UEMS Medical Microbiology ETR and Curriculum

UNION EUROPÉENNE DES MÉDECINS SPÉCIALISTES
EU ROP EAN UN ION OF MEDICAL SP ECIALISTS

Association internationale sans but lucratif International non-profit organisation
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Training Requirements for the

Specialty of Medical Microbiology
European Standards of Postgraduate Medical Specialist Training
Preamble
The UEMS is a non-governmental organisation representing national associations of medical

specialists at the European Level. With a current membership of 34 national associations and
operating through 39 Specialist Sections and European Boards, the UEMS is committed to promote
the free movement of medical specialists across Europe while ensuring the highest level of training
which will pave the way to the improvement of quality of care for the benefit of all European citizens.
The UEMS areas of expertise notably encompass Continuing Medical Education, Post Graduate
Training and Quality Assurance.
It is the UEMS' conviction that the quality of medical care and expertise is directly linked to the
quality of training provided to the medical professionals. Therefore the UEMS committed itself to
contribute to the improvement of medical training at the European level through the development of
European Standards in the different medical disciplines. No matter where doctors are trained, they
should have at least the same core competencies.
In 1994, the UEMS adopted its Charter on Post Graduate Training aiming at providing the
recommendations at the European level for good medical training. Made up of six chapters, this
Charter set the basis for the European approach in the field of Post Graduate Training. With five
chapters being common to all specialties, this Charter provided a sixth chapter, known as “Chapter
6”, that each Specialist Section was to complete according to the specific needs of their discipline.
More than a decade after the introduction of this Charter, the UEMS Specialist Sections and
European Boards have continued working on developing these European Standards in Medical
training that reflects modern medical practice and current scientific findings. In doing so, the UEMS
Specialist Sections and European Boards did not aimed to supersede the National Authorities'
competence in defining the content of postgraduate training in their own State but rather to
complement these and ensure that high quality training is provided across Europe.
PRESIDENT: DR ROMUALD KRAJEWSKI SECRETARY-GENERAL: DR EDWIN BORMAN

TREASURER: DR GIORGIO BERCHICCI LIAISON OFFICER: DR ZLATKO FRAS
U N I O N E U R O P É E N N E D E S M É D E C I N S S P É C I A LI S T E S
E UR O P E A N UN I O N O F M E D I C A L S P E C I A L I S T S
Association internationale sans but lucratif – International non-profit organisation
At the European level, the legal mechanism ensuring the free movement of doctors through the
recognition of their qualifications was established back in the 1970s by the European Union. Sectorial
Directives were adopted and one Directive addressed specifically the issue of medical Training at the
European level. However, in 2005, the European Commission proposed to the European Parliament
and Council to have a unique legal framework for the recognition of the Professional Qualifications to
facilitate and improve the mobility of all workers throughout Europe. This Directive 2005/36/EC
established the mechanism of automatic mutual recognition of qualifications for medical doctors
according to training requirements within all Member States; this is based on the length of training in
the Specialty and the title of qualification.
Given the long-standing experience of UEMS Specialist Sections and European Boards on the one
hand and the European legal framework enabling Medical Specialists and Trainees to move from one
country to another on the other hand, the UEMS is uniquely in position to provide specialty-based
recommendations. The UEMS values professional competence as “the habitual and judicious use of
communication, knowledge, technical skills, clinical reasoning, emotions, values, and reflection in
daily practice for the benefit of the individual and community being served”1. While professional
activity is regulated by national law in EU Member States, it is the UEMS understanding that it has to
comply with International treaties and UN declarations on Human Rights as well as the WMA
International Code of Medical Ethics.
This document derives from the previous Chapter 6 of the Training Charter and provides definitions
of specialist competencies and procedures as well as how to document and assess them. For the sake
of transparency and coherence, it has been renamed as “Training Requirements for the Specialty of
X”. This document aims to provide the basic Training Requirements for each specialty and should be
regularly updated by UEMS Specialist Sections and European Boards to reflect scientific and medical
progress. The three-part structure of this documents reflects the UEMS approach to have a coherent
pragmatic document not only for medical specialists but also for decision-makers at the National and
European level interested in knowing more about medical specialist training.
Introduction
Ideally every EU member state recognizing the specialty should have a professional specialist society
of Medical Microbiology. Man power planning and forthcoming quantitative training facilities are the
responsibility of the national medical association on the advice of the Medical Microbiology specialty
group. The specialty of Medical Microbiology should be represented in the national medical
association in each EU country.
The Central Monitoring Authority of the specialty of Medical Microbiology is the UEMS Section of
Medical Microbiology which, in consultation with the Professional Affairs Committee of the European
1
Defining and Assessing Professional Competence, Dr Ronald M. Epstein and Dr Edward M. Houndert, Journal
of American Medical Association, January 9, 2002, Vol 287 No 2

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Society of Clinical Microbiology and Infectious Diseases (ESCMID: www.escmid.org), produces

guidelines for training in the specialty and produces a training programme blueprint to be filled in
with the specific aspects of the training, pertinent to the individual EC member states.
A revised core training programme and training programme for Medical Microbiology was published
on the internet under auspices of the Medical Microbiology Commission of the UEMS Section of
Medical Biopathology in 2007.
In 2008 a Section of Medical Microbiology was created within the UEMS. After the creation of a
separate section it was decided to adopt the version of Chapter 6 of the UEMS Charter on
Postgraduate Training for Medical Microbiology which was used when Medical Microbiology was still
a part of Medical Biopathology as a basis for the further development and modernisation of specialist
training. The current standard is again derived from this but has undergone certain changes.
It is recognised that the practice of Medical Microbiology differs across EU member states, ranging
from a principally laboratory-based specialty in states where there is a legal obligation for all reports
to be signed by a Medical Microbiologist, to a predominantly clinically-based service, particularly in
those states where there are few infectious disease physicians. In the latter states, much of the
diagnosis and management of patients with infection is directed by Medical Microbiologists.
Training centres are recommended to apply for the status of ESCMID Collaborative Centre, which will
enable and promote the exchange of trainees within the European Union and UEMS member
countries.
I. Training Requirements for Trainees

