The College recommends that candidates attempt the Part 1 examination after a minimum of two years of JRCPTB / GMC-approved training in Immunology. For medically qualified International Medical Graduate trainees, who do not train within the JRCPTB / GMC system, a minimum of two 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 FRCPath examinations, International Medical Graduate 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. 

The Part 1 examination comprises a written examination:  

There are two three-hour written papers, comprising short-note style questions and structured essay-style questions.

Paper 1 will examine the knowledge of scientific principles underpinning the practice of clinical and diagnostic immunology. All candidates will be required to answer this paper.

Paper 2 will test the 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 that address both the clinical and laboratory assessment, and the treatment of patients with disorders of the immune system. The second version, for non-medical candidates, will replace those questions requiring in knowledge of clinical assessment and treatment with alternative questions concerning the effective delivery of diagnostic immunology services. may include clinical features of disease and principles of treatment. It is axiomatic that the two versions will share some questions.

The College recommends that candidates attempt the Part 1 examination after completing a minimum of three years training in a Clinical Scientist (Grade A) training programme approved by the Association for Clinical Biochemistry Immunology Professional Committee. The training and entry requirements for non-medical candidates in other posts or from overseas will be judged by the College on an ad hominem basis.

To successfully complete the Part 2 examination candidates must demonstrate a level of competence and professional maturity appropriate for independent practice as a consultant. The curriculum covered by the examination is as set out in the current version of the JRCPTB / GMC curriculum in Immunology.

The General Medical Council has approved changes to the Part 2 examination for candidates in a UK medical training programme, removing the requirement for a written option if one's CCT date is on or after 1 May 2020. See the Examination news and dates section of the website for further details.  

Format of the practical examination

The examination will be taken over one day and comprise of six one hour stations covering immunochemistry, flow cytometry, autoimmunity, data analysis, quality assurance and quality control and clinical vignettes. Information may be provided on an Ipad. 

Standard of the practical examination

The examination will test the ability of candidates to function as an independent practitioner in the field of diagnostic laboratory Immunology.

The oral examination will have an objective structured format and will not duplicate topics that are better covered by the practical examination. The oral examination will last for 60 minutes and will be conducted by two pairs of examiners, 30 minutes being spent with each pair of examiners.

Communications skills essential for immunologists and it is important that both medical and non-medical trainees develop their clinical liaison skills to enable them to offer appropriate clinical advice to their colleagues, and to think through the consequences of advice for patient management. Medical candidates will be asked questions on the clinical management of patients with diseases of the immune system.

Marking of the oral examination

Section one:

Two Diagnostic problems (50% of marks). One will be Immunology, and one will be an allegy clinical scenario.

Communication with patients and relatives, and ethical issues to be included

Treatment and complications to be included

Section two:

Laboratory Quality assurance (25% of marks)

Scientific, translational and technological advances (25% of marks)

 Candidates will have to achieve a pass in both sections to secure an overall pass in the oral examination. Compensation of marks between the two sections is possible for candidates with a borderline fail in one section.

The written module, of the Part 2 examination will be one of the following options:

(a) PhD/MD thesis, normally completed during the training period

(b) a series of refereed, published papers (or in press)

(c) a casebook, as set out below

Instructions for the written component of the Part 2 examination

Candidates should read carefully the generic guidelines published by the College for such submissions.

Candidates submitting a series of refereed published papers should note that the quality of the publications and the candidate’s contributions to the research work will be the determining factors. As a guideline a minimum of three publications (not unrelated case reports) with the candidate as the first author would be required. With multi-author publications proportionately more publications would be required, the number depending upon the extent and significance of the contributions made by the candidate. The papers must deal with original research, or substantial scholarly reviews written from a clinical or scientific point of view published in recognised peer reviewed journals. Individual case reports would only be allowed if they describe a substantial clinical or scientific advance. Case reports may be admissible as components of the casebook.

The casebook option

• Candidates must submit 8 cases in the casebook, which must provide an overview of Immunology practice. At least four cases must include a substantial laboratory component.
•  Non-medical candidates should present cases from an appropriate laboratory perspective.
• The standardised method of assessment and scoring is given below.
• All cases must provide discussion of the context, review of published literature or relevant practice, and evidence of reflective learning.
• The word limit of each case should be 2000 words.

 

	Type of case	General content
1-4	Clinical	Description of a single patient or group of patients with regard to investigation, diagnosis or management. Cases must represent the broad range of clinical immunology (e.g. immunodeficiency, allergy, autoimmunity and lymphoproliferative disease) and the candidate must demonstrate a substantial personal role in the clinical management and / or,  laboratory investigation of at least two of these cases.
5	Audit	Review of a specific aspect of clinical or laboratory practice.
6	Laboratory practice	Examples include troubleshooting a poorly functioning assay, or setting up a new assay. The report should contain an outline of  about Quality management.
7	Management or communication	This might be a business case for a new assay or service; or establishment of Trust guidelines regarding use of a specific therapy, etc. Alternatively, to demonstrate communication skills, this might be a patient leaflet or a component of a laboratory handbook, providing evidence of the ability to communicate with patients, lay people or non-specialists.
8	Optional	The final case is flexible. This may include a case from any of the categories above or may reflect another aspect of immunological practice, e.g. description of a research project.

