Internal Medicine Training (IMT)

When was IMT implemented?

IMT was implemented in August 2019 and there will be no further recruitment to CMT. There will be phased implementation of the full training model with new curricula for group 2 specialties starting in 2021 and group 1 specialties in 2022. Please see our recruitment page for further information

How does IMT differ from CMT?

IMT is a three year programme that delivers the following improvements:

  • supported transition to the medical registrar role
  • a more structured programme with mandatory training in geriatric medicine, critical care and outpatients 
  • longer placements in IMY3 to provide more continuity in training
  • simulation based learning
  • a curriculum based on a small number of high-level learning outcomes rather than a large number of granular competencies
  • a programme of assessment which is holistic and intuitive
  • additional time in which to gain MRCP if needed

How will the IMY3 year differ from ST3?

The new programme will better prepare trainees for the role of the medical registrar. There will be a critical progression point at the end of the second year (IMY2) to ensure trainees have the required capabilities and are entrusted to ‘step up’ to the medical registrar role in IMY3. For most, the trainee will be entrusted to manage the acute unselected take and manage the deteriorating patient with indirect supervision. For a few, this will be for a period of time in a supportive training environment with the supervising physician readily available.

How will I be allocated to IMY3?

Each school will manage a locally-run process for allocating rotations for IMY3. The principles for this process are:

  • The training programme director (TPD) for Internal Medicine will hold interim reviews in IMY2 to gauge whether trainees are likely to undertake IMY3
  • The TPD and workforce team will request preferences for the available rotations from all trainees considering a progression into IMY3
  • Specialty training undertaken in IMY3 will not be taken into consideration in the selection process for ST4 higher specialty training and trainees can use IMY3 as an opportunity to experience a specialty complementary to their chosen career path
  • When finalising allocations, the TPD/s will take into account the learning needs of the trainee and the service provision requirements across the region.

A guidance document is available here.

Can I complete IMT in less than 36 months?

Trainees may have addtional training and/or experience before recruitment into IMT Stage 1 than those who have entered directly after Foundation Training. This training may have taken place within UK or overseas, and it may have had a varying level of appropriate educational regulation and supervision. In such cases it may be approrpriate for trainees to be moved into IMY2 and have a shorter overall training time. Guidance on the process for this is given here.

How do I apply for IMT?

Information on applying for IMT and ACCS is available on the IMT recruitment website. The recruitment process section of the website guides you through a recruitment round, including dates and posts, eligibility criteria, planning your application, applying, interviews and offers.

Acute Care Common Stem (ACCS)

I am a current ACCS-Acute Medicine trainee in my CT3 year. Which ARCP decision aid should I refer to?

A transitional ARCP decision aid has been produced for ACCS-AM CT3 trainees in post from August 2020. This document and accompanying guidance is available on the ACCS webpage.

What are my options for continuing training in 2021?

Trainees completing CT3 ACCS-AM will be eligible to apply for ST3 recruitment in 2021 but this will be limited to a small number of group 1 vacancies (mostly in GU Medicine, Neurology and Palliative Medicine) and group 2 specialties. Alternatively, trainees can remain in core training and convert to the ACCS-Internal Medicine (ACCS-IM) programme and complete IMT in order to be eligible for ST4 reruitment to group 1 specialties in 2022. IMY3 will be provided in their existing training programme and trainees are advised to discuss their career intentions with the local IMT training programme director as soon as possible. A third option is to apply for ST4 via the alternative certificate route. Please see our recruitment page for further information.

How will the new ACCS-Internal Medicine training programme be structured?

A new curriculum has been developed which describes the learning outcomes for the generic two year ACCS programme in which trainees will rotate through placements in Emergency Medicine, Internal Medicine, Anaesthetics and Intensive Care Medicine. The new curriculum will be implemented in August 2021. ACCS-Internal Medicine will be an indicative four year programme and trainees will complete the core programme for JRCPTB physician specialties by undertaking Internal Medicine year 2 and year 3 (IMY2 and IMY3). 

Academic training

Will academic trainees be required to dual train in Internal Medicine?

Academic doctors training in a group 1 specialty will dual train with Internal Medicine. The new training pathway for group 1 specialties is designed to make doctors in these specialties better general physicians and this reflects the recommendations of the 2013 Shape of Training review. It will not be possible to single accredit in any group 1 specialty alone.

