Wales Acute Medicine Trainee Booklet June 2016€¦ · o Speciality based clinics - Cardiology,...

ACUTEMEDICINEHIGHERTRAININGPROGRAMME

StRHANDBOOKWALESDEANERY

Acute Medicine StR handbook - Version 2 (Aled Huws, June 2016) Adapted from Gastroenterology and Respiratory StR handbooks

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WELCOME!CROESO Acute medicine is a vibrant, rewarding, and rapidly developing medical speciality, concerned with the assessment, diagnosis and management of adults presenting to secondary care with acute medical illness. It also involves the management of busy acute medical units (AMUs) to ensure they deliver high-quality, efficient and patient-centred care. This handbook provides an overview of the Acute Medicine Specialist Training scheme and details the essential information required for trainees. The Welsh Higher Training Programme in Acute Medicine fulfils all the recommendations of the Royal College of Physicians and GMC for accreditation in this speciality and aims to offer the highest quality training in hospitals situated throughout Wales. The four-year programme is designed to provide trainees with a Certificate of Completion of Training (CCT) in Acute Internal Medicine (AIM) with the option of extending training to a fifth year in General internal Medicine (GIM), or to dually accredit in another speciality. Core trainees from both Core Medical Training (CMT) and Acute Care Common Stem (ACCS) are eligible to apply for the Acute Medicine StR programme. We hope you enjoy your time in Wales and look forward to working with you. Note: If you spot any errors, omissions, contradictions, or if any updates are needed please contact Dr Nia Rathbone ([email protected]) or Dr Aled Huws ([email protected]). The definitive guides for training and curriculum matters remain the Gold Guide and the speciality curricula.


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CONTENTSAcute Medicine Training – Overview…………………………………...……………………....5 Wales Deanery....................................................................................................................6 Acute Medicine Specialist Training Committee (STC) .......................................................7 Wales Higher Training Programme in Acute Medicine …………...………………………….8

Entry Criteria……………………………………………...…………….……………………...8 Training Programme – General Comments………….…………...……...…………………8 Postgraduate Training Pathway ………………………………………...……...…………..8 Speciality Experience………………………………………………………………...……...11

ST placements..................................................................................................................12 Sample Rotations…………………………...…………………….……………………...….13

Hospitals participating in training ....................................................................................14 Acute Consultants / Associate Specialists in Wales……………………...………………...15 Educational and Clinical Supervisors...............................................................................16

Educational supervisors ..............................................................................................16 Clinical supervisors .....................................................................................................17 Patient safety concerns ...............................................................................................17 Undermining/bullying ..................................................................................................17

Specialist Skill………………………………………………………...………………………....18 Curricula ..........................................................................................................................19 E-portfolio (JRCPTB)........................................................................................................20

Key points.....................................................................................................................21 Overview of AIM training requirements……………………………………………………22 Overview of GIM training requirements……………………………………...…...............22

Work Based Placed Assessments (WBPAs)………………………………………………....25 Supervised Learning Events (SLEs)..............................................................................25 Mini-clinical evaluation exercise (mini-CEX) ................................................................25 Case-based discussion (CbD)......................................................................................25 Direct observation of procedural skills (DOPS) ...........................................................25 Acute care assessment tool (ACAT) ............................................................................25 Multi-source feedback (MSF).......................................................................................26 Patient survey...............................................................................................................26 Audit Assessment…………………………………………………………………………....26


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Quality Improvement Project Assessment Tool…………………………………............26 Teaching observation ..................................................................................................26 Multiple consultant report (MCR) ................................................................................27 Audits ..........................................................................................................................27 Firth calculator..............................................................................................................27 Personal library………………...…..………………………………………………………...28 Training quality surveys……...……………………….……………………………….........28

Annual calendar................................................................................................................28 Training days and leave....................................................................................................29

Acute Medicine Summer School..................................................................................29 Welsh Acute Physicians Society (WAPS)………………………………………………….29 GIM Training ................................................................................................................29 Study Leave..................................................................................................................30 Annual leave ................................................................................................................30

Speciality Certificate Examination (SCE)..........................................................................31 Annual Review of Competence Progression (ARCP).......................................................34

Principal ARCP outcomes............................................................................................35 Penultimate Year Assessment (PYA)................................................................................36 Completion of training .....................................................................................................37 Out of Programme (OOP) requests .................................................................................38 Acting up as a consultant (AUC).......................................................................................39 Flexible / Less Than Full Time Training (LTFT) ................................................................40 Professional Support Unit (PSU)......................................................................................40 Useful training related websites ......................................................................................41

Society for Acute Medicine………...……………………………………………………….41 Journals .......................................................................................................................41 Other societies and organisations................................................................................41 Useful training resources……………………….............................................................42

Appendix 1: AIM/GIM ARCP Checklist……………………………………………………….43 Appendix 2: GIM PYA Checklist……………………………………………………………….44


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Acute Medicine Training – Overview Acute Internal Medicine (AIM) was formally recognised as a speciality in 2009, having previously been a subspeciality of General Internal Medicine (GIM). This was in response to the growing need for a senior medical presence supervising acute medical takes within an Acute Medical Unit (AMU) environment and has resulted in a massive expansion of Consultant Acute Physicians along with the development of Acute Medicine training programmes. Over recent years, the Wales Deanery has expanded the number of training posts in this evolving field in recognition of the increasing number of appointments of Acute Physicians nationally. In Wales we currently have 13 training posts of 4 years duration with the option of dual accreditation. Entry to the Acute Medicine training programme can either be from Core Medical Training (CMT) or Acute Care Common Stem (ACCS). Our training programme is exciting and varied. The experience it offers is unique as it allows rotation through many different specialties at registrar level in a variety of work settings and intensities. It also offers the opportunity for trainees to develop their own area of interest or special skill whilst satisfying the core curriculum requirements. AIM is a hospital-based speciality, with the majority of the work involving care of medical patients around the time of admission to hospital. The spectrum of clinical problems encountered in the AMU is very wide, and this variability enables trainees to become experts in assessment, investigation, diagnosis and management across multiple disciplines. The posts are a mixture of AMU, ambulatory care, elderly medicine, respiratory, cardiology and intensive care medicine rotations. Training concentrates on the recognition and management of medical emergencies, the development of acute medical services and the acquisition of skills in leadership and management of the AMU as a whole. The requirement to obtain an additional specialist skill or interest during higher training enables acute medicine trainees to pursue a professional qualification, diagnostic skill or research interest that will enhance their clinical practice. These interests can be maintained throughout their career as an Acute Physician, adding another dimension to the speciality.


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Wales Deanery http://www.walesdeanery.org/ The aim of the Wales Deanery is to commission, quality assure and support the education and training of trainees in Wales. The Deanery manages out of programme experience, flexible or less than full time training, inter-deanery transfers and ARCPs in conjunction with the Acute Medicine STCs. There are several important people within the Deanery who will monitor and help support your training: Acute Internal Medicine (AIM)

• Trudy McMullin E-mail: [email protected] Telephone number: 02920 687483

General Internal Medicine (GIM)

• Robert McGowan E-mail: [email protected] Telephone number: 02920 687588

Speciality Training Manager

• Hilary Williams E-mail: [email protected] Telephone number: 02920 687444


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Acute Medicine Specialist Training Committee (STC) The main role of the STC is to organise the speciality training programme in Wales. It consists of Acute Medicine consultants from each of the Health Boards within Wales, consultants from the specialties through which our trainees rotate along with a trainee representative. A Chair and a Training Programme Director (TPD) oversee the STC. TPDs are responsible for managing the speciality training programme including recruitment, placements and ARCPs. They also assist the Deanery with managing trainees in difficulty. Acute Medicine STC Chair Dr Nia Rathbone Consultant Acute Physician Royal Glamorgan Hospital, Llantrisant E-mail: [email protected] Training Programme Director (TPD) Dr Tom Cozens Consultant Acute Physician Royal Gwent Hospital, Newport E-mail: [email protected] StR Trainee Representative Appointed on annual basis


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Wales Higher Training Programme in Acute Medicine Entry Criteria Entry into Acute Medicine higher speciality training is possible following successful completion of both a Foundation Programme and a Core Training programme - either Core Medical Training (CMT) or Acute Care Common Stem (ACCS). The minimum experience in CMT posts in Medicine is 24 months or 24-36 months in ACCS posts of which at least 12 months must include the care of acute medical inpatients. Full membership of the Royal College of Physicians (MRCP) is a minimum educational requirement for entry to the programme at ST3 grade. The other qualities considered essential or desirable are detailed in the ST3 Acute Internal Medicine Person Specification, which can be found via the following link: http://www.st3recruitment.org.uk/specialties/acute-internal-medicine.html Postgraduate Training Pathway The following diagrams illustrate the different postgraduate training pathways in Acute Internal Medicine leading to single or dual CCT:


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The following diagram shows an example programme for dual CCT in ICM and AIM:


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Specialty Experience The program has been constructed to ensure exposure to specialities relevant to Acute Medicine. Training includes time on AMU and Ambulatory Care as well as attachments in other relevant specialties, with a focus on managerial AMU experience towards the end of higher specialist training. The trainees will gain experience in the following fields:

• Acute Internal Medicine, including experience working in o Acute Medical Units (AMUs) = Medical Admissions Units (MAUs) or Clinical

Decisions Units (CDUs) o Ambulatory care (AECU or MDUs) o Acute non-selected takes

• Cardiology

• Critical Care (ITU, HDU, CCU)

• General Internal Medicine including acute non-selected takes (minimum 4

months): o Respiratory Medicine o Care of the Elderly

• Out Patient experience

o Rapid Access Medical outpatient clinics / ‘Hot Clinics’ o Acute Medicine review clinics o Speciality based clinics - Cardiology, Respiratory Medicine, and Medicine

for the Elderly The final year of training should include at least 6 months experience within an Acute Medical Unit that is led by an Acute Physician. This should include training in management and leadership skills as well as taking a more senior, but supervised, role within the running of the acute medical take. Throughout training the trainee should be aware of the need to acquire a special competency or skill that is specifically relevant to Acute Internal Medicine. Acquisition of one of these competencies is a mandatory part of training and trainees should review with their educational supervisor as early as possible in their training which of these would be most relevant for their career development, and sustainable in the long term. This is detailed in the ‘Specialist Skill’ chapter on page 18 of this handbook. The trainee will be required to take part in organised, relevant courses particularly those which form part of the Core Curriculum, and the regional GIM Training sessions. The trainee will be expected to keep abreast of current developments within the speciality, to practice evidence-based medicine and to help to change practice within the department where appropriate. Computer literacy is essential in order to ensure effective audit of all clinical / managerial aspects of the work of the department.


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ST Placements Each clinical placement usually commences in the first week of August each year. However, should a trainee leave the programme outside this changeover interval, the start date of a newly appointed ST3 may be brought forward or delayed to match the timing of the vacancy left by the departing trainee. The trainee will be placed in one LHB (usually one hospital) for the whole year though trainees may rotate between specialties at various intervals throughout the year. Most trainees rotate to North Wales for at least one year of their training. The TPD will endeavour to inform trainees of as many of their future placements with as much advance notice as is reasonably possible. It may occasionally be possible, if circumstances permit, to inform some trainees of their placements for the entire 4/5 year training programme though this has to date proved difficult given the fluctuating number and staggered CCT dates of trainees, as well as the expanding number of hospitals participating in training over recent years. Trainees will usually rotate through ICU/Cardiology in the early part of training. Those trainees rotating through North Wales will usually do so in the earlier years of their training. The final year is usually in South Wales and should include at least 6 months experience within an AMU led by an Acute Physician. Thus, there will be a degree of certainty about where the trainee will be geographically located for the duration of their training although this is not totally guaranteed. A ‘Survival Guide to Cardiology & ICU’ has been produced by one of the current trainees and contains invaluable tips and practical advice to help prepare trainees for what is often regarded as a rather daunting year. This handout, along with a host of other useful documents, will be given to trainees at the beginning of their training and can be accessed via the WAPS cloud account. If trainees step out of programme for any reason, it is anticipated that they will return to the rotation they left. If a grace period is required, trainees may need to go back to the beginning of their rotation. It is very important for trainees to arrange a meeting with their educational supervisor within the first couple of weeks of their first rotation to discuss their personal development plan and educational needs for that year – this should be recorded on an ‘induction appraisal form’ on the NHS e-portfolio. The StR’s weekly timetable will vary significantly with each placement. It is acknowledged by the STC that the trainees are entitled to one protected session per week for specialist skill / service improvement / admin. The following table shows sample training rotations (5-year, for those aiming for dual accreditation with GIM). Please note: these examples are meant only as a guide to illustrate the usual locations and sequence of the rotations. The actual rotations allocated by the TPD will depend on placement availability, service demand and training needs of the individual.


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Trainee 4

Trainee 3

Trainee 2

Trainee 1

CDU

ICU

Cardiology

MAU

Wrexham

Maelor

Stroke

Princess of Wales

Cardiology

UH

W IC

U

UH

W

Year 1 - ST3

Resp 4/12 IC

U

Cardiology

CO

TE 2/12

AECU

Resp 4/12

Cardiology

UH

W IC

U

UH

W AEC

U

Royal Glam

organ

CO

TE 2/12

Royal Glam

organ

Year 2 – ST4

Resp 4/12

AECU

CO

TE 4/12

Stroke

CDU

Resp 4/12

CO

TE 2/12

Royal Glam

organ

AECU

Royal Glam

organ

CDU

Princess of Wales

Stroke

Princess of Wales

Year 3 – ST5

MAU

Nevill H

all

MAU

Ysbyty Gw

ynedd

MAU

Royal Gw

ent

MAU

Ysbyty Glan C

lwyd

Year 4 – ST6

Stroke C

DU

Princess of Wales

CDU

Prince Charles

MAU

Nevill H

all

MAU

Royal Gw

ent

Year 5 – ST7

Sample R

otations:


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Hospitals participating in training Training is provided in 9 hospitals in 5 Health Boards across Wales. The post holder will be required to work at any of the following Health Boards in Wales:

• Abertawe Bro Morgannwg University Health Board • Aneurin Bevan Health Board • Betsi Cadwaladr University Health Board • Cardiff and Vale University Health Board • Cwm Taf Health Board

* Note: The list of Clinical Placement Coordinators (CPC) is subject to change. Trainees will be informed of their CPC by the TPD upon commencing each placement.

Hospital Speciality / Experience Clinical Placement Coordinators - *May 2016

Ysbyty Gwynedd, Bangor

AMU Dr Chris Subbe

Ysbyty Glan Clwyd, Rhyl

AMU, A&E Majors,

Dr Hari Nair

Wrexham Maelor Hospital, Wrexham

AMU, MDU Dr Sarah Dyer

Nevill Hall Hospital, Abergavenny

MAU Dr Matt Brouns

Royal Gwent Hospital, Newport

MAU Dr Tom Cozens

Princess of Wales Hospital, Bridgend

CDU Stroke Medicine / COTE

Dr John Hounsell Dr Harish Bhat (Stroke)

Royal Glamorgan Hospital, Llantrisant

AECU (Ambulatory Care) AMU Respiratory COTE

Dr Les Ala / Dr Chris Hodcroft Dr Amit Benjamin (Resp) Dr Biswas (COTE)

Prince Charles Hospital, Merthyr Tydfil

CDU, MDU

Dr Aled Huws

University Hospital of Wales, Cardiff

ICU Cardiology

Dr Chris Hingston (ICU) Dr Richard Wheeler (Cardio)


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Acute Consultants / Associate Specialists in Wales Note: This list is subject to change. Updated 31/8/15.

• Royal Gwent Hospital (RGH), Newport: o Hannah Brothers o Tom Cozens o Paul Mizen o Llifon Edwards o Haris Saleem o Emma Mason o Ferran Cavalle o Anna Lewis

• Nevill Hall Hospital (NHH), Abergavenny:

o Matt Brouns

• Ysbyty Ystrad Fawr (YYF), Ystrad Mynach: o Mohamed Adlan

• University Hospital of Wales (UHW), Cardiff:

o Dave Thomas o Anil Kumar

• University Hospital Llandough (UHL), Cardiff:

o Ahmed Osman o Anna De Lloyd o Nolan Arulraj

• Princess of Wales Hospital (POW), Bridgend:

o John Hounsell

• Royal Glamorgan Hospital (RGL), Llantrisant: o Les Ala o Nia Rathbone o Chris Hodcroft o Kate Speed o Nerys Conway o Atul Kalhan o Eugene Tabiowo