In order to become a trainee for the speciality Medical Microbiology the candidate has to be a
qualified medical doctor. Procedures for recruiting medical doctors, who have fulfilled the
requirements for basic medical training leading to an EC recognized medical diploma, must be
transparent.
1. Content of training
a. Theoretical knowledge
The core of Medical Microbiology consists of the subjects bacteriology, virology, mycology and
parasitology and includes in these fields the following knowledge: clinical advice/counselling:
diagnosis, treatment and prevention, isolation identification of pathogens and diagnostics including
serology, antibiotic and antifungal susceptibility testing, the use of molecular methods within these
fields, antibiotic/antimicrobial (antibacterial, antiviral, antimycobacterial, antimycotic and
antiparasitic) therapy, antibiotic stewardship. In addition laboratory management is an essential part
of the abilities of a medical microbiologist, and includes quality control and quality assurance,

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economics/budgeting and leadership training. Medical microbiologists should also learn about public
health and Infection control; consisting of counselling, auditing and accreditation, surveillance of
pathogens, resistance and nosocomial infections, epidemiology, bioinformatics and molecular typing.
In addition a specialist in Medical Microbiology should have relevant clinical practice in his/her
training to be able to give informed clinical interpretation of test results and be able to give
independent clinical interpretation of the patient in question. The field of Medical Microbiology
covers almost all aspects of medicine and ranges from general practice to specialised hospital
programmes (e.g. haematology and transplantations).
b. Practical skills
The specialist training should produce medical microbiologists able to provide specialist opinion in
their clinical discipline and who should have developed the appropriate management skills to lead a
department of Medical Microbiology, if required. The trained medical microbiologist should be
competent to:
1. Give advice as a physician on the diagnosis, treatment and prevention of microbial diseases.
2. Provide a scientific basis for laboratory diagnosis; to set protocols and to maintain standards
within the laboratory.
3. Undertake the management responsibilities required from the director of a Medical Microbiology
laboratory.
4. Take charge of infection control in hospitals
5. Propose hospital policies on the control of antibiotic usage and on the prevention of hospital
acquired infection
6. Collaborate with national surveillance organisations and public health authorities and to provide
services for these organisations
7. Participate in the training programs for medical microbiologists, infection control doctors and
other experts in the field of microbial diseases.
8. Undertake research and development in the specialty of Medical Microbiology
c. Professionalism
The abilities that are essential for a specialist in Medical Microbiology are: Being a medical expert,
having good communication, academic, cooperative and, organisational/administrative abilities.
It is expected that the finished specialist during his/her education has acquired attitudes that
promote a high professional and ethical standard and a positive collaboration with colleagues and
other professional groups.
Relevant elements to obtain these qualifications are a recognition that Medical Microbiology
primarily is to serve the patient. This requires a high degree of willingness for fast and good
communication with clinical colleagues. A motivation for their own professional development
includes, amongst others, participation in continued medical education. It is expected that specialists
in Medical Microbiology have respect for colleagues and other professional groups working in the
medical laboratories.

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Training in such attitudes comes first and foremost by model learning from supervisor and other
senior doctors.
2. Organisation of training
a. Assessment and evaluation
The training programme should contain sufficient opportunities to check the trainee’s proceedings
by means of observations during critical practical situations, written proofs of critical assessments by
the trainer and examinations of knowledge. The frequency of these tests is laid down in the training
programme. Trainers and other staff members involved in the training process should be trained to
be able to critically make an assessment of the trainee’s knowledge, skills and attitude.
The section will not require that an examination should be passed but will leave the decision to have
an examination or not to the medical associations in the individual member states. Nevertheless an
assessment of the candidate should be made by the trainer based on theoretical knowledge,
practical skills (amongst others based on the candidates log book or equivalent) and the candidates
professionalism.
The section encourages the use of courses, both national and international, to train the candidates.
Certain subjects might better be seen in an international course, e.g. parasitology courses on a
European level, especially in countries with no institutes for tropical diseases.
b. Schedule of training
Specialisation in Medical Microbiology requires education within clinical medicine, microbiology,

laboratory management, public health & infection control and science. The duration of the
specialisation should be at least 60 months (5 years, including any compulsory periods in clinical
medicine required for entry into formal Medical Microbiology training after obtaining a license to
practice (authorisation). One or more of the subjects (laboratory management, public health &
infection control and science) may be integrated within Medical Microbiology. In this case,
documentation for acquired skills is required. Amendments or minor changes that may be necessary
in single countries should on a European level comply with a mandatory minimum of five years of
training for medical microbiologists.
The training period may be reduced when there is proof of experience in one or more of the major
different themes as stated in the UEMS Section of Medical Microbiology training program (e.g.
bacteriology, virology, mycology, parasitology, practical clinical training, and infection control). This
experience should imply a period of more than twice the training period needed in the specific
theme and the period in practice should not have taken place longer than 5 years before the training
is started. The reduction shall not be more than half of the period required for training in the specific
theme.
• Medical Microbiology (at least 24 months). The following subjects should be covered:
Bacteriology, Virology, Mycology and Parasitology. The subjects (virology, parasitology and

