Internal Medicine Training (IMT)

How we got here…

ALASTAIR MILLER MA MB FRCP FRCP (Edin) DTM&HDeputy Medical DirectorChair Clinical Development CommitteeJoint Royal College of Physicians Training Board

Hon Senior LecturerInstitute of Infection & Global Health, University of Liverpool

Consultant Physician in Acute MedicineNorth Cumbria University Hospitals Trust

Timelines

• Core Medical Training commenced August 2007

• Shape of Training published October 2013• Plus “Francis” and “Future Hospital”

• Internal Medicine Committee met August 2015

• Internal Medicine Training Stage 1 (IMTS1) curriculum approved by GMC December 2017

• IMT commenced August 2019

Structure

• Completion of IMTS1 takes 3 years (indicative)• IMY1 - 3

• This is followed by IMTS2 • curriculum currently at GMC

• 1 year if integrated within higher specialty training

• 3 years if stand alone programme

• Group 2 Specialties may recruit from those who have completed IMY2 andcompleted MRCP (ie have an ARCP outcome 1)

• All curricula for higher specialty training (HST) have been or are about to be submitted to COG/CAG

Group 1 specialties (dual train with Internal Medicine)

Group 2 specialties (single CCT)

Acute Internal Medicine Allergy

Cardiology Audio vestibular Medicine

Clinical Pharmacology and Therapeutics Aviation and Space Medicine

Endocrinology and Diabetes Mellitus Clinical Genetics

Geriatric Medicine Clinical Neurophysiology

Gastroenterology Dermatology **

Genitourinary medicine Haematology

Infectious Diseases* Immunology

Neurology Medical Ophthalmology

Palliative Medicine Nuclear Medicine

Renal Medicine Paediatric Cardiology

Respiratory Medicine Pharmaceutical Medicine

Rheumatology Rehabilitation Medicine

Tropical Medicine* Sport and Exercise Medicine

*Discussion ongoing re dual programmes with MM/MV **Detail of programme to be determinedMedical Oncology not included - ongoing discussion with UKSTSG

Principal changes

• Stage 1 training now 3 years

• 14 Capabilities in Practice (CiPs) replace 120 competencies

• Syllabus confined to “Presentations and Conditions”

• Specific experiences mandated

• IMTS2 and HST inextricably linked in all Group 1 specialties – cannot “drop” IM

• May progress into IMY3 without MRCP

Mandated experiential learning• 10 weeks critical care experience

• Currently can be done in 2 blocks but to become 12 weeks “full immersion” unbroken block ASAP

• Geriatrics• “…four month attachment to a team led by a consultant geriatrician during the

training programme is an absolute minimum”

• Outpatients• Minimum of 80 over 3 years

• Inpatients• Trainees should be involved in the day-to-day management of acutely unwell

medical inpatients for at least 24 months of the internal medicine stage 1 training programme.

• Acute take• 100 patients per year. 500 over 3 years

Duration of attachments

There has been much discussion about what is the optimum duration of any particular attachment. Longer attachments foster team relationships and ensure that trainees feel more involved and valued and develop enhanced support networks. However shorter attachments mean that a trainee may be exposed to more specialties. The exact pattern of individual rotations will remain a matter for TPDs as long as all the curricular objectives are fulfilled. However, attachments to the main specialties should be at least 4 months in IMY1 and IMY2 and a minimum of six months in IMY3.

Practical procedures

• Removed distinction over “life threatening”

• Many now just require skills lab competence• Chest drains, paracentesis, external pacing, circulatory access

• Under further discussion

What has not changed

• Workplace Based Assessment (WBAs)

• No additional SCE for internal medicine

• Supervision process…?

• ARCP process…?

• Medicine!

MRCP(UK)

• PACES 2020

• Trainees will be expected to achieve full MRCP by the end of IMY2 but failure to achieve this is not a bar to progression per se (although will result in ARCP outcome 2 – or 3)

• MRCP is not an assessment of the ability to lead the acute take (Level 3 CiP1) but

• It is a substantial piece of evidence

Challenges!!!