Careers in laboratory medicine

What is a Clinical Scientist?

Clinical Scientist is a protected title and practising Clinical Scientists must be registered with the Health and Care Professions Council. A Clinical Scientist in microbiology oversees specialist tests for diagnosing and managing infectious diseases. The roles undertaken are diverse and often involve advising medical and healthcare professionals about laboratory test results within the clinical context of infection.

Who is the guidance for?

This guidance is for scientists who are already working in some form of clinical diagnostic laboratory who wish to become HCPC-registered as a Clinical Scientist. We understand that individuals wishing to become Clinical Scientists via the equivalence process differ widely in their experience and career paths; it is therefore not possible to write a one-size-fits-all guidance. This document is designed to give broad advice for those wishing to become Clinical Scientists in microbiology.

What is the equivalence process?

Applicants are asked to submit a portfolio comprising evidence of education, skills, knowledge, and professional experience that align to Good Scientific Practice (GSP), and the core and discipline-specific curricula of the Scientist Training Programme (STP).

It is not prescribed that an applicant provides evidence that is the same as completing the three-year STP. The evidence submitted should show equivalent knowledge, skills, education, and experience commensurate with a practising Clinical Scientist. The presented evidence should demonstrate the depth and breadth of your experience – think quality rather than quantity. It is acknowledged that applicants may currently work in niche area, it is important to present evidence that demonstrates knowledge and understanding of the wider field of microbiology and the clinical presentation of infection. Candidates should reflect on their practice, demonstrating how they have progressed to their current position.

After successfully completing the portfolio stage applicants will be invited for a viva with HCPC-registered Clinical Scientists, Biomedical Scientists, and lay chairperson to assess their ability to practice.

What are the Domains of Good Scientific Practice?

AHCS Good Scientific Practice 2021 (PDF download)

• Domain 1: Professional Practice – Patient-centred care; Scope of practice; Communication; Professional responsibilities; Working with others.
• Domain 2: Scientific practice – Data and reporting; Technical proficiency; Quality assurance.
• Domain 3: Clinical practice – Clinical activity; Clinical investigation and therapeutics
• Domain 4: Research, development and innovation – Research activity; Service development.
• Domain 5: Clinical leadership – Developing self; Leading others.

What are the core STP modules?

Curriculum Library

• Introduction to Healthcare Science, Professional Practice and Clinical Leadership
• Research methods

What are the microbiology STP-specific modules?

• Introduction to Clinical Bacteriology
• Introduction to Clinical Virology
• Molecular Pathology in Infection Sciences
• Epidemiology and Health Protection
• Infectious Disease in the Community and Hospital Setting
• Antimicrobial Therapy
• High Risk Groups
• Mycology and Parasitology
• Public Health Worldwide Implications for Clinical Microbiology

What types of evidence are required?

Try to demonstrate the application of your learning and reflection. Examples of knowledge acquisition or shadowing would not be sufficient for all areas. Evidence of participation, ‘learning by doing’, and active engagement is required in all domains. Evidence presented must demonstrate the application of Level 7 (MSc) standard of knowledge.

Broadly speaking, areas to cover could be broken down into three sections: laboratory experience, clinical experience, and research experience. Many applicants will find that they have weaker evidence in one of more of these sections. Performing a gap-analysis to highlight which types of experience need to be gained is a good place to start.

Laboratory experience should include evidence of communication of complex results and regular engagement with the clinical teams that are supported by your laboratory services; it is vital to demonstrate that you lead and develop the clinical services and the staff within the laboratory.

Case Based Discussions (CBDs) can be an excellent way to demonstrate evidence of meeting several GSP domains and STP requirements in a single piece of work. They can demonstrate understanding of a pathogen / infection, its epidemiology, clinical & laboratory diagnosis, management, and prevention. Royal College of Pathologists guidance on CBDs can be found HERE. Submitting a selection of CBDs can be a good way to demonstrate practice across the breadth of the STP curriculum. CBDs must demonstrate reflection and evidence of discussion with a senior Clinical Scientist or Consultant to support the level of practice of the applicant.

Journal clubs are an excellent way to demonstrate that you are keeping up to date with the literature, as well as evidencing that you are regularly critically appraising the literature. Journal editorial roles or working with professional societies to award grants and review guidelines will support several standards of practice.

The entire portfolio should be reflective and demonstrate how you have developed in your role up to this point. It can be used to show how experiencing new or challenging experiences makes you feel and makes you a better scientist; for example, if you are presenting research papers describe your contribution to the paper and how your contributions have differed in each project and your different learning outcomes.

Demonstrating the application of your knowledge and learning can be achieved by cross reference to a job description and an appraisal document can be used to demonstrate that your current role and scope of practice are equivalent to a Clinical Scientist role.

Referees who can provide supporting statements should be chosen carefully; ideally a Clinical Scientist Consultant or Medical Consultant should support your application. It is important that the referees not only know you and your abilities well, but also know the equivalence process. They can then write their statements to support and highlight the appropriate areas of your CV and application.

How do I prepare for the viva?

Preparation for the viva should draw on all of your experiences to date. Assessors will ask questions to demonstrate your understanding of the five main domains of Good Scientific practice. The questions are mostly scenario-based and will test your ability to apply the principles of GSP in your practice as a trainee Clinical Scientist, and your ability to draw on your experience/training to make good clinical judgment in support of patient management, interpret complex scientific data for training purposes, interpret healthcare policies and procedures, and contribute to service development through, for examples audit trails, review/update of SOPs, and implementation of new services. Preparing a portfolio that demonstrates understanding of the presentation of infection in the wider context of Medical Microbiology will support your preparation.