• Prince Charles Hospital (PCH), Merthyr Tydfil

o Mohamed Hassan o Mark Stephens o Aled Huws o Vikas Lodhi o Joanne Morris

• Morriston Hospital (MH), Swansea (not currently participating in ST training):

o Steve Lennox


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o Ali Al Hassani

• Ysbyty Gwynedd (YG), Bangor o Hassan Mohammed o Anwar Khan o Chris Subbe

• Ysbyty Glan Clwyd (YGC), Rhyl

o Aye Nyunt o Hari Nair o Atanu Basu o Sarah Davies

• Wrexham Maelor Hospital (WMH), Wrexham

o Sarah Dyer o James Kilbane

Educational & Clinical Supervisors Each trainee will have two nominated supervisors who will be named at the beginning of their rotation; one clinical placement coordinator (who will change with the various placements – listed on page 14) and one educational supervisor (who should remain the same for the entire training). Note: there will be a number of clinical supervisors within each post but only one clinical placement coordinator. Educational supervisors It is your responsibility to arrange regular meetings with your educational supervisor (ES) and ensure the e-portfolio is up to date and reviewed. If you have difficulty arranging meetings with your educational or clinical placement coordinator (CPC) or have any other concerns you should speak with your TPD. You should have four meetings with your ES during each placement, with documentation completed on the e-portfolio:

1. Induction appraisal – within initial 4 weeks of the post 2. Mid-point review (optional but recommended) 3. ES report / review (prior to ARCP) 4. End of attachment appraisal – end of July prior to rotation to next post

A formal process of appraisals and reviews underpins training. This process ensures adequate supervision during training, provides continuity between posts and different supervisors and is one of the main ways of providing feedback to trainees. All appraisals should be recorded in the ePortfolio. For those who are dually accrediting, it is important to look at and complete your training requirements for both AIM and GIM – this includes audits, SLEs and attendance at training days.


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The supervisor’s main responsibilities are to use e-Portfolio evidence such as outcomes of assessments, reflections and personal development plans to inform appraisal meetings. They are also expected to update the trainee’s record of progress through the curriculum, write end-of-attachment appraisals and supervisor’s reports. Clinical supervisors Clinical supervisors (CS) are responsible for overseeing your day-to-day clinical work, such as inpatient work and outpatient clinics, and providing constructive feedback during a training placement. Your ES will also seek feedback about your progress and performance from your CPC or CS – this will be recorded in your multiple consultant reports (MCRs). In some cases your CPC will also be your ES i.e. the roles will be merged. All elements of work in training posts must be supervised with the level of supervision varying depending on the experience of the trainee and the clinical exposure and case mix undertaken. Outpatient and referral supervision must routinely include the opportunity to personally discuss all cases if required. It is required that the clinical supervisor devotes at least one hour per week in their timetable per trainee for this work. As training progresses the trainee should have the opportunity for increasing autonomy, consistent with safe and effective care for the patient. Any concerns or problems (either personal or related to your job) that you experience during your placement can be discussed with your clinical placement coordinator or educational supervisor or any other member of the department you feel comfortable approaching. If there are any issues with your placement or job plan, you should approach your CP/CPC as the first point of contact, who will then inform your ED who will in turn contact the TPD. If you do not feel comfortable discussing or are unable to resolve any concerns raised you are welcome to contact the TPD directly. There is also in each hospital a tutor of the Royal College of Physicians, who is available for discussion. Patient safety concerns Any concerns you have relating to patient safety should be discussed with either your clinical placement coordinator or educational supervisor. If these concerns potentially relate to your supervisors they should be discussed with the head of department or local clinical director. Undermining / bullying If you encounter or witness any undermining or bullying during your placements you should discuss this with either your clinical placement coordinator or educational supervisor. If you feel this involves your supervisors you can discuss this with the TPD.


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Specialist Skill The development of an additional skill or qualification is a mandatory requirement of training in Acute Medicine. This specialist skill must be acquired before the date of the trainees CCT. For some trainees, this may be a procedural skill or a practical interest such as echocardiography, ultrasonography or scoping; while for others it may be an academic interest where they’ll gain a qualification in healthcare management, leadership or medical education, or it could be developing an interest in another medical field such as stroke, intensive care medicine or medical toxicology. Some may choose to undertake a serious bit of medical research during their training years. Note: Please refer to the corresponding section in the AIM curriculum for a more exhaustive list of the types of specialist skills that may be acquired by trainees. The new ‘Specialist Skill’ section on the SAM website also has a comprehensive list and detailed information on 23 possible options for specialist skill: https://www.jrcptb.org.uk/specialities/acute-medicine http://www.acutemedicine.org.uk/what-we-do/training-and-education/skills/ In considering which specialist skill to develop, the trainee should consider how the acquisition of the skill may benefit the delivery of the Acute Medicine service overall. Choice of skill should take place as early in Acute Internal Medicine training as is possible. The skill should be one that can be used and developed throughout the physician’s career. We try to accommodate the trainees’ choice of special skill and the sooner the decision is made the sooner we will be able to support this choice. However, if there is specific skill desired by the trainee before application but falls outside the options listed on the SAM website, trainees are encouraged to contact the programme director as early as possible. It is recommended that a trainee should choose only ONE specialist skill in which to achieve competence. It is not anticipated that any trainee should be trying to adopt extensive experience in multiple skills during the training programme. Whichever specialist skill the trainee chooses there must be robust arrangements for training, assessment of competence, and maintenance of competence as defined by the relevant authority for each skill (e.g. BSE for echocardiography or JAG for endoscopy). It is important that an individual trainee recognises that continued exposure to and practise of a procedural skill is the only way to sustain competence in that skill. The choice of procedural skill should therefore be made whilst taking into account which is most likely to be required by the health service after training is complete. Discussion with the programme director or Educational Supervisor is recommended when making this decision.


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Curricula Both the AIM and GIM curricula along with respective ARCP decision aids are available on the JRCPTB website http://www.jrcptb.org.uk/specialties or accessible through links on your e-portfolio. These documents outline the competencies required to achieve your CCT, including the requirements for assessments and progress at each stage of your training. It is important to ensure that evidence of your training is uploaded to your e-portfolio on a regular basis, with adequate linking between your assessments or reflections and relevant parts of the curriculum (NB: you can link to more than one part of your curriculum). AIM Curriculum AIM curriculum 2009 (amended 2012) & decision aid (revised November 2014) http://www.jrcptb.org.uk/specialities/acute-medicine The AIM curriculum has been designed to enable StRs on completion of CCT to apply for Acute Medicine consultant posts armed with competencies for the delivery of high quality medical care to acutely ill patients and also the managerial skills required to run AMUs. The curriculum emphasises the skills and competencies that must be acquired in the acute medical settings but also reflects those that are relevant to the inpatient and outpatient settings including ambulatory care. Specific competencies in the management of patients requiring level 2 care are also mandatory for trainees undertaking training in AIM. It also details how these competencies will be assessed as a trainee progresses through the syllabus. GIM Curriculum GIM curriculum 2009 (amended 2012) & decision aid (revised November 2014) http://www.jrcptb.org.uk/specialties/general-internal-medicine-gim Within the GIM curriculum there is an emphasis on the training of physicians with the ability to investigate, treat and diagnose patients with chronic medical symptoms, with the provision of high quality review skills for inpatients and outpatients fulfilling the requirement of consultant-led continuity of care. While these attributes are not emphasised in the AIM curriculum it is clear that these are competencies that must be acquired for those pursuing a dual CCT in AIM and GIM. It is recognised that there is a hierarchy of competencies within each curriculum. It is expected that the breadth and depth of evidence presented for the emergency presentations, top symptom presentations and procedures will be greater than that for the common competencies and the other important presentations which should be sampled to a lesser extent i.e. work place assessment evidence is not required for all of these competencies. However, there must be evidence of engagement with that section of the curriculum.


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E-portfolio (JRCPTB) Trainees are required to register for specialist training with JRCPTB at the start of their training programmes. Enrolment with JRCPTB is mandatory and has an enrolment fee, which can either be paid to the JRCPTB with an upfront one off payment of £845 (tax deductible) in 2016, or as instalments of £169 per annum paid alongside collegiate membership. The maximum duration of payment is 5 years (even if you take longer to complete your training). Trainees can enrol online at https://www.jrcptb.org.uk On enrolling with JRCPTB trainees will be given access to the e-Portfolio. https://www.nhseportfolios.org This web-based e-portfolio is where trainees should record their assessments, appraisals, reflections on learning experiences, acquisition of competencies and progress through training. It allows evidence to be built up to inform decisions on a trainee’s progress and provides tools to support trainees’ education and development. Note: the JRCPTB will not provide a paper-based alternative to the e-portfolio. It is important to become familiar with the different components of the e-portfolio early in your training, as it provides evidence of adequate progression, assessed at your annual ARCP. It includes a record of meetings with your educational supervisor, Clinical supervisor, examination and certificates, personal library (80MB limit), workplace based assessments (WPBAs) / Supervised Learning Events (SLEs) with links to your curriculum and Annual Review of Competence Progression (ARCP) outcomes. It is primarily the trainee’s responsibility to ensure the e-portfolio is kept up to date though supervisors also have access to shared parts of the portfolio and have a responsibility to record appraisal outcomes and sign off the record of competence. The trainee must also arrange assessments and ensure they are recorded, prepare drafts of appraisal forms, maintain their personal development plan, record their reflections on learning and record their progress through the curriculum. If you have any difficulties in engaging your ES in the e-portfolio you must inform the TPD immediately – it will not be accepted as a reason for incomplete information provided at your ARCPs.


