It is worth seeking local advice from specialist registrars or the training director of your local training programme.The training programme Specialist registrars enjoy a highly structured training in clinical radiology, with emphasis on consultant led departments. Finding yourself and your work heavily supervised can be disconcerting for some new trainees, who may previously have enjoyed considerable autonomy. At the moment, structured training in clinical radiology takes five years. This training broadly breaks down as follows: Years 1-4 There are 48 months of structured training to cover the subspecialties in the core curriculum and the core experience.

This can be divided into system based subspecialties such as vascular, cardiac, chest, musculoskeletal, and neuroradiological imaging; technique based subspecialties such as CT, ultrasound scanning, MRI, and intervention; disease based subspecialties such as oncology and trauma; and age based subspecialties such as paediatrics. Many training schemes will use the first year to prepare trainees for the part 1 examination, so typically there will be a medical physics course. Many schemes also provide further courses on anatomy and radiological technique.Year 5 This is a 12 month period of subspecialty training, which allows concentrated training in one (or more) subspecialties.

An additional year (year 6) is required for training in particular areas such as neuroradiology, interventional radiology, and nuclear medicine. After satisfactory progression through the record of in-training assessment (RITA) process, a certificate of completion of specialist training (CCST) is awarded. Examination structure There are currently two examinations: the first and the final fellow of the Royal College of Radiologists (FRCR) examinations.The first FRCR examination has changed considerably in recent years. The examination is uncoupled at present—in other words, a candidate may sit the examination (a series of multiple choice questions) without being in a radiology training scheme.The part 1 syllabus deals with ionising radiation, the relation between radiology and matter, and legislation governing exposure to medical ionising radiation.

The challenging final FRCR examination is in two parts, and has also been substantially revised. Part A consists of six modules. The candidate can begin to sit these after 18 months’ training.All six must be achieved before attempting part B.

Part B focuses on viva and reporting skills. Career prospects The good news for potential applicants (and the unfortunate reality for practising radiologists) is that most departments of radiology are understaffed. Vacancies for consultants can be found in many departments throughout the United Kingdom.

The United Kingdom has about 1500 consultant radiologists. The Royal College of Radiologists estimates that it would take a total of 3000 to staff satisfactorily the nation’s imaging requirements for a 9 to 5 working day.If a round the clock, 24 hours a day service becomes a reality, then 6000 radiologists will be necessary. So there is no shortage of career opportunities. Coloured angiogram of a stent in the iliac artery Credit: ZEPHYR/SPL Further reading and information * Frank J.

A career in nuclear medicine. BMJ 2003;327: s137-8. http://bmj. bmjjournals.

com/cgi/content/full/327/7422/s137-a * Royal College of Radiologists. Structured training in clinical radiology. 3rd ed. London:RCR, 2000 * Royal College of Radiologists: www. rcr. ac. uk * Society of Radiologists in Training: www.

thesrt. org. uk Future advances As with all other aspects of radiology, delivery of the training is currently under review. It has been suggested that the award of the CCST may be possible after four years, rather than the current five.There is also considerable national interest in the creation of academies of radiology. These institutions could enable trainees to gain experience in imaging in an academic rather than a clinical environment, which would allow greater numbers of registrars to be trained and thus help to alleviate the manpower problem.Further information The Society of Radiologists in Training has produced a comprehensive and accessible website which is crammed with important links and information for those interested in pursuing a career in radiology.

It covers topics such as how to negotiate the interview, sample interview questions, shortlisting requirements, and a list of UK schemes. It also gives information on the examination structure, sample multiple choice questions, and advice on preparing for the consultant interview. The bottom line So there you have it.Rapidly advancing imaging technology represents a huge challenge both intellectually and clinically. Radiology therefore offers a terrific opportunity to be a generalist or to subspecialise in a wide variety of individual subjects. Radiologists collaborate routinely with a host of clinical specialties, so there is something for everyone. A much respected colleague once said to me: “One thing I love about this job is that when I arrive in the morning, I can’t predict the clinical challenges the day will bring.

”He was right of course, but (and keep this to yourself) that’s part of the fun. Dermatology The scope of dermatology Disorders of the skin, hair, and nails fall within the remit of a dermatologist. The specialty is divided broadly into medical and surgical fields, with clinicians in secondary care often practising both. It should be noted that in some countries, training and practice in dermatology are combined with venereology, whereas in the United Kingdom, genitourinary medicine is a separate specialty.Dermatology is chiefly an outpatient specialty, and most patient referrals request an initial diagnosis and treatment of an unknown skin disease or review of more complex and chronic cases beyond the skill of the general practitioner.

