JRCPTB
Key points from the new CMT
GIM curricula
Guide for trainers and trainees
Rationale for change
• 2007 curricula split into 2 parts - GIM/acute and generic
• Need simple way of clearly linking to GMC Good Medical
Practice which will enable relicensing for Juniors
• Need to retain good features e.g. Top 20 presentations,
linkage of competences to assessments, use of ePortfolio
• Need to link to 2009 Academy work that all curricula will
have a common competences section (replaces generic)
• MRCP (UK) did not map to CMT curriculum and not
necessary to complete Core training i.e. position of exam
unclear
• Levels 1,2 and 3 not easily defined
• Trainee and service pressure to redevelop clarity over
specialty of GIM and loss of dual CCT
• JRCPTB desire to support separate specialty of Acute
Medicine
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Moving from the two Curricula of 2007
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To a new single curriculum for
2009
Moving from a career pathway like this
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Moving to a career pathway like this
Selection
FY2
36 to 60 months
to completion
minimum
Selection
Core Medical Training or
Acute Care Common Stem
GIM Training
MRCP (UK) and WPBAs
Work place based assessments
JRCPTB
Moving to a career pathway like this for
dual CCT
Selection
60 months to
completion
minimum
Selection
Specialty
Core Medical Training
Specialty
FY2
GIM
MRCP
Work Placed Based Assessments
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Main features (1)
• Core competences have replaced the generic
curriculum and will underpin all speciality
curricula
• 4 Emergency, ‘Top 20’ and ‘Other Presentations’
remain
• All parts of the curricula have mapped
assessments
• MRCP in its three components Part 1, Part 2
and PACES maps to all parts of the curriculum
for the CMT stage of GIM training and is
necessary for full completion of CMT
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Main features (2)
• Spiral curriculum remains,GIM represents
‘maturation’ of the CMT trainee
• For system and symptom specific competences
clearly defined,assessments will ‘sample’ the
curriculum. One assessment will usually cover
several areas of the curriculum.
• Procedural competences clearly defined
• Progression through the full curricula well
defined by the decision aids
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Examples of the new layout
Curriculum starts with common
competences
Layout of syllabus
• Standardised throughout – knowledge, skills,
behaviours
• Assessment methods highlighted e.g. CbD,
ACAT and mini-CEX
• Four Domains of the new framework for GMC
Good Medical Practice which each item relates
to highlighted
• For Common Competences – descriptor levels
described 1-2, relevant to CMT and 3-4
Specialty training
• Will be linked and “made live” by ePortfolio
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• Will enable
Relicensing for
Junior Doctors by
providing evidence
such as work place
based assessments
and MRCP attainment
from the ePortfolio
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Emergency presentations
Top 20 Presentations
Other important presentations
System specific competences
Moving from just a computer exercise
• New curricula will be
fully integrated with
ePortfolio
• Competences will be
achieved from work
place based
assessments and
MRCP
• Consultants playing
an active part in this
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CMT e-Portfolio Assessors
Aug 08 – May 09
ACAT
Average
percentage overall
rating
44
5.04
Consultant
4087
SpR
4771
52
SAS
399
4
5.09
CMT e-Portfolio Assessors
Aug 08 – May 09
CBD
Average
percentage overall
rating
45
5.00
Consultant
4134
SpR
4604
51
SAS
357
4
5.07
CMT e-Portfolio Assessors
Aug 08 – May 09
mini-CEX
Consultant
3215
28%
5.04
SpR
7268
63%
5.11
SAS
4%
Nurse
1%
GP
0
SHO
2%
Other
2%
Key to progression is the ARCP
decision grid
• Based on feedback from users e.g. CMT
Committee and HoS
• Recognises portfolio review at 8,16 and 23
• ARCP annual at 11or 12 and 23 or 24
• More clarity e.g. numbers of assessments in
each 8 month block and minimum by consultants
• Explicit about achievement of all parts of MRCP
being necessary for full completion of CMT and
attainment of CMT certificate
JRCPTB
Core Medical Training ARCP Decision Aid – standards for recognising satisfactory progress
Month
8/9
ePortfolio review (locally)
Common Competences (25)
CMT Year 2
ARCP at
month 11
or12
Month 16
ePortfolio review (locally)
Competent in minimum half of areas at level
1 and half of level 2 descriptors (ACAT/
CbD/ mini-CEX/ MSF)
Competent in minimum of a third at
level 1 or 2 descriptor (ACAT/ CbD/
mini-CEX/ MSF)
Review progress against month 8/9 targets
Year 1 MSF completed and satisfactory.