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E-Portfolio - Key points

• Ensure that all of your personal details including e-mail address are kept up to date within the ‘Profile’ section.

• You should complete a PDP (personal development plan) at the start of each clinical attachment and prior to your ARCP to outline your objectives for your next placement (this information will be used to plan the rotation)

• Each review meeting and report entered by your ES must include that it covers

both Acute Medicine & GIM (if working towards dual accreditation)

• You should review the decision aids for both Acute Medicine & GIM at the start of each placement so that you are aware of your requirements for the forthcoming year – this includes the appropriate number of SLEs

• Your e-portfolio and assessments should be updated regularly throughout

the year and linked to the relevant parts of the curriculum. The number of times an SLE can be linked to curriculum competencies is limited to eight for each ACAT and two for CbD & mini-CEXs

• Your ES should sign off the different components of your curriculum. This can be

very time consuming but can now be done as a group sign off or sampling of the curriculum rather that exhaustively sign off every competence.

• It is worth using the Royal College of Physicians diary to record your CPD activity – an annual summary can be uploaded as a PDF to your personal library (it is also recommended at your GIM PYA)

• Courses etc can only be validated if certificates are uploaded to your e-portfolio

(this usually requires completion of feedback)

• Any absences from work should be recorded on your e-portfolio. You will be required to complete a trainee absence form, sent to you by the deanery, ahead of your ARCP every year. Your TPD should be notified of periods > 2 weeks, which may potentially require an extension to your CCT date.

The assessments required for stage of the training programme is summarised in the AIM and GIM decision aids (see links in ‘Curricula’ chapter). An overview is provided below, however this is not exhaustive:


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Overview of AIM training requirements

1. Educational Supervisor (ES) report to cover training year since last ARCP

2. 4 - 6 Multiple Consultant Report (MCR) must be completed annually – each MCR must be completed by either the trainee’s clinical supervisor / clinical placement coordinator or consultants who the trainee has regular working contact with (not consultants that trainees have fleeting contact with e.g. on-call). For dual accrediting trainees, 2 MCRs must include feedback on GIM clinical abilities. Summary of the MCR and any actions resulting to be recorded in ES report

3. Specialist Certificate Exam (SCE) AIM SCE usually taken in years 3 or 4 and

achieved by CCT 4. Valid ALS throughout training (these are valid for 4 years) – evidenced in the

‘Certificate and Exams’ section of your e-portfolio. 5. Supervised Learning Events (SLEs) - Minimum of 10 SLEs (ACATs, CbDs and mini

CEX) per year of training – to include a minimum of 6 ACATs SLEs should be performed proportionately throughout each training year by a number of different assessors across the breadth of the curriculum. Structured feedback should be given to aid the trainee’s personal development

6. Multi-source feedback (MSF) - Minimum of 12 raters including 3 consultants and a

mixture of other staff (medical and non-medical) Replies should be received within 3 months for a valid MSF. If significant concerns are raised then arrangements should be made for a repeat MSF. An MSF should be completed per year. Don’t forget your self-assessment!

7. A Patient Survey should be completed in the first two years and another in the last

two years e.g. during years 2 and 4 (i.e. ST4 and ST6). 8. AIM Audit or AIM Quality Improvement projects 4 before CCT one of which must

complete the loop. Ideally a Quality Improvement assessment (QIPAT) or Audit assessment should be performed

9. Teaching observation 1 before PYA 10. Signed off for: common competencies, emergency presentations, top

presentations & other important presentations. One assessment in each major domain should be covered during your placement

11. Common competencies - Confirmation by educational supervisor that level 3 or 4

achieved. Ten do not require linked evidence unless concerns are identified. Evidence of engagement with 75% of remaining competencies to be determined by sampling and level achieved recorded in the ES report


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12. Emergency presentations Evidence of engagement required for all 4 emergency presentations by end of AIM training. ES to confirm level achieved and complete rating for each presentation. Evidence to include ACATs, mini-CEXs and CbDs

13. Top presentations. Evidence of engagement required for all top presentations by

end of AIM training. Level achieved to be determined by sampling and recorded in ES report

14. Practical procedures - summative DOPS evidence required for each of the

following: a. Clinically independent by completion of ST3 for:

i. Central venous cannulation (by femoral approach as a minimum) with ultrasound guidance where appropriate*

ii. Abdominal paracentesis* iii. DC cardioversion iv. Knee aspiration

b. Clinically independent by completion of year 3 AIM for: i. Intercostal drainage (1) Pneumothorax insertion using Seldinger

technique* ii. Intercostal drainage (2) Pleural Effusion using Seldinger technique

following ultrasound guidance* iii. By PYA: signed off for CVP line insertion, intercostal drain insertion

using ultrasound c. Clinically independent by PYA for:

i. Arterial line d. Competent in skills lab by PYA for (these have been removed from the

curriculum though there may be a delay until the decision aid is updated): i. Temporary cardiac pacing via transvenous route* ii. Sengstaken- Blakemore Tube insertion*

Summative sign off for routine procedures to be undertaken on one occasion with one assessor to confirm clinical independence. Summative DOPS sign off for potentially life threatening procedures (marked with asterisk) to be undertaken on at least two occasions with two different assessors (one assessor per occasion)

15. Clinical activity - Annual Summary of Training Calculator uploaded to your personal

library: a. Acute take: 1250 patients seen before CCT b. Ambulatory Care: 300 new patients seen before CCT

16. Clinical experience with relevant competencies in AMU, Cardiovascular medicine,

Respiratory Medicine, Geriatric Medicine, Intensive Care Medicine Specialist Skill training

17. Teaching – satisfactory record of teaching attendance (should be specified at

induction but evidence of attendance at a minimum of 70% of deanery training days


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should be achieved) with 100 hours external AIM teaching (including regional teaching days) before CCT

Overview of GIM training requirements For dually accrediting trainees - as per AIM requirements except: / in addition to AIM requirements

1. GIM Audit or GIM Quality Improvement projects Need to have lead one before CCT one of which must complete the loop. Quality Improvement assessment tool (QIPAT) or Audit assessment (AA) to be performed

2. Multiple Consultant Reports (MCR) of the 4 - 6 MCRs that must be completed annually, 2 MCRs must include feedback on GIM clinical abilities for dual accrediting trainees

3. Clinical activity:

o GIM Acute Take: 1000 patients seen before CCT o Outpatients clinics (or equivalent): 186 clinics performed before CCT

(approximately 1500 outpatients) Please note: AIM trainees dually accrediting with GIM can count new ambulatory care patient contact experience as outpatients for the GIM curriculum. Each SLEs can be linked to both AIM and GIM curriculums i.e. the SLEs do not need to be duplicated for the purposes of satisfying both curriculum requirements. Similarly, though the absolute number required for each curriculum differs, the same patient contact experience can be counted towards the clinical activity requirements for both curriculums.


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Workplace-based Assessments (WPBAs) The various workplace based assessment methods are described below. More information about these methods including guidance for trainees and assessors is available in the ePortfolio and on the JRCPTB website www.jrcptb.org.uk. These assessment tools are available online in the ePortfolio and assessments should be recorded in the trainee’s ePortfolio. Printable versions of some of the forms can be found in the document library on this website. http://www.jrcptb.org.uk/assessment/workplace-based-assessment Supervised Learning Events (SLEs) Trainees should aim for at least 10 SLEs (ACATs, CbDs and mini CEX) - to include a minimum of 6 ACATs. SLEs should be performed proportionately throughout each training year by a number of different assessors across the breadth of the curriculum. Structured feedback should be given to aid the trainee’s personal development mini-Clinical Evaluation Exercise (mini-CEX) This supervised learning event tool evaluates a clinical encounter with a patient to provide feedback on skills essential for good clinical care such as history taking, examination and clinical reasoning. The trainee receives immediate feedback to aid learning. It can be used at any time and in any setting when there is a trainee and patient interaction and an assessor is available.

