Before the trend to specialisation, although many consultant physicians developed an expertise in their chosen areas, most practiced general internal medicine and dealt with a wide range of medical problems. These included patients admitted as emergencies, patients with multiple disorders, patients referred to outpatient clinics for investigation and diagnosis, and patients referred by specialist services - as outpatients or urgent inpatient referrals.
The demands of admitting and managing acutely ill medical patients have spawned a sub-specialty within General Medicine. Acute Medicine has been established to improve the quality and safety of care for people who are acutely ill. It is defined in the RCP's report Acute Medicine - Making it Work for Patients as: 'That part of general (internal) medicine concerned with the immediate and early specialist management of adult patients with a wide range of medical conditions who present in hospital as emergencies.' Details about Acute Medicine can be found on this site.
2009 GIM Curriculum
Following on from the statement released on 5th February 2009 by the Joint Royal Colleges of Physicians Training Board (JRCPTB) regarding plans to reinstate the system for award of dual certificates of completion of training (CCTs) in General Internal Medicine (GIM) and acute Medical Specialties, the JRCPTB is pleased to announce the new curriculum for General Internal Medicine. This curriculum replaced the GIM (Acute) Medicine (2007) curriculum in August 2009 to allow trainees once again to achieve CCTs in their specialty and General Internal Medicine.
The current GIM (Acute) Medicine Curriculum was introduced in 2007 to satisfy the demand for physicians trained with appropriate skills to lead acute medical admission units. It explicitly stated how progression would occur through the different levels of the spiral curriculum. Level 1 competences were to be achieved during Core Medical Training before entry to Specialist training. Achievement of Level 2 competences would be recognised by the award of a credential that confirmed the trainee's acquisition of competences to allow participation as a Consultant in the acute medical take. Level 3 competences were defined specifically for trainees in Acute Medicine training programmes, who would be the leaders and mainstay of acute medical units.
This new curriculum has been produced to meet the increasing needs of patients as identified by the service, for physicians to manage and enhance patient care in the acute medical units. It also addresses the concerns of trainees. Trainees recruited in 2007 and 2008 expressed the wish to be able to achieve dual CCT's in GIM and another acute medical specialty as they were concerned that without a CCT for GIM, their competence to participate in the acute medical take might be called into question.
The new curriculum differs from the GIM (Acute) Medicine (2007) curriculum in that it better defines the need to demonstrate maturation of the trainee's competences through the duration of training. In Core Medicine the trainee is expected to be able to recognise and diagnose the common medical conditions. In subsequent training in GIM, the trainee builds on the core competences, as they acquire skills in the treatment and management of complex medical problems in both in-patient and out-patient settings. There is a greater emphasis on the need to understand the use of pharmacological agents and their complications in patients with multi-system disease.
The JRCPTB has ensured that PMETB'S quality standards will be met, while still emphasising the need for progressive acquisition of competences in the ‘Top 20' Common Presentations and Other Important Presentations. The previously separate "Generic Curriculum" has also been incorporated into the main body of the curriculum. This early use of the has allowed the mapping of assessments to the General Medical Council domains of Good Medical Practice and is a significant advance.
The JRCPTB wishes to ensure those trainees who are signed up to the current GIM (Acute) Medicine Curriculum (2007) (i.e. all those trainees who commenced training in GIM together with their chosen medical specialty in 2007 and 2008) are not perceived to be disadvantaged by not having the appropriate dual CCT qualifications. Trainees who wish to transfer to the new curriculum will be able to do this by providing the appropriate evidence as detailed in the curriculum. Please see the flowchart for details on how to transfer.
Competence Based Curricula and Assessment - StRs (For trainees who commenced training between 1 August 2007 to 31 July 2009)
The assessment blueprints show the possible methods that can be used to assess each of the competences in the curriculum. Trainees and trainers should refer to the blueprints for guidance on the appropriate assessment methods for each aspect of the curriculum, and so plan the training programme according to the criteria set by the ARCP/RITA Decision Aid. It is not expected that all competences will be assessed by all methods, rather that there will be a sampling of competences within a variety of settings, both within formal and workplace-based assessment, from which overall competence acquisition has to be determined.
Further information on the various methods of assessment can be viewed in the Assessment section of this website.
Acute care common stem (Medicine) trainees will also follow the ACCS training manual.
The diagram below describes the training pathways for General Internal Medicine (Acute) trainees who entered training from 1 August 2007 to 31 July 2009.
Competence Based Curricula - SpR (for trainees who commenced training between 1 Jan 2003 and 31 July 2007)
The JCHMT introduced revised curricula for all the medical specialties together with a generic curriculum that applied to all trainees back in 2003. These are competence-based and set out the knowledge, skills and attitudes to be acquired by trainees before they may be awarded a CCT.
Curricula - SpR (for trainees who commenced training before 1 Jan 2003)
The curricula for trainees enrolling pre 01/01/03 are no longer available on the website but can be obtained by request to ptb@jrcptb.org.uk
Current members of the General Internal Medicine Specialist Advisory Committee. Please contact the
Committee Manager for further details.