Acute Internal Medicine (AIM)
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 Medicine, JRCPTB is pleased to announce the new curriculum for Acute Internal Medicine (AIM). This curriculum, in conjunction the 2009 General Internal Medicine curriculum allows trainees to achieve a CCTs in General Internal Medicine and Acute Internal Medicine.
The JRCPTB has ensured that PMETB's quality standards have been met, while still emphasising the need for progressive acquisition of competencies in the ‘Top 20' Common Medical presentations and ‘Other Important Presentations', and maturation in the management of these conditions. The previously separate "Generic Curriculum" has also been incorporated into the main body of the curriculum. This early use of the Academy of Medical Royal Colleges Common Competencies Framework has allowed the mapping of assessments to the General Medical Council domains of Good Medical Practice and is a significant advance.
The new AIM curriculum differs from the GIM (Acute) Medicine (2007) version in that it defines the need to demonstrate maturation of the trainee's competencies through the duration of training. In the relevant core training programmes (CMT or ACCS) the trainee is expected to be able to recognise and diagnose the common medical conditions. In subsequent training in AIM, the trainee builds on these core competencies, as they acquire skills in the treatment and management of complex acute medical problems in the in-patient setting and also acquire advanced practical skills that are directly relevant to the practice of Acute Medicine. There is an emphasis on the understanding of the application and complications of pharmacological agents in patients with multi-system disease, patient safety and prevention of acute illness and the management of acute complications in patients who are already in the hospital as well as patients presenting in an unscheduled manner. These advancing medical skills are enhanced by the acquisition of skills within a critical care environment promoting better management of the severely ill patient.
Furthermore, the specific management, organisational and leadership competencies for the Acute Physician are defined, including the need to review patient pathways and to develop different management strategies for acute medical problems including the development and implementation of ambulatory care protocols.
This new curriculum is underpinned by the definition of core competencies that should be required of all doctors regardless of specialty. All competence acquisition will be subject to assessment and review of satisfactory progress as defined in the ARCP decision aid within the curriculum.
Specialist Training (ST) in Acute Internal Medicine
Entry into Acute Internal Medicine training is possible following successful completion of both a Foundation Programme and a core training programme.
Core Training Programmes
There are two core training programmes in Acute Internal Medicine;
In the following diagrams the items in the green arrow are the methods used as part of the integrated assessment system:
Diagram 1.0 shows the training pathway for Acute Internal Medicine
Diagram 2.0 shows the training pathway for Dual CCT with G(I)MM.JPG)
Diagram 3.0 shows the training pathway for Dual CCT with another Acute training specialty
Sub-specialty of Acute Medicine
Over the past few years there has been a growing realisation that there is a need for a senior medical presence in Medical Assessment and Admission units (MAUs). This has been manifest by the large number of appointments that have been made to MAUs at Consultant and other levels. However, until a few years ago there had been no formal training structure for those who wish to pursue a career involving a Clinical and Managerial leadership role in an MAU. As a consequence the JCHMT (the forerunner to JRCPTB) formally established the subspecialty of Acute Medicine. A sub-specialty does not attract a CCT but grants a sub-specialty entry on a CCT issued in a CCT specialty. The changes in medical training under the aegis of MMC have given us the opportunity to bring Acute Medicine into the mainstream CCT process. For legislative reasons it is not possible simply to substitute Acute Medicine for G(I)M so we have created a hybrid title of G(I)M (Acute Medicine).
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