All trainees in Acute Medicine must develop a specialist skill. These generally fall into one of four categories:
- - Procedural skill (eg: echocardiography)
- - Additional Qualification (eg: medical education)
- - Speciality Interest (eg: intensive care medicine)
- - Research
The Acute Medicine Curriculum on the JRCPTB website lists some of the approved skills and the standards that you must attain. The complete list as of May 2015, with links to further information, can be found here. If you wish to train in a skill not listed on this page, you need to apply to the JRCPTB before you start. To do this you must apply to the Acute Medicine SAC. Contact details are on the JRCPTB website.
For existing Acute Medicine trainees we would offer the following pieces of advice:
- - Decide on your specialist skill early. Certainly by the end of your ST3 year at the very latest you should know what you are going train in and how you will achieve this.
- - Do check with your study leave advisor and your TPD about how other people have trained in your chosen skill and try to ensure that when you move to your next post you will be able to continue your training with a minimum of disruption.
- - Check the curriculum to ensure you are working to the standards you must achieve. Some skills will take much longer than others to develop.
- - Consider the costs of developing your skill. You may have to spend many thousands of pounds to gain a medical education or management diploma and even more for a masters degree.
For full list of specialist skills see the latest guidance on the JRCTB pages
Current skills that Yorkshire can offer are as follows: (Discuss with the TPD if you want to pursue another skill)
Please note only approved courses at named universities will count. If you find a similar course at one not named in the JRCTB guide you will have to complete an application the Specialist Advisory Committee to consider this.
Endoscopy Training in Acute Medicine
Endoscopy training for Acute Medicine trainees is only recommended for those who already have prior experience, as it has proven difficult to achieve the required accreditation for those ‘starting from scratch’.
HOW TO GET ENDOSCOPY TRAINING
You should aim to attend at least one dedicated training list per week (around 42 lists/year). Training lists should be reduced to an appropriate size (for example 6 gastroscopies). A non-training list would usually have 10 cases. Training lists will consist of diagnostic cases only, and be performed under full supervision, until competence is achieved.
JAG Registration and Courses
You will be required to register with The JAG, which is the only way to get accreditation. You will need to complete Form G. You will also need to attend a ‘Basic Skills in Endoscopy’ course. You need to register with the JAG’s training website, JETS (JAG Endoscopy Training System) as this is the only way to book onto courses, which are very popular and fill up quickly. You will need a statement of support from your supervisor and a guarantee of a minimum of a further 6 months endoscopy training after the course.
MAINTAINING A RECORD OF TRAINING
Portfolio of Procedures
The trainee must maintain an accurate portfolio containing a written record of the number and variety of procedures carried out under supervision and independently on JETS e-portfolio.
Formative DOPS Assessment
A minimum of one DOPS should be completed per list. The JAG website has an approved DOPS form for endoscopic procedures and this should be used. The website also has guidelines on completing the DOPS assessment. It is also advisable to be assessed on cases involving sedation, rather than throat spray only, to demonstrate your competency in this skill as well. These should also be filed in your logbook.
Audit of Endoscopic Performance
The portfolio should be supplemented by an audit of your endoscopic performance data. This includes successful oesophageal intubation rates, average doses of sedation used and complication rates. It is usually fairly simple to get a summary from most endoscopy reporting programs.
HOW TO GET JAG ACCREDITATION
This is given when a trainee is able to scope independently, but has not received full accreditation from the JAG. A supervisor is required to be present in the unit for further targeted training or assistance with difficult cases.
Only the JAG can issue the ‘Full Accreditation’ and provide a certificate to you. To apply for certification you will require a ‘declaration of completion of training’ from your supervisor. This requires you to be assessed by two consultants and completion of summative DOPS on at least 2 cases. It also requires an up-to-date portfolio with formative DOPS and trainee assessment forms and a ‘Lifelong Summary of Endoscopic Training Record’. There is no longer a minimum number of procedures that a trainee needs to have performed prior to being given accreditation. The Declaration should then be sent to the JAG along with the relevant supporting information.
