Respiratory Medicine is one of the two major specialties of acute General Internal Medicine (GIM). Approximately 30% of all acute admissions in GIM are for a primary respiratory problem and respiratory physicians are essential and major contributors to the acute medical take in all acute hospital trusts. Respiratory Medicine has a close relationship with Critical Care Medicine.
Most respiratory physicians supervise non-invasive ventilation in the support of patients with acute respiratory failure in the High Dependency Unit environment, and many have sessions helping to run Intensive Care services and expertise in the management of the Adult Respiratory Distress Syndrome. Respiratory physicians have considerable technical skill and have expertise in cardiopulmonary physiology and run lung function laboratories in most hospitals for the interpretation of complex lung function testing, a cornerstone of respiratory diagnosis.
In the outpatient setting, respiratory physicians run the services for lung cancer and tuberculosis in most Trusts. They are referred patients with a vast range of pulmonary and non-pulmonary conditions, the latter since the lung is involved in many non-pulmonary systemic conditions. A large percentage of their outpatient work involves the investigation, diagnosis and management of patients referred with the non-specific complaints of chest pain, cough and breathlessness of unknown cause such that most respiratory physicians have considerable expertise in dealing with diagnostic uncertainty. For this reason, they are often a port of call for other medical practitioners when there are other more general non-specific symptoms for which a diagnostic explanation is elusive.
Entry into Respiratory Medicine training is possible following successful completion of both a foundation programme and a core training programme. The two core programmes for Respiratory Medicine are:
- 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.
Information on the Specialty Certificate Examination (SCE) in Respiratory Medicine can be found on the MRCP(UK) website.
The curriculm was amended in 2014 (approved by the GMC in 2015). The amendments include:
- Definition of the minimum training requirements for pulmonary vascular diseases (E12), cystic fibrosis (E16), lung transplantation (E20)
- Learning objectives for practical procedural areas (F(b) and Bronchoscopy (F5) clarify the need for formal sign off of competence in safe sedation
- Pleural ultrasound level 1 (F6) updated to reflect Royal College of Radiologists Focused Ultrasound Training Standards, 2012
Previous versions of the curriculum are no longer available online but copies can be requested from firstname.lastname@example.org.
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. ARCP decision aids were revised to reflect the changes to the assessment and review process from August 2014 and replace all previous versions.
Two versions of the ARCP decision aid are available and trainees on dual training programmes in Respiratory Medicine and GIM should ensure they refer to the dual CCT decision aid.
The SAC for Respiratory medicine has provided the following guidance on the minimum training requirements for acquiring competencies in pulmonary hypertension, lung transplantation and cystic fibrosis.