It is important to answer the questions with examples to demonstrate evidence of your participation, leadership, assertiveness, and being proactive in your practice as a Clinical Scientist. In doing so, you demonstrate to the assessors that you have acquired the experience they are looking for and that you satisfy the criteria for competency in the domain(s) being assessed. Before you attend your viva, arrange a mock viva with your trainers to go through a set of possible questions that will assess you on all the five main domains.

Analytical toxicology is concerned with the role of the laboratory in the diagnosis, treatment and prevention of poisoning. Analytical toxicologists spend much of their time measuring compounds such as alcohols, drugs and poisons in biological samples and in providing an interpretation of any results generated.

Most Clinical Biochemistry laboratories within the NHS will perform a degree of analytical toxicology as part of their routine workload, usually for patients who present to the emergency department having knowingly or accidentally ingested a poison.

There are a number of more specialised analytical toxicology laboratories within the NHS which are able to offer a much greater range of toxicological testing. The range of compounds which may be used by the poisoned patient is vast and the numbers of compounds used is increasing all of the time. This means that the identification of the compounds that an individual may have taken and the interpretation of the results generated is often highly challenging and requires specialist equipment and expertise.  Clinical Scientists who work within this setting may be required to develop and update specialist assays, often using more manual techniques and instrumentation including high resolution and tandem mass spectrometry, high performance liquid chromatography, gas chromatography-mass spectrometry and inductively-coupled plasma mass spectrometry. They may also be required to troubleshoot and monitor the performance of these assays, interpret data generated by assays, as well as provide interpretative advice to service users. In some rarer circumstances, they may also be asked to give expert opinion in court.  The types of tests performed by these more specialist laboratories include screening for drugs of abuse in samples submitted by substance misuse patients, therapeutic drug monitoring of compounds which require regular review if being taken by a patient, screening of samples from acutely unwell patients presenting to the emergency department or other clinical settings, and post-mortem analytical toxicology to assist in the Coronial investigation process.

Most individuals who choose to specialise in analytical toxicology first complete the STP. This gives the trainee a broad understanding of Clinical Biochemistry. In addition to clinical knowledge, this training also covers a range of skills including analytical techniques, professional practice and research methods. Individuals may also come from a medical background, with exposure to Clinical Biochemistry often coming in the form of placements in laboratories during foundation training. Individuals who pursue this route and who want to specialise in toxicology may choose to demonstrate competence by other routes including by joining the European Register of Toxicologists.

Inherited metabolic diseases comprise a large class of genetic diseases involving disorders of metabolism. The majority are due to defects of single genes that code for enzymes that facilitate conversion of various substances (substrates) into others (products). In most of the disorders, problems arise due to accumulation of substances which are toxic or interfere with normal function, or to the effects of reduced ability to synthesize essential compounds.

Inherited metabolic diseases are rare disorders but early diagnosis and treatment can be life-saving and prevent long-term complications.  As specialist investigations are required for the diagnosis and monitoring of inherited metabolic diseases, these are available in a limited number of specialist metabolic laboratories (also known as Biochemical Genetics).  These laboratories utilise a number of advanced biochemical technologies including tandem mass spectrometry, high pressure liquid chromatography, cellulose acetate electrophoresis, spectrometry, tissue culture and enzyme analysis, and genetic technologies.  Metabolic laboratories combine advanced scientific procedures with manual techniques such as Thin Layer Chromatography to identify and monitor a diverse spectrum of metabolic diseases.

Clinical Scientists who work within this field will be required to develop and update specialist assays in addition to performing and troubleshooting complex assays.  Clinical Scientists are responsible for maintaining a high quality metabolic service which adheres to external quality standards and is reactive to clinical service users.  Furthermore, all Clinical Scientists are required to interpret complex results and provide appropriate diagnostic and interpretative advice to clinical teams.  There is considerable liaison between the specialist metabolic clinical teams and the metabolic laboratories but also with external laboratories and clinicians for whom laboratories provide a referral metabolic service.    

Inherited Metabolic disease laboratories are also involved in the provision of the National Newborn Screening Programme.  Clinical Scientists involved in this area are required to develop and maintain specialist services for the detection of the Inherited Metabolic Diseases included within the National Screening Programme.  This role further requires the liaison with clinical metabolic teams upon identification of presumptive positive cases to ensure appropriate follow-up testing is completed and that results are conveyed to clinical teams and families as mandated by national protocols.

Individuals who choose to specialise in inherited metabolic disease typically complete the STP training programme.  This provides a broad understanding of Clinical Biochemistry which is essential for understanding the basis of metabolic disease but also includes specialist rotations, of which one is inherited metabolic disease and is completed in a specialist metabolic laboratory. They would then develop their specific knowledge by working in one of the specialist laboratories and attending relevant training courses and conferences.  However, it is recognised that Clinical Scientists who currently work within academic research, public health and teaching or the medical equipment industry also have the necessary skills to develop a career within this speciality.  To facilitate this, a Clinical Scientist Apprenticeship scheme is in development whereby NHS laboratories will be able to offer a 3 year training apprenticeship which will culminate in registration of the apprentice with the Health and Care Professions Council (HCPC), allowing further career progression to clinical scientists who have not followed the STP route of entry.

A career in Inherited Metabolic Disease is a demanding, challenging and extremely rewarding career within Clinical Biochemistry.  It allows clinical scientists to utilise complex scientific technologies to diagnose and monitor patients with rare inherited disorders.