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Academy News: December 2004Training differences in UK, US As a fellow-in-training (FIT) in the United Kingdom, it was an enormously uplifting and inspirational experience to attend the 2004 AAAAI Annual Meeting and, in particular, the FIT Day. The United States has far more FITs than we do, so I was first overwhelmed by the scale of events, and then delighted at having found so many fellow FITs. In the UK, allergy is a very new clinical specialty. Training in allergy is quite separate from training in immunology. Some UK immunologists have developed their clinical allergy experience and will see patients with allergies, but most immunologists do not run a full-time allergy service. Thus, only a very small percentage of UK patients with an allergy see an allergist. The patient with asthma may be seen by a chest physician, the patient with rhinitis by the ear, nose and throat surgeon, and the patient with eczema by a dermatologist. Food allergy is dealt with by the family doctor, or in many cases, will not be managed at all. Patients with drug allergy, venom allergy or seasonal allergic rhinitis who require desensitization will often have difficulties even finding local expertise. Currently, the UK has six FITs in allergy and 23 in immunology. Traditionally, allergy has been an academic speciality, with most consultant allergists having trained as respiratory physicians. Most academic allergists in the UK will devote a couple of sessions a week to seeing patients in clinic, but full-time, clinical allergy consultants number fewer than 10. An allergy training program was developed in 2000 with the aim of radically expanding allergy services and educating other physicians. UK training structure To specialize in allergy, physicians must pass both parts of the demanding Membership of the Royal College of Physicians (MRCP) exam. Most candidates take this exam after four or five posts in different medical specialities, and on average, it is completed four years after obtaining MB BS. Without the MRCP exam, a candidate cannot apply for a specialist post in hospital medicine. Once accepted into a training post, the trainee is known as an allergy specialist registrar (SpR). An SpR is the UK equivalent of an FIT. The SpR training is clinical and lasts five years. However, most SpRs will pursue academic research. In addition, they will spend two or three years in the laboratory working towards a medical or doctoral degree, and four years training clinically. At the end of each year the SpR’s progress is assessed by an interview called a record of in-training appraisal (RITA). The SpR’s clinical experience consists of working in outpatient clinics, seeing in-patient referrals, and teaching at both undergraduate and postgraduate levels. Being one of only six allergy trainees in the UK invariably means you quickly get to know your consultant colleagues and receive excellent supervision while training. The UK allergy community is small, friendly, and provides numerous opportunities for SpRs to network and create their own attachments within their training. The challenge for all UK allergy trainees is to continue the work of the British Society of Allergy and Clinical Immunology. Their goal is to promote allergy as a specialty in its own right and continue to push for a further expansion in SpR numbers. Thus, each allergy SpR must look not only at their individual training, but at the specialty of allergy as a whole and the picture that we are aiming for in 10-20 years time. It is a proposition that is both daunting and exciting. Personally, it has been inspiring and educational for me to be involved with the AAAAI FIT Committee. The United States and UK training schemes are different, but as allergists, our goals are very similar. Looking to the future, I hope that UK and United States trainee allergists will continue to interact. Perhaps an exchange will even be possible between UK SpRs and American FITs, thus allowing us to appreciate each other’s training systems first hand. |
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