Occasionally, patients are very unwell or incapable of applying therapies at home and require inpatient admission under the care of a dermatologist until they can be managed in the community. Patients are also admitted to day case units for the infusion of novel biologic therapies to manage psoriasis and other skin diseases.[12] A dermatologist will assess emergency referrals from general practice and skin disease in hospital inpatients, and will provide advice to other clinicians, such as general practitioners, over the phone.

Weekend on-call duties are less demanding than in other medical specialties; typically a registrar can be expected to cover one in four weekends. Dermatologists manage acute and chronic disorders of the skin. There are many subspecialties in dermatology (box 1), and a consultant in a tertiary referral centre will often have an interest in one or two of these in addition to practising general dermatology or holding a surgical interest.

Box 1: Subspecialties and interests * Medical dermatology * Surgical dermatology * Dermatopathology * Hair and nail disorders * Genital skin disease * Paediatric dermatology * Immunodermatology, including patch testing * Blistering disorders * Connective tissue diseases * Photodermatology * Cosmetic dermatology * Genetic skin disease Diagnoses are clinical in the overwhelming majority of cases, and dermatology requires relatively few investigations. Clinically diagnosing skin disorders takes skill and experience, plus a good grounding in clinical medicine.Dermatologists use a comprehensive formulary with topical therapies, systemic drugs including novel immunomodulatory drugs, phototherapies (with or without oral sensitisers), laser treatments, cryotherapy, and other treatment modalities alone or in combination—a huge variety of treatments to manage a tremendous number of diseases. Box 2 presents some of the pros and cons of a career in dermatology.

Box 2: Advantages and disadvantages of dermatology Advantages * Variety of patients; all ages and genders * Clinical variety * Reliance on clinical diagnostic skills.* Rewarding work—curable or controllable diseases * Patients rarely life threateningly unwell * Less demanding out of hours workload * Medical and surgical options * Can link clinical findings to pathological findings * Great opportunities for clinical or lab based research—skin is visible and accessible * Flexible specialist training Disadvantages * Very large and increasing tumour workload * Busy working week, requiring good time management skills * Competition for jobs is tough at specialty trainee year 3 level * Less acute work than some other specialties Medical dermatology.Medical dermatology, an emerging subspecialty, is the study and care of patients with: * Skin diseases that can have systemic manifestations, including connective tissue diseases, vasculitis, sarcoidosis, graft versus host disease, and severe drug reactions. * Potentially disabling or fatal skin diseases usually treated with systemic therapy, such as severe psoriasis, severe atopic eczema, cutaneous T cell lymphoma, and autoimmune blistering diseases. * Cutaneous manifestations of systemic disease. The British Society for Medical Dermatology has been formed to advance this subspecialty in the UK.Surgical dermatology For those of you keen to indulge your surgical passions, there is good news.

Dermatology manages a substantial turnover of skin tumours (both benign and malignant), of which surgical excision is the primary form of management. A surgical dermatologist uses clinical judgment and a dermatoscope (a hand held, illuminated magnifying instrument) to identify lesions that require excision for histological confirmation and further treatment. Occasionally, incisional or punch biopsies are taken to solve diagnostically challenging medical dermatoses.Dermatological surgeons, like plastic surgeons, operate from scalp to sole. In specialist centres there is an overlap of these disciplines because dermatologists are able to perform technically demanding excisions from the face and close wounds with flaps of adjacent skin or skin grafts from more distant sites with proficiency equal to that of plastic surgeons. Mohs micrographic surgery has added a further dimension to surgical dermatology by allowing microscopic confirmation of full excision of a primary tumour before surgical closure of a wound.In Mohs surgery, the patient waits with a dressing placed over the open wound while tissue is being analysed, ensuring a high rate of curative surgery while sparing healthy tissue, thereby reducing cosmetic comorbidity. [13] It is offered in 11 centres in the UK, and many others around the world.

It has been shown to be effective in the management of malignant melanoma[8] and basal and squamous cell carcinomas. [14] Compared with many surgical disciplines, surgical dermatology boasts very favourable outcomes.Operative morbidity is low, mortality is essentially nonexistent, and most individuals are cured when a tumour has been excised, adding to the rewards of the surgery. Forensic Psychiatry Nature of the work Forensic psychiatry is a unique field of psychiatry which deals with the assessment and treatment of mentally disordered offenders. It requires sophisticated understanding of the interface between mental health and the law. The work of forensic patients is stimulating as patients present with diverse psychopathologies and complex psycho-social difficulties.Forensic psychiatrists have to balance the needs of the individual and the risk to society.

They provide medical treatment in a secure environment or where patients are subject to legal restrictions. Working in forensic psychiatry Assessment and treatment settings vary, from high security hospitals through to medium secure units, low secure units, prison settings and community based services. Knowledge of the law in relation to clinical practice is central to the work and there is regular involvement with criminal justice agencies and the courts.The majority of patients have had contact with the criminal justice system, although a minority are referred from NHS facilities (if their behaviour is challenging and they pose a risk which cannot be safely managed in less restrictive environments). The range of referrals is immense, from minor to very serious offenders, as well as non-offenders with high risk behaviours. The reasons for referral include advice on risk management and consideration for admission to a forensic service.

