Preparing for GIM ARCP

Mo AyeTraining Programme Director

General Internal Medicine

With thanks to:Dr Sega Pathmanathan

Lead Training Programme Director

Key Points

• Training is trainee led

• Generic ES training doesn’t address:

o ePortfolios

o Specific specialty or GIM requirement

• The GIM SAC now mandates a separate GIM ES report

• ARCP outcomes should not be a surprise

Objectives

• ES Report

• GIM StR requirements

• ARCP Process

• PYA

• Adverse Outcome

• ARCP 6

Educational Supervision

Educational Supervision

• Initial meeting

• Regular updates

• Prepare for ARCP

• Support

The initial meeting

• Make it as early as possible, on rotation, and allocate adequate time

• Review previous ARCPs, ES reports, Form R

• Consider an agenda

The initial meeting

• Identify training needs and how they will be achieved:

• SLEs, study leave, attachments elsewhere

• Ensure GIM & Speciality issues are addressed

• Refer to ARCP decision aids

• Populate the PDP and an honest, achievable timetable

Meet regularly

• Mark progress against ARCP decision aids

• Ensure the curricula are linked appropriately

o Self-rate and get ES sign off for competencies

• Use the free text to justify competency

• SLEs, MSF, MCR

• Identify and escalate concerns early

• Clear targets for next meeting

Prepare for the ARCP

• Allow plenty of time for the ES reports

o Separate ES report for GIM and speciality

• ARCP outcomes are predictable!

• Remember the lockdown date:

o 1 May for GIM

https://1drv.ms/w/s!AutJJhphvf-

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Guide to ES report

GIM training requirements

GIM Requirements

• ALS

• CPD

• ACAT, assessments

• ES report/MCR/MSF

• GIM Logbook

• Curriculum

• GIM placement

• (Adequate Reflection)

• Form R

• Other

ALS

• Valid: 4 years

• Must be valid at ARCP

• If expired, local Trust must be informed

• Instructor status allowed

• Must be in certificates section and verified by ES

NO ALS = Outcome 2

ACAT and other SLEs

• Minimum 18 ACATs at CCT

• 6 must be in final year

• Must be GIM - 2 allowed from speciality (eg 16 GIM + 2 respiratory)

• Minimum 5 patients

• Must be on AMU or ACU

• Must all be satisfactory

• Ideally lead the ward round

• Allowed up to 8 links

• Minimum 10 SLEs per year

ES Report

• Must have a separate GIM ES report completed in addition to speciality ES report

• Does not necessarily need completion if in an non-GIM year

• Can be completed by any consultant with MRCP and CCT:

o even those not ‘doing’ GIM

Multiple Consultant Report (MCR)

• 4-6 per year

• At least 2 should be from GIM consultants

o AAU, other MEDICAL specialities

• Should all be Satisfactory

• ES should not do an MCR

o MCR should inform ES

• Avoid MSF consultants

MSF

• At least 2 satisfactory MSFs before CCT

• Minimum 12 responders

• Minimum 3 consultants

• A mix of clinical and non-clinical staff

Curriculum

• Must be signed off by both ES and trainee

• At least 2 links per item

• Only 1 can be a reflection

• Emergency Presentations complete by end of ST3

• Mandatory (Part A) procedures complete by end of ST3

https://www.jrcptb.org.uk/sites/default/file

s/GIM%20ARCP%20Decision%20Aid%2

0%28August%202017%29.pdf

JRCPTB decision aid

Emergency Presentations

Procedures

Procedures

• Cannot count signoff from CMT

• Part A – Must be live summative DOPS

• 2 x DOPS for ascitic tap (∵ potentially life threatening)

• 1 x DOPS for knee aspiration

• 1 x DOPS for DC cardioversion

• Part B – Can be simulated

• Chest drain course certifcicate accepted

• CVP course certificate accepted

Curriculum

• Cannot use assessments from prior to Training Programme

• Max number of links:

o ACAT – 8

o Mini-CEX – 2

o CbD – 2

• Avoid excessive links:

o Less is more — a few good quality links suffice

o Keep links up to date

Stages of GIM

• STAGE 1: First year of GIM

• ST3 unless the first year is in a Teaching hospital with no GIM

• if there are rotation-specific variance with reduced the educational activity an ARCP can assess pro rata and should clearly list the outstanding requirements to achieve stage 1

