Development of a new Internal Medicine curriculum
April 2017: Update on curriculum development
The Shape of Training (SoT) review was a catalyst for reform of postgraduate training of all doctors to ensure it is more patient focused, more general (especially in the early years) and with more flexibility of career structure. For physician training, the views and recommendations of SoT were similar to those of the Future Hospital Commission and the Francis report. With an ageing population, elderly patients exhibit many co-morbidities and acute medical services need a different approach to training the physician of the future.
This has led to the development and re-design of training in Internal Medicine and the physicianly specialties.
Acting on behalf of the three Royal Colleges of Physicians, the JRCPTB and MRCP(UK) have produced a new model for physician training consisting of a minimum of seven years (dual) training period after the initial two foundation years, leading to a CCT in a specialty and Internal Medicine. The new curriculum has a particular focus on formally demonstrating the General Medical Council’s (GMC) requirements around general professional capabilities (GPCs).
The proposed model of training will:
1. Provide patients and the NHS with both the trained generalists and specialists they need (especially in the provision of acute and unscheduled care)
2. Deliver better support to trainees and more relevant training
3. Strengthen, not lengthen training
4. Address the serious issue of rota gaps
The curriculum for stage 1 of Internal Medicine training has been developed with input from trainees, service representatives, lay persons and consultants who are actively involved in delivering teaching and training across the UK. This has been through the work of the Internal Medicine Committee and its subgroups and at regular stakeholder engagement events. In addition, a 'proof of concept' study was conducted in 2016 which led to significant changes to the draft curriculum (please see the proof of concept page for the full report).
The new curriculum is based on high level outcomes rather than multiple competencies and the programme of assessment will be more holistic and authentic, continuing the move away from a ‘tick-box’ culture. Instead of 120 competencies in core medical training alone, the new curriculum has 14 Competencies in Practice (CiPs) which must be delivered over the usual seven years of training. CiPs are defined as a ‘critical path to professional work that can be identified as a unit to be entrusted to a trainee once efficient competency has been reached'. CiPs emphasise the role of observation and judgement as it occurs in real life.
How will this model help to deliver exceptionally trained general physicians with diverse specialist skills to manage the changing needs of our population?
- Simulation training will offer time and a safe learning environment for all stages of trainees to learn new skills
- Increased exposure to outpatients in a set period of training aims to help trainees focus on this area of learning and reduce inter-hospital variability
- Experience in HDU/ITU will also enable trainees to be exposed to these different areas at an earlier stage
- Training in geriatrics will help equip doctors with the skills required to treat our ageing multi-morbid population
- The third year will focus on a ‘step-up’ role in Acute Medicine as the Medical Registrar which will allow trainees to learn to lead the acute take in a supportive environment.
We will continue to develop the curriculum following consultation with key stakeholders and aim to submit to the GMC in summer 2017.
July 2016: Interview with Professor David Black, JRCPTB Medical Director
Dr Katherine Walesby, chair of the Royal College of Physicians of Edinburgh Trainee and Members' Committee and current Clinical Research Fellow and medical registrar in Geriatric Medicine, met with Professor David Black to discuss many of the questions that physicians in training have about the proposed Internal Medicine curriculum and its potential impacts on the structure and assessment of medical training.
The interview is structured in five parts. Click on the links below to view each part of the interview.
October 2015: Response to the Shape of Training mapping exercise
The Federation of Royal Colleges of Physicians of the UK submitted a response to the Academy of Medical Royal Colleges (AoMRC) Shape of Training mapping exercise on 12 October 2015. Representatives of the three Colleges and the JRCPTB continue to engage with the UK Shape of Training Steering Group and this page will be used to provide updates.
Key points of the response:
- We support the need to restructure aspects of the training of physicians to support the management of acute medical emergencies, chronic disease management, comorbidities, complexity and the needs of an ageing society. In doing so we also recognise an opportunity to begin the process of service and education transformation but we are not seeking to alter the current length of physician training.
- We recognise that there are many ways to better support the acute medical take and acute care, both within the hospital and the community. These are specialty dependent, but with an expectation that specialties will have knowledge of the acute take, contribute to the care of acutely unwell patients, and have the skills to do that.
- Changes for training in all specialties will be aligned with the General Medical Council changes to Generic Professional Capabilities and a new approach to assessment.
- The curricula will allow simpler and more regular updating to accommodate the needs of patients and new innovations in treatment. In particular we want maximum flexibility in the early years to permit more pluri-potential training and for later training to ensure appropriate development and maintenance of skills and competencies.
The complete submission can be found below.