key points from the new cmt gim curricula guide for trainers and trainees jrcptb

Key points from the new CMT GIM curricula

Guide for trainers and trainees

JRCPTB

Rationale for change• 2007 curricula split into 2 parts - GIM/acute and generic • Need simple way of clearly linking to GMC Good Medical

Practice which will enable relicensing for Juniors• Need to retain good features e.g. Top 20 presentations,

linkage of competences to assessments, use of ePortfolio• Need to link to 2009 Academy work that all curricula will

have a common competences section (replaces generic)• MRCP (UK) did not map to CMT curriculum and not

necessary to complete Core training i.e. position of exam unclear

• Levels 1,2 and 3 not easily defined• Trainee and service pressure to redevelop clarity over

specialty of GIM and loss of dual CCT• JRCPTB desire to support separate specialty of Acute

Medicine

JRCPTB

Moving from the two Curricula of 2007

To a new single curriculum for 2009

JRCPTB

Moving from a career pathway like this

JRCPTB

Moving to a career pathway like this

FY2

MRCP (UK) and WPBAs

GIM TrainingCore Medical Training or Acute Care Common Stem

Selection Selection

36 to 60 months to completion

minimum

Work place based assessments

JRCPTB

Specialty

Moving to a career pathway like this for dual CCT

FY2

MRCP

Core Medical Training

Selection Selection

60 months to completion minimum

GIMSpecialty

Work Placed Based Assessments

JRCPTB

Main features (1)

• Core competences have replaced the generic curriculum and will underpin all speciality curricula

• 4 Emergency, ‘Top 20’ and ‘Other Presentations’ remain

• All parts of the curricula have mapped assessments

• MRCP in its three components Part 1, Part 2 and PACES maps to all parts of the curriculum for the CMT stage of GIM training and is necessary for full completion of CMT

JRCPTB

Main features (2)

• Spiral curriculum remains,GIM represents ‘maturation’ of the CMT trainee

• For system and symptom specific competences clearly defined,assessments will ‘sample’ the curriculum. One assessment will usually cover several areas of the curriculum.

• Procedural competences clearly defined• Progression through the full curricula well

defined by the decision aids

JRCPTB

Examples of the new layout

Curriculum starts with common competences

JRCPTB

Layout of syllabus

• Standardised throughout – knowledge, skills, behaviours

• Assessment methods highlighted e.g. CbD, ACAT and mini-CEX

• Four Domains of the new framework for GMC Good Medical Practice which each item relates to highlighted

• For Common Competences – descriptor levels described 1-2, relevant to CMT and 3-4 Specialty training

• Will be linked and “made live” by ePortfolio

JRCPTB

• Will enable Relicensing for Junior Doctors by providing evidence such as work place based assessments and MRCP attainment from the ePortfolio

JRCPTB

Emergency presentations

Other important presentations

System specific competences

Moving from just a computer exercise

• New curricula will be fully integrated with ePortfolio

• Competences will be achieved from work place based assessments and MRCP

• Consultants playing an active part in this

JRCPTB

percentage

Average overall rating

Consultant 4087 44 5.04

SpR 4771 52 5.09

SAS 399 4

CMT e-Portfolio Assessors Aug 08 – May 09 ACAT

percentage

Average overall rating

Consultant 4134 45 5.00

SpR 4604 51 5.07

SAS 357 4

CMT e-Portfolio Assessors Aug 08 – May 09 CBD

Consultant 3215 28% 5.04

SpR 7268 63% 5.11

SAS 4%

Nurse 1%

GP 0

SHO 2%

Other 2%

CMT e-Portfolio Assessors Aug 08 – May 09 mini-CEX

Key to progression is the ARCP decision grid• Based on feedback from users e.g. CMT

Committee and HoS• Recognises portfolio review at 8,16 and 23• ARCP annual at 11or 12 and 23 or 24• More clarity e.g. numbers of assessments in

each 8 month block and minimum by consultants• Explicit about achievement of all parts of MRCP

being necessary for full completion of CMT and attainment of CMT certificate

JRCPTB

Core Medical Training ARCP Decision Aid – standards for recognising satisfactory progress

CMT Year 1 CMT Year 2

Month 8/9

ePortfolio review (locally)

ARCP at month 11 or12

Month 16


Month 22/ 23


ARCP at month

23 or24

Common Competences (25)

Competent in minimum of a third at level 1 or 2 descriptor (ACAT/ CbD/ mini-CEX/ MSF)

Competent in minimum half of areas at level 1 and half of level 2 descriptors (ACAT/ CbD/ mini-CEX/ MSF)

Year 1 MSF completed and satisfactory.

