Internal Medicine Training (IMT) programme
How does IMT differ from CMT?
IMT is a three-year programme which replaced CMT in August 2019. It 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 does the IMY3 year differ from ST3?
IMY3 prepares 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.
How will the change affect doctors who are training less than full time?
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.
Can I complete IMT in less than 36 months?
Trainees may have additional training and/or experience before recruitment into IMT Stage 1 compared to 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 appropriate 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.
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 have not entered specialty training before August 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 or 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 is an alternative certificate route to higher specialty training for doctors who have not completed IMT or ACCS-Internal Medicine. Please see the IMT recruitment website for further information.
If I undertake 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.
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 then 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
Group 1 / group 2 specialties
What are group 1 and group 2 specialties?
With the development of internal medicine and new curricula, higher specialty training has been divided into two groups. Group 1 specialties dual train 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 indicative 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 do not undertake further IM training and are single accrediting. The entry criteria for these specialties require completion of two years of IM stage 1 training or three years of ACCS-IM plus MRCP(UK) diploma (alternative programmes may be acceptable, please refer to the relevant person specification). It is also possible to apply having completed IMY3.
A list of the group 1 and group 2 specialties is available here.
When do I need to decide whether I want to apply to a group 1 or 2 specialty?
Trainees will be appointed to a 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. 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. You can only apply for a group 2 specialty from IMY2 whereas from IMY3 you can apply for either a group 1 or group 2 specialty.
What are the expectations for completion of IMY2 if I apply for a group 2 specialty?
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.
Transition and gap analysis
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 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 previous curriculum with the agreement of the postgraduate dean. Please see the Transition to the new curricula page for more information about the process and exemption criteria. 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.
When should the gap analysis be completed and by whom?
The gap analysis may be completed before or soon after starting the new training year. For group 1 specialties, this gap analysis includes a review of internal medicine capabilities and may require the input of an an additional supervisor or training programme director for IM. Further information on gap analysis can be found here.
When should I transfer if I am less than full time or out of programme?
It is recommended that transition occurs at the start of the new training year, but if this is not practical then an alternative date should be discussed and agreed locally.
If I am exempted from transferring, can I choose to transfer at a later date?
It may be possible to transfer at a later date if agreed and supported by the local specialty and internal medicine training programme directors and head of school.
Dual Training with Internal Medicine
Will I need a separate ARCP for IM?
An ARCP outcome will need to be recorded for both specialties in a dual programme.There may be a separate ARCP for IM or a combined ARCP which also reviews progression in the specialty. This will be decided at a local level.
If I have previous ePortfolio evidence of IM experience, can I get my General Internal Medicine CCT before my specialty CCT?
While experience outside of the training programme should be expected to contribute towards your capabilities in practice, the two CCT dates must be aligned and it is not possible to CCT in IM at an earlier date. It is a curriculum requirement that IM capabilities are demonstrated in the final year of training.
Is there a separate ARCP for IM?
There should be an IM ARCP, but this may take the form of a combined ARCP with the specialty or a separate ARCP.
Can the 750 patients presenting with acute medical problems be patients within your own specialty who have acute medical/general medical problems?
While the distinction between Internal Medicine placements and specialty ones is somewhat artificial, an important principle of the new group 1 curricula is that trainees acquire a perspective on patient management that is not delivered by their own parent specialty consultants. This includes the acute, post-acute and chronic management of conditions.
How much IM do I need to do if I’m training in a ‘new' group 1 specialty?
Trainees will need to complete an indicative year within the specialty training period, but three months of specialty time will contribute towards that year. Please see out guidance for new group 1 specialties.
How will this affect MCRs and MSFs?
A single MCR or MSF can be used to inform the outcome in both specialty and IM, but the MCRs must be appropriately focussed to give information about both specialty and IM performance. Meanwhile, if there are any years when trainees are only working within specialty, MCRs need not focus on IM requirements.
Can someone with a CCT in GIM supervise the GIM component if they aren’t on the GIM rota?
They can supervise the GIM activity. However, some of the MCRs will have to include mention of activity in the acute take, and this could only be done by someone on the GIM rota.
Will trainees who are acting up have to meet the requirements for AUT activity in the final year?
They will, but this may be done while acting up.
Training in Intensive Care Medicine (ICM)
Is it possible to train in ICM if dual training in IM?
The GMC has approved 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 be posted on the JRCPTB and FICM websites when available.
Do I have to transition if I have previously dropped General Internal Medicine?
