Dr Tom Middlemiss, ST4
Brief ‘definition’ of specialty

Symptom control of patients with life-limiting illnesses, both oncological and non-oncological.

Brief run-down of training programme content and duration

The training is four years long. The MRCP(UK) or MRCGP is required for entry at ST3. Time is split between working in a hospice, in a hospital liaison service and in the community.

Exam requirements

There is an exit exam usually taken in the third year of training.

Other requirements

Eportfolio maintenance with the usual combination of workplace-based assessments (WPBA). Trainees are expected to attend three courses during the training period: advanced communication, education training and a management course.  There are also 7 national training days within Scotland per year.

Opportunities/expectations for out of programme/research

There are two well-established palliative care research teams in Edinburgh with experience with postgraduate degree students. There is the possibility of out of programme research (OOPR) for a PhD or MD. There is no expectation to participate in out of programme experience and it is the exception to the rule.

A day in the life of a Registrar/Consultant

A Consultant’s work can vary depending on their choice of focus on either hospice or hospital medicine. Within a hospice, a Registrar may be responsible for approximately ten inpatients with several new admissions per week. There may be responsibilities such as taking advisory phone calls from the community and seeing outpatients in the day hospice setting. Appropriate time is available throughout the day to be able to have potentially lengthy conversations with patients and relatives on a range of topics. Education of other specialties, whatever the setting, is always a high priority for palliative care specialists.

Pros and Cons of working in this specialty


  • A relatively small number of patients compared to other medical specialties gives the opportunity to be able to fully explore patient concerns
  • The symptom control of patients towards the end of their life is very rewarding and can make a tremendous impact both for the patient and their relatives, before death and afterwards
  • Small and evolving specialty with opportunities for service development as a consultant


  • While this is changing, dealing with a relatively low evidence base may be frustrating for some
  • There are always many ways of successfully achieving the same goals. This could lead some to argue that palliative doctors practice anecdotal medicine and this could be true to a certain extent. However, the ethical context of research in palliative care means that this issue will never fully be resolved
  • A career in palliative medicine can be emotionally demanding. An awareness of the potential impact is important
How this specialty differs to others and what made me choose it

The benefits to patients of symptom management are immediate and are measurable by the patient’s responses. Working in palliative care gives me the chance to make an incredible difference at a pivotal moment in both a person’s life and their family’s experience of that time. The repercussions of a ‘good’ or ‘bad’ death can resonate for many years afterwards. My work environment is genuinely patient-focused and my colleagues are invariably well-motivated, emotionally aware individuals who are a pleasure to work with. Overall there is very high job satisfaction.

Tips for success in applying for this specialty
  • The difficulty in achieving ‘commitment to specialty’ in palliative care is getting some experience in the field. There are usually only a few FY2/ST1 jobs in palliative care
  • Future trainees would be well advised to try and spend some time with a palliative care team, participate in an audit within a hospice or hospital setting and submit a poster to a national or international conference (not as challenging as it may seem)
  • Also, I have not met a Consultant yet who is not committed to encouraging prospective trainees to find out more about the specialty and offering time and advice – just approach one!
  • Attending conferences or courses such as advanced communication is also beneficial
  • The most important thing is satisfying yourself that you want to train in a specialty that you may not have had very much clinical time doing
For more information

The Joint Royal College of Physicians Trainee Board (JRCPTB) website