Competent in all to level 2 descriptor

(ACAT/ CbD/ mini-CEX/ MSF)

Emergency Presentations (4) Some experience of all

(ACAT/ CbD/ mini-CEX )

Competent in all

(ACAT/CbD/ mini-CEX )

Competent in all

(ACAT/ CbD/ mini-CEX)

Top 20 Presentations (20) Some experience of half


Competent in half


Competent in all


Other Presentations (40) Competent in a quarter


Competent in half


Competent in minimum of 34/40


Procedures (17) Independent in at least half (DOPS) Independent in at least two thirds (DOPS) Independent in 15/17 (DOPS)

Examinations Review MRCP Pt1/Pt2 progress

Enables achievement of competences

Review MRCP Pt1/ Pt2 /PACES progress


Ensure MRCP(UK) diploma acquired


ALS Valid

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Minimum number of workplace assessments by Consultant Assessor in each 8 month Block

3 X ACAT

3 X CbD

3 X mini-CEX

3 X ACAT

3 X CbD

3 X mini-CEX

3 X ACAT

3 X CbD

3 X mini-CEX

Annually

Required

1 X MSF

DOPs until independence in

procedures demonstrated

1 X MSF

DOPs until independence in

procedures demonstrated

Events giving concern The following events occurring at any time may trigger review of trainee’s progress and possible remedial training: issues of professional behaviour; poor performance in work-place based assessments; poor MSF performance; issues arising from supervisor report; issues of patient safety

Key to implementation will be continuing use of ePortfolio

Will look the same

Link to new curricula

Will still be able to link a number of competences to single assessment and now include parts of MRCP

JRCPTB

Example portfolio

MRCP(UK)

• Fully mapped to CMT part of GIM curricula• There was a change in regulations in 2008• Part 1 can still be taken in FY2 year as previously but

now can be taken after one years experience as opposed to 18 months

• Part 2 and PACES can be taken simultaneously if wanted

• CMT final certification of completion requires full MRCP (career progress with this during training will be monitored with ARCP and depending on progress may be extended in exceptional circumstances for some trainees for >2 years)

JRCPTB

Significant task of implementation

• All new 2009 CMT trainees start on new 2009 GIM curricula on CMT part

• CMT trainees who started in 2008 will complete the 2007 curricula (acute conditions and generic) on which they started

• Need to inform trainees and trainers of change which starts in August 2009

JRCPTB

CMT part of new curriculum

Affects 2000 trainees and trainers

from August 2009

JRCPTB

Specialty training in GIM

JRCPTB

Implementation of the GIM curriculum in acute medical

specialties

• Passing of MRCP(UK) is now one of the main required competences to exit from CMT

• ePortfolio used to record acquisition of competences

• Logbook of anonymised patient contacts where possible,’experience’ prior to August 2007 will be accepted

• GIM competences will usually be acquired on the acute medical take and in triaged in-patient wards and specialty outpatient clinics

JRCPTB

GIM progression(1)

• ARCP crucial• Documentary evidence of WPBA’s

essential• HOS’/SAC SHA reps will need to

establish close links with GIM and acute medical specialty training program directors to ensure that specialty STC’s have a designated GIM- responsible STC member.

JRCPTB

ST3 to CCT ARCP Decision Aid – standards for recognising satisfactory progress

1st Year GIM 2nd Year GIM 3rd Year GIM

Common Competences

Competent at level 3 or 4 descriptors in minimum of a third (assessed by ACAT/CbD/PS/mini-CEX /Teaching Observation)

Competent at level 3 or 4 descriptors in minimum of two thirds (assessed by ACAT/CbD/PS/mini-CEX /Teaching Observation)

Competent at level 3 or 4 descriptors in all (assessed by ACAT/CbD/ PS/mini-CEX /Teaching Observation)

Management and leadership

Demonstrate acquisition of leadership skills in supervising the work of Foundation and Core Medical trainees during the acute medical take

Demonstrate implementation of evidence based medicine whenever possible with the use of common guidelines Demonstrate good practice in teamworking and contributing to multi-disciplinary teams.

Able to supervise and lead a complete medical take of at least 20 patients including management of complex patients both as emergencies and in patients

Able to supervise more junior trainees and to liaise with other specialties.

Awareness and implementation of local clinical governance policies and involvement in a local management role within directorates, as an observer or trainee representative

General Internal Medicine Acute Medical Presentations (Symptom Based Competences)

Demonstrate senior clinical management skills for Top 20 presentations and knowledge of at least half of the ’Other Presentations’

Competent in the senior-level clinical management of all Top 20 and the Other Presentations including some complex cases involving inpatients and acute take patients

Successful completion of at least 2 GIM audits

Demonstrate adequate creation of management and investigation pathways and instigation of safe patient treatment for all of the top 20 and ‘Other presentations’ including the vast majority of complex cases that would be encountered in inpatients and on the medical take.

