key points from the new cmt gim curricula guide for trainers and trainees jrcptb
TRANSCRIPT
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
Top 20 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
ePortfolio review (locally)
Month 22/ 23
ePortfolio review (locally)
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
(ACAT/ CbD/ mini-CEX)
Competent in half
(ACAT/ CbD/ mini-CEX)
Competent in all
(ACAT/ CbD/ mini-CEX)
Other Presentations (40) Competent in a quarter
(ACAT/ CbD/ mini-CEX)
Competent in half
(ACAT/ CbD/ mini-CEX)
Competent in minimum of 34/40
(ACAT/ CbD/ mini-CEX)
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
Enables achievement of competences
Ensure MRCP(UK) diploma acquired
Enables achievement of competences
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
Required evidence(2)
• 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
Required evidence(3)
• 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
Required evidence(4)
• 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