General Internal Medicine (GIM)

The 2009 General (Internal) Medicine curriculum is designed to ‘equip trainees in specialty training programmes with the competences needed to allow participation at a senior level on the acute medical take, and to provide advice on the investigation and management of inpatients and outpatients with acute and chronic medical problems’ (JRCPTB 2009). Health Education Kent, Surrey and Sussex fulfils all GIM curriculum requirements for Specialists Registrars seeking to obtain dual accreditation in their speciality plus GIM. Throughout their two to three years of GIM training our SpRs have regular commitment to acute unselected medical take of varying but usually high intensity. This affords them invaluable opportunities for experiential learning in GIM and development of leadership, supervisory and teaching skills.

Experiential SpR training in General Internal Medicine is supplemented and enhanced by internal and external GIM CPD. Internal CPD is assured by formal lectures, tutorials, grand rounds, multidisciplinary and radiology meetings. Each year HEKSS also provides 5 days of external GIM CPD, mapping to the GIM Curriculum. This helps to ensure that our specialist registrars meet their requirement of 100 hours GIM CPD by the time of CCT.

Essential to SpR training are the processes of interim review (IR) and review of competencies for progression (ARCP). During those years when they are involved in acute general medical take, specialist registrars who are dually accrediting undergo separate interim review and ARCP in GIM as well as their parent specialty. These reviews are conducted at HEKSS by members of the GIM STC, who ensure that SpRs are on track for GIM accreditation. We ensure that no unforeseen mandatory targets, which could prolong training time, are identified by the external SAC GIM assessor at Penultimate Year assessment, prior to the award of a CCT in GIM. This review process also provides us with excellent opportunity for SpR counselling and guidance regarding the JRCPTB GIM curriculum.

Which Trusts should I apply for to gain experience in G(I)M?

There is no need to worry about choice of Trust within HEKSS for delivery of your G(I)M training. This will mainly depend upon the requirements of your parent specialty training; your specialty Training Programme Director will construct a rotation for you.

All our Trusts guarantee excellent experience in every aspect of G(I)M which you will need to equip you to become an accredited consultant physician in  G(I)M.  Our general medical case mix is broad, as our patient population comprises all socioeconomic groups, which are of diverse ethnicity and wide age range.  We have Trusts close to the M25 motorway; near the two major national airports, Heathrow and Gatwick; in the countryside and at the coast (including our Teaching Hospital, Brighton and Sussex University Hospital). These offer a wide range of acute take experience in all varieties of hospital admissions.

How is G(I)M training delivered at HEKSS Trusts?

SpR training in G(I)M is gained experientially by managing patient admissions on the acute take.  You will be guided by our HEKSS consultant physicians who are are professionals dedicated to managing acute medical admissions. Most of us participate in the acute take as lead consultant on call, while the others (for example- cardiology, renal and gastroenterology physicians) provide 24 hour support and conduct seperate intra- and post –take ward rounds. This multi-specialty consultant input to the acute on-call not only enhances patient care but also affords additional specialty experiential learning and support.

You will also gain considerable G(I)M experience through day to day care of inpatients on the wards and outpatient clinics. Internal CPD is assured by formal lectures, tutorials, grand rounds, multidisciplinary and radiology meetings which take place at all our Trusts.

How is my G(I)M training planned ?

HEKSS has a Specialty Training Committee (STC) in G(I)M, with representatives from all specialties that dually accredit with G(I)M and, in addition, representatives from those specialties which currently are not involved in the on call, e.g.  Infectious Disease, Dermatology, Neurology, Haematolo-oncology.  We very much encourage membership from our cohort of G(I)M SpRs and trainee representatives from various medical specialties feedback suggestions for improvement at our twice yearly meetings.

What is the G(I)M curriculum and how is it assessed?

General (Internal) Medicine has its own separate curriculum.The aim of this is to ensure that you encounter all aspects of General Medicine in order to enable you to be the consultant leading the acute take by completion of your training period in your parent specialty.

Each spring HEKSS conducts separate Interim Reviews in G(I)M and members of the G(I)M STC  meet all  SpRs face to face.   This gives us invaluable opportunity to get to know our SpRs, offer advice and support and also obtain feedback on our posts so that we may make adjustments as necesssary.  The Interim Review process helps us to check that our SpRs are progressing smoothly along the spiral G(I)M curriculum and meeting all necessary targets for their Annual Review of Competence Progression (ARCP), which is conducted (usually)  remotely later in the year.

