Leicester’s IMT JourneyDr Dheya Biswas – Consultant in Acute and General Medicine & College Tutor

&

Dr Lucy Beishon – Dunhill Research Training Fellow & former Associate College Tutor

CT & ACT National Conference

Royal College of Physicians

October 2019

The Journey’s Start

• Once per month teaching session

• Ad hoc arrangement for clinics, procedures, bedside exam teaching

• Simulation just starting up

• Poor feedback in National and local Trainees’ Survey

• Split deanery (North and South East Midlands)

• UHL Mock PACES

Improving the CMT programme

UHL

• Weekly teaching programme

• Procedural skills courses

• Simulation days (human factors)

• “Clinic week”

• CMT induction and handbook

• Better connection between Trust, CTs and deanery/TPD

• Directorate of Clinical Education

• Director of Clinical Education and Clinical Tutors

Regional

• Unified School of Medicine with new Head of School, new TPD

• Improved regional induction

• Better concordance of programme across Trusts

• Regional careers day

• Regional QI conference

• Significant improvement in trainee feedback

Challenges in the CMT programme

• Clinic attendance and experiences

• Gaining procedural independence as required

• Teaching attendance

• Trainees feeling no different to FY doctors on wards

• Trainees getting off busy wards

The IMT Survey East Midlands

Lucy Beishon

Dunhill research Training Fellow

IMT survey

• CMT 1-2 surveyed March-April 2018– 67 responded

• Consultation group of 70 trainees

• 20 question survey– Design of IMT programme

– Role of ITU, community, and geriatric placements

– Teaching and education

How would you like to shape your IMT3 year?• Concerns IMT3 will be used as extra SHO or unsupported/unsupervised SpR

• Separate junior SpR rota with senior SpR available for support

• Gaining confidence to work as a Medical SpR in a supported way

• Many opting for acute medicine with “ology” of choice

• Option for other opportunities i.e. Masters, medical education etc.

• Dedicated clinic/endoscopy/procedure list

What would you like to gain from an ITU/HDU post?

• Procedural competencies

• When to refer/escalate appropriately

• Experience with managing critically ill patients

• Decision making

• Experience of inotropes and ventilation support

“Experience and confidence in assessing and stabilising the unwell medical patient, in deciding the ceiling of care, in putting central lines, in understanding what rescue therapies ITU has to offer.”

What would you like to gain from a geriatrics post?

• Concerns it is to fill rota gaps

• Outpatients and community experience

• Front door geriatrics & admission avoidance

• Sub-speciality focusses

• MDT/holistic care

• “managing frailty”, complexity, polypharmacy

• Improve skills & knowledge in Geri’s

Recommendations• IMT3 must be a junior SpR role

• SIM training highly rated– clinical reasoning, leadership, simulated med SpR scenarios

• ITU experience highly valued by trainees – ITU referrals on the wards & ED

• Flavour of Geris sub-specialties scheduled into rota– Mandatory stroke & RAP experience

• Geriatrics needs to be more than a ward based job

“CMT is really good training as start to medicine and making it into 3 years including IMT3 would be helpful as a bridging option from junior to a senior doctor to work independently and making decisions as registrar, it will be safe for patients and good for learning as a physicians”

Preparation for IMT

Who?

• TPD, Head of School

• Director of Clinical Education + team

• UHL Workforce planning / HR / JDAs

• Specialty colleagues (ITU, geriatrics etc.)

• Clinical Skills Centre

• Community partners

• (advantage of a large, tertiary Trust)

What?

• Create additional posts to staff 3 years

• Structure of 3-year programme– IMT 1 = enhanced geriatrics block

– IMT 2 = 4 months immersive ITU block

• Enhanced geriatrics block

• Revised procedural skills courses

• Redesigned simulation to include outpatients

• Revised teaching programme

Challenges in delivering IMT

Pre-August 2019

• Number of IMT posts

• Specialty and Community partners

• Delivering clinic numbers & experience

• Training Educational Supervisors

• Engagement from consultant physicians

• Nervousness around change from number of competencies to quality / level for Capabilities in Practice

Going live

• Clinics

• Initial meetings with ES/CS

• How to deliver aspects– Professional development meetings

– Local Faculty Groups

• Provision and funding of procedure and sim days

• Trainees being off wards for clinic / meetings / teaching..

Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun Jul

Placement 1 Placement 2 Placement 3

Professional Development

Meetings

Induction Meeting

Trust Induction

ProgrammeInduction

MSF

SLEs

CS Induction

CS appraisal

Placement Induction

LFG

MCR

ESR

ARCP

Concerns / Challenges moving forwardsCTs / UHL

• Useful experience in clinics

• Clinic weeks / time to get to clinic

• Number + content of trainee-trainer meetings

• Engagement with consultant physicians

• ESs and CSs understanding & delivering their roles - supporting first IMT MCRs & ESRs

• Junior reg rota

• Flow of information from SAC / RCP

Trainees

• Clinics

• Finding information on IMT

• Understanding curriculum & decision aid

• Seeking more specifics on ARCP requirements

• Exam preparation and exam specific teaching

• General nervousness that programme will deliver

Solutions & Initiatives

• Clinic “toolkit”

• Guidance sheets for supervisors and trainees

• Face-to-face meetings with departments and ESs

• Quick updates to trainees at start of teaching sessions

• Rota planning for junior reg tier on medical on-call rota

• Information sharing through Regional CT & ACT meetings

Thank you for listening!

• Questions?