Background to general internal medicine (GIM)

Single accreditation for GIM

Pure GIM is an exciting development in UK medical training and practise. There are many similarities with the ‘hospitalist’ movement in the United States of America. A discussion of this is included in an article by Elizabeth Esterbrook further down this page.

The three-year standalone GIM training programme offers a way of building the much needed workforce to address the increasing complexity of patients with medical conditions. Over the last 20 years UK medical practise has tended towards excellence in specialty training and delivery. However, the changing demographics of the UK population is meaning an increase in the number of patients with complex comorbidities many of whom do not necessarily fall into a frail and elderly category and therefore a need for excellence in training and delivery of GIM.

Additionally, there are large numbers of patients who need the input of a GIM physician because of other, non-physician medical problems or their complex social circumstance. For instance, patients with significant psychiatric conditions or those who are homeless are often in need of the input from physicians who are primarily trained to deliver GIM.

The Standalone GIM pilot programmes are increasingly and excitingly including experience in a community setting.

For more information about applications visit the physician higher specialty training recruitment website.

Hospitalist medicine in the UK – written by Dr Elizabeth Estabrook

The UK is an outlier in its approach to the care of medical patients that are hospitalised. Almost all Western health systems have a 'generalist' who manages the day to day care of patients on the ward. Having trained in internal medicine in the USA, I completed an internal medicine residency program and become what they call a 'hospitalist'. Over the last 25 years this has been the fastest growing specialty in the USA. Patients admitted with a medical condition are primarily managed the internal medicine hospitalist and specialist input is sought on a case by case basis. This can include anything from acute myocardial infarction, decompensated cirrhosis, to complex lung disease. This model has been shown to be highly effective in improving patient care and reducing length of stay. Of course there is variation in how this model is delivered depending on local resources and specialist care is needed in many cases. However, specialist opinion, diagnostics and interventions are sought in conjunction with the hospitalist who aims to provide a holistic approach to their care, especially when some patients will need multiple specialties involved in their care. The internal medicine physician is a highly respected position for those who wish to be the “diagnosticians” of the hospital. Their opinion is sought in order to evaluate complex and undiagnosed patients and in addition, in many hospitals, actively involved in the day to day management of post-operative patients with complex co-morbidities or complications.

In creating the GIM run-through training, NHS England have given the UK an opportunity to develop a similar model. This is not as revolutionary as some might think – we are actually familiar with this model in general paediatrics and elderly care medicine which already employ a very similar model. For those aged 18-80 a generalist model has the potential to revolutionise the way we practice hospital medicine. As a recognised specialty that prides itself in diagnosing complex and interesting presentations, as well as the holistic care of patients with complex multi-morbid disease that are hospitalised, it is time that it is recognised as an essential component to NHS care. This model can allow for a rewarding and flexible career for those interested in hospital medicine, whilst having the potential to allow other specialists to have more time to focus on their clinic and procedural lists. As waiting times and demand increase, the generalist has the potential to improve outcomes both in and outside the hospital.