Participant Guidance
Proof of concept study of the use of
Competencies in Practice (CiPs) in internal
medicine
Contents
What is the proof of concept study?
The aim of the study
Timeline
What will I be expected to do in the study?
Roles and Responsibilities
Making ‘entrustment decisions’
What are the Internal Medicine CiPs and how are they assessed?
Other recommended support materials
In addition to the contents of this guide the following materials are also available. We will be developing the FAQ section
so please check our dedicated webpage throughout the process.
ePortfolio user
guides
ePortfolio videos
Frequently Asked
Questions
HELPDESK: support is available throughout the process from our dedicated team via [email protected] or
0203 075 1625 or 0203 075 1287
What is the proof of concept study?
As you know the JRCPTB is currently developing the new internal medicine curriculum on behalf of the Federation of the
Royal Colleges of Physicians.
An integral part of this work involves the development of a supporting assessment system. The present curricula for
physician training are based on achieving a large number of individual competencies that are assessed throughout
training by a variety of different methods. An improved, more authentic, simplified and more easily deliverable system
for assessing progress through the new curricula could be attained by centring the curriculum on a smaller number of
outcomes rather than multiple detailed competencies.
We propose to describe training outcomes as ‘Competencies in Practice’ (CiPs) and have identified 14 CiPs for internal
medicine (See table 1: The Internal Medicine CiPs) that collectively cover the key professional activities expected of a
fully trained physician.
Within each CiP we have described four ‘levels’ at which a trainee may be judged to be performing (See table 1: The
Internal Medicine CiPs). Ascribing a specific level to each CiP for each trainee will allow progress to be gauged and to
relate progress to what tasks are actually performed in the clinical workplace and the level of supervision that the task
must be performed under.
This approach is not an alternative to competency-based education, but an evolution of that concept that can usefully
translate competency into real life clinical practice.
The successful implementation of an outcome-based model of training depends on the ability of supervisors to make
judgements about a trainee’s performance in relation to a number of broad, observable outcomes of relevance to the
delivery of patient care. That is, judgements about what ‘level’ the trainee is performing at in each of the 14 CiPs. We
have currently called these judgements ‘entrustment decisions’.
Full details of the CiPs and levels are provided below – essentially, when a trainee is adjudged to be performing at level 4
for each of the 14 competencies in internal medicine, and to have completed other mandatory aspects of training
(including specialty-specific CiPs), they will be considered to have fulfilled the requirements of the training programme.
Given that this approach is significantly different from the current system, is currently largely conceptual, and may have
significant impact on training and education practice, we wish to explore its feasibility and acceptability in the UK NHS
setting in a controlled way before considering implementation and for that reason have entitled this study ‘Proof of
Concept’. Our study has been sponsored by our partners Health Education England, NHS Education Scotland and the
Wales Deanery.
The aim of the study
The study will explore:
1. Whether clinical and educational supervisors are able to make entrustment decisions, in a range of clinical
specialties and learning environments, across the entire range of 14 different ‘CiPs’ and four different
performance levels.
2. What types and forms of evidence supervisors require, and trainees feel are necessary, to make such
decisions.
3. Whether trainees and supervisors find the approach more or less acceptable than the current approach.
Specifically is it more or less complex, more or less time consuming, and more or less fair.
4. Whether the currently proposed ‘levels’ (1-4) are equally meaningful, useful and helpful for all of our
proposed CiPs
5. Whether face-to-face training is perceived as helpful to participants.
Timeline
In order to make this as an authentic experience as possible we shall be asking the participants to complete their
paperwork in July, post-ARCP (where possible). This will enable us to consider the role of CiPs at a time when usual end
of training year assessments are underway and trainee portfolios should be completely up to date.
The summary timeline is as follows:




Face to Face training sessions and electronic guidance materials released - June 2016.
Trainees/Supervisors complete the forms and survey – July 2016
Evaluation team consider the data - July to August 2016
Evaluation complete - October 2016
IMPORTANT: The proof of concept study is to be conducted entirely separately from the ARCP. Under no
circumstances should the paperwork completed as part of the study be used to inform the ARCP process.
Supporting materials
In addition to the contents of this guide the following materials are also available on our dedicated webpage
ePortfolio user
guides
ePortfolio videos
Frequently Asked
Questions
HELPDESK: support is available throughout the process from our dedicated team via [email protected] or
0203 075 1625 or 0203 075 1287
What will I be expected to do in the study?
Participating trainees have been linked with their clinical and educational supervisors in the existing ePortfolio.
Each participating trainee will be required to attend one meeting with their educational supervisor. At these meetings
they will discuss progress in relation to each CiP and agree a level at which they are currently performing. Newlydeveloped forms will be used by both the clinical and educational supervisors to rate the trainee’s progress against 14
internal medicine CiPs, using a clearly defined framework of levels.
1. Before each meeting
Trainees will
a) Ensure that at least one clinical supervisor has completed an assessment of their performance using the new CiP
Study Clinical Supervisor Report.
b) Consider what evidence they need to provide to inform the decisions made about their performance at each CiP
c) Complete a CiP Study Trainee Self-Assessment and indicate the level at which they feel that they are performing
to inform the discussion with the educational supervisor. This form must be completed ahead of the meeting
with the educational supervisor.
Clinical Supervisors will
a) Review the trainee’s e-portfolio and consider their personal experience of the trainee.
b) Complete a CiP Study Clinical Supervisor Report indicating what level they feel the trainee is performing at for
each CiP. There is no requirement to discuss the completion of the report with the trainee, but its contents will
be available to the trainee once the form is submitted.
Educational Supervisors will
a) Review the trainee’s e-portfolio and consider the Clinical Supervisor report and trainee self-assessment that
have been provided on the new forms.
2. During each meeting
a) The educational supervisor – trainee pairs will discuss progress and performance and agree and document a
level of performance for each CiP on the CiP Study Educational Supervisor Report.
Note: If there is disagreement between a trainee and educational supervisor about their level of performance,
this will be specifically documented.
3. After each meeting
a) Trainees, clinical and educational supervisors will complete a short evaluation questionnaire
All participants will receive a letter confirming their participation upon receipt of the completed evaluation
questionnaire.
Roles and Responsibilities
Overview of the process
EDUCATIONAL SUPERVISOR
CLINICAL SUPERVISOR
TRAINEE
Completes clinical
supervisor report
Completes self assessment
form
Reviews completed clinical
supervisor report, trainee self
assessment form and
ePortfolio
EDUCATIONAL SUPERVISOR
AND TRAINEE
Face to face meeting to
discuss progress to inform
final decision
Trainees
You will obviously be integral to the process!
Trainees are asked to:
 familiarise themselves with the forms on the ePortfolio
 consider what evidence you will use to inform the ‘final entrustment decision’ made by your educational
supervisor in a face to face discussion
 make a self-assessment of your level of performance using the CiP Study Trainee Self-Assessment form
 ensure that at least one of our recruited clinical supervisor fills in a form about you.
Please note that there is no need to specifically link current evidence to the curriculum in this study as, in the future,
each CiP will be an integral part of, and thus clearly link to, the curriculum.
A key part of the study is to seek your views about the types and amount of evidence that you think it will be necessary
for a trainee to present to enable entrustment decisions to be made. Remember that some of our current sources of
evidence (for example, case based discussions) could eventually be regarded as unhelpful, or you may feel that other
sources that we do not currently use could be included in the new system. This is for you to decide!
This study relates only to internal medicine so please bear that in mind when considering your supporting evidence.
Key deadlines: We will need your support in ensuring that your clinical supervisor(s) has completed their paperwork by
Friday 15 July and that your educational supervisor has submitted their form by no later than Friday 29 July 2016. You
will need to complete the self-assessment form prior to the meeting with your educational supervisor.
Clinical Supervisors (CS)
As clinical supervisor you will have access to a new form which asks you to assign a level against each CiP. You will be
required to provide a small amount of commentary to support each CiP and will be required to summarise the evidence
you have used to make this judgment.
A key part of the study is to seek your views about the types and amount of evidence that you think it will be necessary
for a trainee to present to enable entrustment decisions to be made. Remember that some of our current sources of
evidence ( for example, case based discussions) could eventually be regarded as unhelpful for some or all CiPs, or you
may feel that other sources that we do not currently use could be included in the new system. This is for you to decide!
This study relates only to internal medicine so please bear that in mind when considering your supporting evidence.
Key Deadline: This form is the first step in the process so you must complete this by no later than Friday 15 July 2016.
Educational Supervisor (ES)
The educational supervisor is ultimately responsible for making the final ‘entrustment’ decision about the doctor in
training, awarding a level for each of the 14 CiPs.
What tools can be used?
We suggest three key sources of information that you can use to inform your entrustment decision.
1. New CiP Study Clinical Supervisor Report: you will have at least one new clinical supervisor report available for
your trainee. In this report the clinical supervisor will have rated the trainee against each CiP, noting additional
comments, feedback and detailing the evidence used to inform their rating.
2. Existing trainee portfolio: as now, you will have access to completed WPBAs and other evidence to inform your
final decision. Bear in mind however, that the type and volume of portfolio material could be different were this
system to be introduced into real practice. We need you to consider what will the minimum level of information
you feel you would require in the future will be.
3. Face to face meeting: all educational supervisors must finally meet with their trainee to discuss progress, their
self-assessment and discuss evidence the trainee believes supports attainment of particular levels.
A key part of the study is to seek your views about the types and amount of evidence that you think it will be necessary
for a trainee to present to enable entrustment decisions to be made. Remember that some of our current sources of
evidence ( for example, case based discussions) could eventually be regarded as unhelpful for some or all CiPs, or you
may feel that other sources that we do not currently use could be included in the new system. This is for you to decide!
This study relates only to internal medicine so please bear that in mind when considering your supporting evidence.
Key Deadline: The final version of the Educational Supervisor report must be submitted on the ePortfolio by Friday 29
July.
Making ‘entrustment decisions’
The new Internal Medicine curriculum is based around 14 competencies in practice (CiP) that we expect all doctors to
have demonstrated and be ‘trusted’ to be able to undertake by the time they complete their CCT. This aims to replace
the large number of tick box competencies in the current GIM and CMT curricula. It is fundamentally based on the
judgement of clinical and educational supervisors, informed by the evidence a trainee collects in their ePortfolio.
The new model of assessment will require educational supervisors to make a summative educational judgement on how
the doctor in training is progressing with their training against each of these 14 competencies in practice (CiP). These
judgements will be used to inform the ARCP. The decision making process at an ARCP records educational progress and
should never replace the day to day decisions about a trainee’s ability to deliver the service.
‘Levels’ of Performance
As outlined in the section What are the CiPs and how are they assessed? each CiP must be considered at four levels;
level 1, level 2, level 3 and level 4.
Level descriptors
CiPs 1-9 are clinical in nature and the following level descriptors apply:




