1. Key points from the new CMT GIM curricula
JRCPTB
Key points from the new CMT GIM curricula
Guide for trainers and trainees

2. Rationale for change JRCPTB
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
JRCPTB

3. Moving from the two Curricula of 2007

4. To a new single curriculum for 2009
JRCPTB
To a new single curriculum for 2009

6. Moving from a career pathway like this
JRCPTB

7. Moving to a career pathway like this
FY2
MRCP (UK) and WPBAs
GIM Training
Core Medical Training or Acute Care Common Stem
Selection
36 to 60 months to completion minimum
Work place based assessments
JRCPTB

8. Moving to a career pathway like this for dual CCT
FY2
MRCP
Core Medical Training
Selection
60 months to completion minimum
GIM
Specialty
Work Placed Based Assessments
Specialty
JRCPTB

9. Main features (1) JRCPTB
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
JRCPTB

10. Main features (2) JRCPTB
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
JRCPTB

11. Examples of the new layout
JRCPTB
Examples of the new layout
Curriculum starts with common competences

13. Layout of syllabus JRCPTB
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
JRCPTB

15. Will enable Relicensing for Junior Doctors by providing evidence such as work place based assessments and MRCP attainment from the ePortfolio
JRCPTB

16. Emergency presentations

17. Top 20 Presentations

18. Other important presentations

19. System specific competences

20. 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
JRCPTB

21. CMT e-Portfolio Assessors Aug 08 – May 09 ACAT
percentage
Average overall rating
Consultant
4087 44
5.04
SpR
4771 52
5.09
SAS
399 4

22. CMT e-Portfolio Assessors Aug 08 – May 09 CBD
percentage
Average overall rating
Consultant
4134 45
5.00
SpR
4604 51
5.07
SAS
357 4

23. 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
SHO 2%
Other

24. 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

26. 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
JRCPTB

28. Example portfolio

29. MRCP(UK) JRCPTB 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

30. 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
JRCPTB

31. CMT part of new curriculum
JRCPTB
CMT part of new curriculum
Affects 2000 trainees and trainers
from August 2009

32. Specialty training in GIM
JRCPTB
Specialty training in GIM

33. 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
JRCPTB

34. GIM progression(1) JRCPTB 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

36. GIM progression(2) JRCPTB
TPD’s/college tutors and educational supervisors must ensure that the e-portfolio 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
JRCPTB

37. 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

38. 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

39. Questions about CCT’s JRCPTB
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)
JRCPTB

40. Communication plan JRCPTB Heads of Schools JRCPTB RAs SACs
RCP Trainees Committee
CMT Committee
College Tutors
Educational Supervisors
Fellows
Trainees
JRCPTB

41. How will GIM/Acute Trainees transfer to the new GIM curriculum?
JRCPTB
How will GIM/Acute Trainees transfer to the new GIM curriculum?
From October 2009

42. Required evidence(1) JRCPTB
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
JRCPTB

43. Required evidence(2) JRCPTB
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
JRCPTB

44. Required evidence(3) JRCPTB
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 new outpatients/and or inpatient complex referrals or ambulatory care patients
JRCPTB

45. Required evidence(4) JRCPTB
Demonstrated senior level competence in the Top 20 and Other Presentations
JRCPTB

46. 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
JRCPTB

47. 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
JRCPTB

48. 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.
JRCPTB

49. 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.
JRCPTB