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Internal medicine training

Background

Until the 1980s, departments of General Internal Medicine (GIM) were commonplace in UK hospitals. Over time, physicians began to focus on the delivery of specialist care and General Practitioners (GPs) have been left to try and coordinate the care for an individual patient across multiple specialty teams. This is now becoming increasingly challenging as medical care develops.

Trusts are now recognising a need for physicians that can deliver high quality general care for patients with multiple, unrelated, complex conditions, without the need to initiate multiple referrals to different specialist teams. Delivering good GIM care will become an increasingly challenging and rewarding part of physician practice.

Read BMJ Article (published 13 February 2012) "Renaissance of hospital generalists"

A View from America: In the USA, the majority of inpatient medicine is managed by “Hospitalists”. These are General Medicine “Attendings” (Consultants) who take care of medical patients from admission to discharge. They provide the daily care of the patient, coordinate Specialist input, and facilitate the multidisciplinary team. This model has increased in popularity and is the fastest growing speciality in the US. Although this model does not fit completely with the UK system, it can give a glimpse of what hospital medicine could look like in the future. This model embraces the role of the Generalist in providing patient centred, holistic care, to ensure that complex medical patients have one primary consultant supervising their care whilst in the hospital. As the General Internal Medicine service expands in the UK, it is likely there will be similarities that we can learn from, to strengthen and improve care for hospitalised patients in the UK.

Internal Medicine Stage 1

In response to recommendations in the Shape of Training Report, and to better equip doctors with the skills needed for a 21st Century NHS, the Joint Royal Colleges of Physicians Training Board (JRCPTB), on behalf of the Federation of the three Royal Colleges of Physicians and with the support of Health Education England, developed a new training model known as Internal Medicine Training. It replaced Core Medical Training in 2019 with the first trainees completing the three-year programme in summer 2022.

Internal Medicine Stage 1 is a three year programme which includes experience in intensive care medicine, geriatric medicine and outpatients. This gives doctors in training wider exposure to medical specialties including dedicated experience in ICU. It is hoped that more people training in Internal Medicine and the physician specialties will reduce rota gaps, provide improved access to outpatient experience and will better prepare trainees as they progress to the medical registrar role.

For further information visit the JRCPTB website.

Internal Medicine Stage 2/ General Internal Medicine

The current General Internal Medicine (GIM) curriculum is designed to provide broad training in the key skills which will be required by consultants taking part in the admission and inpatient management of patients with acute medical problems as well as patients with chronic medical conditions. The curriculum builds on IMS1 to allow the trainee to develop their skills in GIM.

Currently, Higher Specialty Training for physicians who will engage in GIM is via dual training with a Group 1 specialty. Although this new programme will partially address the changing demographic needs, completing postgraduate doctors in training will remain closely embedded in their specialty. This approach is unlikely to meet the growing needs of trusts for general physicians, equipped with the ability to care for patients with multiple, complex conditions.

Single accreditation for General Internal Medicine

Health Education England is responding to a number of trusts that are now (re)opening GIM departments by setting up a number of pilot training programmes for single accreditation in general internal medicine. These pilot programmes, which are in 3 regions (East and West Midlands and Wessex) will look to recruit their first trainees in Autumn 2022 with trainees starting in post late 2022/early 2023.

Dr Phil Bright, Clinical Advisor for Internal Medicine Training at HEE, talks about why we're launching new pilot training programmes for single accreditation in general internal medicine. (YouTube video)

Find out what our pilot sites can offer:

To find out more about the recruitment process, go to the Physician Higher Specialty Training Recruitment website

To apply, go to the Oriel website 

Please note that applications open on 26 July 2022 and the closing date is 16 August 2022.

Find out more about our Enhancing Generalist Skills programme (enhance)