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mycology) may be integrated into bacteriology/general microbiology where no separate

department exists. In order to be able to cover the entire field of Medical Microbiology the
approximate length of each sub-discipline should be: bacteriology - 12 months, virology - 8
months, mycology - 2 months and parasitology - 2 months.
• Laboratory Management (Up to 6 months)
• Public Health and Infection control (up to 12 months):
• Clinical Medicine (minimal 12 months)
and, either
• Science project (6 months): Projects should preferably be based on Medical Microbiology or
translational, i.e. method-based studies within Medical Microbiology that include clinical
information. Clinical epidemiological studies with limited laboratory involvement are
discouraged. The project should lead to a publication: here defined as a presentation (article in
peer reviewed journal, poster or oral presentation) at national or international level.
or
• Direct in-patient care and out-patient clinics in infectious diseases, HIV/AIDS, tuberculosis or
related specialties (6 months).
II. Training Requirements for Trainers

a. Requested qualification and experience and core competencies
Every centre should have one recognised training leader but can have more trainers.
The recognised training leader should have been practising the specialty for at least 5 years after
specialist accreditation. The training leader should be specialist in Medical Microbiology. The training
leader should be supported by a trainer representative and there should be sufficient specialist
medical staff to operate the daily department’s activities. Ideally, the training leader should have
academic qualifications.
The trainer should work out a training program for the trainee in accordance with the trainee’s
progress during the training and the possibilities of the institution, which also complies with national
rules and EU directives and considers UEMS/European Board recommendations.
The ratio between the number of qualified specialists in the teaching staff and the number of
trainees should provide a close personal monitoring of the trainee during his/her training and
provide adequate exposure of the trainee to the training. Therefore this ratio should approximate
one trainer to a maximum of 3 trainees.
b. Quality management for trainers
Evaluation of the training provided should be organized, e.g. evaluation of trainers by trainees.

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III. Training Requirements for Training Institutions

1. Process for recognition as training centre
a. Requirement on clinical activities
All or part of the training can take place in a training centre that offers the full spectrum of facilities
needed for training accordingly the essential themes in Medical Microbiology (University laboratories
or laboratories covering nearly all aspects of Medical Microbiology). Parts of the 5 year training
programme, no longer than 3 years, may be followed in a department with a lesser spectrum of
facilities (small or peripheral laboratories). In any case, all training should take place in a department
that is a recognised training centre. The section of Medical Microbiology encourages training in more
than one institution (small and large) to be able to learn the full spectrum of the subject. The medical
specialist responsible for the training programme, and the trainer representative, should be of
sufficient scientific status, preferably at PhD level, and have at least 5 years of practical specialist
experience in the field of Medical Microbiology.
Training institutions should be part of /or serving a medical centre, harbouring the main leading
clinical specialties such as internal medicine, surgery, paediatrics and gynaecology/obstetrics. In
addition, the trainee should gain experience in serving including clinical consulting in the field of
clinical microbiology on Intensive Care Units and gain experience in the epidemiology of hospital
acquired infections and antibiotic resistance. These main specialties should also be qualified to train
specialists in their respective field.
b. Requirement on equipment, accommodation
The equipment should be of such standard that it meets the current standards of the speciality.
2. Quality Management within Training institutions
It should be aimed at a maximum of 3 trainees per member of the training group.

The quality of the training institution should be audited by an external team of specialists in Medical
Microbiology, delegated by the national medical association or its equal. Audit should take place at
regular intervals, preferably annually. The training institution and the clinical departments should be
subject to auditing procedures according to national requirements for accreditation and certification.
Board, Section of Medical Microbiology

March 2013
Updated May 2013

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Curriculum approved by the European Council 20.10.17
UEMS - SECTION OF MEDICAL MICROBIOLOGY
CORE TRAINING PROGRAMME FOR MEDICAL MICROBIOLOGY

INTRODUCTION
This document sets out a curriculum for medical microbiologists which covers the scientific
base of medical/clinical microbiology, as well as applied aspects, including related fields such
as infectious disease and infection control. Some elements of medical microbiology training
are common to the training in infectious diseases, e.g. infection control. The terms medical
and clinical microbiology means the same and pertains to the scientific base of the study of
diseases afflicted by contagious micro-organisms of any nature, be it viruses, bacteria, fungi
(moulds and yeasts), parasites, or prions.
AIMS OF TRAINING
The main aim of training is competency in delivering specialist practice in Medical
Microbiology.
The core training programme aims to provide the trainee with both the theoretical
foundation and the practical, technical, clinical and managerial skills necessary for the
independent specialist practice of medical microbiology in a clinical environment and for the
advancement of the subject. It must be appreciated that laboratory work and clinical
experience must be closely integrated; therefore laboratory associated clinical duties are an
essential component of the training programme. At the end of their training a certain
behaviour is expected, of which the most important is an enthusiastic approach to learning
and application of knowledge.
SUPERVISION AND ASSESSMENT OF PROGRESS IN TRAINING

