Pathway to Clinical Microbiology Leadership: CPEP Fellowships
In the early stages of the COVID-19 pandemic, clinical microbiologists such as Melissa Miller and Robin Patel were frequently seen on national news broadcasts or quoted in the New York Times or Washington Post, educating the American people on issues related to COVID-19 testing. How did they become nationally recognized experts and, perhaps more importantly, how might you become one?
How Were Training Programs in Medical and Public Health Microbiology Established?
In the late 1950s, a group of 6 American Academy of Microbiology (AAM) fellows led by former ASM President I. R. Baldwin formed the subCommittee of Postdoctoral Educational Programs (CPEP) to begin developing a curriculum for training doctoral-level scientists in medical and public health microbiology. The "Essentials of an approved postdoctoral training programs in Medical and Public Health Microbiology" curriculum was established in 1961. Since then, it has been updated several times to address advances in the field of diagnostic microbiology. The goal of CPEP is to “improve the quality of microbiological laboratory services (diagnostic, educational, consultative and investigative) in health-related fields and, thus, contribute to the health and welfare of the public.” The first CPEP training programs were approved in 1963.
The current iteration of the "Essentials," updated in 2018, provides the blueprint for the aspects of training that must be provided in a CPEP-approved program. In order for a program to be approved, it has to have qualified faculty, including a program director who is a diplomate of the American Board of Medical Microbiology (ABMM) (or is certified by another board acceptable to CPEP), appropriate laboratory facilities with cutting-edge technologies, a rigorous curriculum that addresses each of the 53 CPEP established essentials, and institutional financial support. Prior to approval, a site visit by 2 ABMM diplomates who have in-depth knowledge of the "Essentials" is required. The site visit assures that the program will address the training needs of fellows as described in the "Essentials." Currently, there are 21 CPEP-approved Medical and Public Health Microbiology programs widely distributed in 15 states.
Who Is Eligible for CPEP Programs and What Qualities Should Applicants Have?
Individuals with an earned doctoral degree, including Ph.D. or D.Sc. in the life sciences, D.O., MBBS, M.D., M.D./Ph.D., DVM and DrPH are eligible to apply for CPEP programs. Some programs will consider non-U.S. citizens, but some do not; interested individuals should review the program descriptions of the 21 CPEP-approved programs to determine eligibility (as well as the more detailed information on each program’s site). The number of applicants varies year-to-year, but in my 30 years as a CPEP program director, we typically had 25-50 applicants for each position. Of the 21 programs, 10-15 accept a candidate each year.
For graduate students, postdoctoral fellows or medical residents, here are things to consider about a career in clinical microbiology:
Modern health care is team-oriented, with the microbiologist working closely with a variety of health care providers. Key teammates are physicians and their care extenders (physician assistants and nurse practitioners), nurses, pharmacists, medical laboratory professionals (including Doctorates of Clinical Laboratory Science), infection preventionists and public health colleagues. Being a good teammate is an essential quality for anyone who wishes to work in health care. It may mean accepting that others will get credit for the hard work you do.
The tools you have in your toolbox are important. Do you have skills and knowledge that can translate into a clinical setting? Before graduate students or postdoctoral fellows apply to programs, they should spend time in a clinical laboratory to understand how their skills and talent might translate into that work environment.
Do you have the level of commitment it takes to work in an ever-changing environment where mistakes may have dire consequences for patients and their families? Are you committed to being on the cutting edge of diagnostic microbiology and infectious disease? Teaching is an integral part of diagnostic microbiology. Are you committed to being a good teacher?
Most importantly, do you believe that you have a passion for serving others in a job that requires a 24/7 commitment?
What Is Training in a CPEP-Approved Program Like?
For someone who has completed a Ph.D., D.Sc. or DrPH, the initial stages of a CPEP training program can be overwhelming. Put simply, the trainee is thrust into an environment requiring a working knowledge of hundreds of different microbes that can infect humans in 4 distinct disciplines within microbiology: bacteriology, mycology, parasitology and virology. Trainees need to acquire skills that allow them to detect these pathogens in a variety of clinical specimens using a wide array of diagnostic tools.
Once fellows have developed this wide-ranging knowledge, they then need to learn to apply it to the clinical situations with which they are confronted. They do all this while 'under the microscope' of training staff who are much more knowledgeable and experienced. To be successful, fellows must work extremely hard, be willing to ask questions constantly and learn to say "I don’t know" more than they may have ever done in their lives, all while gaining increasing confidence in their breadth of knowledge, critical thinking and problem-solving skills.