Level 1: Observations of the activity – no execution
Level 2: Trusted to act with close supervision
Level 3: Trusted to act with supervision available quickly
Level 4: Trusted to act unsupervised (with clinical oversight within training)
CiPs 10-14 are non-clinical and have different descriptors:




Level 1: No or limited knowledge or experience
Level 2: Knowledge but limited experience, trusted to act with close supervision
Level 3: Knowledge and experience, trusted to act with guidance available
Level 4: Experienced and trusted to level of independent practice
Level 1
It is likely that Level 1 will have been achieved during Foundation training. However, in some cases supervisors may
consider that a trainee would benefit from observing an activity before being able to act under supervision.
Please note; level 1 should only be awarded where it genuinely reflects the level of supervision required. It should not
be used where there is insufficient evidence or the activity has not been observed. In these circumstances the option of
insufficient evidence / not observed should be selected on the report.
Level 2
At the start of Internal Medicine it is expected that most trainees will be trusted to act with close or direct supervision,
in accordance with the context in which they are working.
For example, a trainee may undertake a ward round without direct supervision but would be limited to what decisions
and actions they could take without confirming with a doctor at a higher level. Conversely, direct supervision may be
required for breaking bad news
Level 3
This level applies when the trainee is ‘trusted’ to undertake an activity not under close supervision but with supervision
available quickly.
Examples might include running an out-patient clinic with the consultant in the next room only discussing cases with
them at the end of the afternoon, or running an acute take overnight with a consultant available for regular post-take
ward rounds but on-call from home.
It is important that a clear decision has been made that a doctor is ‘trusted’ to undertake this activity and this is
documented during their training. This is a positive decision by a supervisor that they can move, and practice to level 3,
rather than at level 2 where they require close supervision at all times.
Level 4
The final level is level 4. Essentially level 4 means the clinical or educational supervisor is satisfied that the doctor in
training can act unsupervised, based on their judgements of the trainee’s performance and ePortfolio evidence.
It is only when level 4 has been reached in all 14 competencies in practice that a doctor can complete training and
receive a CCT. While they remain in a training programme they are still under clinical supervisor oversight as is the
situation now. A level 4 decision is a very important summative decision; the supervisor is saying that in their
professional judgement they are now ‘trusted’ to undertake this activity at the level of a CCT.
Appendix 1 outlines the grid detailing expected level by stage of training, against each of the CiPs.
What are the Internal Medicine CiPs and how are they assessed?
Each of the 14 CiPs are shown in table 1 and are key outcomes we expect doctors in training to demonstrate while
moving through their training.
In table 1 note that each of the 14 CiPs has