 

Outcome of marking casebook:

Grade A: Attainment of 50% of marks, with no serious errors or ommisions.

Grade B: Errors or ommissions that need rectification before attaining Grade A

Grade C: Poor quality work that cannot be redeemed.

(Award of Grade C will be exceptional).

 

Marking scheme for clinical case reports

Patient case reports are valuable opportunities to integrate clinical and laboratory findings with background information about immunological mechanisms of disease. While some clinical case reports will describe new or unusual information, novelty is not an essential requirement of the Casebook case reports. Each case report should include an initial background page with a title and contributors. The candidate must state exactly who did what; they must have been responsible for the majority of the work. 

Area	Standard	Mark
States clearly how much of work their own	Fail if not majority.
Abstract	The abstract of a patient case report should succinctly summarise key issues in the main text of the report.	5
Introduction	The introduction section should provide the subject, purpose, and merit of the case report. It should provide a succinct literature review. (in the word limit of 2000/case a comprehensive and detailed literaure review is not possible)	30
Description of case, including brief outline of history and examination, and relevant laboratory results	The case presentation section should be in  enough detail for the reader to understand the main learning points of the case	30
Discussion	The discussion section should summarise the reasons underpinning the conclusions and the learning points.	30
Conclusion	The conclusion section should be brief and provide a conclusion with a summary of the main laerning points.	5

 

Marking scheme for audit

The audit report should include an initial background page with title of audit and contributors. The candidate must state exactly who did what; they must have been responsible for the majority of the work. The idea does not have to have been their own, but plan for audit, data collection and data analysis must have been. Just analysing someone else’s data would not be deemed sufficient.

Area	Standard	Mark
States clearly how much of work their own	Fail if not majority and elements of design, data collection and data analysis not stated.
An acceptable rationale for the audit is provided	This must explain why the audit was worth doing.	20
The audit must be conducted against agreed standards	The origin of the standards must be stated. This must include a reference and state whether the standards are national, regional, network-wide or local. Justification must be given if there is local variation to other accepted standards e.g. nationally published.	10
Sample size and selection	Sample size must be appropriate to the question posed by the audit and in consideration of other factors such as the number of specimens or the audit time frame. The method of sample selection must be described e.g. random selection.	10
Data collection	Methods must be clearly described.	15
Analysis and interpretation	Detail of analysis must be given, with valid interpretation of results.	25
Identification and implementation of any changes required	Details must be given of any actions required to rectify problems identified.	10
Re-audit	Re-audit should be included if it has been undertaken.  If not, a clear plan for re-audit must be given.	10

 

Marking scheme for business case

Multiple opportunities should present themselves over a 5 year training period for trainees to be involved in the development of a business case / investment bid. The purpose of including this in the portfolio is that developing a service is an important role of a consultant, and trainees should have a thorough understanding of the processes involved. This is not a test of financial acumen or mathematical ability!

In the modern NHS, the main responsibility of a consultant is to make a valid clinical/scientific case and this the aspect that the candidate should concentrate on.

 

Area	Standard	Mark
States clearly how much of work their own	Fail if not majority.
Rationale for the development	Clear background to the development, written in terms that a non-expert can understand.	10
Evidence of strategic thinking	Proposal fits in with identified aims of the department / Trust / NHS.	15
Aims and objectives	Clear definition of aims and objectives, which are realistic and timely.	10
Detail of proposal	Detailed description of the proposal, with time frames and clear implementation plan.  Should include detail of implications for other parts of the hospital / department, etc.	35
Evidence that either alternatives to the proposal have been considered and / or consequences of not doing the proposal detailed	Option appraisal / risk assessment (or elements thereof) should be included.	5
Financial, space, staff implications	Costings and impact of proposal, evidence that indirect costs and effects as well as direct have been considered (staffing, skill mix, building work, IT issues, costs, regulatory impact, referral patterns, length of stay, length of reporting times, etc).	5

 

Marking scheme for laboratory performance case

Assessment of laboratory assay performance and quality control management is a key aspect of training in clinical immunology. The laboratory performance case report should include an initial background page with title of report and contributors. The candidate must state exactly who did what; they must have been responsible for the majority of the work.  The plan for the assessment / troubleshooting / introduction of a new assay and relevant data analysis must have been their own work.

Area	Standard	Mark
States clearly how much of work their own	Fail if not majority.
Background to the issue	Clear description of the issue that is being addressed (e.g. loss of assay performance, introduction of new assay) and its implications.	15
Aims and objectives	Clear definition of aims and objectives, which are realistic and timely.	5
Clear and structured assessment and action plan	Include evidence that relevant alternatives have been considered.	20
Analysis and interpretation	Details of analysis must be given, with valid interpretation of results.	20
Discussion of quality management	Should demonstrate detailed, clinically appropriate and critical review of relevant internal QC and external quality assurance procedures.	20
Identification and implementation of any changes required	Details must be give of any actions required and if implemented.	20