The good news for the trainee is that institutions with CPEP programs attract faculty and staff who are committed to their success. The training essentials create an educational structure that allows fellows to become competent in many different aspects of diagnostic microbiology. The ultimate goal of each CPEP program is to help trainees become valued members of the health care team and, with experience and dedication, leaders in the discipline.
What Is the American Board of Medical Microbiology (ABMM) Certification Process?
A critical step in a clinical microbiologist career is to acquire certification to direct a clinical or public health microbiology laboratory. ASM offers opportunities for certification by examination through the ABMM. There are 3 pathways to qualify to take the ABMM certification examination:
- Complete a 2-year CPEP fellowship.
- Complete an Accreditation Council for Graduate Medical Education (ACGME) fellowship in Medical Microbiology (or the Canadian equivalent).
- Have 3 years of practical experience as either a postdoctoral fellow in a non-accredited program or as laboratory director in a clinical or public health laboratory. Attestation of this experience must be made by an individual qualified to direct a Clinical Laboratory Improvement Amendments (CLIA)-certified laboratory or the applicant’s country equivalent if not trained or practicing in the United States.
The certification examination consists of 200 multiple-choice questions, which test knowledge in 4 areas:
- Laboratory testing.
- Laboratory administration.
- Laboratory safety and security.
- Clinical and public health consultations.
The examination is given once a year at examination centers throughout the world. Between 2016-2021, the overall passing rate for the ABMM examination ranged between 47-65%. However, in that same time period, 94/95 of newly graduated CPEP fellows passed the examination and became ABMM diplomates.
ABMM certification is recognized under the Clinical Laboratory Improvement Amendments of 1988 final rule and by all 12 states in the United States that require licensure to become a laboratory director (Calif., Fla., Ga., Hawaii, La., Mont., Nev., N.Y., N.D., R.I., Tenn. and W.Va.). ABMM board certification or eligibility is an important qualification for most job postings for clinical microbiology directors in academic medical centers or affiliated teaching hospitals, as well as many national reference laboratories. In addition, board certification is required by many hospitals for Ph.D. clinical microbiologists to be eligible to be members of the medical staff.
Because the practice of clinical and public health microbiology is constantly changing, ABMM requires re-certification every 3 years. Individuals re-certify by providing evidence of 150 hours of continuing medical education during the 3-year interval.
What Career Opportunities Are Available to ABMM Diplomates?
Over the past year, approximately 30 job opportunities for board-certified, doctoral level microbiologists have been posted on Clinmicronet, an ASM-sponsored, closed, curated, global listserv for approximately 900 clinical microbiology and public health laboratory directors. This large number of job opportunities reflects a demographic shift that is occurring in the leadership of the clinical and public health community due to the wave of retirements in the baby boom generation.
For positions in academic medical centers, expertise is particularly sought in molecular diagnostics, especially in next generation sequencing (NGS). Over the next decade, it is likely that applications of artificial intelligence, CRISPR/Cas and metabolomics will find a niche in the diagnosis of infectious diseases as proteomics, next generation sequencing and robotics have in the past decade. Translating these technologies into efficient, accurate diagnostic tests will require individuals who understand these complex technologies and can apply them to current or emerging infectious agents.
In addition, opportunities will continue to arise for ABMM diplomates in diagnostic and pharmaceutical companies preparing for the next pandemic, whether it be an unknown virus or treatments for microbes that are becoming increasingly resistant to all currently known classes of antimicrobials.
Because the skill set that CPEP graduates develop is valued by employers, in a salary survey of ASM members, this group of individuals was the highest compensated group, with a median salary of $166,700. Some members of this group also had opportunities to receive performance bonuses.
Although the financial rewards are significant, the opportunity to pursue ASM leadership roles is also appealing. Two of the last 5 ASM Presidents have been clinical microbiologists. Clinical microbiologists play leadership roles in ASM journals, publications such as the Manual of Clinical Microbiology and Clinical Microbiology Procedures Handbook, the ASM Microbe and Clinical Virology Symposium meetings, as fellows in the American Academy of Microbiology, by mentoring the next generation of microbiology by leading CPEP programs and in advocacy through ASM’s Clinical and Public Health Microbiology Committee. Additionally, ABMM diplomates have leadership roles in a variety of other professional organizations including the Infectious Disease Society of America, Association of Public Health Laboratories, Clinical and Laboratory Standards Institute, College of American Pathologists and American Society for Clinical Pathology.
CPEP fellowship and ABMM certification gave me the opportunity to have a fulfilling and exciting career. That same opportunity awaits you.
The author would like to thank ASM archivist Jeff Karr for providing several historic documents used in the preparation of this post, and Peggy McNult (ASM staff) for her critical review.