a number
a title
a bulleted list of key observable activities, tasks or behaviours that inform the achievement of that outcome,
a reminder of the level descriptors and the expected level at different stages of training
a list of the type of evidence that may have been collected in the ePortfolio which could supplement decisions
made by the clinical and educational supervisor based on observation of how the doctor has worked in the
workplace.
The clinical and educational supervisors are asked to make a judgement as to what level the trainee is performing at for
each CiP. Even where the trainee is making satisfactory progress, there is still an opportunity to reflect development
needs. In the event the trainee is not at the level expected for their stage of training it is essential to document what
level they are at, and why the expected level has not been reached.
To further assist decision making Appendix 1 summarises the expected levels for trainees for each CiP that we would
normally expect a trainee to have achieved by their year (or stage) of training ie ST1-ST7. It would be quite usual for
trainees to achieve a 3 or a 4 earlier than predicted in this grid. However any trainee achieving a 3 or 4 later than
predicted in this grid would normally have specific developmental requirements and should be listed in the comments
box on the form. Please refer to table 1 for the CiP descriptors, levels and suggested evidence.
Table 1: The Internal Medicine CiPs
CiP 1
Managing an acute unselected take
Descriptors (key
observable activities,
tasks and behaviours)


Level descriptors and
stage of training level
expected to be achieved
Suggested evidence to
inform decision
CiP 2
Descriptors (key
observable activities,
tasks and behaviours)
demonstrates behaviour appropriately with regard to patients
demonstrates behaviour appropriately with regard to clinical and other professional
colleagues
 demonstrates effective consultation skills including challenging circumstances
 demonstrates ability to negotiate shared decision making
 demonstrates effective clinical leadership
 accurate diagnosis of patients presenting on an acute unselected take over a standard
shift
 appropriate management of acute problems in patients presenting on an acute
unselected take over a standard shift
 appropriate liaison with specialty services when required
 Level 1: Observations of the activity – no execution (expected at Foundation level)
 Level 2: Trusted to act with close supervision – ST1
 Level 3: Trusted to act with supervision available quickly – ST3
 Level 4: Trusted to act unsupervised (with clinical oversight within training) – ST6
 CiP Study Clinical Supervisor Report
 MSF
 CbD
 ACAT
 Logbook of cases
 Simulation training with assessment (eg IMPACT)
Managing an acute specialty–related take






Level descriptors and
stage of training level
expected to be achieved



Suggested evidence to
inform decision






demonstrates behaviour appropriately with regard to patients
demonstrates behaviour appropriately with regard to clinical and other professional
colleagues
demonstrates effective consultation skills including challenging circumstances
demonstrates ability to negotiate shared decision making
demonstrates effective clinical leadership
appropriate continuing management of acute medical illness in patients admitted to
hospital on an acute unselected take or selected take
Level 1: Observations of the activity – no execution (expected at Foundation level)
Level 2: Trusted to act with close supervision – ST1
Level 3: Trusted to act with supervision available quickly – ST3
Level 4: Trusted to act unsupervised (with clinical oversight within training) – ST6
CiP Study Clinical Supervisor Report
MSF
CbD
ACAT
Logbook of cases
Simulation training with assessment (eg IMPACT)
CiP 3
Providing continuity of care to medical in-patients, including management of
comorbidities and cognitive impairment
Descriptors (key
observable activities,
tasks and behaviours)


Level descriptors and
stage of training level
expected to be achieved
Suggested evidence to
inform decision
CiP 4
Descriptors (key
observable activities,
tasks and behaviours)
demonstrates behaviour appropriately with regard to patients
demonstrates behaviour appropriately with regard to clinical and other professional
colleagues
 demonstrates effective consultation skills including challenging circumstances
 identifies and manages barriers to communication (eg cognitive impairment, speech and
hearing problems, capacity issues)
 demonstrates ability to negotiate shared decision making
 appropriate liaison with other specialty services when required
 appropriate management of comorbidities in medial inpatients (unselected take,
selected acute take or specialty admissions)
 demonstrates awareness of the quality of patient experience
 Level 1: Observations of the activity – no execution (expected at Foundation level)
 Level 2: Trusted to act with close supervision – ST1
 Level 3: Trusted to act with supervision available quickly – ST3
 Level 4: Trusted to act unsupervised (with clinical oversight within training) – ST6
 CiP Study Clinical Supervisor Report
 MSF
 ACAT
 Mini-CEX
 DOPS
 MRCP(UK)
Managing patients in an outpatient clinic, ambulatory or community setting, including
management of long term conditions