What is the application process for academic programmes?

Academic programmes will be advertised and recruited to by each region. Candidates should apply directly but will also need to go through the IMT recruitment process to confirm eligibility for IMT if they are appointed at ST1-ST2 level. The length of the IMT element of the run through programme will depend on whether the academic programme is in a group 1 or group 2 specialty and applicants should check the detail of the individual programme. Some regions offer academic core programmes and these may vary in length – please refer to the employing body for information.

How will the change affect doctors who are currently in academic training programmes?

Academic programmes starting at ST1 currently include CMT as part of a run through programme and trainees enter specialty training at ST3 after two years of CMT. Trainees who do not move into higher training by 2021 will require IMY3 training and this will be arranged by the HEE local office/deanery. A training needs analysis will be carried out to determine the training and experience required to complete the new curriculum requirements and there will be guidance available to support this process. 

Higher specialty academic trainees will need to transfer to the new curricula in line with the transition arrangements for the specialty. Please see our guidance on Transition to the new curricula.

Group 1 / group 2 specialties

When do I need to decide whether I want to apply to a group 1 or 2 specialty? 

Trainees will be appointed to three year IMT programme. Training programme directors will discuss your career intentions with you to help advise you and to allow for programme planning. You can choose to leave the programme after IMY2 whether or not you are successfully appointed to a group 2 specialty or stay and complete IMY3.

Can I complete all three years of IMT and still apply to a group 2 specialty? 

Yes you will still be eligible to apply for group 2 specialties and you may wish to complete the full three year programme to give you flexibility to apply for any specialty. Trainees will not be disadvantaged if they do not complete IMY3 if the entry criteria for a specialty only requires completion of the first two years of IMT. 

If I am appointed to Neurology, Genitourinary Medicine or Palliative Medicine in 2021 will I be required to transfer to the new curricula after 2022? 

Trainees who are already in training prior to August 2021 will not be required to transfer to the new curriuclum but are encouraged to maintain general medicall skills and will be supported to transfer if possible. Trainees who start ST3 in these specialties in August 2021 will be required to transfer to the new current curriculum in August 2022 in line with GMC policy, unless the postgraduate dean confirms that it is not safe or practical and this will be determined on an individual basis. Please see our guidance on Transition to the new curricula

Will I need to declare if I plan to do an IMY3 year in advance, or let my training programme director know towards the end of IMY2 depending on if I get the group 2 specialty job I want?

To enable better planning of the programme and distribution of posts it will be very useful if you indicate your intent as far in advance as possible. This indication is non-binding, however, up to the point of the notice period required by your employment/training contract. The system is designed to be flexible but we do need you to work with us in appreciation of the planning and service challenges that late changes can cause. You can only apply for a group 2 specialty from IMY2 whereas from IMY3 you can apply for either a group 1 of group 2 specialty. Applications should be discussed at your interim review. The system is designed to be flexible but we do need you to work with us in appreciation of the planning and service challenges that late changes can cause.

What are the expectations for completion of the IMT programme if I apply for a group 2 specialty and therefore only complete two years of IMT?

The full programme exit criteria only apply at the end of the IMY3. You will not have to meet all the criteria by the end of IMY2. The IMT ARCP Decision Aid provides guidance on how you will be assessed at the end of IMY2. You must get an ARCP outcome 1 and have the full MRCP(UK) Diploma or have an outcome 2(U5) and subsequently pass the MRCP(UK) to take up a group 2 post.

Why do I have to dual accredit now in some specialties when I didn't have to before?

The new training pathway for group 1 specialties is designed to make doctors in these specialties better general physicians and this reflects the recommendations of the 2013 Shape of Training review. The new IM curriculum specifies that all group 1 specialties, including the new dual-accreditation pathways of neurology, palliative medicine and genitourinary medicine, must complete IM training through to stage 2. It will no longer be possible for trainees to single accredit in these specialties or indeed in any group 1 specialty alone.

If I complete the IMY3 year will this go against me when I apply for my group 2 specialty?

No. Trainees may take this option as it will give them more time to complete the MRCP(UK) examinations and potentially provide extra elements in their CV that will better prepare them for their specialty application.

