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Our specialty guest interview this week features Dr Deborah Kirkham. Deborah is an ST5 sexual health doctor in Manchester. Her specialism is GUM and HIV. She has completed 2 clinical fellowships including the National Medical Director’s CF last year and holds a PGME as well as being an OSCE examiner. She offers us her insights into this unusual specialty and some insider tips for final year medical students.
Name: Deborah Kirkham
Location: Northwestern England, OOPE – London
Qualifications: MBChB (hons) with European Studies, MRes (merit), PGCert Med Ed, MRCP (UK), Dip G-U Med, DFSRH
Time in the NHS: Started medical school in 2004, qualified in 2009
1) When did you decide to become a GUM/ HIV specialist?
I first got involved in sexual health as a medical student when I volunteered to do peer sex education in local high schools as part of the Apause programme (Added Power and Understanding in Sex Education). I then did a project on HIV/AIDS and later did my final year elective in Tanzania where I observed HIV clinics and saw the impact of the infection on whole populations.
Then, as an FY2 I worked in obstetrics and gynaecology and whilst seeing patients in termination clinic I started to learn more about STI screening and contraception choices after termination. I knew that I wanted to be a physician, and thought that GUM would suit my skills and interests. I also wanted to do a specialty where I would have the opportunity to build a portfolio career to satisfy my interests in other areas like medical education, and management and leadership.
2) What aspects of being a GUM/ HIV specialist have you enjoyed the most? What has been hard?
I enjoy the fact that we can often ‘cure’ patients in front of us and diagnose and treat the same day. I like that I can reassure someone and they leave feeling happier and more confident about themselves.
As it is a small specialty, in my first two years as an ST3/ST4 I was the only GUM trainee in the hospital which meant I felt a bit isolated, and unsure how I was performing compared to peers.
3) What’s the single worst thing about being a GUM/ HIV specialist?
People asking “Why on earth would you choose to do that?!”
4) Could you share with us your most challenging moment during your training?
Coming back to training after having over a year out of programme. At the end of ST4 my confidence and competence had grown, and I felt like I could manage most clinical scenarios. Coming back into ST5 after my OOPE, I had to spend a few months getting back up to speed, whilst feeling all the time that I should know as I was now a senior trainee.
5) What do you think are the most critical personality traits that a doctor should possess for a career in GUM?
Empathy, a sense of humour, and a non-judgmental attitude.
6) How much experience had you had in GUM before deciding to specialise in this? Many junior doctors worry about choosing a specialism they haven’t had much experience in, how did you counteract this?
I had never done a job in GUM before I applied but I had experience in other areas of sexual health so I was pretty sure it was right for me. I had done an audit during my time in obs and gynae about long acting reversible contraception following termination which I presented at a national conference. I also arranged to do a few sessions of shadowing with a local GUM Consultant. This all helped me to prove my commitment to specialty in the GUM application form and interview.
7) You were a NIHR Academic Clinical Fellow in Medical Education from 2012-2015. What exactly did this involve and why did you decide to apply to it? Did this have any impact on your specialist training?
I found out about the NIHR ACF at a deanery event which I attended in my role as a foundation representative in FY2. The deadline was in 6 weeks and I decided to apply. I was invited to interview but was unfortunately unsuccessful. That gave me another year to gain experience in research and medical education to show I was committed to the role, and for me it was second time lucky.
During the ACF, I had the opportunity to complete a Masters of Research in Public Health alongside my clinical training. This was very challenging as I was also doing MRCP and later my specialty exams at the same time. My dissertation outlining my original research on doctors’ perceptions of prescribing violations was my proudest moment. I also finished a Postgraduate Certificate in Medical Education (self-funded), and used the skills I had learnt as a clinical tutor.
I wanted the opportunity to learn more about medical education and research. I achieved that, also developed skills in generic areas like time management, writing skills, and self motivation.
Because my ACF was not specialty specific I still had to go through open competition to get my ST3 number which was quite stressful as I could have lost my ACF if I hadn’t got a number.
8) What do you think are the biggest challenges facing medical education in the next 5 years? Do you see any solutions to these problems?
I think medical students expect more from their undergraduate training as university fees have risen so much in recent years. Perhaps that means they are also more motivated to do well and take advantage of the opportunities presented to them.
The balance of postgraduate training and service provision in a time of financial austerity is difficult across the NHS. In my specialty, the tendering out of services to third party companies such as Virgin Care has caused unintended consequences. These businesses are not set up to provide postgraduate training, so alternative solutions have had to be found.
When finances are so tight, training can fall down the list of priorities. However, the recent junior doctor contract debacle has got a lot of junior doctors reengaged in issues affecting their training and the wider NHS.
9) We have a number of users who are final year medical students. Since you are an OSCE examiner, what is your advice to medical students sitting the OSCE?
Preparation, preparation, preparation. Make sure it looks like you have performed each examination/skill/explanation/interpretation a hundred times (because you have!). That leaves your brain free to think about the diagnosis and management rather than trying to remember which bit of the body to examine next!
Make sure you stick to what the OSCE stem asks you to do, and listen to the patient, they will tell you what you need to know. Find out what they are concerned about and address it.
Don’t presume anything, always start with an open question “How can I help you today” (I found this out the hard way in my 3rd year undergraduate OSCE – disaster!).
10) Finally, what’s your number one piece of advice to junior doctors who are considering applying for specialist GUM training?
Arrange some shadowing and show your commitment through extra-curricular activities if you haven’t got any relevant experience through your rotations. Get in touch with someone in the specialty and ask them to look at your application.
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