Starting Higher Specialty Training in Acute Internal Medicine

Start dates and first ARCP

The Higher Specialty Training programme in Acute Internal Medicine is a total of 4 years, running from ST4 to ST7. Start dates depend on the recruitment round:

• First round: training commences around the first week of September, with ARCP expected the following June.
• Second round: training usually commences around March, with ARCP expected the following January.

Please note these timings are subject to change.

Your first year: settling into the role

As a new Higher Specialty Trainee, the expectation is that you settle into the role of becoming an Acute Physician. Working within Acute Medicine entails on-call commitments alongside working in the Acute Medical Unit (AMU) / Medical Assessment Unit (MAU), Same Day Emergency Care (SDEC) and the Medical Short Stay Unit.

Point-of-care ultrasound (FAMUS)

The FAMUS expectation is to complete the theoretical component and commence supervised scanning, gaining competence towards independent scanning and eventual accreditation by the end of the ST5 year.

Procedural skills

Acute Medicine trainees are expected to become competent in the practical procedures set out in the AIM curriculum, such as pleural aspiration, chest drain insertion, lumbar puncture, abdominal paracentesis, central venous access and DC cardioversion.

Gaining competence: Initially, you will show evidence of competence through Direct Observation of Procedural Skills (DOPS), supervised by a trainer.

Maintaining competence: Once signed off, you will be expected to maintain your competences throughout training. Evidence of this can include:

• Keeping an up-to-date procedural logbook
• Direct teaching of procedures to junior colleagues
• Teaching at simulation sessions
• Attending refresher courses

Specialty experience

Along with growing your skills in Acute Medicine, each year of training includes a rotation or secondment to a specialty. Over the 4-year programme, you will rotate through the following four specialties:

• Geriatric Medicine
• Respiratory Medicine
• Critical Care
• Cardiology

The order of these rotations will vary depending on your training site and rotation, and trainee preferences are taken into account wherever possible. These rotations are designed to broaden your experience in the specialties most closely linked to acute medical practice, while you continue to contribute to the acute medical take.

Teaching, Quality Improvement and Leadership

There are prospects to be involved in teaching throughout training. Organised Regional Training Days (RTDs) run for both AIM and GIM, covering the curriculum and supporting you towards your ARCP requirements.
There are ample opportunities to get involved in Quality Improvement Projects (QIP) and leadership, both within your hospital and at regional level.

Specialty skills

Alongside core Acute Medicine training, you will be expected to develop a specialty skill during your training. This allows you to build an area of particular interest and expertise that you can bring to your future consultant role.

Examples of specialty skills include:

• Advanced point-of-care ultrasound or echocardiography
• Palliative and end-of-life care
• Medical education
• Quality improvement, leadership and management
• Research
• Clinical toxicology
• Stroke medicine or care of the older person
• Maternal medicine

You are encouraged to discuss your specialty skill with your Educational Supervisor early in training, so that it can be planned into your rotations and supported over the programme.
AIM Specialty skills (2022 curriculum)

Expectations for each training year

The ARCP Decision Aid provides guidance on the expectations for each year of training. Information is available from the JRCPTB website giving detailed guidance on the Acute Medicine ARCP assessment blueprints and curriculum. 

The latest update Combine decision aid for AIM and GIM https://heeoe.hee.nhs.uk/sites/default/files/combined-decision-aid.pdf

Here is the link to the new Acute Medicine curriculum  -  Acute Internal Medicine 
 

Welcome Pack for the Deanery

A Guide for Less Than Full Time Training

The HEE Trainee resources Guide

SuppoRT for those returning to practice after a period away from clinical practice

Professional Support & Wellbeing Unit

Relocation & Expenses Resources

Improving Flexibility for trainees in their working lives by expanding Less Than Full Time Training

Training days aim to cover the Acute Internal Medicine curriculum (hyperlink) developed by the Joint Royal Colleges of Physicians Training Board and seek to build and sustain the community of Acute Medicine across the region.

