SPECIALTY TRAINING CURRICULUM FOR ACUTE INTERNAL MEDICINE AUGUST 2009 (AMENDMENTS MADE AUGUST 2012) Joint Royal Colleges of Physicians Training Board 5 St Andrews Place Regent’s Park London NW1 4LB Telephone: (020) 79351174 Facsimile: (020)7486 4160 Email: [email protected] Website: www.jrcptb.org.uk 2009 Acute Internal Medicine Curriculum (Amendments August 2012) Page 1 of 164 Table of Contents 1 Introduction ................................................................................................................ 3 2 Rationale ................................................................................................................... 4 2.1 Purposes of the curriculum ........................................................................................ 4 2.2 Development ............................................................................................................. 6 2.3 Training Pathway ....................................................................................................... 6 2.4 Enrolment with JRCPTB .......................................................................................... 11 2.5 Duration of training .................................................................................................. 11 2.6 Flexible training ....................................................................................................... 11 2.7 Dual CCT ................................................................................................................. 11 3 Content of learning .................................................................................................. 11 3.1 Programme content and objectives ......................................................................... 12 3.2 Good Medical Practice ............................................................................................ 12 3.3 Syllabus ................................................................................................................... 13 Common Competencies ............................................................................................. 17 General AIM Competencies ....................................................................................... 53 Symptom Based Competencies - AIM........................................................................ 54 Emergency Presentations .......................................................................................... 54 ‘The Top Presentations’ – Common Medical Presentations ...................................... 58 Other Important Presentations - AIM .......................................................................... 73 System Specific Competencies .................................................................................. 93 Synthesis of Competencies that must be acquired .................................................. 130 Investigation Competencies ..................................................................................... 137 Procedural Competencies for AIM ............................................................................ 140 Acute Internal Medicine Specialist Skills .................................................................. 141 4 Learning and Teaching .......................................................................................... 144 4.1 The training programme ........................................................................................ 144 4.2 Requirements of AIM training programme ............................................................ 146 4.3 Teaching and learning methods ............................................................................ 147 4.4 Research ............................................................................................................... 148 5 Assessment ........................................................................................................... 149 5.1 The assessment system ........................................................................................ 149 5.2 Assessment Blueprint ............................................................................................ 149 5.3 Assessment methods ............................................................................................ 149 5.4 Decisions on progress (ARCP) ............................................................................. 151 5.5 AIM ARCP Decision Aid ........................................................................................ 153 5.6 Penultimate Year Assessment (PYA) ................................................................... 159 5.7 Complaints and Appeals ....................................................................................... 159 6 Supervision and feedback ..................................................................................... 159 6.1 Supervision ............................................................................................................ 159 6.2 Appraisal ................................................................................................................ 160 7 Managing curriculum implementation ................................................................... 161 7.1 Intended use of curriculum by trainers and trainees ............................................. 162 7.2 Recording progress ............................................................................................... 162 8 Curriculum review and updating ............................................................................ 162 9 Equality and diversity ............................................................................................ 163 2009 Acute Internal Medicine Curriculum (Amendments August 2012) Page 2 of 164 1 Introduction There has been rapid change in the organisation and delivery of care for patients with medical illnesses since the Acute Internal Medicine sub specialty curriculum was introduced in July 2005. The continued growth of this area of care has been reflected by the large number of reports and recommendations that suggest methods by which care may be improved for patients with acute medical problems. This includes rapid assessment by a senior decision maker, facilitated access to investigations, accurate diagnosis and prompt instigation of treatment either within an ambulatory setting or when an inpatient hospital stay is required. Furthermore, standards for the delivery of acute care have been suggested and should be adhered to be all aspiring to provide acute care to medical patients. Acute hospital physicians are required to provide high level care for patients with acute medical problems but also specialist care for outpatients who present acutely and, in many situations, inpatients. There is recognition that physicians play a vital role in the management of in-patients (e.g. in surgical wards) who require an acute medical opinion and this includes within the Hospital at Night structures established within NHS hospitals. Many hospitals have developed Acute Medical Units (the agreed term for these units) where the first 48 -72 hours of care are provided. This supports early, safe discharge of up to 60% of patients to a community setting, most often their own home. Critical to these developments is the Acute Physician who has been prepared to develop new pathways of care with prompt diagnosis, investigation and treatment. – the right person, in the right setting, first time. In parallel with these organisational and structural changes, medical education has undergone major reforms. The implementation of the Foundation programme, with doctors leaving the F2 year with “acute safe” competencies, the increased number of medical graduates and the implementation of Good Medical Practice have added to the need to define and map all parts of all the new curricula to the 4 domains of Good Medical Practice. In association with this there has been the need to clearly define assessment methods that have been allocated to all sections of the syllabus. These new initiatives will support trainees and trainers to identify how trainees should progress through the new curriculum acquiring the necessary knowledge, skills and behaviours and how these will be assessed. Mapping the 4 domains of Good Medical Practice to the curriculum provides the opportunity to better define, and thus improve, the skills and behaviours that trainees require to communicate with patients, carers and their families. The Acute Internal Medicine (AIM) curriculum reflects the on-going change in clinical practice in hospitals where there is an increasing need for physicians dedicated to providing prompt, high quality and effective management of patients who present with acute medical illness. This is essential to improve patient care and outcomes. And recognises the increasing number of patients with complex medical problems and associated acute exacerbations. Effective acute multiprofessional pathways and processes are critical to the delivery of best care. Trainees in Acute Internal medicine will therefore acquire competencies relevant to: the prompt practical management of acute presentation of medical illness, the management of medical patients in an in-patient setting, the development of new patient pathways to maximise safe, effective care in the community where feasible, the provision of leadership skills within an acute medical unit, 2009 Acute Internal Medicine Curriculum (Amendments August 2012) Page 3 of 164 the development