The aim of the examination
The examination assesses whether trainees in immunology have acquired the requisite highly specialised scientific knowledge, clinical skills, laboratory skills and attitudes required to:
· diagnose, treat and where relevant, prevent diseases characterised by immunodeficiency, autoimmunity or allergy (hypersensitivity)
· professionally direct a diagnostic immunology laboratory service.
Within this scheme, the purpose of the Part 1 examination is to determine whether a trainee has successfully acquired the core body of knowledge and basic skills which underpin the ability to practise as a clinical immunologist and continue training to consultant level, encompassing fundamental concepts of immunobiology, immunopathology and the principles of diagnostic and therapeutic immunology. The standard that the candidates will be expected to achieve in this assessment will be commensurate with having completed two years of training, as outlined in the objective-based immunology curriculum published by the Joint Committee on Higher Medical Training (JCHMT).
The purpose of the Part 2 examination is to provide quality assurance that a trainee who has successfully completed the objective-based curriculum in immunology, including stratified assessment through the Record of In-Training Assessment (RITA) process (or its equivalent for clinical scientists or overseas candidates), is able to practise as an independent specialist in immunology and, in the case of medically qualified candidates, is qualified to be awarded a CCST in the specialty.
The MRCPath examination is a key assessment tool (but not the only one) used at three stages of training, as summarised below.
Stage Examination Factor assessed Tool
At end of two years (medical) or three years (scientist) of HST Part 1 Core knowledge baseBasic laboratory skillsIntegration of laboratory data with clinical situations Part 1 written essaysPart 1 objective structured practical examination and viva (but see below).
Between second and fourth years of HST Part 2 Ability to formulate question that can be answered by scientific investigationAbility to undertake self-directed researchAbility to write up work in standard scientific format Dissertation, portfolio of papers or evidence of higher degree
At four to five years of HST Part 2 Clinical patient management (medical), laboratory problem solving (medical/scientist), clinical liaison (scientist), laboratory management (both), readiness for independent practice Structured extended oral examination
Medical candidates intending to practise in the UK
For these candidates training will occur under the aegis of the Joint Committee on Higher Medical Training (JCHMT) at The Royal College of Physicians. The JCHMT has published an objective based training curriculum in immunology, which covers the requirements for both Part 1 and Part 2 examinations and approves Higher Specialist Training (HST) programmes for these trainees. The goal of the JCHMT immunology curriculum is to enable trainees to acquire the requisite highly specialised scientific knowledge, clinical skills and laboratory skills required to: (i) diagnose, treat and where relevant, prevent diseases characterised by immunodeficiency, autoimmunity, or allergy; (ii) direct a diagnostic immunology laboratory service. Assessment visits of the postgraduate programme by members of the Immunology SAC of the JCHMT ensure that an appropriate standard of training is offered at each training centre. The annual RITA and penultimate year assessment (PYA) are also important aspects of training to ensure that the trainee is making adequate progress. Regular three or six-monthly meetings between trainees and designated trainers should also be in place to complement the RITAs.
Non-medical candidates should have a minimum of three years training in an approved higher specialist training programme conforming to the Grade A clinical scientist training programme in immunology, which has been published by the Association of Clinical Scientists in Immunology. Such training will take place at approved diagnostic laboratories serving a large hospital or group of hospitals. Practical experience at the bench and experience in clinical liaison must be gained in all major aspects of clinical immunology.
Training programme for the Part 2 examination
The training programme will follow in detail the components outlined in the JCHMT curriculum (or the equivalent Grade B clinical scientist training programme), with formal RITA, as outlined in the aforementioned curricula.
During this period, the trainee should extend the knowledge and experience gained during the training period for the Part 1 and thus accumulate advanced clinical, technical, scientific and managerial skills required to direct a diagnostic immunology laboratory. It is usually at this stage that candidates will need to complete the dissertation that is required for the Part 2. However, candidates may have started research work earlier in their training, which could provide a topic for the dissertation. They may by extension of such research acquire an MD or PhD, which can be presented for the Part 2 examination instead of a dissertation. This period is also the appropriate time to develop special expertise in a particular area of immunology (eg vasculitis, primary immunodeficiency, transplantation medicine, etc).
Candidates who take time out of the programme for research appointments should make every effort to seek approval from the College of their research work before embarking on this course.
