When an immunologist is the chief character in a popular television series, immunology, the newest of the laboratory specialties, has clearly arrived as a) identifiable and b) glamorous. Immunology has a major impact currently in science, but so far the medical applications from these basic discoveries are few. Many of the scientific pre-occupations of immunologists, to do with fine detail of the immune response, are not always helpful when the clinical immunologist is confronted with a child with recurrent infections or obscure allergies.

The challenge is to find ways to use the science to develop tests and treatments, and this is why this area of pathology is particularly fascinating. Advances in understanding and treatment of HIV infection have been a recent success, and bringing science to bear on allergic disease is starting to yield basic insights into what had been rather a 'soft' clinical area. The new genetics of primary immune deficiencies has also been particularly enlightening.

Most immunologists will have responsibility for a laboratory which provides a service to several hospitals or even a region. Some of the tests are relatively uncommon, and a large population is needed to generate the workload so that tests are done frequently enough to maintain expertise. The core repertoire is the investigation of autoimmune disease, specialised immunochemistry, and numbers and function of cells of the immune system; many also do in vitro testing for allergies; some are involved in transplantation and immunogenetics. The staff are used to introducing and developing new tests, and the skills and experience that are needed attract and motivate high quality scientists, often with a strong research background. As a relatively new specialty, immunology is on its mettle to show it can add more value to tests which might otherwise be a side-line done by another pathology discipline. This healthy competition means the immunologist needs to be a politician as well as an enthusiast.

Apart from providing clinical advice on the wards, most immunologists run dedicated out-patient clinics; many have a special expertise in immunoglobulin infusion for antibody deficiency, and most will be referred allergies, rheumatological and vasculitic problems, and will probably try to avoid being swamped with post-viral fatigue syndrome referrals. To call for the immunologist when other opinions on an obscure condition are conflicting or unhelpful still seems to be instinctive in some circles, although as medical schools teach more of the subject, we are all immunologists now. The card-carrying, trained enthusiasts are continually being asked to up-date, teach and explain, and are expected to be experts and communicators. Luckily the intellectual rewards of keeping up with this rapidly expanding field are particularly worthwhile - at least I think so, but then I'm an immunologist.

For further information on training programmes, please contact the Training & Educational Standards Department on 020 7451 6741 or email education@rcpath.org

Dr Scott Pereira

The College Specialty Advisory Committee on Immunology