Information about the Diploma in Tropical Medicine and Hygiene can be found here.
During 2002 a system of accreditation of courses of study in preparation for the examination was put in place and has been a requirement since 2003.
The Royal College of Physicians will accept applications from candidates who have completed, or are in the process of completing, the Tropical Medicine and Hygiene course at the Schools of Tropical Medicine and Hygiene in the following locations:
Examination candidates will need to submit evidence to confirm your attendance at one of these courses.
Please note: If you require information on any of the Tropical Medicine and Hygiene courses, please contact the respective Schools (mentioned above) rather than Examinations Department staff at the Royal College of Physicians.
Focused Acute Medicine Ultrasound (FAMUS) is the point of care ultrasound standard created specifically for Acute Medicine physicians to aid the management of the acutely unwell adult patient. It is endorsed by the Society for Acute Medicine and recognised by the AIM training committee as a specialist skill.
Please click this link for relevant documents, for information on how to register, how to accredit and useful learning resources. We recommend you download and read the curriculum pack which outlines the accreditation process in detail.
Please Contact Emmanouil Astrinakis, consultant radiologist at Leeds for any questions
This is a very difficult skill to undertake and all candidates should discuss this carefully with their TPD.
As a minimum trainees are expected to obtain FICE accreditation (50 reviewed scans), with ongoing evidence of CPD (20 further logbook cases per year) and five reflective case studies. A more advanced level is that of the BSE transthoracic echocardiography (TTE) accreditation (250 scans).
How to train in this skill
There are a number of FICE-approved one day courses to learn the basics of focussed echo, and an online module to complete. 50 scans have to be completed within 12 months (10 directly supervised, all reviewed by a mentor or supervisor). A triggered assessment is then undertaken and if passed the paperwork must be sent to the ICS for ratification. All the details of the training are in the accreditation pack .
In order to ensure ongoing CPD and time spent training in this skill a further 20 logbook scans will be needed per year, as well as a total of five reflective cases where the focussed echo has directly influenced patient management (entered as reflective logs on the ePortfolio).
Eligibility for BSE accreditation depends on the supervisor and echocardiography department having BSE accreditation and BSE membership. There is a list of courses and further information about BSE accreditation available on BSE website.
Part-time courses: The practical elements of FICE and BSE will both be undertaken part time, alongside regular clinical commitments.
Fellowships/other paid posts: Yes – there are an increasing number of echo/ultrasound fellowships (often linked to critical care posts) that could be taken as an OOPE/OOPT.
Likely financial cost of training in this skill
FICE: ICS administration £50, FICE course £200, BSE: Written exam £150, Logbook submission £150, BSE annual fee: £60
Courses >£2000 (practice/exam prep)
FEEL accreditation is not considered adequate for specialist skill status; those with FEEL may wish to consider undertaking the supervised logbook/assessment components of FICE in order to become FICE accredited.
In the context of an additional skill in Acute Medicine, medical education means a diploma or masters degree. Medical education is not ‘teaching’, it is the study of education for undergraduate and postgraduate clinicians, and covers topics such as:
- Curriculum development
- Research skills
- Teaching and learning
Medical education is developing rapidly in the UK and this is the ideal time to develop a specialist interest and get qualifications. Acute Medicine is an ideal area for education research and it is possible that dissertation topics can be supported by the Deanery.
If you would like to pursue an interest in academic medical education, you are strongly advised to join one of the following educational societies:
Association for the Study of Medical Education (ASME) at www.asme.org.uk
Association for Medical Education in Europe (AMEE) - thoroughly recommended - at www.amee.org
You may also be interested in the Academy of Medical Educators at www.medicaleducators.org
The most popular medical education courses are at Dundee, Cardiff, UCL (joint with the Royal College of Physicians), Warwick and Leeds. The Association for the Study of Medical Education (ASME) may also be able to provide details of UK courses if you contact them via their website. The standard and delivery of different programmes varies eg some are purely distance learning and some involve face-to-face sessions. It is anticipated that course fees for individual modules can be claimed back by trainees through the study leave budget. Funded places are available if you enrol on the Leeds course.
