New Internal Medicine curriculum

Background

In response to the recommendations set out in the Shape of Training Report and other drivers, the Joint Royal Colleges of Physicians Training Board (JRCPTB) 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 will ensure that CCT holders are competent to practise independently at consultant level in both their specialty and internal medicine. 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.

Internal Medicine Training (IMT)

IMT will be a three year programme which will prepare doctors to become a medical registrar and provide them with the skills needed to manage patients presenting with a wide range of general medical symptoms and conditions. Experience in intensive care medicine, geriatric medicine and outpatients will be mandated and trainees will receive simulation training throughout the programme. Holistic decisions on progress will be made for the fourteen high level capabilities in practice (CiPs) using the professional judgement of appropriately trained, expert assessors. This represents a significant move away from the much criticised ‘tick box’ approach of previous curricula. 

Implementation

The organisation and delivery of IM stage 1 curriculum will be the responsibility of the HEE local offices, NHS Education Scotland (NES), Northern Ireland Medical and Dental Training Agency (NIMDTA) and the Wales Deanery. The JRCPTB will continue to engage with and provide guidance to the heads of schools of medicine and key regional stakeholders to support them in planning IMT programmes. NHS Employers has been involved in all stages of development of the curriculum and will also provide briefings and FAQs to support implementation. 

The new curriculum represents a major change to the way early years training is delivered and assessed so training will be needed to support supervisors and trainees.  The JRCPTB has developed a teaching toolkit for this purpose with all the materials needed for regional faculty to deliver training to each education site. Faculty training sessions will be held in each deanery/HEE local area in early 2019 and training will be cascaded to all supervisors and trainees in time for implementation of the curriculum in August 2019.

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 intergrated 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. 

Medical Oncology - discussions are ongoing regarding this specialty

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 Ophthalmology, Nuclear Medicine, Paediatric Cardiology, Pharmaceutical Medicine, Rehabilitation Medicine and Sport and Exercise Medicine.

Medical Oncology - discussions are ongoing regarding this specialty