Case-based Discussion (CbD) The CbD is a tool for supervised learning events based on a trainee's management of a patient and provides feedback on clinical reasoning, decision-making and application of medical knowledge in relation to patient care. It also serves as a method to document conversations about, and presentations of, cases by trainees. The CbD should focus on a written record (such as written case notes, out-patient letter, discharge summary). A typical encounter might be when presenting newly referred patients in the outpatient department. Direct Observation of Procedural Skills (DOPS) A DOPS is an assessment tool designed to evaluate the performance of a trainee in undertaking a practical procedure, against a structured checklist. The trainee receives immediate feedback to identify strengths and areas for development. DOPS have been separated into two categories for routine and life-threatening procedures, with a clear differentiation of formative and summative sign off. Formative DOPS for routine and potentially life threatening procedures should be undertaken before doing a summative DOPS and can be undertake as many times as the trainee and their supervisor feel is necessary. Summative DOPS should be undertaken as follows:

Acute Care Assessment Tool (ACAT) The ACAT is designed to be used for supervised learning events on the acute medical take (but may be on a ward round or covering a day's management of admissions and


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ward work). The ACAT looks at clinical assessment and management, decision-making, team working, time management, record keeping and handover for the whole time period and multiple patients. There should be a minimum of 5 cases for an ACAT assessment. Multi-source feedback (MSF) This tool is a method of assessing generic skills such as communication, leadership, team working, reliability etc, across the domains of Good Medical Practice. This provides objective systematic collection and feedback of performance data on a trainee, derived from a number of colleagues. ‘Raters' are individuals with whom the trainee works, and includes doctors, administration staff, and other allied professionals. The trainee will not see the individual responses by raters, feedback is given to the trainee by the Educational Supervisor. Trainees are also required to complete a self-assessment form. If significant concerns are raised then arrangements should be made for a repeat MSF

Patient Survey (PS) Patient Survey address issues, including behaviour of the doctor and effectiveness of the consultation, which are important to patients. It is intended to assess the trainee's performance in areas such as interpersonal skills, communication skills and professionalism by concentrating solely on their performance during one consultation. Patient survey guidance, survey forms and summary forms are available in the assessment section of the JRCPTB website. The summary form must be completed and signed off by your ES and then uploaded to your personal library as evidence. Audit Assessment (AA) The Audit Assessment tool is designed to assess a trainee's competence in completing an audit. The Audit Assessment can be based on review of audit documentation or on a presentation of the audit at a meeting. If possible the trainee should be assessed on the same audit by more than one assessor Quality improvement project assessment tool (QIPAT) The QIP Assessment tool is designed to assess a trainee's competence in completing a quality improvement project. The trainee should be given immediate feedback to identify strengths and areas for development. All workplace-based assessments are intended primarily to support learning so this feedback is very important. The QIP Assessment can be based on review of QIP documentation OR on a presentation of the QIP at a meeting. If possible the trainee should be assessed on the same QIP by more than one assessor. Assessors can be any doctor with suitable experience - for trainees in higher speciality training this is likely to be consultants. Teaching Observation (TO) The Teaching Observation is designed to provide structured, formative feedback to trainees on their competence at teaching. The Teaching Observation can be based on any instance of formalised teaching by the trainee which has been observed by the assessor. The process should be trainee-led (identifying appropriate teaching sessions and assessors) and one TO should be completed before PYA in AIM & GIM


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Multiple Consultant Report (MCR) The Multiple Consultant Report (MCR) was introduced in 2013 and is designed to capture the views of consultant supervisors on a trainee's clinical performance. It must be completed by a minimum of 4 consultants (maximum of six) or associate specialists / speciality doctors (not trainees) who are able to provide feedback on a trainee's clinical performance. Educational supervisors should not be asked to complete an MCR for their own trainees as they will complete the ES report. Note these are different to MSF assessments. Each MCR form is completed by a single consultant who should either be the trainee’s clinical supervisor (or clinical placement coordinator) or a consultant who the trainee has regular working contact with and not a consultant who the trainee may have fleeting contact with e.g. on-call. For dual accrediting trainees with GIM, 2 MCRs must include feedback on GIM clinical abilities. A summary of the MCR and any actions resulting is to be recorded in the ES’s report. Therefore if four MCRs are required, four consultants should complete a form each resulting in four MCR forms. The MCRs will be automatically collated and summarised in the MCR Year Summary Sheet that will inform the ES report at the end of the training year. The MCR requests feedback on clinical performance and must be completed in addition to the Multi Source Feedback (MSF) tool. The same consultant may be approached to complete both forms. Out of programme trainees are also advised to complete these reports. Trainees who are less than full time should complete the number of MCRs pro rata following discussion with their education supervisor. Further information is available in the assessment section of the JRCPTB website.

Audits AIM trainees are required to complete four audits or quality improvement projects (QIP) prior to CCT (one per year), one of which must complete the loop. These should be uploaded to the personal library. An audit assessment tool or QIPAT assesses a trainee’s competency in completing an audit / QIP and must be completed after review of the documentation or presentation at a meeting. Those trainees dually accrediting with GIM are also required to complete a single GIM audit / QIP prior to CCT (and complete an audit assessment tool). Ideally an audit should be commenced near the start of the placement so there is an opportunity to perform a second/further cycle later in the year. Involvement in a local service development is also equally acceptable.

Annual Summary of Training Calculator This calculator calculates your acute medical and outpatient experience. It is available for download from the GIM section of the Wales deanery website (see below link), with an alternative version downloadable from the GIM section of the JRCPTB website: https://www.walesdeanery.org/specialties/general-internal-medicine


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http://www.jrcptb.org.uk/specialties/general-internal-medicine-gim It should be updated annually and uploaded to your personal library. The AIM decision aid stipulates that 1250 acute take patients and 300 new Ambulatory care patients should be seen prior to CCT, whilst the GIM decision aid states that 1000 patients should be seen on the acute intake and 186 outpatient clinics attended (approx 1500 outpatients) before a trainees CCT date.

Personal library This section of the e-portfolio allows you to upload electronic documents to provide evidence of your training (ALS/SCE/CPD certificates, audits etc). You can upload any file type, however it is limited to 80MB of space. The files can be organised into folders & subfolders. Training quality surveys The national GMC training survey serves to monitor the quality of medical education and training in the UK. In addition an online placement survey is sent out towards the end of each rotation. Completion is a mandatory requirement of training and allows the quality and balance of the training rotations to be maintained. Annual calendar

• February: AIM Trainee Survey • March : ST Applications • April: ST3 Interviews • May: Society for Acute Medicine Spring Conference • May: Spring Meeting of the Society of Physicians in Wales (Portmeirion) • May: AIM ARCPs • May/June : Acute Medicine Summer School • May/June: Welsh Acute Physicians’ Society Spring Symposium • June: Society of Acute Medicine Benchmarking Audit (SAMBA) • June/July: Acute Medicine Awareness Week • September: Society for Acute Medicine International Conference • September: GIM ARCPs • October: Welsh Acute Physicians’ Society Autumn Symposium • November: Society of Physicians of Wales and Royal College of Physicians

Joint Update in General and Acute Medicine (Cardiff)


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Training days and leave Acute Medicine Summer School

The Acute Medicine Summer School is an annual training week arranged for Acute Medicine trainees and is held alternately between North and South Wales, usually at a rural hotel location. It provides a varied programme of activities including service improvement workshops, video simulation sessions on emergency clinical scenarios, practical procedure workshops, debates on contentious clinical issues, a journal club, guideline updates and a number of talks by distinguished local and national speakers on a range of different topics. One of the training days is a national ‘Acute Medicine Symposium’ organised by WAPS. Attendance is mandatory and it is the responsibility of the trainee to ensure that any on-call commitments are swapped to allow attendance. Any difficulty in obtaining leave for the mandatory training week should be reported to the TPD as soon as possible. Welsh Acute Physicians’ Society (WAPS)

The recently formed Welsh Acute Physicians' Society is dedicated to furthering Acute Medicine and supporting trainees in Wales. The group was set up predominantly by a group of acute medicine trainees to raise the profile of the speciality across Wales but is open to all those with an interest in acute medical care and education. The society organises educational events such as the Acute Medicine Symposium, which provides 6 CPD points. Trainees joining the training programme will automatically gain membership to this society and free entry to all symposiums. GIM Training Several GIM core curriculum training courses are available each year, with dates advertised in your e-portfolio. The mandatory GIM core curriculum training days required for CCT are:

• Core Management & Leadership Training • Teaching Techniques • Communication Skills • Medical Law • Assessing Trainees • Medical Ethics

Trainees are also required to attend at least 3 GIM generic curriculum regional StR teaching days (around 4 per year) . These courses are arranged by the deanery and take


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place in South Wales with video link available to North Wales trainees. You may need to contact the organisers to find out dates and get onto email lists. If the trainee does not comply with the minimum attendance percentage of 70%, they will obtain an unsatisfactory ARCP outcome. Currently the North Wales days are organised by Dr. Ben Thomas or Dr. David Glover in Wrexham Maelor Hospital. Booking contact: 01978 727123 or Email: [email protected] The South Wales teaching days are managed by Dr Aled Roberts (STC Chair) & Dr Biju Mohamed (TPD). Any enquiries, should be directed to Dr Roberts Email: [email protected]) or Dr Mohamed [email protected] GIM courses are advertised on the e-portfolio and RCP / Wales deanery website. For full information on dates or to book your place on the training days, please contact Miss Ceri Cook at the Wales Deanery: E-mail: [email protected] no: 02920 687588 You are required to provide evidence of 100 hours of “external” GIM CPD points prior to your CCT. We advise registering for the RCP CPD diary – a summary of your CPD for each year can be uploaded to your personal library as a PDF (this is also recommendation at your GIM PYA).

