Policy responses and statements

Name of organisation:

Department of Health

Name of policy document:

Application for a New Medical Specialty - Acute Internal Medicine

Deadline for response:

20 February 2009

Background: The UK Academy has forwarded a letter to the President from the Medical Education and Training section of the Workforce Directorate of the Department of Health. The letter states the following:

The Joint Royal Colleges of Physicians Training Board has applied for the recognition of a new specialty in Acute Internal Medicine. Although many doctors, commissioners and employers believe that there is training in a specialty of acute medicine, none exists. Most of the trainees are training in general internal medicine; a few trainees are training in the subspecialty acute medicine. JRCPTB use the working title GIM (acute); the present content of GIM has a significant acute medicine emphasis.

Recognition of a new medical specialty of Acute Internal Medicine has therefore been proposed because:

• There is a need for employers, commissioners and most of all patients to be clear that the doctor employed and dealing with acute medical problems has a specialty in that discipline. GIM is a widely recognised specialty in Europe, the present content is at odds with the rest of Europe Also a revision to the curriculum content and assessment system to facilitate the achievement of dual CCTs would be welcomed.
• As certification and revalidation are implemented, there is a need for Doctors to have a certificate in the relevant specialty.
• Presently there is a mismatch between what is best for patients and service in terms of clarity, both in terms of skills and in qualification, and the present CCT in GIM.

This request has support from Postgraduate Medical Education and Training Board, the Specialty Advisory Committee in General Internal Medicine and the lead Dean.

However, there is a protocol for the formal consideration of such proposals. This requires consultation with the service, educational and other interests before regulations are amended to include a new specialty. The purpose of this letter is to establish how such a specialty would sit alongside other specialties in terms of service provision and education. The DoH would very much welcome views generally, and specifically on:

- The effect this new specialty would have on service both in primary and secondary care and in relation to gaps in current provision. In particular, the potential of a new specialty to stimulate the provision of services in new ways and across traditional boundaries

- The inter relationship with other specialties and the effect a new specialty would have on them

COMMENTS ON
DEPARTMENT OF HEALTH
APPLICATION FOR A NEW MEDICAL SPECIALTY: ACUTE INTERNAL MEDICINE

The Royal College of Physicians of Edinburgh is pleased to respond to the Department of Health on Application for a New Medical Specialty: Acute Internal Medicine.

The Royal College of Physicians of Edinburgh (RCPE) as one of the sponsors of the Joint Royal Colleges of Physicians Training Board (JRCPTB) supports strongly the application for the new specialty of Acute Internal Medicine (AIM).

The new speciality is necessary to ensure doctors develop competencies to deal with the acutely unwell patient in the early phases of their illness. This builds on the high quality care delivered currently by a combination of specialist acute physicians and other physicians participating in the acute care rotas.

Doctors in  AIM will acquire specialist skills to level 3 of the curriculum to support HDU (level 2 care) as defined in the Acute Medical Task Force Report and the Consensus Statement published by the RCPE  to be able to work closely with critical care.*    This will involve dedicated rotations in relevant medical specialties to ensure AIM is integrated into medical and critical care within a hospital and not be seen as a specialty silo. It is therefore essential for the AIM curriculum to retain all current General Medicine competencies.

Current trainees in Acute Medicine must not be disadvantaged and a transition phase or process should be constructed so their training is recognised i.e. GIM/Acute Medicine on the specialist register. Clear advice to all trainees about the amount of experience required to achieve accreditation whether through CESR or the CCT route is essential.

In answer to the specific questions:

The effect of AIM on primary and secondary care

Acute Medicine is the largest interface with primary care in terms of numbers of patients admitted to hospital and the contact time. As such, developing interfaces with primary care are essential and include the development of ambulatory care as a recognised and high quality care pathway.

The inter-relationship of AIM with other specialities

Acute Medicine has developed as an exemplar of multi-professional working and this must be maintained and developed in line with patient need. Interrelationships with all medical specialties must be fostered and it is imperative that AIM does not become isolated. In most hospitals the emergency admission rota will be covered by a combination of physicians in AIM and in other medical specialties.

*
Acute medical care. The right person, in the right setting – first time. Report of the acute medicine task force. RCPL. October 2007

RCPE Consensus statement on Acute Medicine. November 2008

Copies of this response are available from:

Lesley Lockhart,
Royal College of Physicians of Edinburgh,
9 Queen Street,
Edinburgh,
EH2 1JQ.

Tel: 0131 225 7324 ext 608
Fax: 0131 220 3939

[20 February 2009]