ASME and AMEE hold annual conferences which are usually well attended by clinicians from Yorkshire. Much of the language of medical education is that of the social sciences, which can be difficult for doctors to grasp at first, and it is sometimes useful to be able to talk things through with a colleague.
Fish D and Coles C. Medical Education, developing a curriculum for practice. Open University Press, Maidenhead, 2005.
Cooper N and Forrest K [Eds]. Essential Guide to Educational Supervision (in postgraduate medical education). Wiley-Blackwell, 2008.
Fish D and De Cossart L. Developing the wise doctor: a resource for trainers and trainees (in practice). Royal Society of Medicine Press Ltd, London, 2007.
Talbot M. Monkey see, monkey do. A critique of the competency model in graduate medical education. Medical Education 2004; 38: 587 – 92.
Pope C [Ed]. Qualitative research in healthcare. Nicholas Mays/BMJBlackwell,2006
Dr Hannah Murray – Leeds
Management versus leadership
Management is a set of process that can keep a complicated system of people and technology running smoothly using measures like planning, budgeting, organising/staffing and problem-solving. Leadership is about defining what the future should look like, align people to that vision, and inspire them to make it happen, despite any obstacles (Kotter 1996).
Doctors treating patients based on clinical expertise but remaining absolved from the managerial aspects of an organisation is no longer viable and hinders the growth of a ‘learning organisation’. It is notable that the best performing NHS trusts have more doctors and nurses in managerial and leadership roles.
It is now a mandatory requirement that all physicians achieve competency in management and leadership to an appropriate level throughout their training and working life. The NHS Institute for Innovation and Improvement has developed a useful tool ‘Medical Leadership Competency Framework’ for self-assessment and obtaining structured feedback from colleagues to identify strengths and areas for development. The link to the tool is below:
http://www.leadershipacademy.nhs.uk/ How to develop management and leadership as an ‘additional skill’
For Acute Medicine trainees who wish to develop management and leadership skills as their ‘specialist skill’, there are some excellent opportunities available. Although there is no formally defined career pathway, diploma and degree programmes (eg MSc/MBA/MA) are available and practical workplace experience can be obtained alongside this in collaboration with your base hospital.
For Yorkshire trainees, I would recommend the part-time ‘MSc in leadership, management and change’ at the School of Health Studies, Bradford University. Former trainees have enjoyed it and found all the staff are very supportive. Further information regarding this programme can be obtained from Bradford University.
Further information also available from Dr Prasad Karadi, Consultant in Acute Medicine, Calderdale
The most well known Diploma or Masters Degree in Toxicology is available from Cardiff University, and is a distance learning course, with some optional (but very valuable) update meetings.
Current fees in 2018 are £4,475 annually.
The course consists of six five-week study units covering subjects such as: drug safety and pharmo-vigilance; mechanisms of toxicity; major toxins; management and prevention of toxicity; poisonings and toxicovigilance; occupational and environmental toxicology.
Assessment is by weekly written assessment and written examinations. Masters students submit four 2,500-word assignments and a 15,000-word dissertation.
You can find out more information from the ‘Course Administrator Pharmacology, Therapeutics and Toxicology’:
School Website: https://www.cardiff.ac.uk/toxicology
Dr S Waring, York. firstname.lastname@example.org
Gaining a CCT in Intensive Care Medicine
Over the past few years, the number of non-anaesthetists training in Intensive Care Medicine (ICM) has increased. Although most Acute Medicine trainees have an ICU placement during their rotation, obtaining a dual CCT in Acute Medicine and Intensive Care Medicine has a number of specific components. From August 2013, trainees are eligible to apply for training in stand-alone ICM, or dual CCTs in Acute Medicine and Intensive Care.
Trainees can now apply for the dual programme from either CMT or ACCS. Application to the dual training is via competitive national interviews for BOTH ICM and Acute Medicine. At the current time this will need to be in the form of stepped recruitment within 18 months of each other, for example, obtaining an NTN in Acute Medicine in August 2013, and an NTN in ICM in August 2014, following competitive interviews. From 2014, it is likely that appointment to both programmes at the same time will be possible.