The requirements for the length spent on each part of Medical Microbiology, supervision,
qualifications of supervisors and assessment of progress in training are set out in the
documents “Training Requirements for the Specialty of Medical Microbiology” and “Minimal
requirements for specialisation in Medical Microbiology in Europe”. Both documents have
been amended by the Sections annual meeting, and the “Training Requirements for the
Specialty of Medical Microbiology” was formally accepted by UEMS in Paris in Sept. 2013.
The matters covered in those documents will not be discussed any further in this document.
GENERAL AIM
To produce trained clinical microbiologists who can provide a specialist opinion in the
discipline and who should have developed the appropriate management skills to lead a
department, if required. The trained medical microbiologist should be competent to:
1. give advice as a physician on the diagnosis, treatment and prevention of microbial and
parasitic diseases.
2. provide a scientific basis for laboratory diagnosis and management; to set protocols and
to maintain standards within the laboratory.
3. undertake the management responsibilities required of the director of a clinical
microbiology laboratory.
4. to provide expert specialist advice in relation to infection control and prevention in
hospitals.
5. propose hospital policies on the control of antibiotic, antiviral, antimycotic and
antiparasitic use.
6. collaborate with national surveillance organisations and public health authorities and
provide services for these organisations
7. participate in education and training programs for medical microbiologists, infection
control doctors, other medical doctors and experts in the field of infectious diseases.
There may also be a role in public education, where relevant and feasible.
8. undertake research and development in the field of medical/clinical microbiology and
infectious diseases.
These eight areas of competence include two (namely 4 and 5) in which additional courses
and/or formal training may be required by law in some European countries. Points 7 and 8
apply mainly to medical microbiologists in academic institutions, but all microbiologists
should have had training in these matters.
OBJECTIVES
Over a minimum 5-year period the trainee should acquire or develop:
a) Good clinical care skills
i. History, examination, investigations, treatment (therapeutics) and
communication (verbal and written).
ii. Management of infectious diseases.
iii. Time management and decision-making.
b) Specialised factual knowledge of the natural history of infectious diseases.
c) Interpretative skills so that a clinically useful opinion can be derived from laboratory
data. Emphasis should be made on the importance of clinical training and
multidisciplinary care.
d) Technical knowledge, gained from familiarity with laboratory technology, so that
methodology appropriate to a clinical problem can be chosen and so that quality
control and quality assurance procedures can be implemented.
e) Research and development experience. Original thought and critical assessment of
published work are important to allow the trainee to contribute in a team, and
individually, to the development of the service.
f) The life-long habits of reading, literature-searches, consultation with colleagues,
attendance at scientific meetings and the presentation of scientific work as part of
continuing professional development (CPD).
g) Data management skills to evaluate information derived from the population served
and from the technical procedures applied in the laboratory. These skills should
include familiarity with IT and the use of spread sheets, databases and statistical
packages etc.
h) Management skills.
The trainee is strongly recommended to gain experience, under supervision, in
developing departmental policies and future strategies and to develop the leadership
skills necessary to implement them. The trainee is strongly recommended to acquire
a basic knowledge of healthcare economics.
i) Presentation skills:
The trainee is required to become familiar with the preparation and delivery of oral
presentations and written scientific reports and should deliver at least one scientific
presentation during their training period. A presentation is defined as an article in
peer reviewed journal, poster or oral presentation at national or international level.
Publications in national or international medical journals should be encouraged.
j) Familiarity with all aspects of health and safety requirements for laboratories.
k) The communication skills required for the practice of microbiology. These include
both informal verbal skills and formal skills such as at committee work and written
work encompassing strategy documents, reports, letters, etc.
l) An understanding of audit, leadership, governance and team working which underpin
microbiology practice.
m) Moral based competencies.
(i) Professional behaviour.
(ii) Ethics and legal issues.
(iii) Patient education and disease prevention.
n) Teaching methods and skills.
CORE TRAINING PROGRAMME: CLINICAL MICROBIOLOGY

Specialisation in Medical Microbiology requires education within clinical medicine, medical
microbiology, public health & infection control, laboratory management and science. The
duration of the specialisation should be at least 60 months, and the training in bacteriology,
virology, mycology and parasitology should be at least 24 months. In order to be able to
cover the entire medical microbiology the approximate length of each sub-discipline should
be: bacteriology - 12 months, virology - 8 months, mycology - 2 months and parasitology - 2
months. One or more of the subjects (e.g. laboratory management, public health & infection
control, scientific basis of clinical microbiology and science) may be integrated within
medical microbiology. In this case, documentation for acquired skills is required, and the
length of the training in medical microbiology should be adjusted to include these subjects.
The recommended length of training in laboratory management is - up to 6 months; public
health and infection control - up to 12 months; clinical medicine - minimal 12 months and
science project (6 months) .
The subjects virology, parasitology and mycology may be integrated into
bacteriology/general microbiology where no separate department exists, but time in a
specialised laboratory in these subdisciplines is advisable.
The following subjects should be covered:
GENERAL MICROBIOLOGY
Applies to all the sub-disciplines of medical microbiology (bacteriology, virology, mycology
and parasitology)
Scientific basis of clinical microbiology

