What is Clinical Immunology?

Hello, I’m Helen and I’m a second year STP in Clinical Immunology. I work with University Hospitals Sussex and so get to work across a few of our hospitals (but mainly based in Brighton). Clinical Immunology is part of the blood sciences group which works closely with Biochemistry, Haematology and Genomics specialties. It’s an area that varies a lot depending on the hospital you are training in but there are four main areas that we test:

• Autoimmunity – eg. Systemic Lupus Erythematosus (SLE), Celiac disease, Rheumatoid arthritis
• Immunodeficiency – eg. Severe Combined Immunodeficiency (SCID), X-linked agammaglobulinemia (XLA), Chronic Granulomatous Disease (CGD)
• Allergy – eg. Anaphylaxis, Oral Allergy Syndrome, Drug allergies
• Haematological Oncology – eg. Chronic Lymphoblastic Leukaemia, Multiple Myeloma

Some hospitals specialise more in certain areas but as an STP we get to learn everything and so this might involve travelling to different hospitals to be able to see it all. We use a range of techniques in immunology such as flow cytometry, ELISA (enzyme linked immunosorbent assays), serum protein electrophoresis, immunofluoresence, immunoblotting and more. As a trainee in immunology we are pretty much always laboratory based, however, there are opportunities to shadow in some clinics.

Immunology is one of the smaller specialisms with usually only a handful of direct entry places each year. This means it’s easy to become quite close to your peers when spending time with them for university teaching, conferences and training events. This is something I love about the STP; there is so much support from the other trainees and even a lot of the registered clinical scientists. The Immunology community is a really close group across the whole NHS so there is always someone to help you if you are stuck.    

Day in the life

I spend most of my time gathering evidence for my STP competencies. As an STP we complete what is essentially a portfolio of evidence to demonstrate we are competent for the role. To do this though, I need to be trained in all of the techniques in the laboratory that are run within the speciality and so there is a lot to learn. On a day I am not learning anything specific, I help to set up the autoimmunity analysers in the morning which involves loading the machines with reagents and running the quality control material. We typically get through about 200 samples per day in my laboratory on the automated analysers and our most common test is the Anti-tTG IgA Antibody test for celiac disease. There are also the flow cytometers in my laboratory which we use to see the characteristics of the cells in a sample. For example, a patient with HIV might require a CD4/CD8 T cell ratio or we can use other cellular investigations to investigate immunodeficiency or some cancers. My personal favourite is performing serum protein electrophoresis to identify and quantify paraproteins in samples which can be a diagnostic marker of multiple myeloma.

Some days I might shadow our principal clinical scientist when they authorise results which usually leads to a lot of discussion of interesting cases and how the results will help lead to a diagnosis. Other days I might be learning a new technique or test on a different analyser where I can gather interesting cases and bits of evidence to complete my competencies. More recently, as a second year, I have now started my research project which will fill the majority of my time for the next few months.

I get involved with lots of other things though. I sometimes help to perform verifications on new instruments and processes. This is when we need to make sure the tests are reliable and accurate and so we run a lot of samples with known results and perform statistical analysis to determine if we can put the test/process into use. I have also had the opportunity to get involved with some teaching at our local medical school where I lead a tutorial session on Tuberculosis and ELISA principles.

My application(s)!

Like many others, I didn’t get a place on the STP the first time, and like so many others I will probably offer the same advice – don’t give up! It is an extremely competitive programme and there really isn’t one best thing you can do to improve your chances. Many of my peers are directly out of university with limited prior laboratory experience, some of my peers have higher education qualifications (even a PhD!), and some of my peers have NHS laboratory or other relevant laboratory experience. We all have really different backgrounds and we all still got a place and receive the same training.
The best thing you can do to prepare yourself for the application is arm yourself with all the available resources. I will list a few of the best ones I used:

• NSHCS STP Curriculum Library (basically all the competencies we have to complete)
• STP job description and person specification
• NHS Constitution
• Trust open days (these are usually advertised at the start of the application process)
• Social media (you will find many STPs on there who are more than happy to chat about their role)

The STP is a really challenging role but it’s so rewarding. I was told when I started that I was in a unique position where my job was to simply learn for the next 3 years and that I should just make the most of all the opportunities to do just that. And it’s true, I have learnt so much in the past year and I’m really looking forward to everything left to come. 

Twitter: @HJImmunoSTP