Month 22/ 23
ePortfolio review
(locally)
Competent in all to
level 2 descriptor
(ACAT/ CbD/ miniCEX/ MSF)
Competent in all
(ACAT/CbD/ mini-CEX )
Competent in all
(ACAT/ CbD/ miniCEX)
Competent in half
(ACAT/ CbD/ mini-CEX)
Competent in all
(ACAT/ CbD/ miniCEX)
Competent in half
(ACAT/ CbD/ mini-CEX)
Competent in
minimum of 34/40
(ACAT/ CbD/ miniCEX)
Independent in at least two thirds (DOPS)
Independent in 15/17
(DOPS)
Examinations
Review MRCP Pt1/Pt2 progress
Enables achievement of
competences
Review MRCP Pt1/ Pt2 /PACES progress
Enables achievement of competences
Ensure MRCP(UK)
diploma acquired
Enables achievement
of competences
ALS
Valid
Valid
Valid
Minimum number of workplace
assessments by Consultant Assessor
in each 8 month Block
3
3
3
Emergency Presentations (4)
Some experience of all
(ACAT/ CbD/ mini-CEX )
Top 20 Presentations (20)
Some experience of half
(ACAT/ CbD/ mini-CEX)
Other Presentations (40)
Competent in a quarter
(ACAT/ CbD/ mini-CEX)
Procedures (17)
Independent in at least half (DOPS)
Annually
Required
Events giving concern
X ACAT
X CbD
X mini-CEX
1
X MSF
DOPs until independence in
procedures demonstrated
3
3
3
X
X
X
ACAT
CbD
mini-CEX
ARCP at
month
23 or24
3
3
3
Review progress against month 22/23 targets
CMT Year 1
X ACAT
X CbD
X mini-CEX
1
X MSF
DOPs until independence in
procedures demonstrated
The following events occurring at any time may trigger review of trainee’s progress and possible remedial training: issues of
professional behaviour; poor performance in work-place based assessments; poor MSF performance; issues arising from supervisor
report; issues of patient safety
Key to implementation will be
continuing use of ePortfolio
Will look the same
Link to new curricula
Will still be able to link a number of competences to
single assessment and now include parts of MRCP
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Example portfolio
MRCP(UK)
• Fully mapped to CMT part of GIM curricula
• There was a change in regulations in 2008
• Part 1 can still be taken in FY2 year as previously but
now can be taken after one years experience as
opposed to 18 months
• Part 2 and PACES can be taken simultaneously if
wanted
• CMT final certification of completion requires full MRCP
(career progress with this during training will be
monitored with ARCP and depending on progress may
be extended in exceptional circumstances for some
trainees for >2 years)
JRCPTB
Significant task of implementation
• All new 2009 CMT trainees start on new
2009 GIM curricula on CMT part
• CMT trainees who started in 2008 will
complete the 2007 curricula (acute
conditions and generic) on which they
started
• Need to inform trainees and trainers of
change which starts in August 2009
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CMT part of new curriculum
Affects 2000 trainees and trainers
from August 2009
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Specialty training in GIM
Implementation of the GIM
curriculum in acute medical
specialties
• Passing of MRCP(UK) is now one of the main
required competences to exit from CMT
• ePortfolio used to record acquisition of
competences
• Logbook of anonymised patient contacts where
possible,’experience’ prior to August 2007 will
be accepted
• GIM competences will usually be acquired on
the acute medical take and in triaged in-patient
wards and specialty outpatient clinics
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GIM progression(1)
• ARCP crucial
• Documentary evidence of WPBA’s
essential
• HOS’/SAC SHA reps will need to
establish close links with GIM and acute
medical specialty training program
directors to ensure that specialty STC’s
have a designated GIM- responsible STC
member.
JRCPTB
ST3 to CCT ARCP Decision Aid – standards for recognising satisfactory progress
st
nd
1 Year GIM
Common Competences
Management and leadership
General Internal Medicine Acute
Medical Presentations (Symptom
Based Competences)
Competent at level 3 or 4 descriptors in
minimum of a third (assessed by
ACAT/CbD/PS/mini-CEX /Teaching
Observation)
Demonstrate acquisition of leadership skills in
supervising the work of Foundation and Core
Medical trainees during the acute medical
2
rd
Year GIM
Competent at level 3 or 4 descriptors in
minimum of two thirds (assessed by
ACAT/CbD/PS/mini-CEX /Teaching
Observation)
Demonstrate implementation of
evidence based medicine whenever
possible with the use of common
guidelines
3 Year GIM
Competent at level 3 or 4 descriptors in all
(assessed by ACAT/CbD/ PS/mini-CEX
/Teaching Observation)
Able to supervise and lead a complete
medical take of at least 20 patients
including management of complex
patients both as emergencies and in
patients
Able to supervise more junior trainees and
to liaise with other specialties.
Awareness and implementation of local
clinical governance policies and
involvement in a local management role
within directorates, as an observer or
trainee representative
take
Demonstrate good practice in teamworking
and contributing to multi-disciplinary teams.
