Education and training
Consultant physicians working in acute internal medicine
There are two main types of consultant physician working in acute internal medicine (AIM):
- acute physicians work whole or part time in the acute medical unit (AMU) and contribute to its day-to-day running and governance
- acute medical intake consultants contribute to the care of patients admitted as an acute admission, usually for out-of-hours care.
Acute physicians have typically trained specifically in AIM, with the possible addition of general internal medicine (GIM). Those who have trained in another acute specialty would generally be expected to have dual accreditation in GIM. Other acute specialties include respiratory medicine, renal medicine, geriatric medicine, rheumatology, infectious diseases, cardiology, and diabetes and endocrinology. Consultants working on the acute medical intake will be trained in an acute medical specialty and GIM.
Training in acute internal medicine
The AIM curriculum can be accessed at the Joint Royal Colleges of Physicians Training Board (JRCTB). The training programme lasts for 4years with an optional 5th year to gain a second certificate of completion of training in GIM. Trainees rotate through AMUs, acute specialties (respiratory, cardiology and acute care in medicine for the elderly are mandatory) and critical care posts to acquire competencies in:
- the prompt practical management of acute presentations of medical illness
- the management of medical patients in an inpatient setting
- the development of new patient pathways to maximise safe, effective care in the community where feasible
- the provision of leadership skills within an acute medical unit
- the development of multiprofessional systems to promote optimal patient care
- the care of patients requiring more intensive levels of care than would be generally managed in a medical ward; these competencies are generally acquired from experience within a critical care unit.
Trainees in AIM must also develop a specialist skill in one of the following areas:
- procedural skill, eg echocardiography
- additional qualification, eg medical education
- specialty interest, eg stroke, intensive care medicine
- research – trainees must demonstrate extensive involvement in research, including the acquisition of research grants and over five research articles published in peer-reviewed journals during their training period.
To enter an AIM training programme doctors will have:
- full MRCP
- completed training in core medical training or acute care common stem training.
Training in AIM equips acute physicians to manage a whole service. AIM evolved from the need to improve the quality of care for acutely unwell medical patients, to manage the increased acute medical workload and to provide senior leadership to AMUs. As AIM has developed, the role of acute physicians has expanded to incorporate:
- education – for medical students and doctors of all grades, as well as the multiprofessional team, for example nurses, advanced nurse practitioners and pharmacists. Acute physicians play a major part in completing work-based assessments for trainee doctors
- service development – especially initiatives to make acute care services safe and efficient, as well as forming links with the community to facilitate safe and early discharge
- implementing national guidelines.
The Academy of Medical Royal Colleges (AoMRC) has produced a cost of training document setting out the mandatory costs of training involved in college enrolment fees, examination costs and GMC fees. Published in October 2017, it has been compiled to help pre-specialty doctors make fully informed career selections, with a clear understanding of the mandatory costs of their future training pathway.
Consultant job plans
Job plans must reflect the nature and intensity of work in AIM. Support should be given to physicians wishing to maintain an interest in another area of clinical practice. Annualised job plans facilitate shift working and properly staffed rosters are essential. Acute physicians wishing to work part time find that sessional work and annualised job plans can provide a good life-work balance. Support should be given to physicians who wish to work part time.
Non-medical workforce in acute internal medicine
The traditional medical workforce model is changing and this can be beneficial to AIM. Enhancing the skills of non-medical professionals can help to bridge the gaps in the medical workforce. Developing a team who shares a long-term vision for the service, irrespective of professional background, is very important. On a day-to-day basis, a consistent, well-developed team carries with it a wealth of local knowledge and information, which will help the service cope at times of peak demand. Examples include:
- healthcare assistants trained to take blood, cannulate, implement care plans and bundles and chase investigations
- advanced nurse practitioners
- physician assistants
- pharmacists – as independent prescribers
- combined physiotherapy, occupational therapy and social work teams to care for older people.