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A day in the life of … a clinical immunology trainee

I am currently in my third of five years of clinical immunology training in Newcastle, UK. I consider myself immensely fortunate to work in this endlessly stimulating specialty, which has given me the opportunity to work with many wonderful people. Clinical immunology is a relatively small specialty, with only around 72 consultants and 30–40 trainees in the UK. Consequently, many people have little exposure to it, including scientists working in the wider immunology field and clinicians in the early years of medical training. I hope to give a flavour of what working in this fascinating specialty entails, and how our work links in with that of colleagues working in other areas of medicine and immunology.

Every day is different

The work of a clinical immunologist is enormously varied and is difficult to distil down to a single ‘typical day’. Many days include a mix of direct clinical work, along with laboratory time, liaison with other specialists, audit and/or research. An average day might begin with a clinic, which will usually include both new and follow-up patients. All clinical immunology trainees take part in clinics covering immunodeficiency, autoimmune disease and allergy. In some regions, clinical immunologists also run HIV clinics, although in most areas these are provided by other specialties. The varied nature of the clinical work provides an interesting mix and ensures that no day is ever boring.

We look after many patients with primary immunodeficiencies, who we follow up for many years and get to know very well. These patients often have many associated medical problems, and see a range of other specialties. Looking after them is one of the most satisfying aspects of our work, involving close interacting with the other specialists and professionals involved, while keeping an overview of their complex problems.

The allergy clinics are very different, but also extremely varied. Many patients we only see once or twice, including some who have had a severe allergic reaction (e.g. anaphylaxis). This is satisfying in another way, enabling you to think through and investigate a problem, make a diagnosis and hopefully offer a management solution that can make a real difference within a relatively short space of time. We also look after patients with severe allergies requiring desensitisation therapy, and those with complex multiple allergies, who often require long-term follow up.

From the clinic to the lab…

After clinic, the rest of my typical day may include lab work. As a trainee, this often involves hands-on benchtop work, as we need to become competent in the assays used in the immunology laboratory. These include flow cytometry, ELISAs and other immunoassays, immunofluorescence, electrophoresis and functional cellular assays. Clinical immunologists are usually also responsible for the running of the immunology laboratory. A key part of our training therefore includes quality control and laboratory management.

Before I finish for the day, I may have some results authorisation to undertake. This involves reviewing any abnormal results and if appropriate providing relevant clinical interpretation. This is another aspect I enjoy, as every result has a patient with a different story behind it, each one providing an opportunity to problem-solve and potentially provide some information that might help in their care. Urgent results are usually phoned directly through to the requesting clinician, and we also receive frequent calls for advice on lab results as well as clinical queries. Consequently, the ability to think on your feet and succinctly communicate the meaning behind complex findings are important skills that we need to develop.

"The varied nature of the clinical work provides an interesting mix and ensures that no day is ever boring."

Opportunities to branch-out

While the above might constitute a typical day, every one is different and there are many opportunities to pursue individual interests. As well as my routine work, I usually have an audit or quality improvement project underway. Involvement in research is actively encouraged, and a large proportion of immunology trainees take time out to undertake a PhD or an MD. There are also many opportunities for travel and to present at national and international conferences, including of course, the BSI Congress.

Immunology is an incredibly fastmoving specialty, and this is a very exciting time to be involved. Important immunological research is driving rapid evolution of our understanding of the immune system, and what happens when it goes wrong. The advent of genomics, for example, has transformed the field of primary immunodeficiency, with new conditions being identified and described with astonishing regularity. From the therapeutic perspective, an enormous range of new immunomodulatory treatments are becoming available for autoimmune and inflammatory diseases.

A rewarding career path

I find one of the most rewarding aspects of clinical immunology is the multidisciplinary nature of the work. We work very closely with nursing staff, biomedical and clinical scientists, academics, and other medical specialties. We are constantly exposed to and interacting with colleagues with a great diversity of skills and experience, from whom there is always so much to learn.

Like a significant proportion of my clinical immunology trainee colleagues, I came into the specialty relatively late, having initially undertaken training in a different medical specialty. This was partly due to lack of awareness of immunology as a career option early in my training. I am now enormously grateful for the opportunity to work in this field, and, from my own experience, I think it is essential that we make every effort to promote this fascinating specialty.

Stephen Boag

Immunology Specialty Registrar, Royal Victoria Infirmary, Newcastle upon Tyne