Many consultant physicians practice general internal medicine in addition to their medical specialty, and many patients are cared for under the umbrella of general internal medicine. These include the full range of adults admitted as emergencies with acute medical problems, ranging from the young fit person with a severe acute illness, to the frail elderly with multiple disorders. Patients with problems that are not clearly within the remit of a particular medical specialty are referred to outpatient clinics for the opinion of a general physician.
Nearly all trainees following the GIM curriculum to CCT will be doing so in parallel with training in another medical specialty. The GIM curriculum defines the competencies needed for the award of a CCT in general internal medicine, which are needed to allow participation at a senior level on the acute medical take, and to provide advice on the investigation and management of inpatients and outpatients with acute and chronic medical problems.
The curriculum reflects the contexts in which GIM is performed, from the admission avoidance clinic to the admitting unit to the inpatient wards and the outpatient clinics. It emphasises the skills and competencies that need to be acquired in these settings and indicates how these will be assessed as trainees progress through the syllabus.
Entry into general internal medicine training is possible following successful completion of both a Foundation Programme and a core training programme. There are two core training programmes in general internal medicine;
- Core Medical Training (CMT)
- Acute Care Common Stem - Acute Medicine (ACCS-AM)
The curriculum for each specialty defines the process of training and the competencies needed for the award of a certificate of completion of training (CCT). The curriculum includes the assessment system for measuring trainees’ progress comprising workplace based assessment and knowledge based assessment.
Previous versions of the curriculum are no longer available online but copies can be requested from email@example.com.
The ARCP decision aid for each specialty defines the targets that have to be achieved for a satisfactory ARCP outcome at the end of each training year. The version below has been revised and replaces all previous documents from August 2017. The changes include:
- Improved guidance notes
- Clarification that ACATs should each include a minimum of 5 cases
- Guidance on sampling, individual sign off and group sign off of competencies
- Clarification of the procedures for which obtaining clinical independence is desirable but not mandatory and skills lab training or satisfactory supervised practice is the minimum requirement
- Footnotes revised to give a clearer definition of clinical independence and to reflect the British Thoracic Society guidelines on ultrasound for pleural procedures
In addition, the CMT and GIM advisory committees have produced guidance on interpretation of DOPS which is available in the forms and guidance section of this page.
GIM training during the COVID pandemic
We recognise that many trainees have contributed to the NHS response to COVID by working on take or caring for inpatients in ways that have provided them with experience and training in GIM. This time may be recognised for training in GIM if the trainee has maintained their portfolio to evidence experience and training, including appropriate WPBAs and Multiple Consultant Reports (MCRs), and demonstrating (e.g. with reflective notes) the learning obtained. Any trainee wanting such time to be recognised for training in GIM should discuss the matter with their Educational Supervisor and raise it at their next ARCP. The ARCP panel will determine the amount of training to be recognised.
Requirement for GIM training in the final year of training
To assure that trainees are up to date and fit to practise GIM at the time of their CCT it is a requirement that they undertake some GIM training in the year before they obtain their CCT. The minimum requirement is for three months involvement in the acute unselected take (minimum 12 on take shifts) concurrent with specialty training, or four weeks attached to an acute medicine service with no concurrent specialty duties. In the final year of training all trainees require completion of a minimum of three ACATs; a minimum of two MCRs by physicians who have worked with the trainee in acute / general medicine confirming that they are practising GIM to the level expected for award of CCT; and a specific GIM Educational Supervisor’s report.
Definition of external GIM teaching or study
External GIM teaching or study is clinical teaching or study that is not within the area of a trainee’s specialty for example, a teaching session on acute kidney injury would be appropriate as GIM teaching for a respiratory medicine trainee but not for a renal medicine trainee. The word ‘external’ does not mean that the teaching or study has to be delivered away from the trainee’s base department or hospital: it refers to the content of teaching or study and not its physical location. Some contribution from online learning modules or courses can count towards external GIM teaching or study, but these would not normally be expected to amount to more than 25% of the total hours of teaching or study. Management and leadership courses do not count as appropriate for GIM teaching or study because they are not clinically based. By convention, ALS (and similar) courses do not count towards GIM teaching or study.
Summary of training calculator
The following calculator is designed 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 that will be used at ARCPs and PYAs. The GIM 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.
Clarification regarding DOPS assessment of procedures
The CMT and GIM advisory committees have produced the following guidance on interpretation of DOPS sign off.
Dual CCT training in Cardiology and General Internal Medicine (GIM)
Guidance on indicative training time for dual training programmes.