Twelve to 18 months before their estimated Certificate of Completion of Training (CCT) date SpRs undergo separate Penultimate Year Assessments in their parent specialty and G(I)M with the HEKSS G(I)M Training Programme Director and an external advisor from the JRCPTB Specialty Advisory Committee at which any outstanding goals are identified.

How else do I learn about the topics in the G(I)M curriculum?

At HEKSS we are pleased to provide separate Regional Training Days in G(I)M, of which there are 5 per year at rotating sites. At present all are delivered within the HEKSS region though we plan to hold some of our Regional Training Days centrally in London at SOAS from 2016.

GIM Regional Training Days are strongly linked to the GIM curriculum, often with a Training Day dedicated to a particular specialty. For example, we organise an annual Cardiology Masterclass in May and ‘No Frills Neurology’ at St. Georges Hospital in June.  Our Regional Training Days are extremely popular, and receive excellent feedback, not only for their educational content but also for giving our SpRs the opportunity to socialise and discuss aspects of their medical training in general and feedback suggestions to the STC representatives.

Each September we hold an internal Medicine Research and Development Day at Brighton, hosted by Prof Kevin Davies of Brighton and Sussex University Hospital. At this all SpRs in medical specialties have the opportunity to present abstracts on their personal work in the fields of audit, research, management innovation and complex or challenging cases they have encountered over the previous year. This is followed by our SpR awards ceremony at which acknowlegement is given to presenters of the best abstracts.

How am I prepared for the acute take?

HEKSS organises Registrar Ready courses to help our trainees achive a smooth trainsition from being a Core Medical Trainee working under the guidance of seniors to leading the acute take as admitting registrar.  With this is mind we have simulation training co-ordinated by our dedicated simulation lead Dr Michael Wilde. This gives our SpRs the opportunity to practice dealing with both routine and more challenging situations that occur in the acute setting.

How do I get help if I should need it?

For SpRs who may be experiencing problems in their training we have experienced physician supervisors who are willling and keen to act as mentors to ensure that never feel unsupported. Most of our physicians in HEKSS are trained as educators and have undertaken the HEKSS Qualified Educational Supervision programme.  We also have a lead who co-ordinates guidance and support.

Which HEKSS Trusts deliver G(I)M Training?

You may gain experience in G(I)M at all our Trusts, though the intensity of on call commitment and the number of patients admitted over 24 hours will vary. 

A Trainee Overview

I am currently an ST4 at East Surrey Hospital dual accrediting in Rheumatology and Internal medicine.  HEKSS is a large deanery with opportunities to train in a mixture of acute district general and tertiary hospitals including Brighton and London. In my experience so far, I have had broad training and exposure to multi-symptom disorders with a mixture of inpatient and outpatient commitments. In terms of the internal medicine, there is a highly varied caseload ensuring you are kept on your toes and thinking on your feet, no 2 days are the same and you are constantly testing all your medical knowledge and experience. It is immensely satisfying and rewarding seeing the immediate positive impact from treating acutely unwell patients during on calls, as well as the frequent opportunities working as part of a large multi-disciplinary team (MDT) with numerous opportunities to learn from others.

There are constant practical opportunities to consolidate your core procedural skills, and further enhance your skills as an all-round general physician.  I believe HEKSS offers unique and excellent opportunities to develop new skills in leadership, management and education with frequent regional training days which will all provide a strong backbone in preparation for life as a consultant.

Dr Othman Kirresh, Rheumatology SPR
East Surrey Hospital, Redhill

Meet the Training Programme Director

Ursula Davies, Consultant Physician and Rheumatologist, Surrey and Sussex NHS Trust

Ursula DaviesI am the Training Programme Director in General (Internal) Medicine for HEKSS. I chair the General Internal Medicine (GIM) Specialty Training Committee (STC), which co-ordinates delivery and assessment of the JRCPTB GIM curriculum in our HEKSS posts. All specialties that dually accredit with GIM, including: endocrinology and diabetes; cardiology; respiratory; medicine; rheumatology; geriatrics; acute medicine; nephrology; and infectious diseases, and have consultant representatives on the GIM STC.

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