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Specialty career profile: diabetes and endocrinology

Dr Suchitra Raj, diabetes and endocrinology specialist registrar at King's College Hospital, London, explains what first drew her to the specialty, and what training and day to day work involves.

What influenced you in choosing your specialty?

During my 4-month rotation in diabetes and endocrinology as a foundation doctor, my interest was really captured. Contrary to what I had previously thought, diabetes was in fact a fast-growing specialty! With the explosion of numerous new drug and technology therapies for people with diabetes, it was an exciting time to join the specialty. During medical school I had little exposure to endocrinology, but I have since found it an exciting remit as it offers integration between basic biochemistry, human physiology and practical medicine.

This largely outpatient-based specialty also offers a different work environment to the daily inpatient ward rounds I was more familiar with. I also have the opportunity to work with various patient groups such as young adults, pregnant women and the elderly population. This meant my day to day job is always kept interesting as it can be so varied.

What training do you have to do to get into your specialty?

Following foundation training, I completed my core medical training before applying for a specialist registrar post in endocrinology and diabetes. I obtained my MRCP(UK) qualification during my core medical training, which was required prior to commencing my registrar role.

Once a registrar training number has been obtained, it is a 5-year training programme with dual accreditation to achieve the Certificate of Completion of Training (CCT). During these 5 years, you are rotated every 12 months between a mix of district and teaching hospitals, but this may vary between individual deaneries.

What rotations did you do in your training and what did you find helpful?

During my core medical training, I requested a 4-month rotation in diabetes and endocrinology which I found helpful to confirm my interest in this specialty. It offered me the opportunity to attend outpatient clinics, which easily get forgotten about during senior house officer (SHO) training as ward work often takes priority. I also found it helpful to do acute medicine rotations, as this not only gave me the opportunity to gain hands-on experience of managing acute diabetic emergencies such as diabetic ketoacidosis, but it also built my confidence in managing an acute take which becomes part of your role as the general medical registrar on call.

Being able to take a concise history and interpreting dynamic function tests to identify an endocrine disorder can be immensely satisfying for both me and the patient. Once an appropriate long term management plan is put in place, treatment can often make a real difference to a patient’s quality of life.

Do you work closely with other specialties?

Yes. For example, within diabetes, in most trusts there is a weekly diabetes foot round which involves working together with orthopaedic and vascular colleagues to manage patients with diabetic foot complications. We also work closely with obstetricians to manage pregnant women with either diabetes or endocrine disorders. Complex pituitary, thyroid and adrenal cases are discussed jointly with surgical and radiology colleagues to formulate appropriate management plans.

In what ways is your job satisfying?

Working with young adults who are diagnosed with type 1 diabetes can be particularly rewarding. We meet them when they are acutely unwell in hospital presenting in diabetic ketoacidosis (DKA) and understandably worried about how a new diagnosis like diabetes can affect their life. Introducing such patients to the host of education and technology available to them - supporting them to lead normal lives whilst managing their chronic condition well - can be very rewarding.

Endocrinology can be challenging, as often manifestations of endocrine disorders may not be localised to a particular organ. Being able to take a concise history and interpreting dynamic function tests to identify an endocrine disorder can be immensely satisfying for both me and the patient. Once an appropriate long term management plan is put in place, treatment can often make a real difference to a patient’s quality of life.

What are your typical working hours?

This is similar to most other medical specialities. As a trainee, I am on the general medical on-call rota which will include late evening and night shifts. On other days, most clinical commitments are kept between 9am–5pm. Each day can be different but, broadly speaking, it is a mix of general medical ward rounds twice a week with an average of 2–3 clinics a week.

Are there opportunities for teaching and research?

Yes. Informal bedside teaching happens on a regular basis with medical students attached to the diabetes and endocrinology firm but there is always demand for registrars to be involved in OSCE [objective structured clinical examination] or PACES [Practical Assessment of Clinical Examination Skills] teaching.

Research within both diabetes and endocrinology disciplines is a growing field. It is not compulsory at present to do research during the registrar training programme. However, increasingly, many registrars are choosing to take time out of the training programme to get involved with clinical research projects which can culminate in an MD or PhD. Showing additional interest in education or healthcare management is also looked upon very positively when interviewing for consultant jobs.

Do you work closely with other healthcare colleagues or groups?

I work closely with diabetes specialist nurses, podiatrists and dieticians on a regular basis to provide a well-rounded management plan for my patients with diabetes. For our elderly patients with diabetes, working closely with our GP colleagues regularly to ensure these patients have a comprehensive management plan to be managed safely in the community is important.

What mix of skills is required to work in your specialty?

Being a team player and enjoying working within a multidisciplinary setting is important, as are good communication skills and empathy to work alongside patients to manage their chronic illness. One should enjoy the process of problem solving for complex endocrine disorders, as well as have the ability to prioritise when assessing a patient with multiple comorbidities.

What advice would you give to someone considering a career in your specialty?

If you are interested in this specialty, it is useful to do a rotation or a taster week where you will be able to spend time with various members of the multidisciplinary team to get a well-rounded experience of the speciality. There are often many audit projects being done in both endocrinology and diabetes – getting involved in a local project will show further commitment towards the speciality. There are also plenty of regional meetings you can attend and, if you are able to present at one of these meetings, this will go a long way to show commitment to the specialty.

The Young Diabetologists and Endocrinologists' Forum (YDEF) is passionate about recruiting to the speciality and also has helpful advice for trainees who are interested.