When a new curriculum and assessment system is introduced, the GMC requires all trainees to transfer to it within two years of its implementation. Academic traines and trainees working less than full time or out of programme will not be exempt from transferring to the new curriculum. The only exception to this requirement are trainees in their final year of training at the time a new curriculum is introduced. They may remain on the ‘old’ curriculum. This requirement to change curriculum means that trainees will be trained and assessed against the most recent standards for the specialty.
We requested a review of this policy for the three specialties which will dual train with Internal Medicine (IM) for the first time from August 2022. This represents a significant change and associated with this are concerns that trainees may not be able to return to practice in acute aspects of internal medicine, particularly when they may have taken significant periods of time out of programme and/or are working less than full time. The specialties in question are Genitourinary Medicine (GUM), Palliative Medicine and Neurology. In addition, a proportion of Cardiology trainees are appointed to single CCT training or ‘drop’ General Internal Medicine (GIM) from their training programme and could face the same issues if required to return to training in internal medicine.
All JRCPTB specialty curricula are being modified and the principles for transition to these new curricula are set out below. Each specialty will produce a detailed plan as part of the curriculum submission to the GMC.
Trainees entering higher specialty training prior to August 2021
- Trainees entering the new dual training specialties of GUM, Palliative Medicine and Neurology or a single CCT programme in Cardiology, prior to August 2021 will not be mandated to transfer from single to dual CCT training programmes but should be strongly encouraged to do so. This should be discussed with, and supported by, the educational supervisor and training programme director. Trainees who have entered training in Palliative Medicine from General Practice or Anaesthetics will not be required to transfer to the new curriculum and dual train with IM.
- Trainees in all other group 1 specialties will be required to transfer to the new curricula in August 2022 (unless in their final year of training). There may be circumstances where a trainee has had to stop training in GIM or working on the acute take and it may not be safe or practical for them to transfer to the new curriculum. The postgraduate dean should be consulted to decide whether the trainee can remain on the ‘old’ curriculum.
- Trainees in group 2 specialties will transfer to the new curricula from August 2021 (unless in their final year of training).
- Doctors may be expected to contribute to the acute take from the point in time when they transfer to the new curriculum / training structure. For this reason, they are advised to maintain experience in internal medicine from the start of their training programme if this is before the time of transition. They may need support to return to this area of practice and ideally, they should have a GIM educational supervisor to help prepare the trainee for curriculum transition.
Trainees entering higher specialty training from August 2021
- Trainees appointed to group 2 specialties from August 2021 will follow the new curricula.
- Applicants to GUM, Neurology and Palliative Medicine in 2021, except those entering Palliative Medicine from non-physician core training routes, will have been given notice that they will be expected to transfer to the new curriculum and advised to maintain and develop general medical capabilities, including managing the acute take. It is expected that trainees starting training in these specialties in August 2021 will be able to transfer to the new curricula in August 2022 and dual accredit in specialty and IM.
- It should be noted that trainees entering the new group 1 specialties in August 2021 will have completed Core Medical Training (CMT) or Acute Care Common Stem – Acute Medicine (ACCS-AM). These programmes do not require sign off of capability in managing the acute unselected take, unlike IM stage 1 training which includes a year of acting as the ‘medical registrar’.
- The training programme director must carry out a gap analysis and deaneries should tailor the training programme to ensure the trainee encounters relevant learning experiences so that they can acquire the necessary capabilities for dual CCT. Any additional training time and change to the CCT date should be agreed at the first ARCP.
- If it is considered neither safe nor practical for a trainee to transfer to the new curriculum the postgraduate dean must be consulted as they will be able to consider the merits of individual cases and, potentially, allow the trainee to remain on the ‘old’ curriculum. In the main, this is expected to apply to those entering from non-physician core training routes. The details of what has been considered and the final decision should be fully documented in each case. Detailed guidance will be provided to support the gap analysis process.
- A small number of trainees in Clinical Pharmacology and Therapeutics (CPT) may be in dual CCT programmes with non-GIM specialties at the time the new curriculum is introduced and may not be able to transfer to the new curriculum. They should be considered on a case by case basis.
- All other group 1 specialties, including Cardiology, will be appointed to dual programmes with GIM in 2021 and trainees will be required to transfer to the new curricula in August 2022.