Genitourinary medicine

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Genitourinary medicine (GUM) is a dynamic, fun speciality which provides care for all aspects of sexual health and HIV medicine. It is a patient-centred speciality which encompasses disciplines from general medicine, virology, microbiology, dermatology, gynaecology and public health, creating a unique and rewarding career.

GUM - trainee characteristics

The nature of genitourinary medicine requires trainees who are:

non-judgemental
excellent communicators
team players
not easily embarrassed, with a good sense of humour.

Summary of the specialty

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 the chronic management of HIV.

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. 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.

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

GUM has limited on-call, thus allowing for a better work-life balance; although there are opportunities to participate in acute medical rotas or specialist sexual health work, such as sexual assault or outreach clinics.

GUM achieves high scores for satisfaction in the annual GMC trainee survey, and most trainees readily achieve consultant status after the four-year training programme. The curriculum was revised in 2010 and is delivered through a variety of learning experiences, including work-based learning and on-the-job supervision. Out-of-programme attachments are encouraged, and a number of trainees pursue HIV care abroad or higher degrees.

‹ A day in the life of an ST5 GUM registrar... (click to view) ›

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 that 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 doesn't 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 speciality 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 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 am on call from 5pm till 9am the next morning. I just hope it's a quiet night!

Applying to ST3 genitourinary medicine

All applications to ST3 GUM posts in 2012 will be handled via the national application model. GUM applicants will need only to complete one single application form, and submit this to the East Midlands Deanery - who will be managing the GUM recruitment process in 2012.

Applicants to GUM will be asked to give deanery/UoA preferences at a later stage of the process (most likely at interview). Candidates will be able to be considered for as many or as few of the available GUM vacancies as they wish, across all deaneries where vacancies are available.

For more information on the national application model, please visit the recruitment models section of this site.