Training in Intensive Care Medicine (ICM)

Will it be possible for trainees in group 1 specialties to train in ICM if they are dual training in IM?

The GMC has agreed in principle to training pathways for Acute Internal Medicine, Renal Medicine and Respiratory Medicine trainees to also train in Intensive Care Medicine (ICM) and Internal Medicine (IM) to CCT level. We are working closely with the Faculty of Intensive Care Medicine to design these pathways and further information will posted on the JRCPTB and FICM websites when available. 

What will be the entry requirement for single CCT ICM training?

The entry criteria for ICM training as a single CCT will be two years of IMT (IMY1 & IMY2).

Transition for trainees who have completed CMT or ACCS-AM

Will I need to complete IMY3 if I have finished CMT or ACCS-AM and do not enter specialty training before 2022? 

The entry requirements for group 1 specialties from August 2022 will require completion of full IMT or equivalent. Trainees who have completed CMT or ACCS-AM will require IMY3 training and this will be arranged in the region in which CMT/ACCS was completed. Doctors may opt to apply to higher training via the alternative certificate route (see below and our recruitment page).

Can my experience after completing CMT/ACCS-AM be accepted as equivalent to IMY3?

There will be an alternative certificate route to higher specialty training in 2022. Please see our recruitment page for further information on the options for current trainees. The proposed alternative certificate for entry to ST4 in 2022 is available to download from the IMT recruitment website.

If I undertake a IMY3 during the transition period will I need to meet all the IMT training requirements? 

Anyone requiring IMY3 training in the transitional period will have a training needs analysis to determine what training and experience is required to meet the curriculum capabilities. Guidance is available here.

How will the change affect doctors who are training less than full time?

CMT/ACCS-AM trainees who are currently training less than full time and will not complete before 2021 will be eligible for IMY3 training in the same deanery. 

Trainees will be entitled to opt for less than full time training in IMT. Less-than-full-time trainees will be required to undertake out of hours duties (including on call) based on the proportion of a doctor's full-time commitment to the same rota. This will be subject to discussion with your employer and local training provider as per the current process.

What happens if I take statutory time out of training for maternity leave or sickness? Will I then have to complete IMY3 on my return?

Each trainee’s situation will be slightly different. If you have completed CMT they you would come back into IMY3. If you have not completed CMT then you would come back at an appropriate point in the new programme but to enter a group 1 specialty training you would have to complete IMY3.

Higher Specialty Training and transition

How will the changes being made to CMT/IMT affect the higher specialty training programmes?

Higher specialty training is split in to two groups. Group 1 specialties will all be dual training with internal medicine and require successful completion of the three-year IM stage 1 curriculum and the IM stage 2 curriculum to CCT. These programmes are generally four years in inductive duration (Cardiology and Neurology are five years). All trainees in group 1 specialties will dual train with internal medicine, this includes academic trainees.

Group 2 specialties will not undertake further IM training and are single accrediting. You can apply from IMY2 or IMY3. If applying from IMY2 you must have an ARCP outcome 1 or outcome 2(U5) and the full MRCP(UK) Diploma to take up the post. 

Will I have to transfer to the new curriculum once it is implemented?

The GMC currently requires trainees to transfer to the most up to date curriculum when implemented, unless they are in their final calendar year of training. Flexibility has been allowed so that where it is not safe or practical for trainees to transfer they may complete training on the 'old' curriculum with the agreement of the postgraduate dean. This will apply for the following groups:

  • Trainees who started training in the new group 1 specialties (GU Medicine, Neurology and Palliative Medicine) prior to August 2021 who have not maintained general/internal medical capabilities
  • Trainees who enter Palliative Medicine in August 2021 or before via the GP or anaesthetics route
  • Trainees who started training in the other group 1 specialties who were not appointed to GIM training or relinquished GIM training and have not maintained general/internal medical capabilities. Trainees may be exempted on an individual basis by the postgraduate dean.

Trainees should be supported to transfer to the new curricula wherever possible and guidance will be provided to support this including a gap analysis tool and a mapping of current curricula competencies to the new capabilities in practice. Trainees will not be required to re-link evidence to the new curriculum in their ePortfolio. Please see Transition to the new curricula