At the end of their training trainees should be able to:
a) explain the basic microbial biology (structure, genetics, taxonomy, physiology,
epidemiology, classification and typing) of major bacterial, viral, fungal and parasitic
agents.
b) use knowledge of basic biology to justify investigations, infection prevention and control
procedures and interpretation of results
c) explain the basis of genetic susceptibility to pathogens and disease.
d) explain the basics of the immune response to infection, host defence mechanisms, the
immune system and immunity to infection and immunodeficiency.
e) compare and contrast cellular and humoral immunity
f) explain the basis of how the immune response protects against infection, and how it may
contribute to pathogenesis of infectious diseases
g) explain the basis of different types of host−parasite relationships, e.g. symbiosis, viral
latency, quasi-species evolution, etc.
h) explain the types of immunodeficiency and how they affect susceptibility to and control
of infectious diseases
i) use knowledge of host−pathogen relationships to analyse clinical presentation of
infections and justify investigations and interpretations of results
j) explain microbial pathogenicity and genetic susceptibility to pathogens and diseases.
k) explain epidemiology of infectious diseases - their surveillance and control.
l) explain typing methods available: the principles, advantages and limitations of various
phenotypic and genotypic methods and describe the role of typing in incident/outbreak
investigations. And as a result, should be able to recommend appropriate typing
methods for clinical and infection control situations and interpret the results.
m) understand about antimicrobial agents, their mode of action and mechanisms of
microbial resistance.
n) explain the basis of how vaccines work
Laboratory safety
Prior to any "hands on" experience of laboratory work, the trainee should be instructed in
basic safety requirements including correct laboratory dress and laboratory hygiene.
Instruction should also be given on the immediate handling and disposal of specimens and
contaminated articles (e.g. inoculating loops, pipettes) at the laboratory bench, the dangers
of aerosols and the procedure for dealing with spillages.
The objective of the training is to obtain an in-depth understanding of health and safety
issues both locally and nationally in order to practice safely in a laboratory and in a clinical or
other setting and to advice on safe practice. The candidate should also obtain an
understanding of risk assessment for dealing with category 3 and 4 pathogens and be
familiar with the requirements for handling of such pathogens.
At the end of formal training, the microbiologist should be able to:

a) explain the principles of standard precautions, hazard groups and containment levels.
b) explain basic laboratory hazards and precautions against them
c) work safely in a laboratory at appropriate containment level
d) describe local procedures for the safe transport of specimens or cultures and also with
national and international postal and packaging regulations for such material.
e) work within and explain to others the current requirements and recommendations,
including legislative framework, on safety in microbiological laboratories underpinning
health and safety at work.
f) explain the principles and operation of microbiological safety cabinets and the
procedures for their decontamination and monitoring of air flow.
g) perform an infection−prevention and control-oriented risk assessment when required
for all procedures undertaken in the hospital, including the laboratory, for all categories
of worker, including the pregnant and immunocompromised
h) act in accordance with the principles of Good Medical Practice
Sterilisation and Disinfection

At the end of formal training, the microbiologist should understand the principles and uses
of sterilisation and disinfection procedures for the preparation of media and instruments
and for microbiological waste disposal. Trainees should be familiar with methods of
monitoring and be capable of formulating a policy on the use of sterilisation and disinfection
in the laboratory, hospital or community and the role of environmental cleaning and
decontamination. They should also be aware of emerging technologies and their
applications.
a) describe the process for disinfection and sterilisation in the hospital and primary care
settings including their indications advantages and limitations
b) make an accurate risk assessment
c) demonstrate when urgent action is required if disinfection and sterilisation fails
Handling of specimens
At the end of formal training, the microbiologist should:
a) be aware and demonstrate that they are able to use this awareness, for each specimen
type, of the optimal methods for collection, transport (including transport media),
storage, reception, identification and documentation, including the requirements and
regulations for high-risk specimens
The trainee should develop a sense of the continuity of identification of specimens from
collection, through culture and further testing to the issuing of a final report. He or she
needs to be aware of critical points in processing where this continuity may fail and be
able to minimise the risk of this
b) be able to assess degrees of urgency for the processing of specimens, including the
provision for an out of hours service and the communication of preliminary results as
applicable
c) be able to decide upon further testing or processing of a specimen as appropriate.
d) be aware of existing reference facilities and their appropriate use
e) understand the evidence base behind Standards of Practice (SOPs)
f) be able to describe the indications for referral of specimens to reference
facilities/centres/laboratories, both for diagnostic and surveillance purposes
g) be able to refer specimens to reference lab appropriately
Data handling
a) have a basic understanding of information technology and in particular, computerised
data handling. He or she should have an appreciation of the advantages and
disadvantages of such systems and a basic understanding of the need for data protection
b) be aware of available technologies for data broadcasting
c) be aware of the developing issues prompted by computerised management of data in
terms of confidentiality, data archiving, and report validation (electronic signature)
d) be familiar with the fundamental aspects of computing- databases, spread sheets, word
processing, internet and how these are used on a day to day basis
Results reporting
a) be able to report laboratory results interpretively to ensure the patient is appropriately
treated
b) be aware of the role of the laboratory report in antibiotic stewardship and infection
control initiatives
c) be able to liaise effectively with wards and primary care based doctors
Microscopy
a) understand the principles of light, fluorescent and electron microscopy and be able to
set up a light microscope
b) be able to perform routine staining techniques including fluorescent dyes
c) be familiar with the appearance of stained preparations and be able to recognise
artefacts and their possible origin
Serologic and antigen-based techniques

a. be able to describe the basis and clinical interpretation of results of basic serological test
methods. E.g. latex agglutination, enzyme-linked immunosorbent assay (ELISA/EIA),
immunofluorescence and the various controls
b. be able to perform simple serological tests
c. be able to provide clinical advice based on interpretation of the results of serology
Molecular microbiology and other emerging technologies

