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More General Medicine on the agenda with launch of IMT programme

2019 is a significant year for Advanced Internal Medicine in the NHS.

This year sees the introduction of Internal Medicine Training (IMT) programme for juniors.

In response to the recommendations set out in the Shape of Training Report, and the realisation that the NHS needs more generalists to deal with the growing demographic pressures, a new model for future physician training has been developed.

Internal Medicine Training (IMT) will form the first three years of post-foundation training and, for the main specialties supporting acute hospital care, an indicative 12 months of further internal medicine training will be integrated flexibly with specialty training in a dual programme.

It replaces the two-year Core Medical Training (CMT) programme from August 2019.

The Joint Royal Colleges of Physicians Training Board, which has developed the IMT programme, says this will ensure that CCT holders are competent to practise independently at consultant level in both their specialty and advanced internal medicine.

This model will enhance the training in internal medicine and will prepare doctors for the management of the acutely unwell patient, with an increased focus on chronic disease management, comorbidity and complexity.

The JRCPT says generic professional capabilities as set out in the GMC’s framework will be embedded in all curricula to emphasise the importance of these professional qualities as well as helping to promote flexibility in postgraduate training.

IMT will be a three-year programme which will prepare doctors to become a medical registrar and provide them with the skills needed to manage patients presenting with a wide range of general medical symptoms and conditions.

Experience in intensive care medicine, geriatric medicine and outpatients will be mandated and trainees will receive simulation training throughout the programme.

Holistic decisions on progress will be made for the fourteen high level capabilities in practice (CiPs) using the professional judgement of appropriately trained, expert assessors. This represents a significant move away from the much criticised ‘tick box’ approach of previous curricula, says the JRCPT.

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SPECIALTIES IMPLEMENTING 3-YEARS IMT:

The following specialties will require completion of a full 3-year IMT for juniors to progress:

  • Acute Internal Medicine
  • Cardiology
  • Clinical Pharmacology and Therapeutics
  • Endocrinology and Diabetes Mellitus
  • Geriatric Medicine
  • Gastroenterology
  • Genitourinary Medicine
  • Infectious Diseases (except when dual with Medical Microbiology or Virology)
  • Neurology
  • Palliative Medicine
  • Renal Medicine
  • Respiratory Medicine
  • Rheumatology

How will IMT differ from CMT?

  • IMT will deliver a training programme which enhances morale, values doctors in training and is ultimately better for patients
  • The 3 years of IMT is intended to equip doctors to lead with confidence the care of general ward and acute take patients
  • The length of the programme will better prepare trainees, providing supported progression for the medical registrar role
  • This is not just CMT plus one year. This is a completely reformed programme and represents a new era in physician training
  • It is hoped that more people training in Internal Medicine and the physician specialties will reduce rota gaps
  • There will be wider exposure to medical specialties including dedicated experience in ICU
  • It will provide improved access to outpatient experience
  • Trainees will be supported though a three-year programme as they progress through the MRCP Exam.
  • There will be graded and supported increase in responsibility across the 3 years of the programme
  • The JRCPTB will ensure that Educational Supervisors have access to a training package that will enable them to successfully provide strengthened and focused support alongside the assessment of the new Generic Professional Capabilities
  • A new assessment system will be in place to ensure that IMT trainees are assessed in both formative and summative ways, reducing the concerns about tick-box assessments
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