Level descriptors and
stage of training level
expected to be achieved
Suggested evidence to
inform decision










demonstrates behaviour appropriately with regard to patients
demonstrates behaviour appropriately with regard to clinical and other professional
colleagues
demonstrates effective consultation skills including challenging circumstances
accurate diagnosis and appropriate comprehensive management of patients referred to
an outpatient clinic, ambulatory or community setting
appropriate management of comorbidities in an outpatient clinic
appropriate management of comorbidities in ambulatory or community setting
Level 1: Observations of the activity – no execution (expected at Foundation level)
Level 2: Trusted to act with close supervision – ST1
Level 3: Trusted to act with supervision available quickly – ST3
Level 4: Trusted to act unsupervised (with clinical oversight within training) – ST6
CiP Study Clinical Supervisor Report
ACAT
mini-CEX
Patient survey
Letters generated at OP clinics
CiP 5
Managing medical problems in patients in other specialties and special cases
Descriptors (key
observable activities,
tasks and behaviours)
Level descriptors and
stage of training level
expected to be achieved
 demonstrates effective consultation skills including challenging circumstances
 management of medical problems in inpatients under the care of other specialties
 appropriate and timely liaison with other medical specialty services when required
 Level 1: Observations of the activity – no execution (expected at Foundation level)
 Level 2: Trusted to act with close supervision – ST1
 Level 3: Trusted to act with supervision available quickly – ST3
 Level 4: Trusted to act unsupervised (with clinical oversight within training) – ST6
 CiP Study Clinical Supervisors Report
 ACAT
 CbD
 MRCP(UK)
Managing a multi-disciplinary team including effective discharge planning
Suggested evidence to
inform decision
CiP 6
Descriptors (key
observable activities,
tasks and behaviours)
Level descriptors and
stage of training level
expected to be achieved
Suggested evidence to
inform decision
CiP 7
Descriptors (key
observable activities,
tasks and behaviours)
Level descriptors and
stage of training level
expected to be achieved
Suggested evidence to
inform decision


demonstrates behaviour appropriately with regard to patients
demonstrates behaviour appropriately with regard to clinical and other professional
colleagues
 demonstrates effective consultation skills including challenging circumstances
 demonstrates effective clinical leadership
 demonstrates ability to work well in a multi-disciplinary team, in all relevant roles
 Effectively estimates length of stay
 Identifies appropriate discharge plan
 Recognise the importance of prompt and accurate information sharing with primary
care team following hospital discharge
 Level 1: Observations of the activity – no execution (expected at Foundation level)
 Level 2: Trusted to act with close supervision – ST1
 Level 3: Trusted to act with supervision available quickly – ST3
 Level 4: Trusted to act unsupervised (with clinical oversight within training) – ST6
 CiP Study Clinical Supervisor Report
 MSF
 ACAT
 Discharge summaries
Delivering effective resuscitation and managing the acutely deteriorating patient










competence in assessment and resuscitation
able to promptly assess the acutely deteriorating patient, including those who are
shocked or unconscious
effective participation in decision making with regard to resuscitation decisions
Level 1: Observations of the activity – no execution (expected at Foundation level)
Level 2: Trusted to act with close supervision – ST1
Level 3: Trusted to act with supervision available quickly – ST3
Level 4: Trusted to act unsupervised (with clinical oversight within training) – ST6
CiP Study Clinical Supervisor Report
DOPS
ACAT
CiP 8
Descriptors (key
observable activities,
tasks and behaviours)
Level descriptors and
stage of training level
expected to be achieved
Suggested evidence to
inform decision
CiP 9
Descriptors (key
observable activities,
tasks and behaviours)
 MSF
 ALS certificate
 Logbook of cases
 Reflection
 Simulation training with assessment (eg IMPACT)
Managing end of life and palliative care skills