a) be able to describe and have a basic understanding of current used molecular and
other new techniques available to diagnostic laboratories (e.g., DNA/RNA
preparation, hybridisation, nucleic acid amplification techniques (NAT), MaldiTOF,
etc.).
b) have gained experience with (when available) and be able to describe the selection of
appropriate diagnostic tests, both molecular and other emerging technologies, and
their advantages and limitations
c) be able to provide clinical advice based on interpretation of the results current used
molecular and other new techniques available to diagnostic laboratories
d) be able to describe automated, and rapid techniques available to medical/clinical
microbiology
e) be able to evaluate critically the need for emerging techniques within the laboratory,
including cost effectiveness and effects on staffing levels and working practices
f) be aware of the potential role of point of care testing, including quality assurance of
these tests
BACTERIOLOGY
At the end of formal training, a microbiologist should be able to:
a) describe basic diagnostic and screening methods in bacteriology. The methods should
include culture methods, microscopy, serology and molecular methods
b) process routine specimens received in the laboratory and carry out further tests
necessary for full identification of pathogens. Certain tests will require specialist expertise
for full identification, e.g. in house molecular tests. This implies that what is considered
routine specimens will vary.
c) interpret results from diagnostic methods to give clinical advice/counselling, for infection
control purposes, and for the prevention of bacterial diseases
d) explain about bacteriological policies in relation to health care workers, pregnancy,
transplantation and immunisation
e) refer to or request specialist expertise when appropriate
f) perform and interpret antibiotic susceptibility testing
g) recommend appropriate use of anti-bacterial agents, including agents against
mycobacteria
h) initiate and manage an antibiotic stewardship programme
More specific on culture methods

a) describe the basic principles of the diversity of microbial metabolism
b) choose and use correctly for diagnostic purposes from the wide range of selective,
enrichment, inhibitory and chromogenic media available for general and specialised use
and be able to choose relevant media in common use in medical laboratories
c) correctly utilise the physical growth requirements of micro-organisms including
atmosphere and optimal temperature and have an appreciation of the growth kinetics of
both solid phase and broth cultures. It is important in this context to know those micro-
organisms and clinical situations in which detectable growth may require prolonged
incubation
d) describe common growth media in use and have an understanding of internal quality
control of such preparations. Trainees should at some stage in their training have taken
part in the preparation of growth media
e) process all common specimens, recognise potential pathogens from a mixture of
colonies on culture plates and separate such colonies in order to achieve the pure
growth necessary for further work
f) perform tests leading to the identification of all common pathogens, for instance in
house tests, MaldiTOF, molecular tests and commercially produced kits (e.g. kits for
enzyme assays) and rapid diagnostic kits, ELISA, latex agglutination, etc.
g) utilise the principles and methods of molecular identification and epidemiologic typing
applied to diagnosis, outbreak investigation and epidemiological surveillance
h) be aware of available reference facilities for further identification including serotyping
and all other typing schemes, both phenotypic and genotypic
VIROLOGY
a) describe the aetiology, risk factors and clinical presentation and treatment of viral
infections
b) use basic and advanced diagnostic and screening virology methodology, including
serology and molecular methods
c) describe methods available for antiviral susceptibility testing and their limitations
d) describe basic antiviral susceptibility testing and interpret antiviral susceptibility testing
results
e) recognise when susceptibility testing is required for an individual patient
f) describe the different anti-viral agents and the general principles of their mode of action
g) recommend appropriate anti-viral agents and treatment strategies
h) interpret test results to give clinical advice/counselling, for infection control purposes,
and for prevention of viral diseases
i) describe in detail the diagnosis and management of viral infections (e.g., rubella,
varicella, parvovirus, CMV) in the context of pregnancy
j) describe viral infections causing immunodeficiency (in particular HIV infection):
epidemiology, clinical features, laboratory diagnosis, prevention strategies
k) describe viral infections associated with severely immunocompromised patients: clinical
features, laboratory diagnosis
l) explain virology policies in relation to health care workers, pregnancy, transplantation
and immunisation
m) use reference facilities appropriately
MYCOLOGY
a) describe the aetiology, risk factors and clinical presentation and treatment of both
superficial (skin, hair, nails and mucous membranes) and systemic (e.g. candidosis,
aspergillosis and cryptococcosis) fungal infections
b) use basic diagnostic mycology methodology, including interpretation of serological
tests for fungal antigens and antibodies and molecular methods (if not available the
trainee should be able to explain the possibilities).
c) interpret results to give clinical advice/counselling, for infection control purposes,
and for prevention of fungal diseases.
d) recognise and diagnose superficial and deep seated fungal infection.
e) recognise special problems associated with the immune-compromised host.
f) examine skin, hair, nails, etc. for presence of fungal elements
g) describe methods available for antifungal susceptibility testing and their limitations
h) to recognise when susceptibility testing is required for an individual patients
i) describe the different anti-fungal agents and the general principles of their mode of
action, and recommend anti-fungal treatment strategies.
j) to use reference facilities appropriately
PARASITOLOGY
a) describe the epidemiology and clinical features of important imported and endemic
parasitic diseases likely to present in the country where the training took place (e.g.
malaria, intestinal protozoa, intestinal helminths, leishmaniasis, trypanosomiasis,
filariasis, schistosomiasis, toxoplasmosis, toxocariasis, giardiasis and hyatid disease –
it will vary which are considered imported and which endemic)
b) describe infections associated with severely immunocompromised patients:
epidemiology, clinical features and laboratory diagnosis (e.g. microsporidiosis,
cryptosporidiosis)
c) describe in detail the diagnosis and management of toxoplasmosis in the context of
pregnancy
d) use basic diagnostic parasitology methodology: examine blood, stool and other
tissues for the presence of protozoa and helminths.
e) identify major parasitic species
f) measure parasite size under the microscope
g) plan and select appropriate diagnostics (microscopy and/or serology and/or
molecular methods) for parasite infections
h) interpret diagnostic results to give clinical advice/counselling, for infection control
purposes, and for prevention of parasitic diseases.
i) explain epidemiology and clinical features of important endemic and imported
parasitic infections.
j) recommend appropriate anti-parasitic drugs and treatment strategies.
k) to use reference facilities appropriately
ANTIMICROBIALS
a. have a thorough understanding and knowledge of the range of therapies available for
infectious disease, the clinical indications for their use and their side effect profile
b. be able to explain the classification of antimicrobial agents and their modes of action
c. be able to determine the antimicrobial susceptibilities of an isolate using common
techniques and interpret the results using nationally or internationally approved
breakpoints, including appropriate quality control
d. be able to perform minimum inhibitory concentrations (MICs) and interpret the results
using nationally or internationally approved breakpoints, including appropriate quality
control
e. be familiar with the strengths and weaknesses of automated susceptibility test methods
f. have an understanding of the pharmacodynamics, pharmacokinetics and the therapeutic
and toxic effects of antimicrobial drugs and be able to advise on appropriate dosage
regimens
g. understand the principles of interpretative reading of antibiograms and the use of expert
system software for that purpose
h. be familiar with clinically relevant natural and acquired resistance phenotypes of
common bacterial pathogens, viruses, parasites and yeasts
i. be familiar with the epidemiology of antimicrobial resistance at global and local level and
of its clinical and financial implications as regards susceptibility testing, choice of therapy
and control of hospital infection
j. be able to explain the basic principles of prophylaxis, both with antimicrobials and with
immune globulins
k. be able to explain empiric and directed antimicrobial use
l. be able to describe the means of prevention of emergence of antimicrobial resistance.
m. be able to participate in the surveillance of antimicrobial resistance
n. be able to describe existing vaccines and the schedules of immunisation
INFECTION CONTROL IN HOSPITAL AND COMMUNITY