Study Leave The Wales Deanery defines the study leave budget annually (currently capped at around £800 per trainee). Each specialist trainee is entitled to 30 days study leave per annum. Attendance at ARCPs and core curriculum for specialist trainees is mandatory and therefore not deducted from your annual study leave. All study leave must be requested and authorised using the INTREPID 10 online system. This database keeps a record of all leave taken throughout your training and remaining study leave budget available. Study leave will be granted at the discretion of your departmental leave coordinator. Most hospitals require a minimum of 6 weeks notice to allow cancellation of outpatient clinics and other clinical commitments, although this can vary between different Health Boards (this should be discussed at your local induction meeting). Annual leave Trainees in their first five years of NHS employment are entitled 27 days of annual leave, increasing to 32 days thereafter. Similar to study leave, at least 6 weeks notice is often required to allow cancellation of your clinical commitments. The process for gaining annual leave will vary between Health Boards and should be discussed at your local induction meeting at the start of your placement.


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Speciality Certificate Examination (SCE) http://www.mrcpuk.org/mrcpuk-examinations/speciality-certificate-examinations The Speciality Certificate Examination (SCE) in Acute Internal Medicine is delivered once a year and is designed to test the trainee’s knowledge of Acute Medicine. It is compulsory for all trainees on the AIM curriculum and should be undertaken in the fourth or fifth year of training prior to the year of CCT. There are no entry requirements for the exam, and there are no limits to the number of attempts you can make at the exam during your training although you should allow sufficient time for completion before your CCT date. You cannot receive a CCT without this exam and your training may not be extended for more than one year if you fail the exam in your final year. Though some people may (incorrectly) refer to the SCE as an ‘exit exam’, you can take the exam at any stage of your training after being appointed to a substantive ST3 training post in Acute Medicine. Passing the SCE gives you the right to put MRCP (UK) (Acute Medicine) after your name on completion of training. At the current time there is only one exam sitting per year but this may increase in the future, if there is sufficient demand. It is a computer-based examination held in the autumn each year, in Pearson VUE test centres throughout the UK. The cost of the exam is £665 (after August 2016), which this is tax deductible. There are two 3-hour papers, each consisting of 100 ‘best of five’ multiple choice type questions and tests the extra knowledge base that the trainees have acquired since taking the MRCP(UK) diploma. The examination is made up of questions covering the whole AIM curriculum, selected by a predetermined blueprint (see link to blueprint overleaf). In addition to testing core knowledge and comprehension, this format also assesses the ability to interpret information and to solve clinical problems. There will be five options – one correct answer and four alternatives to the correct answer. The four distractors will be closely related to the preferred option but less correct, therefore acting as plausible alternatives. You are expected to display a level of knowledge equivalent to a consultant practicing in Acute Medicine and this will include knowledge of relevant guidelines and scoring systems. Samples questions are available on the SAM website and the MRCP website displays the latest news about the exam, including dates, fees and how to apply. The style and content of the questions is quite similar to MRCP Part II and that going back to your practice question books for those exams might be a good starting point. There is, as one might expect, a skew towards more “acute” conditions that would present to the AMU and therefore we would advise focusing more on these rather than the chronic diseases which would more naturally present to a specialist outpatient clinic. Previous diets have included a greater emphasis on topics such as poisoning and the signs and symptoms of illicit drug-use than would be expected in the average MRCP Part II paper. Another area worth focusing on would be common simple scoring systems (e.g. CURB-65, ABCD2, Ranson score) so that you can calculate them and are aware of what mortality each score confers upon a patient. Trainees are therefore advised to


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keep up to date with guidelines and latest practice recommendations relevant to Acute Medicine. Useful resources for trainees Preparation for the SCE requires a wide breadth of knowledge around the curriculum and should involve reading of textbooks, journals and guidelines. Experience of the MRCP(UK) examination provides an excellent background to the format of the examination. WAPS Cloud account

• Exclusive resource for trainees containing up-to-date clinical information, guidelines, revision notes, critical appraisal tools, checklists, ARCP decision aids and training week information. It is also used as a networking tool where trainees can upload photos. We also use our WhatsApp group for networking and socialising.

Suggested sources for reading and revision are listed below: Guidelines

• National Institute for Health and Clinical Excellence (NICE) • Scottish Intercollegiate Guidelines Network (SIGN) • The Society for Acute Medicine (SAM) • European Society of Cardiology (ESC) • British Thoracic Society (BTS)

Textbooks

• Oxford Textbook of Medicine (Eds David A. Warrell, Timothy M. Cox, John D. Firth. Published by Oxford University Press)

• Oxford Handbook of Acute Medicine (Eds Punit Ramrakha, Kevin Moore, Amir Sam. Published by Oxford University Press)

• Best of 5 MCQs for the Acute Medicine SCE (Ed Nigel Lane. Published by Oxford University Press)

• Oxford Desk Reference: Acute Medicine (Ed Richard Leach. Published by Oxford University Press)

Journals

• Acute Medicine (Published by Rila) • Clinical Medicine (Journal of the Royal College of Physicians of London) • Journal of the Royal College of Physicians of Edinburgh


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Sample questions These online sample questions give an indication of the type of question you can expect in the exam:

• MRCPUK Sample Questions http://www.mrcpuk.org/acute-medicine-sample-questions

• Onexamination.com online questions: http://www.onexamination.com/exams/general-medicine/acute-medicine-sce#QuestionBrowser

SCE in Acute Medicine blueprint

• SCE in Acute Medicine General Information & Blueprint (MRCPUK) http://www.mrcpuk.org/mrcpuk-examinations/speciality-certificate-examinations/specialties/acute-medicine


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Annual Review of Competence Progression (ARCP) The Annual Review of Competence Progression (ARCP) process is the formal method by which a trainee’s progression through his/her training programme is monitored and recorded. ARCP is not an assessment – it is the review of the evidence of training and assessment. ARCPs are required for all trainees including those out of programme (OOP), LTFT and LAT. The deaneries are responsible for organising and conducting ARCPs. Trainees dually accrediting with GIM will have separate face-to-face ARCPs for both the AIM and GIM components of your training in their ST3 year and for their PYA. At the end of each year (usually in June for Acute Medicine) the trainee will meet with the ARCP panel to review progress over the previous year. This meeting will also provide the trainee with the opportunity to discuss their future training needs and they will also have the opportunity to comment frankly on the quality of the training he or she is receiving without fear of subsequent discrimination. An educational supervisor report covering the whole training year is required before the ARCP. Therefore, the JRCPTB strongly recommends that trainees have an informal e-Portfolio review with their educational supervisor ahead of the ARCP. This provides an opportunity for early detection of trainees who are failing to gather the required evidence for ARCP. This report should bring to the attention of the panel events that are causing concern e.g. patient safety issues, professional behaviour issues, poor performance in work-place based assessments, poor MSF report, issues reported by other clinicians. It is expected that serious events would trigger a deanery review even if an ARCP was not due. The evidence to be reviewed by ARCP panels should be collected in the trainee’s e-Portfolio. It is important that all the necessary documentation is completed and uploaded to the e-portfolio in advance of the ARCP for review, including: ES reports, curriculum components, WBPAs / SLEs, audits tools, MCRs, MSFs and patient surveys. In order to ensure that the external assessor is given sufficient time to review the portfolio it is strongly recommended that trainees fully update their eportfolios two weeks in advance of their ARCP date. Leaving this until the last minute will risk an unsuccessful outcome at your ARCP. The ARCP Decision Aid (see link below) gives details of the evidence required of trainees for submission to the ARCP panels. This is a table that includes a column for each training year which documents the targets that have to be achieved for a Satisfactory ARCP outcome at the end of the training year. A very useful ‘Pre-ARCP Checklist for Educational Supervisors and Trainees’ is available via the JRCPTB website: http://www.jrcptb.org.uk/training-certification/arcp-decision-aids


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Principal ARCP outcomes Outcome 1 Satisfactory progress – Achieving progress and development of

competencies at the expected rate (this is what you want!) Outcome 2 Development of specific competencies required - Additional training time

not required Outcome 3 Inadequate progress - Additional training time required (this is usually only

issued on a single occasion, except for extenuating circumstances) Incomplete evidence presented.

