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.
How does IMT differ from CMT?
IMT is a three year programme 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 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 do I apply for IMT?
Information on applying for IMT and ACCS acute medicine 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.
Will there be recruitment to ST3 posts next year in 2021
There will be full recruitment to group 2 specialties but recruitment is likely to be limited to group 1 specialties. Click here for full information
When will I be able to see what IMT programmes are on offer?
All regions have provided full rotation information for the first two years of the programme, including the hospital, specialty information and duration of each post. IMY3 will be within the same region as IMY1/IMY2 and some regions will be providing specific information about programmes when preferences are selected. All regions will provide more information for their programmes over the coming months. Please see the IMT recruitment website for further information.
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.
I am interested in a non-JRCPTB specialty which currently requires CMT for entry at ST3. Will I need to complete IMT?
All specialties will be producing new curricula and will define the entry criteria for higher training. We anticipate that most non-physician specialties which currently accept CMT will require two years of IMT but recommend that you check the person specification at the time of application.
What will be the duration of the total training programme in each specialty?
All JRCPTB specialties are in the process of producing new curricula in line with the model for physician training. The overall length of training for group 1 specialties will be the same as for current dual training programmes with GIM. As an example, currently dual training in Geriatric Medicine and GIM comprises two years CMT plus five years higher specialist training, so seven years in total. In future, dual training will become three years IMT plus four years HST so still seven years in total. The exception to this will be the three specialties which will be dual training with IM for the first time – Genitourinary Medicine, Palliative Medicine and Neurology – which will gain one year in overall duration.
Training in group 2 specialties will be the same length as current training.
Acute Care Common Stem - Acute Medicine (ACCS-AM)
Will there be a new training programme for ACCS-AM?
ACCS-AM is a core programme for all JRCPTB specialties. The ACCS curriculum is currently under review and the JRCPTB is involved in developing a new programme for ACCS-AM which will comprise an indicative two years rotating through Emergency Medicine, Acute Internal Medicine, Anaesthetics and Intensive Care Medicine followed by completion of IMY2 and IMY3 (four years in total). This will ensure trainees are eligible for entry to group 1 specialties. It is anticipated that the ACCS curriculum will be implemented in 2021 and there will be transitional arrangements for trainees already in ACCS-AM programmes.
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 or 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.
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 apply in 2021 for the final year of ST3 recruitment to Neurology, Genitourinary Medicine or Palliative Medicine will I be required to transfer to the new curricula after 2022?
It is expected that there will be a final year of recruitment to ST3 in these specialties in 2021. The GMC requires doctors to train to the most current curricula and currently requires trainees to move to a new curriculum within two years of implementation. The transitional arrangements for these specialties will need to be determined and will be published once agreed with the GMC.
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.
There will be no option to single accredit in group 1 specialties and all trainees will dual train in internal medicine.
If I choose or I have to 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?
We are currently working with the Faculty of Intensive Care Medicine and the GMC to support the physician specialties of Acute Internal Medicine, Renal Medicine and Respiratory Medicine continuing to train in ICM. 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. This is subject to the new ICM curriculum being approved by the GMC in May 2020.
Transition for current CMT and ACCS-AM trainees
Will I need to complete IMY3 if I leave CMT or ACCS-AM and do not enter specialty training before 2022?
The entry requirements for group 1 specialties from 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. Any trainee who is considering taking up an IMY3 post in the future is encouraged to submit an expression of interest via the following this link.
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. There will be national guidance to support this process.
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 if I don't want to go back to the Deanery that I completed CMT in, can I get an IMY3 post in another location?
The offer of a place is based on returning to your previous deanery. The process of return is currently being designed. If return is by a completive selection process, then you would be able to apply to a deanery of your choice. Alternatively, if offered an IMY3 post in your previous deanery by allocation it may be possible to apply through the inter-deanery transfer process. Such a transfer could not be guaranteed.
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.
Can my time out of training after completing CMT be counted towards completion of IMY3 if I have kept assessments/a portfolio?
This is possible. When you join an IMY3 programme a gap analysis would have to be undertaken to assess what you have been doing after CMT and to determine whether this can be counted towards your IMY3 or whether it would allow you to accelerate through the IMY3 year.
Higher Specialty Training
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).
Group 2 specialties 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.
The curricula for both Group 1 and 2 are currently being written to be in the same format as IMS1 with high level learning outcomes - capabilities in practice - rather than competencies.
At what point will the new curriculum apply to me if I start the traditional ST3 posts in 2020, 2021? Do we now need to meet all competencies in four instead of five years for example?
Under current GMC rules you will have to convert to the new curricula within two years of implementation. The new curricula for group 1 specialties will become active in 2022 by when the curricula for group 2 specialties will have been active for one year.
There will be guidance on transition to the new curricula including a gap analysis for trainees moving curricula or who return to training. We will provide a mapping of current curricula competencies to the new capabilities in practice to help with this process.
What happens if I want to take time out of higher specialty training? Will I have to switch to the new curriculum on my return?
This is likely to be the case. Under current GMC rules all trainees on legacy curricula must switch to new curricula two years after those curricula become active.