Background
Palliative medicine is one of the specialties within medicine. Currently there are approximately 252 consultants, 82 (full time equivalent) non-consultant career grade doctors and 201 trainees working in the specialty in the UK, 25% of whom are training flexibly. Some non-consultant career grade doctors combine practice in palliative medicine with part-time work in General Practice.
There remains a shortage of trained specialists in palliative medicine, with a number of unfilled consultant posts across the UK. The number of doctors in training has increased however and it is anticipated that there will be 325 consultants by 2013.
What is Palliative Medicine?
Palliative medicine is a relatively new specialty that was first recognised by the Royal College of Physicians as a specialty in 1987. It has continued to grow in size and influence since that time. Originally borne out of the need to improve the quality of life for people with advanced cancer and with its roots in the hospice movement, the specialty is increasingly relevant to any patient with advanced, progressive illness requiring specialist input to improve their quality of remaining life. This has been endorsed in recent years by the publication of several National Service Frameworks, such as Renal Medicine, Long Term Conditions and Cardiology. Its place within cancer management is described in detail in the NICE Guidance "Improving Supportive and Palliative Care for Adults with Cancer, 2004."
The holistic nature of palliative medicine encompasses the physical, psychosocial and/or spiritual domains of care and as such, good multi-professional working is fundamental to its success. Palliative care is delivered in a variety of settings, including hospice and specialist palliative care units, hospital and community. Many hospice inpatient and community services sit within the charitable sector, supported by the NHS. Doctors are involved in the direct management of hospice inpatients and outpatients and usually act in an advisory capacity in hospital and community teams. The delivery of education and training to a variety of professional groups to improve the standard of general palliative care runs in parallel with the direct delivery of a specialist service.
Due to the nature of their work, palliative medicine physicians enjoy close working relationships with a variety of colleagues including those in general practice, medical and clinical oncology and other medical and surgical specialties.
Core Competencies for the Palliative Medicine Physician
From the above description of the role, it can be seen that a good palliative medicine physician needs a variety of skills and competencies, including:
- A background in a broad range of medical specialties with the ability to manage general medical problems in the context of advanced disease.
- Excellent clinical skills in diagnosing and managing the physical problems associated with advanced disease.
- Understanding of the evidence base for decision-making.
- Commitment to providing holistic care for patients and their families/carers.
- Skilful working within both multidisciplinary and multi-professional teams.
- Ability to work for patients and their carers across all care settings.
- Highly developed communication skills are needed to handle complex and sensitive discussions with patients, carers and colleagues and to work collaboratively with a number of clinical teams.
- A good understanding of ethical frameworks that underpin decision-making is required.
- Ability to teach/train different staff groups in different settings.
- Skills in developing and managing the service.
Choosing a career in Palliative Medicine
Palliative medicine can be highly rewarding with a good mix of clinical work and opportunities to rely on highly developed clinical skills and judgement. It is a young specialty with new challenges and opportunities allowing for a varied and changing career.
A sense of achievement is provided by the setting of realistic goals of care with patients and carers to improve quality of life. Time to give holistic care is built into the work and is valued by patients and staff alike. Strong team-working with a broad range of expert colleagues provides a supportive working environment. There are opportunities to work in a variety of settings during training. Consultant posts are varied in their structure with the possibility of developing special interests. Influencing the delivery of palliative care across the broader health community by teaching, training and developing services provides good job satisfaction.
Competence Based Curricula and Assessment - StRs (for trainees who commenced training from 1 August 2007 to present)
There are two versions of curricula for this training period:
StRs who commenced training between 1st August 2007 and 3rd August 2010 will follow the 2007 version of their specialty curriculum and the 2007 Generic curriculum. Please see the 2007 Curriculum section of this webpage.
StRs who commenced training from 4th August 2010 onwards will use the 2010 version of their specialty curriculum. There is no need to follow the previously known ‘Generic curriculum' as this has now been embedded into the specialty curriculum. Please see the 2010 Curriculum section of this webpage.
The Joint Royal Colleges of Physicians Training Board (JRCPTB) is pleased to announce the 2010 Palliative Medicine curriculum which has been reviewed and rewritten to:
- meet the GMC's 6 new standards as detailed in their Standards for Curricula and Assessment systems
- keep up to date with medical advances and changes in the service and training
- incorporate the framework documents produced by the Academy of Medical Royal Colleges (AoMRC) detailing Common, Medical Leadership and Health Inequality competencies
- include 5 new assessment methods (Acute Care Assessment Tool, Case based Discussion, Patient Survey, Teaching Observation and Audit Assessment).
This new curriculum has improved content, design and usability compared to its predecessors, and reflects a great deal of hard work and time expended by specialty curriculum groups. This curriculum will become the training manual for all trainees entering ST3 from 4th August 2010.
For further information on the 2010 curriculum it is recommended that you read the Quick Start Curriculum Guide.
If you have any queries or problems regarding the 2010 curriculum please email ptb@jrcptb.org.uk.
Core Training Programmes
Entry into Palliative Medicine training is possible following successful completion of both a foundation programme and a core training programme.
There are 5 core training programmes for Palliative Medicine training:
Assessment
The following methods are used as part of the integrated assessment system:
The assessment blueprint, which is embedded in the clinical syllabus, shows the possible methods that can be used to assess each of the competencies in the curriculum. Trainees and trainers should refer to the blueprint 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 Decision Aid. It is not expected that all competencies will be assessed by all methods, rather that there will be a sampling of competencies within a variety of settings, both within formal and workplace-based assessment, from which overall competence acquisition has to be determined.
Please view the 2010 curriculum for Palliative Medicine for full details on the training routes and selection criteria.
Entry into Palliative Medicine training is possible following successful completion of both a Foundation Programme and a core training programme.
Please view the 2007 curriculum for Palliative Medicine for full details on the training routes and selection criteria.
Assessment
The assessment blueprints show the possible methods that can be used to assess each of the competencies 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 competencies will be assessed by all methods, rather that there will be a sampling of competencies 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.
The diagram below describes the training pathways in general terms.
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.