• STATE 2: ST4-6

• If second year is in a DGH, aim to have Stage 2 signed off

• CCT: ST6-7

GIM Placement

• Minimum 3 years of GIM Acute on calls

• ICU exposure

• CCU cover

• Ideally at least 18-24 months of DGH

• At least 3 months GIM in final year

CPD

• Minimum 100 hours

• Must be external- not Grand Round etc

• Can count 6 hours of speciality CPD

• Can have up to 20 hours online- RCP, BMJ

• Upload certificates

• Can also count SAM conference, RCP updates

GIM Logbook

• Firth Calculator

• Updated yearly

• Signed by ES to verify

Form R

• Upload to portfolio

• Includes:

• Time off work

• Complaints or SUI’s

Other

• Management course

• Evidence of leadership

• 1x GIM Audit- out-with speciality

• Needs an assessment

• Teaching course

• Evidence of teaching non clinicians (excl med students)

Reflection

• Must have reasonable Detail

ARCP

ARCP Process

• Joint ARCP with speciality

• Remote assessment

• Minimum panel of 3

• Follows decision aid

• Outcome decided remotely

• Must have an updated Form R

• Lockdown date for requirements to be met- 1st May

ARCP Outcomes

Outcome 1: Satisfactory progress

Outcome 2: Development of specific competencies, no additional time

Outcome 3: Inadequate progress, additional training time required

Outcome 4: Released from training programme

Outcome 5: Incomplete evidence, additional time may be required

Outcome 6: Gained all required competencies, recommended for CCT

• Judgements based on available evidence (eg SLEs)?

• Appropriate suggestions for trainee’s development

• Areas of good practice

• Report produced with regard to ARCP decision aid and stage of training

• Areas of development identified, appropriate advice/guidance

• ALS uploaded and confirmed

• GIM external CPD hours confirmed

• No of acute patients seen and outpatient clinics attended and confirmed

Constructive Feedback

Adverse outcomes

Adverse outcome

• Face to face

• Presence of APD

• No OOPE

• No chance of accelerated CCT

• Reviewed after 6 months

• Consecutive adverse outcome may extend training

• 2 x Outcome 5 = 2

• 2 x Outcome 2 = 3

• 2 x Outcome 3 = 4

Adverse Outcome

• Invalid ALS

• No ES Report

• No Form R

• Insufficient SLEs

• Curriculum competencies not signed off

• Not at appropriate stage

• Unsatisfactory report/assessments

Outcome 5 vs Outcome 2

• Outcome 2: Assessment/evidence not undertaken

• Outcome 5: missing evidence

• Outcome 5 can be upgraded to Outcome 1, but has to be done by specified time-usually 2-4 weeks

• Cannot have more than 1 outcome 5

• Either outcome means you CANNOT Accelerate (5 is under review)

Penultimate year assessment (PYA)

PYA

• At least 12-18 months prior to CCT

• Undertaken by external assessor

• Local TPD Present

• Full assessment of Eportfolio and documentation

• Presentation and CV

PYA

• Mandatory Targets Set

• Specified time for targets

• CCT can be altered

• Must match parent speciality

• THIS IS NOT AN ARCP

PYA

• If OOPE/Maternity is taken after PYA, A repeat PYA may be needed if CCT date is 2 years or more from PYA

• Virtual PYA

ARCP 6

• Completed training requirements and ePortfolio

• Must have a panel of 3

• PYA targets must be completed

• Sent to external for scrutiny:

• PYA Assessor

• JRCPTB

• GMC

• Need at least 2 months for completion

ARCP 6

• Do not resign until you have been given your CCT

• If you haven’t completed your PYA requirements by the CCT date- you will be given an automatic outcome 3 and extension to training

Tips

• Organise your portfolio

• Make it easy to be assessed

• Keep up to date with assessments

• Remember your dates

• Continuous update

• Give your ES time

• Be proactive

• Use the decision aid

Any Queries?

• Programme Support

• medicine.yh@hee.nhs.uk

• Contacts:

• Dr Sega Pathmanathan - Hull

• Dr Joe Hogg - Pinderfields

• Dr Sathish Kallankara - Hull

• Dr Mo Aye - Hull

• Dr Mohsen El-Kossi - Doncaster

• Dr Imran Aslam - Sheffield

Some web links

• http://www.yorksandhumberdeanery.nhs.uk/medicine/general_(internal)_medicine/

• https://www.jrcptb.org.uk/specialties/general-internal-medicine-gim

• https://www.jrcptb.org.uk/specialties/core-medical-training-and-acute-care-common-stem-medicine