Outcome 4 Released from training programme – with or without specified competences

Outcome 5 Incomplete evidence presented - Additional training time may be required. Further evidence must be provided within a 2-week period to allow progression with training. Failure to achieve this will result in an outcome 3

Outcome 6 Gained all required competences – Will be recommended as having completed the higher training programme and will be recommended for award of a CCT

Outcome 7 Used for Fixed-term Speciality Trainees (FTSTAs) or LAT trainees Outcome 8 Used for out of programme trainees


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Penultimate Year Assessment (PYA) http://www.jrcptb.org.uk/training-certification/penultimate-year-assessment The penultimate ARCP prior to your anticipated CCT date is known as a “PYA” and the panel will include an external assessor from outside the Wales deanery. JRCPTB and the deanery will coordinate the appointment of this assessor. The PYA meeting will take place approximately 12 – 18 months before your provisional CCT date and will summarise your progress to date and highlight/document any specific training objectives required to achieve your CCT. This includes any areas the trainee identifies where they perceive extra training is required. It is important that you ensure that all aspects of your e-portfolio are up to date a minimum of 4 weeks prior to this meeting. This includes all previous ARCP outcomes and educational supervisors reports. You are also required to upload your CV and a Summary of Clinical Experience (SOCE) form to your personal library in a folder titled ‘PYA paperwork’. The panel may ask you to prepare a short PowerPoint presentation to summarise their training achievements to date. Trainees aiming for dual accreditation will have separate PYA meetings for Acute Medicine and GIM. The GIM PYA will also assess your completion of management and teaching courses. External assessors now complete their PYA report directly onto the e-portfolio. This will document any agreed mandatory and recommended training requirements and should be available within 10 days of your PYA. The JRCPTB will then send notification to you confirming your CCT date and any agreed mandatory and recommended training requirements. You will be unable to progress to your final year of training until your PYA has been achieved.


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Completion of training http://www.jrcptb.org.uk/trainingandcert/Pages/Completing-Training.aspx Trainees whose CCT date falls after 28th February 2015 will no longer need to complete a yellow notification ‘Notification Form’ for Completion of Training from the JRCPTB that was previously sent out to trainees approx 6 months prior to CCT date

The PYA tab on your e-portfolio will list any mandatory and/or recommended requirements from your PYA. Separate PYA forms will be completed for Acute Medicine & GIM. Once these requirements have been achieved, you should arrange a meeting with the speciality TPD (below) for review of the evidence and issue of an ‘Outcome 6’ (recommendation for completion of the training programme) on the e-portfolio:

o AIM TPD: Dr Tom Cozen (Royal Gwent) [email protected] o GIM TPD: Biju Mohamed (UHW) [email protected]

Any enquires regarding this process can also be discussed with the Wales Deanery Higher Training Office:

o Robert McGowan (GIM) [email protected] o Trudy McMullin (Acute Medicine) [email protected] o Hilary Williams (Speciality Training Manager) [email protected]

These new changes mean that the SAC will receive CCT applications within 10 days of the trainee receiving an ARCP outcome 6. Depending on your employer, some of them will allow you to start the day after registrar training finishes as locum consultant, pending formal acceptance of CCT. This then becomes substantive once you have your CCT.

Once the form is approved the JRCPTB will send a recommendation to the GMC who will then contact you to join the Specialist Register:

o This currently costs £420 (April 2015) GMC website: www.gmc-uk.org o This cannot be done before your CCT date o Do not forget to inform your medical indemnity (MDU/MPS)

Once you have gained your CCT you will need to resign from your training number (even if this is during your post-CCT extension period) by writing to the Welsh Deanery, your TPD/STC chair, and your Health board, giving them 3 months notice. You will be eligible for an automatic post-CCT extension period of 6 months from your CCT date. This should be organised about 6 months before your CCT date. Unless you advise otherwise, the STC will presume you wish to take advantage of this and that you will leave the training scheme 6 months after your CCT date. A second 6 months extension will only be granted in exceptional circumstances after application to the Postgraduate Dean and with written support from your STC. If you resign less than 3 months from your CCT date you will still need to work the 3 months notice. However if you get a consultant post in the same health board you may be able to be a locum consultant until completing the 3 months.


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Out of Programme (OOP) requests http://www.walesdeanery.org/index.php/en/deanery/wales-deanery-policies/203-oop/301- out-of-programme-oopt-oope-oopr-oopc.html An ST trainee may take a period of time out of programme to undertake research or training, gain clinical experience or as a career break. Trainees are required to obtain formal approval prospectively from the Wales deanery to take time out of programme and will not normally be agreed until a trainee has been in programme for at least 1 year. The Deanery ask for requests for OOP to be submitted at least 6 months prior to your start date (form available on the Deanery website) and after discussion with your ES and Training Programme Director, as StRs can only be released at certain times of the rotation to allow sufficient time for a replacement to be appointed. Any extensions to time out of programme should be discussed and requested through the Deanery & signed off by the TPD. No credit can be awarded for time OOP without JRCPTB approval and approval cannot be granted retrospectively – it must be applied for and granted by the JRCPTB/GMC prior to OOPE. Types of OOP category: (detailed descriptions are available in the Gold Guide):

1. OOPR – Time out of programme for research A period of research may be undertaken often for a higher degree (eg: MD, PhD). Up to 12 months credit may be included towards your CCT. In respiratory medicine in Wales these requests will be sent for external peer review

2. OOPT – Time out of programme for training A trainee may gain opportunity to undertake training outside of their regular training programme either in the UK or abroad. The SAC will review how much credit may be provided towards your CCT.

3. OOPE – Time out of programme for clinical experience A trainee may gain experience similar to OOPR or OOPT, but not related to the curriculum. There is therefore not the ability to credit this period towards your CCT.

4. OOPC – Time out of programme for career breaks

It may occur for a variety of reasons including a period of parental, sick or exceptional leave. This also includes a period of acting up as a consultant.


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Acting up as a consultant (AUC) http://www.jrcptb.org.uk/training-certification/out-programme “Acting up” provides doctors in training coming towards the end of their training with the experience of navigating the transition from trainee to consultant while maintaining an element of supervision. Trainees are eligible to act up as a consultant within 1 year of their provisional CCT date. It is a type of OOPT period. A total of 3 months can be counted towards the CCT. Although acting up often fulfils a genuine service requirement, it is not the same as being a locum consultant, which can only be undertaken after obtaining your CCT. . “Acting up” requires a named supervisor in the hospital where you are attached (not necessarily from the same speciality) who will always be available for support, including out of hours or during on-call work. They will need to follow the JRCPTB rules below:

• The term 'acting up' and not locum must be applied • The total credit that can be awarded towards CCT or CESR (CP) is 3 months. For

trainees on less than full time training the chronological time is calculated on a pro rata basis

• Approval from the Postgraduate Dean/Deanery/LETB has been given for the appointment

• Acting up attachments are restricted to the final year of higher specialist training If you are considering a period of acting up, it should initially be discussed with your Educational Supervisor and Training Programme Director. If suitable you should complete the AUC form available on the deanery website. A three month notification period is usually also be required by your employing Health Board to arrange appropriate cover for your existing post (in some cases you may be required to resign from your post within the Health Board).