a) have had first-hand experience of local infection control problems, including outbreaks
of infection and their management
b) be familiar with the workings of infection control meetings including local and regional
infection control committees
c) be aware of those areas of hospital and community health that require infection control
policies
d) have worked closely with the infection control nurse both in day to day duties and in the
education of those involved with infection control issues
e) have participated in visits to clinical and non-clinical areas to advise on infection control.
These should include kitchen inspections, especially those conducted by environmental
health officers, operating theatres and Central Sterilisation Services Departments
(CSSDs). Relationships should be developed with key personnel in the CSSD, pharmacy
and laundry
f) be able to describe the principles of patient isolation and their application, including that
of the febrile traveller
g) be familiar with documentation relevant to infection control at local, national and super-
national level and to have a knowledge of existing working party recommendations (e.g.
MRSA, Shigella, Clostridium difficile, norovirus, avian influenza and SARS)
h) have gained some experience of public health microbiology with secondment if
necessary to a Public Health Laboratory
i) have had experience of communicable disease control in the community by working with
Environmental Health Officers
j) become familiar with the physical and chemical agents used in hospital infection control.
k) be able to describe the principles of notification and epidemiologic surveillance of
infectious diseases and antimicrobial resistance and be aware of legal requirements for
reporting communicable disease cases to public health authorities
l) be aware of issues related to bioterrorism
m) be able to describe routes of transmission and methods of preventing nosocomial spread
of common and important infecting organisms (and Multi-drug resistant organisms
(MDROs)), including but not limited to: meticillin-resistant and -sensitive Staphylococcus
aureus, vancomycin-resistant enterococci, varicella zoster virus, enteric infections
including viral diarrhoea, respiratory tract infections including TB, blood-borne viruses,
extended-spectrum beta-lactamase-producing organisms (ESBLs), multiply-resistant
Acinetobacter baumanii, Clostridium difficile associated diarrhoea
n) be able to use knowledge of infection prevention and control in recommendation for the
management of patients with infection
o) be able to liaise effectively with Infection Prevention & Control Team and the clinicians
and advise coordination infection prevention and control and public health management
of patients
p) recognise the need for confidentiality
Audit and clinical governance

