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
In 2009, the JRCPTB reinstated the system for the award of dual certificates of completion of training (CCTs) in general internal medicine (GIM) and acute medical specialties. The JRCPTB announced the curriculum for general internal medicine in 2009. This curriculum replaced the GIM (Acute) medicine (2007) curriculum to allow trainees once again to achieve CCTs in their specialty and general internal medicine.
Transferring to the 2009 GIM curriculum
The JRCPTB wishes to ensure those trainees who are signed up to the 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. However, trainees who wish to transfer to the 2009 curriculum will be able to do this by providing the appropriate evidence as detailed in the curriculum. Please see the flowchart below for details on how to transfer:
The following calculator has been put together to allow trainees to calculate their acute medical take and outpatient (or outpatient-equivalent) experience in a manner consistent with the ‘2009 GIM decision aid (revised 2012)' that will be used at ARCPs and PYAs. The general internal medicine SAC recommends this to trainees and assessors as an easy means of providing information that is required to inform these assessments, although its use is not mandatory.
2012 updates to the 2009 GIM curriculum
The 2009 general internal medicine (GIM) curriculum was revised with effect from August 2012 onwards. All trainees who are following the 2009 GIM curriculum will be expected to adopt the changes below on a prospective basis.
For the trainees and trainers involved in the WPBA pilot, all of the following curriculum changes will still apply.
The main changes are best viewed by considering the ARCP decision aid for the GIM curriculum which contains a narrative about the hierarchy of competencies and the evidence required to demonstrate satisfactory progress against the curriculum requirements.
The ARCP targets are laid out in a tabular format. The targets have now been set for for each stage of training in GIM instead of years. Please use the summary calculator above to calculate your acute medical take and outpatient (or outpatient-equivalent) experience.
The main purpose of the 2014 revision has been to introduce the MCR. The 2012 revision was to respond to the call to reduce the assessment burden upon trainees and their trainers, without losing the advances that have been made since the curricula were initially revised in 2007 and improved in 2009.
- The ‘Top 20 presentations' section of the curriculum has now been renamed the ‘Top Presentations' to allow expansion or reduction as required.
- The grid 'Acute kidney injury and chronic kidney disease' has been promoted from 'Other Important' to the 'Top Presentations'.
- There is no significant change to the evidence required for the 'Emergency' and 'Top Presentations' but the amount of evidence required to demonstrate engagement with the Other Presentations and Common Competencies part of the curriculum is significantly reduced. The sign off on the ePortfolio will be for the group of competencies rather than the numerous individual competencies.
- The minimum 'clinic or equivalent' numbers in GIM have been updated to 186 by the end of GIM training.
- Competencies on the following topics have been incorporated into the curricula to highlight their importance:
- Transition of adolescent care
- Domestic violence
- Back to work
The procedural competencies for CMT were updated in 2011, and the GIM procedures now follow suit. The changes have been driven by national patient safety guidance (see decision aids for details) so the wording in the curriculum about achieving, maintaining and documenting competency has been updated. It has been made more explicit that formative DOPS should be completed before summative DOPS, and that a minimum of two satisfactory summative DOPS from different assessors are required to demonstrate a procedural competence in a potentially life threatening procedure.
A new DOPS form for central venous cannulation has been developed. The specialty forms for chest drains, DC Cardioversion and temporary pacing will be made available to Core & GIM trainees in view of the requirements for some experience or clinical independence in these procedures.
Some of the DOPS forms have been simplified and a new rating added to allow comment on clinical skills lab competence (to stimulate more widespread use of simulation in training).
In an attempt to improve the formative / teaching element of the WPBAs, some of the forms have been simplified to encourage more free text feedback. Feedback and reflection are key components of learning.
The educational supervisor's report remains key in informing the TPD about trainee progress so the section on clinical skills has been expanded, and there are prompts for comments about reflection and additional tools such as Quality Improvement Assessment Tool and Patient Survey.
A list of frequently asked questions is also available.
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 firstname.lastname@example.org
Current members of the General Internal Medicine Specialist Advisory Committee. Please contact the Committee Manager
for further details.