Forensic Psychiatrists also provide specialist advice to the courts, the probation service, the prison service and psychiatric colleagues. The specialty has expanded considerably in the last ten years; with an expansion of specialist medium secure services for women, for example, for patients with learning disability and patients with personality disorders. Forensic psychiatry has also seen an expansion of forensic low secure beds, which provide a care pathway for patients as they rehabilitate and work towards discharge.It is likely that that there will be further expansion in low secure services and community forensic services.

The last 10 years has seen a concomitant reduction in the number of high secure beds in the country. Common procedures / interventions Court Work Forensic psychiatrists regularly provide expert witness evidence to courts, for example to Crown Courts in criminal cases (including serious violent crimes) such as homicide or through court diversion schemes in a Magistrates Courts.Forensic psychiatrists regularly give opinions to the courts in respect of: * Defendant’s fitness to plead and fitness to stand trial * Capacity to form an intent * Advice to the courts on the available psychiatric defences * Appropriateness of a mental health disposal at the time of sentencing * Nature of a particular mental disorder and link to future risks * Prognosis and availability of “appropriate treatment” * Level of security required to treat a patient and manage risk Consultation Work.In advising colleagues in the care of patients deemed to be a risk to others, forensic psychiatrists will need to be competent to provide a detailed forensic psychiatry assessment including advice on: * Risk assessment including use of structured risk assessments * Risk management * Expertise on pharmacological and psychological treatment approaches to violent behaviours associated with mental disorders * Psychodynamic formulation of the case * Therapeutic use of security Community forensic work provides opportunities to assess and to work with mentally disordered offenders in residential facilities.In addition there are opportunities to provide consultation to probation staff in respect of clients in bail hostels and probation accommodation.

Forensic psychiatry may also include inter agency working. Haematology What do haematologists do? Clinical haematology Patient care has now become the main focus of most haematologists’ workload. Haematologists have direct responsibility for their own patients and are concerned with the management of medical, surgical, obstetric, and paediatric patients within the hospital.

Patients are of all ages and have a broad mix of life threatening, acute, chronic, and terminal disorders.Most patients are extremely worried about having to see a haematologist and are grateful for the care we give them. Clinical haematologists often develop strong relationships with their patients. This may be because the patient has a protracted spell in hospital, in the case of acute leukaemia or bone marrow transplantation, or because he or she has a genetic disorder. Haematologists treat several of the most common genetic diseases in the United Kingdom, such as sickle cell disease, haemophilia, thalassaemia, and lysosomal storage disorders.

With these disorders it is not uncommon for patients to have the same haematologist for the lifespan of the patient or until the consultant retires (whichever is shorter). Some subspecialties (such as haemoglobinopathies) may be practised predominantly in certain areas of the country for demographic reasons, while others (such as treatment of haemophilia or bone marrow transplantation) are practised mainly in accredited specialist centres—usually in large teaching hospitals.This may need to be taken into account when deciding on subspecialisation. Specialist interests within haematology * Haemato-oncology * Bone marrow transplantation * Coagulation and platelet disorders (including haemophilia, thrombophilia, thrombotic thrombocytopenic purpura) * Red cell disorders (including sickle cell disease and thalassaemia) * Transfusion medicine * Obstetric haematology * Lysosomal storage disorders.

* Laboratory haematology (including diagnostic haemopathology) * Paediatric haematology * Bone marrow failure syndromes Laboratory haematology Most consultant haematologists also have considerable responsibility in the laboratory. A hospital always has a routine laboratory, a coagulation laboratory, and a transfusion laboratory (which provide basic haematological tests such as full blood counts, erythrocyte sedimentation rates, or plasma viscosity; coagulation screens; and blood cross matching).Most hospitals also have specialist laboratories providing one or more of the following: haematinics, haemoglobin electrophoresis, and diagnostic bone marrow interpretation.

Larger centres are also able to provide specialist coagulation tests (thrombophilia screens and factor levels), specialist red cell tests (erythropoeitin, red cell enzymes, and membrane tests), and specialist diagnostic haemato-oncology (immunophenotyping, cytogenetics). Most specialist transfusion tests are done in the larger centres or blood transfusion centres.Credit: SIERAKOWSKI/REX The consultant haematologist is head of the laboratory and must work closely with biomedical scientists to ensure that well qualified staff perform high quality work in a safe laboratory environment. Much of the day to day laboratory management is provided by senior biomedical scientists.

However, haematologists must have an understanding of the principles and limits of the tests done as well as an understanding of the meaning of the results. The role of the haematologist is to provide interpretation