Immunology and Allergy

Components of Training for Joint Fellowship of RACP and RCPA

Core training
Trainees will undertake at least four years following completion of basic physician training and the FRACP Examination comprising:

• Up to two years of clinical practice in immunology and allergy including not less than one full time year in a recognised training position directly supervising inpatient and outpatient care.
  
• Not less than a total of two years of laboratory based diagnostic immunopathology; ( a significant proportion of which should be spent in supervised training positions within Australia and New Zealand).
  
• A 12 month elective in a related area such as research will be accredited but trainees are encouraged to retain a regular component of clinical and laboratory activity if possible.

Clinical training should include inpatient and outpatient experience in the diagnosis and management of primary immune deficiency disorders; organ specific and multisystem autoimmune diseases (including relevant rheumatological disorders); systemic vasculitides; lymphoproliferative disorders and dysproteinaemias; human immunodeficiency virus infection and its complications and allergic disorders including drug reactions, asthma, rhinitis, urticaria/angioedema and anaphylaxis.

Trainees are expected (often through the process of consultation) to be familiar with aspects of other organ based specialties (particularly neurology, nephrology, dermatology, gastroenterology, otolaryngology and clinical transplantation) relevant to immunological and allergic disorders. A working knowledge of the aerobiology and immunochemistry of clinically relevant allergens and the principles and practice of desensitisation is important. A detailed knowledge of the indications, dosages and adverse reactions of the commonly used immune suppressive drugs, antihistamines, immunoglobulin preparations, inhaled bronchodilators and steroids should be required.

The trainee must understand the principles of immunological assays in common use (ELISA, RIA, immunodiffusion, agglutination, Western Blot, immunohistochemistry, direct and indirect immunofluoresence, electrophoresis, rate nephelometry, leucocyte isolation and proliferation, flow cytometry, skin testing and molecular methods used in genetic testing.

The trainee should develop a hands-on working familiarity with the full range of diagnostic tests and should be given responsibility for reviewing results and generating reports. The trainee should be prepared to interpret results of the following tests: immunoglobulin and complement component quantitation; characterisation of serum and urinary paraproteins; detection of antibodies to autoantigens, allergens, gliadin and microbial pathogens (including screening and confirmatory tests for HIV 1/2); quantification of lymphocyte subsets; characterisation of lymphoid malignancies using immunophenotyping and molecular studies of B+T cell receptor gene rearrangement; lymphocyte and neutrophil function; molecular and serological tissue typing and the molecular assessment of lymphote activation molecules and receptors in primary immune deficiencies.

Participation in the laboratory's QA activities is regarded as an important part of the trainee's activities.

Successful completion of the joint immunology program also depends on satisfying requirements of the Board of Censors of the RCPA which include successful completion of the examination in Pathological Sciences and the Part One and Two Immunology /Allergy Examinations. It is recommended that the Part One Examination is not attempted until the trainee has completed at least 18 months of immunopathology training. These examinations are to be sat in separate years. Only in exceptional circumstances will candidates be allowed to sit part One and Part Two in the same year, and approval for this must be sought form the Board of Censors of the RCPA.

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