Examination MRCP(UK) diploma held

ALS valid valid valid

Annually Required 1 satisfactory MSF, 1 Patient Survey 1 satisfactory MSF, 1 Patient Survey

Logbook

Minimum of 1000 patients as seen on acute take during the period of dual training with evidence of individual activity to be provided. A minimum of 450 new or outpatient referrals (including ambulatory care) and a minimum of 1500 follow-up outpatients during the period of dual training with evidence of activity provided. Evidence must be provided of a minimum of 100 hours external GIM training during the period of dual training

Minimum number of work place assessments by Consultant Assessors per year

6 x ACATs; 4 x CBDs; 4 x mini-CEX; Audit Assessment where relevant

To be spread throughout the year

Events giving concern The following events occurring at any time may trigger review of trainee’s progress and possible remedial training: issues of professional behaviour; poor performance in work-place based assessments; poor MSF performance; issues arising from supervisor report; issues of patient safety

GIM progression(2)

• TPD’s/college tutors and educational supervisors must ensure that the e-portfolio is properly completed,ARCP’s are properly conducted and that trainees are gathering their documentary evidence.

• JRCPTB will need to link more closely to STC chairs and TPD’s

JRCPTB

Current status of trainees re CCT in GIM

• Pre January 2003,dually accrediting-no change• January 2003-July 2007,dually accrediting-no

change• July 2007-July 2009,recruited into single

medical specialty training,eligible for level 2 credential in GIM/Acute Medicine: will be able to apply to transfer to the new GIM curriculum and then progress to a CCT in GIM as well as their specialty provided that the curricula requirements are fulfilled.

JRCPTB

Current status of July 2007-July 2009 GIM/Acute level 3 STR’s

• The 350 STR’S in this group can remain in their current training programs where they will receive a CCT in GIM/acute medicine.or,

• They can apply to transfer to the new acute medicine curriculum once this has PMETB approval and acute medicine is recognised as a speciality.This new curriculum will award a CCT in Acute Medicine,provided the training program is successfully completed.

JRCPTB

Questions about CCT’s

• Can level 3 GIM/acute STR’s obtain a new GIM CCT as well as an acute medicine CCT? (yes,in theory)

• Can level 2 GIM/acute STR’s transfer to the new acute medicine curriculum?(no ,but they can get a GIM/acute CCT by completing a one year MAU-based high quality training post)

• Are there any legal/mandatory problems in allowing transfer for level 2 trainees without external assessment of their training but by ‘sampling’ of trainee portfolios in each deanery?(should be OK)

JRCPTB

Communication plan

• Heads of Schools• JRCPTB• RAs• SACs• RCP Trainees Committee• CMT Committee• College Tutors• Educational Supervisors• Fellows• Trainees

JRCPTB

How will GIM/Acute Trainees transfer to the new GIM

curriculum?From October 2009

JRCPTB

Required evidence(1)

• WPBAs as defined in the GIM (Acute) ARCP Decision Aid

• Minimum:– 3 ACATs (aiming for 6), 4 mini-CEX and 4

CbD per year;– DOPS until independence in procedures

demonstrated;– MSF

JRCPTB


• Evidence of attendance at a minimum of 70% of Deanery training days where 2 hours of GIM is provided

• Evidence of attendance at a minimum of 35 hours per year of external GIM conferences or courses

• A proportion of this training can be achieved by recognition of e-learning modules

JRCPTB


• Personal management of an indicative number of 300 patients per year admitted on the general medical “take”

• Personal management of equivalent over 3 years of 450 new outpatients/and or inpatient complex referrals or ambulatory care patients

JRCPTB


• Demonstrated senior level competence in the Top 20 and Other Presentations

JRCPTB

Outpatients

• 450 new out patients over the duration of training can include new interfirm referrals

• It is essential that logbooks are used to record OP and interfirm referral numbers

• Workplace-based assessments are the key to providing documentary evidence of GIM exposure

JRCPTB

Outpatients experience

• Usually in the primary specialty

• Can be obtained in clinics in other specialties

• Minimum of 450 new or referral patients over dual training period

• Minimum of 1500 follow up patients over the dual training period

JRCPTB

Context of in and out patients

• GIM experience can be accumulated in specialty in patient wards and in specialty out patients where patients often have multisystem conditions.This will usually occur in the trainee’s own specialty.

JRCPTB

Transferring to GIM in ST4(2008 entry) and ST5 (2007 entry)

• ST4 trainees will transfer at their ARCP conducted in the presence of local GIM STC.

• ST5 trainees will transfer at their PYA or ARCP (whichever is sooner) in the presence of local GIM STC. This will require more time for these PYA’s and new documentation from JRCPTB to facilitate a review of training before the PYA.

• Externality will be provided by the SAC ‘sampling’ the PYAs and ARCPs on a random basis to ensure even quality.

JRCPTB

key points from the new cmt gim curricula guide for trainers and trainees jrcptb

Documents

eportfolio jrcptb slide

trainees jrcptb slide

completion of cmt jrcptb

decision aids jrcptb

cmt curriculum

assessments mrcp

core competences

eportfolio competences