In response to the recommendations set out in the Shape of Training Report and other drivers, we have developed a model for future physician training. Internal Medicine Training (IMT) will form the first three years of post-foundation training and, for the main specialties supporting acute hospital care, an indicative 12 months of further internal medicine training will be integrated flexibly with specialty training in a dual programme. This model will enhance the training in internal medicine and will prepare doctors for the management of the acutely unwell patient, with an increased focus on chronic disease management, comorbidity and complexity. Generic professional capabilities (GPCs) as set out in the GMC's framework will be embedded in all curricula to emphasise the importance of these professional qualities as well as helping to promote flexibility in postgraduate training.
The Internal Medicine (IM) stage 1 curriculum was approved by the GMC on 8 December 2017 and will replace Core Medical Training (CMT) from August 2019. The Acute Care Common Stem (ACCS) curriculum will be revised in line with the parent specialty curricula and an intercollegiate group is taking this work forward.
The curriculum was developed with the active input of consultants involved in delivering teaching and training across the UK, trainees, service representatives and lay representatives. This has been through the work of the Internal Medicine Committee (IMC) and its subgroups and at regular stakeholder engagement events. A 'proof of concept' study was conducted in 2016 and a wide consultation exercise was carried out in 2017 to ensure the curriculum is fit for purpose and deliverable across the UK.
Training pathway: Group 1 specialties
Group 1 specialties are the main specialties supporting acute hospital care and the majority of training opportunities are in these specialties. IMT will comprise the first three years post-foundation training followed by competitive entry into a group 1 specialty plus internal medicine (dual CCT). An indicative 12 months of internal medicine will be integrated with specialty training in a dual programme. The overall duration of the training programmes will be detailed in each specialty curricula.
Group 1 specialties: Acute Internal Medicine, Cardiology, Clinical Pharmacology & Therapeutics, Endocrinology & Diabetes Mellitus, Gastroenterology, Genitourinary Medicine, Geriatric Medicine, Infectious Diseases (except when dual with Medical Microbiology or Virology), Neurology, Palliative Medicine, Renal Medicine, Respiratory Medicine, Rheumatology and Tropical Medicine (except when dual with Medical Microbiology or Virology).
Training pathway: Group 2 specialties
A number of specialties managed by JRCPTB will continue to deliver non-acute, primarily outpatient-based services and will not dual train in internal medicine. These specialties will recruit into ST3 posts from IMY2 but trainees who have completed the full three year IMT programme will not be precluded from applying for group 2 specialty training. Alternative core training pathways may be accepted for some group 2 specialties and will be defined in the relevant curricula and person specifications. The indicative duration of the training programmes will be detailed in each specialty curricula.
Group 2 specialties: Allergy, Audiovestibular Medicine, Aviation & Space Medicine, Clinical Genetics, Clinical Neurophysiology, Dermatology, Haematology, Immunology, Infectious Diseases (when dual with Medical Microbiology or Virology), Medical Oncology, Medical Ophthalmology, Nuclear Medicine, Paediatric Cardiology, Pharmaceutical Medicine, Rehabilitation Medicine, Sport and Exercise Medicine, Tropical Medicine (when dual with Medical Microbiology or Virology).
Clinical Oncology, Medical Microbiology, Medical Virology and Occupational Medicine will also recruit trainees who have completed the first two years of IMT. Trainees will also be able to apply for Intensive Care Medicine single CCT training after two years of IMT.
The diagram below sets out the timeline for recruitment and transition. Further information on recruitment in 2021 and transitional arrangements for trainees already in training will be provided as more information becomes available.
Credit to James Bradley-Watson of the British Junior Cardiology Association