For trainees undergoing dual training, there are three stages:
Consists of CMT1 to ST5. This incorporates 2 years of medicine at CMT followed by 12 months each of Acute Medicine, Anaesthetics and Intensive Care in any order.
Consists of ST6 and ST7. ST6 would consist of 3 months each of Acute Medicine, Cardiac ICU, Neuro ICU and Paediatric ICU. ST7 would generally be 12 months of Acute Medicine.
Consists of ST8 and ST9. ST8 is 12 months ICM, ST9 is 6 months Acute Medicine.
ACCS 1 to ST4. Includes 6 months each of Emergency Medicine, Anaesthetics, Acute Medicine and Intensive Care plus a CMT2 year of general medicine. ST3 and ST4 would incorporate 12 months Acute Medicine, 6 months Anaesthetics and 6 months Intensive Care, in any order.
ST5 and ST6. ST5 would be 3 months each of Acute Medicine, Cardiac ICU, Neuro ICU and Paediatric ICU. ST6 would be 12 months Acute Medicine
ST7 and ST8 would incorporate 12 months Intensive Care and 6 months Acute Medicine.
All trainees must have MRCP in order to enter dual CCT training of Acute Medicine and Intensive Care. In addition, trainees must pass both the Specialty Certificate Examination in Acute Medicine, and the Final FFICM exam in order to gain both CCTs.
The final FFICM exam is taken during Stage 2 training, and must be passed in order to progress to Stage 3. The final FFICM consists of an MCQ paper and SOE (viva) examination.
Most consultant posts in ICM are currently advertised as a split post between Anaesthesia and ICM, although this is changing. ICM is a rewarding specialty to work in, and fits well with many aspects of Acute Medicine (such as absence of ongoing care commitments and outpatient clinics).
The regional advisor for ICM in Yorkshire is Dr Alison Pittard, who works at Leeds General Infirmary. Regional advisors can provide further information on ICM training, and it is a good idea to speak to them before embarking on ICM training.
The Faculty of Intensive Care Medicine website is a must-read for trainees interested in dual accreditation, and includes information on recruitment and curricula. www.ficm.ac.uk
The Intensive Care Society has a trainee division which provides information for trainees on various aspects of ICM. They also hold two conferences per year: ww.ics.ac.uk
Dr Anne Whiteside, Consultant in Acute Medicine and Intensive Care,
Gaining a CCT in Stroke Medicine
A specialty skill in Stroke Medicine requires out-of-program experience in order to gain a CCT. Please visit the JRCPTB website for more information about Stroke Medicine.
The time needed to complete the experiential and learning aspects of the curriculum is a minimum of two years or time equivalent. For trainees enrolled in a specialty where there is already a substantial component of training relevant to stroke, specifically Geriatric Medicine and Neurology, and who have spent the equivalent of at least one year of training in training posts in which they have prospectively achieved competencies relevant to the Stroke Medicine curriculum.
A minimum of one additional full year of advanced Stroke Medicine training attached to a comprehensive stroke service is still required. Trainees who pass their stroke sub-specialty assessment at the end of this year, will prolong their period of training by one year to achieve sub-specialty certification in the Stroke Medicine in addition to certification in their main specialty i.e. so long as it has been prospectively approved by the relevant SACs, the first year will double count towards both the main specialty and Stroke Medicine.
Trainees from medical specialties who have not had exposure to prospectively approved training in Stroke Medicine and/or rehabilitation will require a minimum of an additional 2 years in stroke sub-specialty training to achieve sufficient experience and competencies in the curriculum.
Jon Cooper, Leeds General Infirmary.
Syncope Minimum level of attainment required according to AIM curriculum Two year minimum period (in parallel with the parent speciality), regular syncope/falls clinics supervised by trainers and assessors with the relevant specialist knowledge and skills:
· Assess 100 patients in an acute or clinic setting presenting with syncope/falls. · Independently performed and reported a minimum of 50 tilt tests.
