Definition of specialty
The most versatile of all medical specialties, this is the front-door part of General Internal Medicine (GIM) concerned with the immediate and early specialist (<72 hour) management of adult patients suffering from a wide range of medical conditions who present to, or from within, hospitals requiring urgent or emergency care.
Overview of training programme
Entry from Core Medical Training (CMT) or Acute Care Common Stem (ACCS) into a four-year Higher Specialty Training (HST) programme, resulting in a Certificate of Completion of Training (CCT) in Acute Internal Medicine. Most will choose to gain a dual accreditation in GIM, which adds a further year and will permit ongoing medical care of patients beyond 72 hours. While being predominantly based in Acute Medicine Units, training programmes include a minimum of four months Intensive Treatment Unit (ITU) experience and will typically include rotations spending time in relevant acute specialties such as cardiology, respiratory and medicine for the elderly, ensuring a varied programme and broad knowledge base.
Exam requirements
Full MRCP(UK) is mandatory for entry into Higher Specialty Training (ST3), and the Specialty Certificate Examination (SCE) in Acute Medicine, a computer-based knowledge-based assessment (KBA), must be passed before completion of training (typically sat in the penultimate year).
Other requirements
Specialty skills: trainees are required to develop a specialist skill, with opportunities to do so varying between deaneries. These may be skills in practical procedures (typically echocardiography or upper gastrointestinal [GI] endoscopy), specialty interests (such as intensive care medicine), research, or additional qualifications in medical education, leadership or management. Pre-approved specialist skills and standards to be attained are listed in the curriculum but this list is ever-growing and other skills may be approved providing you apply to the Joint Royal Colleges of Physicians Training Board (JRCPTB) (which your Training Programme Director will assist with). As not all deaneries provide training in all skills, you may want to contact individual deaneries before selecting the region you wish to train in if you wish to pursue a particular specialist skill. Some of these, such as additional qualifications, will not be funded by them and you will be required to either self-fund or seek sponsorship or grants (which are not easy to get) – so early consideration and careful research into your preferred areas is advisable. For useful further information see the Society for Acute Medicine trainee pages
Mandatory training
Advanced life support (ALS) course
Opportunities/expectations for out of programme/research
Historically there have been relatively few research opportunities during training in acute medicine, but this is a growing specialty with a real need to develop a sound research base so trainees keen to do so should be able to create opportunity. Many trainees will choose to attain qualifications in relevant non-clinical areas such as medical education, leadership or management (typically a diploma or higher degree) which may be done part-time in parallel with HST, or during approved time out of programme (OOP). You may pursue qualifications and experience in other relevant clinical specialties, usually entailing OOP experience, in stroke medicine, intensive care medicine, or infectious diseases/tropical medicine, potentially accrediting in these at CCT level.
A day in the life of a... Consultant
8:00am – 11:00am: Debrief night team and carry out morning post-take ward round.
11:00 am – 12:00 pm: Agree priorities with team, confirm bed status with nursing team, and liaise with specialty in-reach teams.
12:00 pm – 1:00 pm: Clinical administration and lunch while working.
1:00 pm – 2:00 pm: Medical student teaching.
2:00 pm – 4:00 pm: Assess new admissions in ‘real-time’ in Acute Medicine Unit and Ambulatory Unit; supervise trainees and students.
4:00 pm – 4:10 pm: Handover to afternoon/evening team; debrief day team.
4:10 pm – 5:00 pm: Dictation and clinical administration.
5:00 pm: Home, or coffee with a colleague, or meet with a family, or part 2 clinical examination (PACES) teaching, or Unit meeting...
Pros and Cons of working in this specialty
Pros
- Highly varied caseload ensuring you are kept on your toes and thinking on your feet – no two days are the same, and you are constantly testing all your medical (and sometimes surgical) knowledge and experience
- Immense satisfaction from meeting acutely unwell patients at their most medically unstable and emotionally/psychologically distressed and seeing immediate positive impact from your actions
- Working with a large multi-disciplinary team (MDT) with constant opportunities to teach and learn
- Good support from other clinical and diagnostic specialties.
- Opportunity to develop and shape a new specialty, and apply and develop skills in leadership, management and education
Cons
- Heavy, unpredictable and growing workload
- Highly pressurised environment as we are often caught between conflicting needs of the Accident and Emergency (A&E) Department and other specialties, and under intense management scrutiny
- The impact of hospital bed shortages is felt here the most.
- Rapid team turnover
- Lack of patient continuity means often missing out discovering final diagnoses in complex cases or the satisfaction of seeing a patient eventually discharged
- Less experienced junior staff and the movement towards a Consultant-present workforce are likely to result in heavier out-of-hours responsibilities – expect Consultant overnight working in the near future
How this specialty differs from others and why I chose it
After three years of medical rotations as a Core Trainee I realised that I became quickly bored in single-organ specialties, and loved a puzzle, so acute medicine really is the ideal fit. We need to be true diagnosticians as our patients come to us with symptoms, not labels, testing our broad medical knowledge and understanding of multiple co-morbidity and polypharmacy. You never know if your next patient is going to be a 97-year-old with a stroke, delirium and fractured hip or a 16-year-old with meningococcal sepsis. Refined clinical decision-making skills are key, and strong leadership is required to manage a busy (often hectic) take.
We work with a particularly large team, relying not only on staff within the Acute Medical Unit (AMU) but considerable specialty in-reach and diagnostic support, making this a sociable specialty with opportunities to work with most of the hospital.
This is one of the few growing specialties and new Consultant posts are currently being made available at a rate that surpasses any of the other medical specialties, so career prospects are good for competent candidates.
Tips for success in applying for this specialty
- If possible, aim to rotate through a variety of medical specialties to develop a broad experience base.
- Take any and all opportunities to practice medical procedures
- Visit a few AMUs – these vary widely, no two are the same
- Attend an ill medical patients’ acute care and treatment (IMPACT) course and acute medicine symposia and conferences (e.g. the Society for Acute Medicine annual national conference and the RCPE St Andrews’ Day Symposium)
- Get involved in an audit in the AMU