demonstrates behaviour appropriately with regard to patients
demonstrates behaviour appropriately with regard to clinical and other professional
colleagues
 demonstrates effective consultation skills including challenging circumstances
 delivers appropriate palliative care and end of life care
 Level 1: Observations of the activity – no execution (expected at Foundation level)
 Level 2: Trusted to act with close supervision – ST1
 Level 3: Trusted to act with supervision available quickly – ST3
 Level 4: Trusted to act unsupervised (with clinical oversight within training) – ST6
 CiP Study Clinical Supervisor Report
 CbD
 Mini-CEX
 MSF
 MRCP (UK)
 Regional teaching
 Reflection
Achieving procedural skills
Please see the curricula/ARCP decision aids for procedures required in accordance with
stage of training
CMT Curriculum / CMT Decision Aid
GIM Curriculum / GIM Decision Aid
Level descriptors and
stage of training level
expected to be achieved
Suggested evidence to
inform decision
CiP 10
Descriptors (key
observable activities,
For each procedure:
 Able to outline the indications for the procedures and take consent
 Evidence of aseptic technique and safe use of analgesia and local anaesthetics
 Evidence of safe learning in clinical skills lab/simulation before performing procedures
clinically
 Level 1: Observations of the activity – no execution (expected at Foundation level)
 Level 2: Trusted to act with close supervision – ST1
 Level 3: Trusted to act with supervision available quickly – ST3
 Level 4: Trusted to act unsupervised (with clinical oversight within training) – ST6
 CiP Study Clinical Supervisor Report
 DOPS
Is focussed on patient safety and delivers effective quality improvement in patient care

raises concerns including errors, serious incidents and adverse events (including ‘never
events’)
tasks and behaviours)
Level descriptors and
stage of training level
expected to be achieved
Suggested evidence to
inform decision
CiP 11
Descriptors (key
observable activities,
tasks and behaviours)
Level descriptors and
stage of training level
expected to be achieved
Suggested evidence to
inform decision
CiP 12
Descriptors (key
observable activities,
tasks and behaviours)
 shares good practice appropriately
 demonstrates the delivery of quality improvement
 Level 1: No or limited knowledge or experience (expected at Foundation level)
 Level 2: Knowledge but limited experience, trusted to act with close supervision – ST1
 Level 3: Knowledge and experience, trusted to act with guidance available – ST2
 Level 4: Experienced and trusted to level of independent practice – ST6
 CiP Study Clinical Supervisor Report
 QIPAT / AA
 CbD
 Mini-CEX
 MSF
 TO
 Participation in / leading quality improvement project
 Reflection on complaints and compliments
 Record of attendance at clinical governance meetings and committees
Carrying out research and managing data appropriately

demonstrates behaviour appropriately with regard to managing clinical
information/data
 demonstrates understanding of principles of research and academic writing
 demonstrates ability to carry out critical appraisal of the literature
 understanding of public health epidemiology and global health patterns
 Follows guidelines on ethical conduct in research and consent for research
 Level 1: No or limited knowledge or experience (expected at Foundation level)
 Level 2: Knowledge but limited experience, trusted to act with close supervision – ST3
 Level 3: Knowledge and experience, trusted to act with guidance available – ST5
 Level 4: Experienced and trusted to level of independent practice – ST7
 CiP Study Clinical Supervisor Report
 GCP certificate
 Attendance at regional teaching
 Quality improvement project / critical analysis of data
 Poster presentations
 Journal club reports
 Higher degrees
 Supervision of trainee undertaking a project
Acting as a clinical teacher and clinical supervisor



ability and experience of teaching and training medical students, junior doctors and
other health care professionals
including:
- delivering teaching and training sessions
- effective assessment of performance
- giving effective feedback
able to supervise less experienced trainees in their clinical assessment and management
of patients
able to supervise less experienced trainees in carrying out appropriate practical
Level descriptors and
stage of training level
expected to be achieved
Suggested evidence to
inform decision
CiP 13
Descriptors (key
observable activities,
tasks and behaviours)
Level descriptors and
stage of training level
expected to be achieved
Suggested evidence to
inform decision
CiP 14
Descriptors (key
observable activities,
tasks and behaviours)
Level descriptors and
stage of training level
expected to be achieved
Suggested evidence to
inform decision
procedures
 able to act a Clinical Supervisor to the standard required by the GMC
 Level 1: No or limited knowledge or experience (expected at Foundation level)
 Level 2: Knowledge but limited experience, trusted to act with close supervision – ST1
 Level 3: Knowledge and experience, trusted to act with guidance available – ST3
 Level 4: Experienced and trusted to level of independent practice – ST7
 CiP Study Clinical Supervisor Report
 MSF
 TO
 Observe undertaking a mini-CEX on a trainee
 Education course such as ‘doctors as educators’ etc
Dealing with ethical and legal issues related to specialty clinical practice