If a trainee has dropped GIM to take up ICM it may not be in the best interest of patient safety or impractical for a trainee to transfer curriculum. A gap analysis should be carried out to determine whether it is possible for the trainee to transition and if not, postgraduate dean’s approval should be sought for the trainee to complete training on the previous curriculum.
The options for current Acute Internal Medicine/Renal Medicine /Respiratory Medicine trainees who are training in ICM and are not in their final year of training are:
What is the entry requirement for single CCT ICM training?
The entry criteria for ICM training as a single CCT is two years of IMT (IMY1 & IMY2).
Would front door Cardiology on the Medical admissions unit seeing chest pain, heart failure, atrial fibrillation etc meet the requirements for an unselected medical take?
No, this would be classified as a specialty take.
Will my training length in Acute Medicine still be 5 years or will it be shortened to 4 years?
There has to be a gap analysis for all trainees who are undergoing transition to the new curriculum to determine what capability has already been acquired and the likely time still needed to get to CCT. The ARCP panel will be required to consider the evidence and set the CCT, but for most there should not be a change of that date.
If I have chosen and am signed off for ultrasound as my specialist skill for AIM & GIM, do I need to choose another specialist skill for CCT?
For the penultimate ARCP in group 1 Higher Specialty Training programmes, will trainees be required to complete a PYR for IM?
It is advisable that the trainee should undertake a 'forward look' with their educational supervisor in their penultimate year to ensure all curricula capabilities will have been achieved by the CCT date.
If trainees have already acquired clinical independence during CMT, do they have to start again with evidencing those procedures in Higher Specialty Training?
No, but there must be evidence of skill maintenance.
Can I use OPCATs to demonstrate evidence against CiPs?
The OPCAT may be used to evidence CiPs but it is not mandated.
For level 2 entrustment, does the direct supervision have to be by a consultant or can it be assessed by a more senior trainee?
Direct supervision must come from someone who has expertise in the area being supervised and has been trained to provide feedback.
How often should we expect GIM ARCPs?
GIM ARCPs should take place annually, with additional ARCPs arranged if a trainee receives an outcome 3.
Is there a particular stage or year when the ARCP panel looks at accelerating CCT?
The panel may choose to bring the CCT date forward at any ARCP if a trainee is expected to be fully capable earlier than the expected training period.
When will the new curricula be available on ePortfolio?
All curricula will be available on ePortfolio from 3rd August. In the interim, they can be viewed on their respective specialty pages here.
When switching to the new curriculum do we have to relink all previous evidence?
You will not be required to re-link your pre-existing evidence from the previous curriculum to the new curriculum. They will remain available to review, so the educational supervisor can refer back to the competencies already achieved as and when necessary.
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.
Breaks in training and LTFT
I am going out of programme before the new curriculum is implemented. When should I do a gap analysis?
The gap analysis should take place soon as possible to help determine what will be required when you return to training.
I’m out of programme while the new curricula are implemented. When do I need to decide whether I’m transferring?
This decision should be made and agreed with your supervisor as soon as possible, and by the end of June 2022.
Do you anticipate that trainees OOP may have to extend training by 1-2 years beyond their previously expected CCT so that they can meet the new criteria?
The time for training will be based on acquisition of capability rather than time, so the type of OOP may influence the overall time that is actually taken to get to CCT
Does time counted during OOPR have to include AUT?
No, but continuing such activity may help in achieving CCT more promptly.
If a doctor is in their last year of training but on OOP, would they need to transition to the new curriculum when they return?
This will need to be a local decision made by the TPD and approved by the postgraduate dean.
If OOPR GIM activities were not documented as planned prospectively, can they be used retrospectively against curriculum requirements?
The activities undertaken should have promoted capability acquisition, and it is appreciated that these may contribute further to your capability in practise than previously anticipated. As the new curricula are capability based, retrospective evaluation of your experience may find that this has included knowledge, skills and experience pertinent to practising general internal medicine, in which case it should be considered towards your CCT.
If you are on maternity leave when the new curriculum comes in August but are in the middle of a training year, will you join the new curriculum when you come back to work even if in the middle of a training year?
You should transfer to the new curriculum as soon as is possible but this should be arranged in discussion with your ES/TPD.
How will the change affect doctors who are training less than full time?
Many doctors who work LTFT acquire capability more quickly than would be suggested by time within training, thus the CCT date may be reached more quickly than if based on the quantity of experience alone.
Where can I find information about changes to my specialty curriculum?
Information about changes to the specialty curriculum can be found in the Rough Guide and on your specialty page here.
When these changes come into effect for CESR applicants?
There will be a transition period for CESR applications, where applicants may choose to apply against either curriculum. Please see the CESR page for more information regarding dates here.