Demonstrate senior clinical management skills
for Top 20 presentations and knowledge of at
least half of the ’Other Presentations’
Competent in the senior-level clinical
management of all Top 20 and the Other
Presentations including some complex cases
involving inpatients and acute take patients
Successful completion of at least 2 GIM
audits
Demonstrate adequate creation of
management and investigation pathways
and instigation of safe patient treatment
for all of the top 20 and ‘Other
presentations’ including the vast majority
of complex cases that would be
encountered in inpatients and on the
medical take.
valid
valid
Examination
MRCP(UK) diploma held
ALS
valid
Annually Required
1 satisfactory MSF, 1 Patient Survey
Logbook
Minimum of 1000 patients as seen on acute take during the period of dual training with evidence of individual activity to be provided. A
minimum of 450 new or outpatient referrals (including ambulatory care) and a minimum of 1500 follow-up outpatients during the period of dual
training with evidence of activity provided. Evidence must be provided of a minimum of 100 hours external GIM training during the period of
dual training
Minimum number of work place
assessments by Consultant
Assessors per year
6 x ACATs; 4 x CBDs; 4 x mini-CEX; Audit Assessment where relevant
To be spread throughout the year
Events giving concern
The following events occurring at any time may trigger review of trainee’s progress and possible remedial training: issues of professional
behaviour; poor performance in work-place based assessments; poor MSF performance; issues arising from supervisor report; issues of
patient safety
1 satisfactory MSF, 1 Patient Survey
GIM progression(2)
• TPD’s/college tutors and educational
supervisors must ensure that the eportfolio is properly completed,ARCP’s are
properly conducted and that trainees are
gathering their documentary evidence.
• JRCPTB will need to link more closely to
STC chairs and TPD’s
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Current status of trainees re
CCT in GIM
• Pre January 2003,dually accrediting-no change
• January 2003-July 2007,dually accrediting-no
change
• July 2007-July 2009,recruited into single
medical specialty training,eligible for level 2
credential in GIM/Acute Medicine: will be able to
apply to transfer to the new GIM curriculum and
then progress to a CCT in GIM as well as their
specialty provided that the curricula
requirements are fulfilled.
JRCPTB
Current status of July 2007-July
2009 GIM/Acute level 3 STR’s
• The 350 STR’S in this group can remain in their
current training programs where they will
receive a CCT in GIM/acute medicine.or,
• They can apply to transfer to the new acute
medicine curriculum once this has PMETB
approval and acute medicine is recognised as a
speciality.This new curriculum will award a CCT
in Acute Medicine,provided the training program
is successfully completed.
JRCPTB
Questions about CCT’s
• Can level 3 GIM/acute STR’s obtain a new GIM
CCT as well as an acute medicine CCT? (yes,in
theory)
• Can level 2 GIM/acute STR’s transfer to the new
acute medicine curriculum?(no ,but they can get
a GIM/acute CCT by completing a one year
MAU-based high quality training post)
• Are there any legal/mandatory problems in
allowing transfer for level 2 trainees without
external assessment of their training but by
‘sampling’ of trainee portfolios in each
deanery?(should be OK)
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Communication plan
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Heads of Schools
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RAs
SACs
RCP Trainees Committee
CMT Committee
College Tutors
Educational Supervisors
Fellows
Trainees
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JRCPTB
How will GIM/Acute Trainees
transfer to the new GIM
curriculum?
From October 2009
Required evidence(1)
• WPBAs as defined in the GIM (Acute)
ARCP Decision Aid
• Minimum:
– 3 ACATs (aiming for 6), 4 mini-CEX and 4
CbD per year;
– DOPS until independence in procedures
demonstrated;
– MSF
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Required evidence(2)
• Evidence of attendance at a minimum of
70% of Deanery training days where 2
hours of GIM is provided
• Evidence of attendance at a minimum of
35 hours per year of external GIM
conferences or courses
• A proportion of this training can be
achieved by recognition of e-learning
modules
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Required evidence(3)
• Personal management of an indicative
number of 300 patients per year admitted
on the general medical “take”
• Personal management of equivalent over
3 years of 450 new outpatients/and or
inpatient complex referrals or ambulatory
care patients
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Required evidence(4)
• Demonstrated senior level competence in
the Top 20 and Other Presentations
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Outpatients
• 450 new out patients over the duration of
training can include new interfirm referrals
• It is essential that logbooks are used to
record OP and interfirm referral numbers
• Workplace-based assessments are the
key to providing documentary evidence of
GIM exposure
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Outpatients experience
• Usually in the primary specialty
• Can be obtained in clinics in other
specialties
• Minimum of 450 new or referral patients
over dual training period
• Minimum of 1500 follow up patients over
the dual training period
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Context of in and out patients
• GIM experience can be accumulated in
specialty in patient wards and in specialty
out patients where patients often have
multisystem conditions.This will usually
occur in the trainee’s own specialty.
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Transferring to GIM in ST4(2008
entry) and ST5 (2007 entry)
• ST4 trainees will transfer at their ARCP
conducted in the presence of local GIM STC.
• ST5 trainees will transfer at their PYA or ARCP
(whichever is sooner) in the presence of local
GIM STC. This will require more time for these
PYA’s and new documentation from JRCPTB to
facilitate a review of training before the PYA.
• Externality will be provided by the SAC
‘sampling’ the PYAs and ARCPs on a random
basis to ensure even quality.
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