demonstrates behaviour with regard to professional regulatory bodies
remains up to date and fit to practise
demonstrates ability to offer apology or explanation when appropriate
understands the safeguarding of vulnerable groups
demonstrates ability to lead the clinical team in ensuring that medical legal factors are
considered openly and consistently
 Level 1: No or limited knowledge or experience (expected at Foundation level)
 Level 2: Knowledge but limited experience, trusted to act with close supervision – ST1
 Level 3: Knowledge and experience, trusted to act with guidance available – ST2
 Level 4: Experienced and trusted to level of independent practice – ST7
 CiP Study Clinical Supervisor Report
 CbD
 DOPS
 Mini-CEX
 MSF
 MRCP(UK)
 Reflective writing
 ALS certificate
 End of life care and capacity assessment
 e-learning / course with assessment
The ability to successfully function within NHS organisational and management systems










demonstrates behaviour appropriately with regard to managers and to management
requests
demonstrates ability to respond appropriately to complaints
demonstrates effective clinical leadership
demonstrates promotion of an open and transparent culture
Level 1: No or limited knowledge or experience (expected at Foundation level)
Level 2: Knowledge but limited experience, trusted to act with close supervision – ST2
Level 3: Knowledge and experience, trusted to act with guidance available – ST3
Level 4: Experienced and trusted to level of independent practice – ST6
CiP Study Clinical Supervisor Report
QIPAT / AA




MSF
CbD
Lead role in governance structures
Management course with practical application observed
KEY
AA
ALS
ES
IMPACT
Mini-CEX
MSF
TO
Audit assessment
Advanced Life Support
Educational supervisor
Ill Medical Patients' Acute Care and Treatment
Mini-clinical evaluation exercise
Multi source feedback
Teaching observation
ACAT
CbD
GCP
MCR
MRCP
QIPAT
Acute care assessment tool
Case-based discussion
Good Clinical Practice
Multiple consultant report
Membership of the Royal Colleges of Physicians
Quality improvement project assessment tool
Appendix 1 Outline grid of the proposed Internal Medicine Curriculum (V19)
SELECTION
PYA
Internal Medicine
Training level
Internal Medicine + Specialty
ST2
ST3
ST4
ST5
ST6
Ambulatory
Focus
Inpatients
Acute care
SPECIALTY
care/OPD
Level to be achieved by end of training year: Level 2: Acting with close supervision, Level 3: Acting with supervision available quickly, Level 4: Acting unsupervised (but still with consultant oversight)
1.
Managing acute unselected take
2.
12.
Managing an acute specialty-related
take
Providing continuity of care to medical
in-patients
Managing outpatients with long term
conditions
Managing medical problems in patients
in other specialties and special cases
Managing an MDT including discharge
planning
Delivering effective resuscitation and
managing the deteriorating patient
Managing end of life and palliative care
skills
Delivering effective quality
improvements in patient care
Carrying out research and managing
data appropriately
Acting as a clinical teacher and clinical
supervisor
Dealing with ethico-legal issues
13.
Working with NHS systems
14.
Achieving procedural skills
3.
4.
5.
6.
7.
8.
9.
10.
11.
Learning should
include:
Assessment must include:
ST1
2
3
2
2
4
3
4
3
4
2
3
4
2
3
4
2
3
4
2
3
4
2
3
4
2
3
4
2
2
2
2
3
4
3
4
3
4
2
3
3
4
Minimum 4/12 Geriatrics
12/12 acute take (Year 3)
Minimum 4/12 AMU
Minimum 4/12 ITU/HDU
Minimum 100 clinics (at least 40 in year 2), can be community based
Clinical improvement project
MRCP(UK)
ST7
4
Minimum of 1 year of contributing to acute take (unselected or within specialty) with ongoing
in-patient responsibility. Minimum of 3/12 in final year
Outpatient clinics in one of more specialties other than main specialty
Clinical improvement project
Evidence of generic capabilities and internal medicine within 2 years of CST
SCE/KBA in main specialty