Careers in Laboratory Medicine

Clinical Scientists are highly trained Scientists who work between laboratory areas and clinicians and can be involved in specialities such as Clinical Biochemistry, Clinical Immunology and Clinical Microbiology as well as other Life Sciences and those in the Physiological Sciences (Audiology and Clinical Physiology) and the Physical Sciences (Medical Physics and Clinical Engineering). There is a similar set of requirements to enter each specialty as all Clinical Scientists must become registered through the Health & Care Professions Council UK (HCPC) as a way of demonstrating 'fitness to work' and a commitment to upholding professional standards.  The HCPC provides security of patient safety in a similar manner as the General Medical Council (GMC) does for the medical profession.

If you would like to read some real life career stories of key healthcare scientists, please browse the NHS publication Extraordinary You.

The National School of Healthcare Science (NSHCS) supports the implementation and delivery of the NHS Scientist Training Programme (STP) and Higher Specialist Scientist Training programme (HSST).

 

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As part of a Clinical Scientist’s training through the STP an MSc in a relevant discipline will be undertaken. For further information on the STP course content and MSc modules please refer to the National School of Healthcare Science.

Following completion of the STP, Clinical Scientists then apply to become state registered with the HCPC demonstrating that they meet their code of conduct and practice. Clinical Scientists then work towards becoming a Fellow of the Royal College of Pathologists (FRCPath) which will enable them to apply for Consultant Clinical Scientist positions. This can be done as alongside their role as a senior or principal clinical scientist or as part of an HSST programme. HSST posts are advertised annually and further information can be found on the NSHCS website. Further details on the FRCPath examination can be found on the Royal College of Pathologists website.

 

Other Clinical Scientist careers within the NHS:

Careers in Toxicology within the NHS

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.

Careers in Metabolic Disease Metabolic Laboratories (Biochemical Genetics) within the NHS

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.

 

Further Links:

Academy for Healthcare Science
National School of Healthcare Science
The Royal College of Pathologists
The International Association of Forensic Toxicologists
Society of Forensic Toxicologists
The LTG
UKIAFT