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Vocational Training Immunology and Allergy (cont.) Components of Joint Training for Fellowships of RACP and RCPA Core Training Trainees will undertake at least 4 years following completion of basic physician training and the FRACP Examination comprising:
 Clinical Training 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. The trainee should acquire a detailed knowledge of the indications, dosages and adverse reactions of the commonly used immune suppressive drugs, antihistamines, immunoglobulin preparations, inhaled bronchodilators and steroids. Laboratory Training 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, gliadins and microbial pathogens (including screening and confirmatory tests for HIV); quantification of lymphocyte subsets; characterisation of lymphoid malignancies using immunophenotyping and molecular studies of B and T cell receptor gene rearrangements; lymphocyte and neutrophil function; molecular and serological tissue typing and the molecular assessment of lymphocyte activation molecules and receptors in primary immune deficiencies. Participation in the laboratory QA activities is regarded as an important part of the trainee's activities. Examinations Successful completion of the joint immunology program also depends on satisfying requirements of the BOC of the RCPA. The BOC requires that trainees spend time in at least 2 accredited training sites. Successful completion of the Part 1 and 2 Immunology Examinations is also required. It is recommended that the Part 1 Examination not be attempted until the trainee has completed at least 18 months of immunopathology training. These examinations should be sat in separate years. Only in exceptional circumstances will candidates be allowed to sit Part 1 and Part 2 in the same year, and approval for this must be sought from the BOC of the RCPA.
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