This page contains information on the specialty of metabolic medicine (chemical pathology), a higher medical specialty recruiting to ST3-level vacancies.

Please note - metabolic medicine is not participating in the RCP ST3 recruitment process.

Recruitment to metabolic medicine is being coordinated by Health Education East Midlands.


The specialty - metabolic medicine / chemical pathology

Development of metabolic medicine

In 2001, the Postgraduate Medical Education and Training Board (PMETB) gave approval for a training programme which would provide additional subspecialty recognition to programmes leading to a CCT (CCT) in chemical pathology or general internal medicine.

A new training subcommittee was established, under the auspices of the JRCPTB, with membership drawn equally from the Royal College of Pathologists and the JRCPTB. This committee approves Regional programmes, and has developed the training record and other documentation necessary for both trainers and trainees.

The specialty

Metabolic medicine is a new and developing specialty which is exciting and rewarding.

Metabolic medicine physicians care for patients with a wide range of both common and rare diseases. Because of the close links with the clinical biochemistry laboratory there are unique opportunities for research.


Metabolic medicine trainee characteristics

Metabolic medicine will particularly suit trainees who are:

  • inquisitive

  • decisive

  • good at reasoning and problem-solving

  • interested in biochemistry and metabolism.


Working in metabolic medicine

Metabolic medicine is a subspecialty of either chemical pathology or general internal medicine but whichever the route of entry into the specialty, metabolic medicine physicians have very close links with the clinical biochemistry laboratory.

The skills required for running a laboratory, both technical and managerial, translate very well to the field of research and many metabolic medicine physicians remain active in research throughout their careers.

Broadly speaking, there are five areas covered in the metablic medicine curriculum:

  • disorders of nutrition eg obesity, patients requiring parenteral nutrition

  • inherited metabolic disease (IMD) eg phenylketonuria, galactosaemia

  • abnormalities of lipid metabolism and cardiovascular risk assessment

  • disorders of calcium metabolism and bone eg osteoporosis, vitamin D deficiency, Paget's disease, osteogenesis imperfecta, renal stones

  • diabetes mellitus.

Metabolic medicine physicians care for a diverse group of patients across all age ranges. Those specialising in inherited metabolic diseases may be involved in the management of children as well as adults.

Advances in diagnostics such as in neonatal screening and new treatments such as enzyme replacement therapies are improving survival in inherited metabolic diseases and managing these patients into adulthood brings novel challenges.

The ability to improve quality of life and long term outcomes in patients with chronic disorders is extremely rewarding.

Though primarily an outpatient specialty, metabolic medicine physicians may also be involved in inpatient care particularly those that need nutritional support eg TPN. Hospital consultations regarding biochemical abnormalities are common as is liaison with general practitioners.

Because of their experience in laboratory management, metabolic medicine physicians often have the opportunity to become involved in medical management later in their careers if they wish.

Unlike some other specialties, metabolic medicine is not oversubscribed and no reduction in training numbers is planned. Improved survival of patients with metabolic disorders will result in an increased need for physicians expert in their care.


Further information