· Independently performed and reported a minimum of 25 carotid sinus massages.
· Achieved satisfactory performance in a minimum of 4 mini-CEX, 4 CbD and 6 DOPS per year relevant to, and spread across curriculum.
· Endorsement of above by clinical supervisor in his report and verified by ES and assessed in ARCP.
How to train in this skill
Trainees are expected to self-organise their training by negotiating sessions with syncope clinics and liaising with their local falls service.
Contact: Dr Sunil Kumar, Acute Medical Consultant at Midyorkshire NHS Trust for more information
Trainees must demonstrate a minimum duration of 12 months working with a diabetes team in an acute setting.
How to train in this skill
20 Diabetes clinics including specialist diabetes clinics such foot, renal etc. Attendance DSN and dietitian clinic and inpatient ward.
· Diagnosis and classification of diabetes mellitus: X4 CBDs
· Diabetic emergencies: DKA, HSS, Hypoglycaemia – Mini-Cex or CBD x 2 each
· Management of patients with diabetes during acute Illness: Minimum 2 CBDs (or 1 Mini-Cex or 1 CBD
· Management of patients with diabetes during acute coronary syndrome: Minimum two CBDs (or one mini-CEX or one CBD)
· Management of patients with diabetes during surgery or other procedures which requires fasting: Minimum two CBDs
· Foot Disease: Minimum two CBDs (or one Mini-Cex and one CBD)
· Age-related conditions and diabetes – the elderly: Minimum two CBDs (or one MiniCex and one CBD)
· Renal disease and hypertension in diabetes: Minimum two CBDs (or one MiniCex and one CBD)
· Inpatient diabetes ward round: X5 ACAT of inpatient diabetes ward round of a minimum 5 cases
· Clinical Topic Review (CTR): A detailed discussion of the Clinical Topic Review previously submitted by the candidate. The CTR should be approximately 2,500 words in length
Recommended courses or training programmes
On Line E-Learning
The attachment will have to be organised with your local TPD. After completion of the requirements for the special skill as laid out above the ARCP will review the trainee continues to have exposure to inpatient diabetes (1 sessions per week) to maintain their competence i.e. 1 inpatient diabetes ward round per week.
Information technology is becoming an ever more important part of modern health care. Most hospitals have a Chief Clinical Information Officer, an executive level role held by a consultant.
They are responsible for having a clinical strategy in overseeing the digital technology being implemented in the Trust. Ensuring that any technology implemented is efficient, cost-effective and adaptable to improve patient care.
Trainees should have a good grasp of computer skills and demonstrate initiative in finding technological solutions to common problems.
Previous trainees have been part of groups implementing and adapting a new Electronic Patient Record. This senior management experience looks very good on CVs and at consultant interviews.
To meet the Acute Medical Curriculum requirements trainees must acquire an approved PgDip in Health Informatics, currently provided by the University of Central Lancashire. This provides an introduction to understanding the role of information, information management and information technology within health and social care. Trainees will complete 6 modules over 2 years with an optional dissertation possible to complete a Master’s qualification.
Current Fees are £3,075 per year but can be supported by study budget and negotiating with local trusts in return for quality improvement work undertaken.
It is advised trainees make good links with their trust’s IT department to help them have practical experience in the delivery of IT to enable them to undertake the course work needed as part of their course.
Dr Daniel McNally (Acute Medical Registrar)
Dr Alistair Morris (CCIO at Calderdale and Huddersfield NHS Trust)
Minimum level of attainment required according to AIM curriculum
Likely financial cost of training in this skill
£3530 for PgDip, £5000 for MSc.
You may be able to use your study budget to contribute towards costs. Alternatively a course may be funded as part of a fellowship.
Quality Improvement in Action
Leadership, Change and Organisational Development
Coaching in a Systemic Context
Practice Development: Independent Study
Developing Research and Evaluation Skills
Two year distance learning (plus a dissertation for MSC)