RCPE Trainee and Members’ Committee Guidance on General Internal Medicine Curriculum

The introduction of the new 2009 General Internal Medicine Curriculum has caused much concern and uncertainty especially for those trainees considering transferring from the 2007 GIM (Acute) Curriculum. This was caused by conflicting information from deaneries and limited information on the JRCPTB website at the time of the curriculum introduction. Much has now been done to rectify the uncertainty but this document aims to answer some of the current concerns and provide advice plus resource links for the new 2009 General Internal Medicine Curriculum.

Rationale for the new curriculum

In recent years, there has been a rapid change in the organisation and delivery of care for patients with medical illnesses. The new General Internal Medicine curriculum reflects the change in practice in hospitals where “true” general medical wards and clinics are diminishing in number but also recognises that an increasing number of patients have complex medical problems involving multiple symptoms. Acute Medicine has rapidly developed as a specialty within general medicine allowing the immediate and specialist management of acutely ill patients within medical assessment units. However, specialist medical physicians must be prepared to accept continued responsibility for patients beyond the acute phase. Although the majority of these inpatients will be within their own speciality, often triaged from a medical assessment unit, they often have multiple ongoing medical conditions.

In preparation for the introduction of licensing and revalidation, the General Medical Council has translated Good Medical Practice into a Framework for Appraisal and Assessment which provides a foundation for the development of the appraisal and assessment system for revalidation. The 4 domains of the Good Medical Practice Framework for Appraisal and Assessment has been mapped to the new curriculum This has also provided the opportunity to define skills and behaviours which trainees require to communicate with patients, carers and their families.

PMETB has developed 17 standards in their document Standards for Curricula and Assessment Systems. The JRCPTB are undertaking a project to review and rewrite 27 specialty curricula to meet PMETB’s 6 new standards. These new curricula have improved content, design and usability compared to their predecessors.

The new 2009 GIM curriculum does not affect those trainees who began HST prior to August 2007. Trainees recruited to ST3 in August 2007 and August 2008 were expected to obtain a level 2 Competency in General Internal Medicine (Acute) and CCT in their speciality. These trainees expressed the strong wish to be able to achieve dual CCTs in GIM and another medical specialty. The introduction of the new curriculum allows these trainees to convert to the new curriculum and obtain a dual CCT. There are no additional costs to do this. ST3 Trainees commencing on the new curriculum from August 2009 will CCT in GIM.

Transferring to the new curriculum for 2007/2008 higher specialist trainees

There has been much debate and speculation as to the exact transfer process caused by an initial lack of information for both trainees, on the JRCPTB website, and deaneries through poor communication. The process now seems clearly defined and transfer has already begun for many trainees. It should be made clear that the transfer to the new GIM curriculum is optional and trainees have the right to continue on their original curriculum which will be supported until the end of their training. For those wishing to transfer a ‘request to transfer proforma’ must be completed and submitted to the JRCPTB and your deanery. Assessment for transfer will occur either at next ARCP or at a dedicated GIM ARCP depending on your deanery.

It should be stressed that detailed diaries or logbooks of patients seen retrospectively is NOT required. Trainees will be expected to provide a statement from their educational supervisor to confirm that the trainee has been involved with General Medicine during the retrospective period that is compatible with requirements of the new curriculum.

Case logbook for the new 2009 GIM curriculum

Once again there was an initial uncertainty of new and follow up patients needed for the case logbook and how these cases were to be recorded. The curriculum now states these numbers clearly. Those trainees who will dual CCT in GIM plus a medical speciality will have 5 years to collect these cases: 1000 new acute take, 450 new or outpatient referrals (‘this includes specialty clinics and ambulatory care patients’), and 1500 follow-up outpatients. Ambulatory care patients include those referred by other specialties while on call for medicine, day case patients and those attending speciality wards for specialist treatment. Data will be gathered from deaneries as to whether trainees struggle to achieve these numbers and if adjustments are necessary this will be made by the JRCPTB. Likewise some years may be more difficult to achieve numbers when in specialty posts but should be made up at district hospital placements.

The logbook for these cases is expected to go live on the eportfolio in the near future. In keeping with the Caldicott review of personally identifiable information details will only include patient initials and type of case. At the end of each year this will be signed off by your educational supervisor for ARCP. Until this is available on eportfolio an example logbook can be found at the first link below. For trainees transferring from the 2007 curriculum this record of cases should begin once the ‘request to transfer’ form has been acknowledged by the JRCPTB.

Specialty Training Curriculum for GIM August 2009