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Flexible / Less Than Full Time Training (LTFT) http://www.walesdeanery.org/index.php/en/less-than-full-time-training-ltft/ltft.html The Less Than Full Time (LTFT) training scheme is available to men and women, married or single, who have reasons which prevent them from working full-time such as:

o being the parent of a young child\children o caring for an ill or disabled relative o having a disability o having a health problem

Part-time training shall meet all the same requirements as full-time training, including taking placements on the rotation in North Wales. The posts are not supernumerary, and will differ to full-time posts only in the possibility of limiting participation in medical activities to a period of at least half of that provided for full-time trainees. The deanery shall ensure that the total duration and quality of part- time training of specialists are not less than those of full-time trainees. Flexible trainees should undertake a pro rata share of the out-of-hours duties (including on-call and other out-of-hours commitments) required of their full-time colleagues in the same programme and at the equivalent stage. Funding for flexible trainees is from deaneries and these posts are not supernumerary. Ideally therefore 2 flexible trainees should share one post to provide appropriate service cover. Dr Nia Rathbone (Consultant Acute Physician & current Acute Medicine TPD, Royal Glamorgan Hospital) is the LTFT lead for acute medicine in Wales. If you are considering flexible training you should inform the Deanery & your TPD as soon as possible. The LTFT training policy is available on the Wales Deanery website (link above) and includes the application form. Trainees are required to undertake no less than 50% of full time training. CCT dates can be estimated using the JRCPTB completion date calculator. Professional Support Unit (PSU) http://walesdeanery.org/index.php/en/careers-and-recruitment/wales-deanery- professional-support-unit.html The deanery is responsible for all trainees throughout Wales and for any issues that arise that may affect their training and progress through the training programme. The PSU provides support for any trainees in the form of advice and guidance and access to experts who can deal with specific areas. Trainees may approach the PSU through a need they have identified themselves or after being advised to seek their support after training difficulties have been identified by clinical or educational supervisors or highlighted through ARCPs. Early identification and support will reduce the potential risks to the trainee, colleagues, patients and the organisation.


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Useful training related websites and resources Society for Acute Medicine (SAM) http://www.acutemedicine.org.uk https://twitter.com/acutemedicine Full annual membership (£120) includes a subscription to the Acute Medicine journal Reduced annual membership for doctors in training (£45) does not include a subscription to the Acute Medicine journal. Membership benefits include:

• Subscription to the society’s quarterly journal ‘Acute Medicine’ www.rila.co.uk • Full subscription to the Society newsletter Acute News (published quarterly

online) • Option to receive the weekly news round-up • Opportunities to work with NICE as SAM as a guidelines stakeholder • Reduced rate registration for Spring and Autumn Meetings • Option to stand for positions on the Society Council • Voting rights • Access to the Society’s online resources

Journals

• Clinical Medicine – The Journal of the Royal College of Physicians https://www.rcplondon.ac.uk/resources/clinical-medicine-journal

• Acute Medicine – The Journal of the Society for Acute Medicine

http://www.rila.co.uk/site/modules.php?name=Journals Other societies and organisations

• GMC http://www.gmc-uk.org/

• Joint Royal College Postgraduate Training Board (JRCPTB) Website

http://www.jrcptb.org.uk

• Royal College of Physicians https://www.rcplondon.ac.uk

• Wales Deanery

http://www.walesdeanery.org/

• Society of Physicians in Wales http://www.societyofphysiciansinwales.org.uk

• Welsh Acute Physicians’ Society (WAPS)

https://twitter.com/AcuteMedWales [email protected]


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• Take AIM www.takeaim.org.uk

Useful training resources

• Intrepid v10 Online Leave & Course Booking System https://www.intrepidv10.co.uk/WAL/sys_Pages/MainMenu/MainMenu.aspx?ReturnUrl=%2fWAL

• The Gold Guide- A Reference Guide for Postgrad. Speciality Training in the UK

http://specialitytraining.hee.nhs.uk/news/the-gold-guide/

• Report of the Acute Medicine Task Force (RCP October 2007) – Acute Medical Care: The right person, in the right setting – first time https://www.rcplondon.ac.uk/publications/acute-medical-care http://www.clinmed.rcpjournal.org/content/9/6/553.full

• RCP Acute Care Toolkits https://www.rcplondon.ac.uk/resources/acute-care-toolkits

• Wales Deanery – General Internal Medicine • http://www.walesdeanery.org/index.php/en/higher-training/general-internal-

medicine.html

• Wales Deanery – Acute Medicine • http://www.walesdeanery.org/index.php/en/higher-training/wales-deanery-acute-

medicine.html

• JRCPTB Acute Medicine ST3 Recruitment / Person Specification http://www.st3recruitment.org.uk/specialties/acute-internal-medicine.html

• Speciality Training Curriculum and ARCP Decision aid for Acute Internal Medicine

http://www.jrcptb.org.uk/specialities/acute-medicine

• Speciality Training Curriculum and Decision aid for General Internal Medicine http://www.jrcptb.org.uk/specialties/general-internal-medicine-gim

• SCE in Acute Medicine General Information & Blueprint (MRCPUK) http://www.mrcpuk.org/mrcpuk-examinations/speciality-certificate-examinations/specialties/acute-medicine

• SCE in Acute Medicine Sample Questions (MRCPUK)

http://www.mrcpuk.org/acute-medicine-sample-questions

• Preparing for Consultant Selection http://careers.bmj.com/careers/advice/view-article.html?id=20020923 http://www.medicalcareers.nhs.uk/postgraduate_doctors/speciality_trainees/consultant_interview_process.aspx


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Appendix 1: AIM / GIM ARCP Checklist Date of ARCP: Name of trainee: Grade of trainee: AIM component Satisfactory ES report Completed MCRs (minimum 4 required: 2 GIM + 2 AIM) Extended leave noted in absences Comments (if applicable) Valid ALS (valid for 4 years) Satisfactory MSF (ST3 + ST5 years) Comments (if applicable) Satisfactory patient survey (ST4 + ST6 years) Comments (if applicable) AM Audit + assessment tool completed (annually) Comments (if applicable) Completed total of 6 mini-CEX + CbD SLE’s - usually 3 of each Comments (if applicable) Satisfactory curriculum competencies/linkage & ES sign off Comments (if applicable) Updated ‘Firth calculator’ (uploaded to personal library) (1250 acute patients and 300 new Ambulatory Care patients before CCT) Comments (if applicable) SCE obtained (ST4+ prior to CCT)

Yes/No Yes/No Yes/No Yes/No Yes/No Yes/No Yes/No Yes/No Yes/No Yes/No

GIM component (Separate GIM ARCPs held in first year of training and for PYA) Required annually 10 WBPA’s (includes minimum of 6 ACATs) Comments (if applicable) Updated ‘Firth calculator’ (uploaded to personal library) (1000 acute patients + 186 clinics required before CCT) Satisfactory curriculum competencies/linkage & ES sign off Comments (if applicable) External GIM CPD (100 hours required before CCT – can include maximum of 20 hours speciality CPD) Comments (if applicable) Advisory (required pre-CCT) 1 GIM audit/service development + assessment tool 1 teaching observation Teaching/management courses Register with RCP CPD diary

Yes/No Yes/No Yes/No Yes/No Yes/No Yes/No Yes/No

REQUIREMENTS/OBJECTIVES ARCP outcome:


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Appendix 2: GIM PYA Checklist Requirements for GIM CCT Y/N Will the trainee have had experience of the management of a minimum of 1000 unselected patients on the acute medical take which should take place over a minimum of 3 years?

Has the trainee obtained the degree of ITU/CCU experience defined in the relevant curriculum?

Will the trainee have had responsibility for the continuing care of inpatients providing GIM expertise & exposure to a selection of speciality outpatients including GIM patients on a one-to-one basis in a minimum of 186 clinics over the years of the training programme?

Is the trainee likely to be competent at performing the practical procedures detailed in the GIM curriculum?

Will the trainee have a valid ALS certificate at the planned CCT date? Has he/she used a proportion of allocated study leave to train in GIM (Target of 100 hours external training, including regional training days)

Has the trainee received confirmation/certificate of attendance for training days? Have satisfactory reports from CS/tutors been received and reviewed? Has the training portfolio been satisfactorily completed? Has the trainee obtained adequate competency in the ‘Top Twenty’ presentations? Are there outstanding ones for which further training is required?

Has the trainee demonstrated adequate competencies in the other 40 presentations? Will further training be required to obtain these?

Has the trainee demonstrated appropriate knowledge of management & received formal management training to include committee work within the trust?

Has the trainee attended formal training in teaching methods & shown satisfactory participation in an organised teaching programme?

Has the trainee led an audit for each training year? Are you satisfied that the trainee has fulfilled the curriculum requirements for generic skills?

Has the trainee registered with the CPD on line diary? Have there been significant periods of absence for sick leave or maternity leave? Have the mandatory curriculum objectives been met? Has the trainee successfully completed the required amount of WBPA’s as stated on the ARCP decision aid?

Does the trainee have any targets that must be met before completion of training? (list)

Wales Acute Medicine Trainee Booklet June 2016€¦ · o Speciality based clinics - Cardiology,...

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