a) have an understanding of the principles of audit
b) have participated in microbiological audit both in the laboratory and the clinical setting
c) understand the importance of clinical governance
d) be aware of regional, national and international practice guidelines
CLINICAL MEDICINE
Clinical practice in departments where the trainee gains experience in the management of
infection will be accepted e.g. Intensive care, Emergency, Surgery, Oncohematology,
Infectious diseases and Paediatrics
At the end of formal training, trainees should:
a) be able to take a relevant basic clinical/infection history and manage common clinical
syndromes (see list below)
b) be able to advise on diagnosis, treatment and prevention of common clinical problems
(see list below)
c) be able to explain results and clinical management plans simply and effectively to both
clinicians and patients
d) be able to assimilate clinical, laboratory and epidemiological information and use this to
differentiate between infections and other conditions
e) be able to select and interpret appropriate tests
f) be able to analyse data to produce specific or differential diagnosis
g) be able to liaise effectively with clinical colleagues through regular ward visits and
participation in collaborative clinical activities. In particular, a close relationship is
required with high dependency units (e.g. ICU, NICU) and specialist units (e.g.
haematology, paediatrics, transplantation, infectious diseases, burns, etc.) where
available.
h) be able to liaise effectively with general practitioners
i) have participated in on-call rotas (including weekends) with consultant cover and have
acquired decision making skills and be capable of prioritisation
j) have participated in postgraduate educational meetings such as Grand Rounds and
lunchtime case presentations
k) be able to provide informed advice on vaccination and immunisation with all products
normally available
l) have undergone clinical training, with experience in the management of patients with
Infectious diseases
m) be able to outline the principles of the epidemiology, presentation, assessment,
diagnosis, management and follow-up of the following clinical syndromes:
 urinary tract infection
 respiratory tract infection
 gastrointestinal infection
 skin, soft tissue, bone- and joint infection
 post-operative infection
 encephalitis/meningitis
 hepatitis, including test interpretation
 patients with skin rashes and their contacts (pregnant and non-pregnant).
 infections in pregnancy, including methods of diagnosis, and implications of infection
for mother and fetus
 congenital infection and infection acquired perinatally
 genitourinary infection including sexually transmitted infections (STIs)
 infections which constitute medical emergencies
 occupational associated infection
 food and water borne infection
 systemic infections including blood stream infections (bacteraemia/septicaemia),
vascular graft infections, endocarditis, etc.
 eye infection
 inoculation incident
 brain abscess
 infections in the immunocompromised (both with and without HIV infection)
including basic understanding of how to make the diagnosis of infection and
treatment options
 common hospital acquired infection (e.g. device-associated infection)
 infection in travellers (e.g. malaria)
 community-acquired and nosocomial infections in which environmental factors play a
role (e.g., food, water, air)
LABORATORY MANAGEMENT
Management
At the end of formal training, the microbiologist should demonstrate awareness of
important aspects of laboratory management including staffing (including personnel
management, staff appraisal, team working and negotiation skills), financial issues (for
instance budget control, departmental budgeting, preparation of a business plan,
contracting processes and service level agreements), planning (e.g. strategic planning) and
implementation of policies and rotas.
The trainee should:
 be able to establish a close rapport and understanding with laboratory staff
 respond constructively to change
 demonstrate appropriate behaviours in multidisciplinary team working
 recognise need for change, and principles involved
 be open minded
He/she should also understand the fundamentals of financial management in health-care
facilities and the principles of medico-economic evaluation of laboratory tests. Ideally
attendance at interview panels should be achieved as part of training.
The trainees should be encouraged to attend appropriate management courses in which the
programme will be sustained by professional managers. Trainees may, as "colleagues", be
permitted to sit in on departmental, directorate and other local committee meetings as
observers. The aims and objectives of this should be to provide them with some experience
of committee procedures, aspects of confidentiality, decision making at a local level and the
importance of maintaining good inter-personal relationships
Quality control
a) be able to explain internal and external quality control systems and quality assurance.
b) be able to process specimens, distributed by an organisation for external quality control
and manage underperformance
c) have an understanding of the existing external quality control schemes and be able to
process data from these schemes
d) be able to describe the importance and relevance of standards to good laboratory
practice
e) be able to explain the evidence base behind standard operating procedures
(SOPs)/examination procedures (EPs) and the importance of audit and quality control to
establish validity
Accreditation
At the end of formal training, the microbiologist should be aware of requirements of
continuing professional development and be informed of any existing laboratory
accreditation schemes and of the process whereby accreditation is conferred.
SCIENCE PROJECT
Science forms the basis of the future development of our field and the trainee should be
encouraged to undertake research and development in the field of medical/clinical
microbiology and infectious diseases during training. This to ensure they develop an
understanding of how new knowledge is acquired.
Projects should preferably be based on medical microbiology or translational, i.e. method-
based studies within medical microbiology that include clinical information. Clinical
epidemiological studies with limited laboratory involvement are discouraged. The project
should lead to a publication: here defined as a presentation (article in peer reviewed journal,
poster or oral presentation) at national or international level.

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UNION EUROPÉENNE DES MÉDECINS SPÉCIALISTES

EU ROP EAN UN ION OF MEDICAL SP ECIALISTS

Training Requirements for the

The UEMS is a non-governmental organisation representing national associations of medical

PRESIDENT: DR ROMUALD KRAJEWSKI SECRETARY-GENERAL: DR EDWIN BORMAN

AVENUE DE LA COURONNE, 20 T +32 2 649 51 64

Society of Clinical Microbiology and Infectious Diseases (ESCMID: www.escmid.org), produces

I. Training Requirements for Trainees

AVENUE DE LA COURONNE, 20 T +32 2 649 51 64

AVENUE DE LA COURONNE, 20 T +32 2 649 51 64

a. Assessment and evaluation

Specialisation in Medical Microbiology requires education within clinical medicine, microbiology,

AVENUE DE LA COURONNE, 20 T +32 2 649 51 64

mycology) may be integrated into bacteriology/general microbiology where no separate

II. Training Requirements for Trainers

b. Quality management for trainers

AVENUE DE LA COURONNE, 20 T +32 2 649 51 64

III. Training Requirements for Training Institutions

a. Requirement on clinical activities

b. Requirement on equipment, accommodation

2. Quality Management within Training institutions

It should be aimed at a maximum of 3 trainees per member of the training group.

Board, Section of Medical Microbiology

AVENUE DE LA COURONNE, 20 T +32 2 649 51 64

UEMS - SECTION OF MEDICAL MICROBIOLOGY

CORE TRAINING PROGRAMME FOR MEDICAL MICROBIOLOGY

SUPERVISION AND ASSESSMENT OF PROGRESS IN TRAINING

CORE TRAINING PROGRAMME: CLINICAL MICROBIOLOGY

The following subjects should be covered:

Scientific basis of clinical microbiology

At the end of formal training, the microbiologist should be able to:

Sterilisation and Disinfection

Serologic and antigen-based techniques

Molecular microbiology and other emerging technologies

More specific on culture methods

INFECTION CONTROL IN HOSPITAL AND COMMUNITY

Audit and clinical governance

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