The regional training days are held across the training year, which runs from August to July. They are hosted by the Trusts within the region. At present they are mostly held virtually via MS Teams; in future, a mixture of in-person and virtual days is likely. All AIM higher specialty trainees in the region are expected to attend, with a minimum attendance of 75% of training days. Study leave should be granted to attend.

The 2026–27 training year will include three simulation/human factors days. It is advisable to have attended at least one simulation per year. 

All the training days are booked via PGVLE both for General Internal Medince and Acute Internal Medicine
Log in or Access issues to PGVLE app: If you want to set up your account in PGVLE, please find the form link below to fill and they will provide this in a week’s time.
https://forms.cloud.microsoft/e/sZG9CCra2B . If still you have any access issues, please contact  england.blendedlearning.eoe@nhs.net

To Book training days:
Regional Teaching Days: please visit Acute Internal Medicine - Regional Training Days | PGVLE.
Regional Teaching Days: please visit GIM Regional Teaching Days | PGVLE

Trainees are also encouraged to attend:

• Society for Acute Medicine meetings and biannual conferences summer/autumn
• Regional RCP updates in Medicine
• Cambridge Medical Seminars
• AMGER(Acute Medicine Regional Eastern Group Conference)- Annual Autumn Regional conference, 6 CPD point 

Training in Acute Internal Medicine should be more than ePortfolio management and ARCP checklists, however, understanding where the finish line is and keeping on top of requirements for this should allow you more time to focus on broader aspects of career development. ARCP's are held twice a year in January/February and June.

For ARCP Focus on :

• Complete Form R;https://trainee.tis.nhs.uk/
• Rating curriculum appropriately and linking evidence
• Achieving the expected SLE for both GIM + AIM
• ES Report : AIM +GIM : Please ensure a clear summary of trainee performance, progression and include information on the list below, aim to complete report 2 weeks ahead of ARCP
• Organised a clear Folder on your personal library with evidence that is easy to review by the panel 
  •  Rotations Done ( ideally 1 per year) ( COE/ ICU/ Cardiology/ Respiratory) 
  • Courses attended
  • Logbook: Up to date : Acute Take, Clinics, Teaching, Procedures
  • Evidence of Simulation courses attended + Human Factors
  • ALS Valid
  • Evidence of SCE exam ( if passed)
  • US Logbook : Progression and certificate if already achieved
  • Leadership course
  • Ensure appropriate numbers of SLE ( Both GIM+AIM)
  • MSF + MSF Summary ( 3 consultants)
  • MCR 
  • Specialty Skill Progression

Your progress will be reviewed by ePortfolio review and form R at ARCP.

Familiarise yourself with the ARCP decision aid to ensure that you understand what curriculum requirements and how many ePortfolio assessments are required by ARCP.

Combine decision aid for AIM and GIM https://heeoe.hee.nhs.uk/sites/default/files/combined-decision-aid.pdf

Document your clinical exposure before your final education supervisor meeting each year using the Firth calculator and JRCPTB CCT date calculator.
Special mention of procedures, clinics attended, clinical attachments, specialty skill, SCE, audit is advisable.
Maintaining a CPD diary is useful preparation for consultant life, it is mandatory to attend 70% of regional training days.

Useful curriculum links: 

JRCPTB AIM curriculum Knowledge Based Assessment
Curriculum Acute Internal Medicine (AIM) 2022 curriculum
ARCP decision aid AIM 2022 ARCP Decision Aid
AIM Specialty skills (2022 curriculum)
Combine decision aid for AIM and GIM https://heeoe.hee.nhs.uk/sites/default/files/combined-decision-aid.pdf
Specialty Certificate Examination Specialty Certificate Examinations

A List of 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
• Outcome 10.1 
• Outcome 10.2

Programme Leadership

Trainee Representatives