Overseas candidates will have their training programmes assessed individually.
Part 1 examination
· Medical candidates intending to practise in the UK
The Part 1 examination may be taken after a minimum of two years of JCHMT-approved training in immunology, by those candidates with MRCP (UK or Ireland) or Membership of The Royal College of Paediatrics and Child Health (UK).
· Overseas medical candidates
For medically-qualified overseas trainees without MRCP who do not train within the JCHMT system, a minimum of three years training in approved diagnostic laboratories serving a large hospital or group of hospitals, is required before entry to the Part 1 examination. Because of the clinical component in MRCPath examinations, overseas trainees are strongly advised to hold appointments in general internal medicine (or paediatrics), either before or during their laboratory training. Practical experience at the bench and experience in clinical liaison must be gained in all major aspects of immunology.
· Non-medical candidates
Non-medical candidates should have a minimum of three years training in a Grade A training programme approved by the Association of Clinical Scientists in Immunology. The training and entry requirements for non-medical candidates from overseas will be judged by the college on an ad hominem basis.
Part 2 examination
· Candidates who have already completed the Part 1 examination will attempt the Part 2 examination after a minimum of four years of Higher Specialist Training in posts recognised by (a) the JCHMT or (b) Association of Clinical Scientists in Immunology or (c) by the College, in case of overseas candidates.
Format and content of the examinations
Part 1 examination
This comprises written papers, a practical and oral examination.
· Written papers
At present there are two three-hour written papers, comprising essay-type questions requiring answers for four out of five questions, unless otherwise stated. (Discussions are underway to change the format of these papers after appropriate consultation and due notice of these changes have been given to trainees and trainers.)
Paper 1 will examine the knowledge of scientific principles underpinning the practice of clinical and diagnostic immunology, which all candidates will be required to answer.
Paper 2 will test knowledge of the clinical aspects of immunology and will comprise of two alternative versions. The first version, which is for medically qualified candidates, will include questions which address clinical assessment and therapy of patients with disorders of the immune system. The second version, for non-medical candidates, will replace those questions which specifically address clinical assessment and therapy with questions testing in-depth scientific principles of immunology or the effective delivery of diagnostic immunology services or research knowledge. It is axiomatic that the two versions will share some questions. The question paper for clinical scientists will be approved by a clinical scientist member of the Examiners Panel.
Standards and marking methods
The questions are set and agreed by a Panel of Examiners, including a clinical scientist. Candidates answer will be marked against standardised model answers, which specify minimum criteria for achieving a pass grade. The marking system is a closed marking system that uses a limited range of marks as follows.
Mark awarded Category
15 (maximum) Excellent pass
14 Clear pass
12 Borderline fail
11 Clear fail
10 (minimum) Bad fail .
Two examiners mark the written papers independently. Their marks for each question are averaged and the average marks for each of the four questions are totalled. The pass-mark for each paper is 50 and marks in excess on 50 from one paper can compensate for a slight underperformance on the other paper, provided the score is 48 or above. A total of 46 marks or below for one paper results in failure of the examination. Candidates are advised to try to obtain an average mark of about 13 per answer, i.e. to manage their time across all four answers per paper and to try to give relevant, informative and balanced answers to each question attempted.
If the marks awarded by the pair of examiners result in different outcomes (i.e pass, fail, borderline) the scripts will be moderated by the Chairman of the Examiners Panel.
· The practical examination
The practical examination will test proficiency in laboratory procedures and the solution of clinical problems. The same practical examination will be offered to both medically and non-medically qualified candidates. The examination will be held over 12 days and will be structured to include modules comprising autoimmunity, immunochemistry, flowcytometry, ELISA, quality control, laboratory safety, troubleshooting in any of above, clinical vignettes for data interpretation and drafting succinct, clinically relevant reports based on the results of laboratory tests.
Standards and marking
The questions will be designed to test basic laboratory, interpretative and clinical competencies commensurate with completion of the training requirements for the Part 1 examination. The papers will be agreed by a Panel of Examiners and outline model answers prepared for determining the standard required for a passing grade. The pass mark in the practical examination is 50% of the total marks assigned to all the questions. Parts of questions may be allotted different marks according to time expected to complete the answer. The candidates answers will be marked by two examiners. The practical examination will be followed by a viva lasting 30 minutes, during which borderline candidates will have the opportunity to redeem their performance.