Health Education England, working across the East of England:
Acute Medicine:
Welcome to Acute Medicine in the East of England deanery. Acute Medicine is a vibrant, rewarding, and rapidly evolving medical specialty, concerned with the assessment, diagnosis and management of adults presenting to secondary care with acute medical illness. Acute Medicine involves the management of busy acute medical units (AMUs), Ambulatory Care Units (Same Day Emergency Care) to ensure they deliver high-quality, efficient and patient centred care, Short Stay Units.
We are a large region geographically which means in your training you can experience the differences in working in a metropolitan Cambridge, to working in a rural DGH ensuring you experience a range of ways of working. We as a specialty prioritize trainee preferences in hospital rotations and are proactive in trying to prevent unnecessarily long commutes.
This website provides an overview of the Acute Medicine Specialist Training scheme and provides information required for trainees.
The four-year program is designed to provide trainees with a Certificate of Completion of Training (CCT) in Acute Internal Medicine (AIM) with the option of dually accrediting in another speciality.
You have to have completed Core trainees from Core Medical Training (CMT), or IMT and Acute Care Common Stem (ACCS) are eligible to apply for the Acute Medicine StR programme.
Health Education East of England (the former Multi-Professional Deanery) has been in the forefront of this development with long established units in the Norfolk and Norwich University Foundation Trust Hospital and Cambridge University Hospitals NHS Foundation Trust (Addenbrooke’s), and many district general hospitals. Although models of care vary, all units manage patients for up to 24 hours, stabilizing critically unwell patients and working in liaison with specialty physicians and primary care.
Attractions of the Specialty
Acute Medicine offers an exciting and varied workload with fantastic opportunities for lifelong learning. An academic basis has been established and interest in research into this field is strongly encouraged.
It provides a great opportunity to be involved with and help shape the future of this new specialty. The development of other skills including education, critical care, management, and ultrasound are actively supported.
Consultant expansion is expected, demand for Consultants is high and therefore job prospects are excellent.
Training
Training concentrates not only on recognition and management of acute medical emergencies, but also on the development of ambulatory care systems, and the acquisition of skills in Focused Ultrasound, Leadership and Management of AMU as a whole.
There is also a requirement to develop an additional specialist skill (usually in the form of either a professional qualification, a procedural skill, or a research degree. Common examples include diplomas in medical education or toxicology and practical skills such as bed side echo). There are also options to extend training and gain extra qualifications in stroke/critical care to CCT level.
Training includes time on AMU with a focus on managerial AMU experience towards the end of higher specialist training. There are also mandatory attachments in respiratory medicine, cardiology, acute elderly care and intensive care. Rotations may also include others such as gastroenterology/neurology/stroke but this varies from region to region.
Focus on medical problems and ongoing care
The specialty is distinct from emergency medicine (ED), because it focuses specifically on medical problems and includes more responsibility for ongoing care - although acute physicians do work in close collaboration with emergency medicine specialists. There is also a close relationship with critical care and most specialities will offer degrees of in-reach into the AMU.
The training programme is four years leading to the award of dual CCT in Acute Internal Medicine and General Internal Medicine.
Details of essential competencies and qualifications are detailed in the person specification for Acute Medicine at ST4, which is available here.
Acute Medicine Trainees throughout there training must have an afternoon (SPA) session for person development/eportfolio/audit, must have an afternoon session for their Specialty Skill and an afternoon session for Ambulatory Care. This ensures a diverse training experience and ensures that trainees are focused on their developmental needs rather than the needs of the service
Trainees will undertake at least 12 months of their programme in an Acute Medical Unit, supervised by one or more consultants specializing in Acute Medicine.
Trainees will spend a minimum of 18 months of their programme in specialties relevant to Acute Medicine, including at least 4 months in each of:
- Cardiology,
- Respiratory
- Elderly care
- Intensive Care Medicine
Trainees undertaking dual accreditation in General Internal Medicine may undertake an additional 1 year in general medical posts during their programme.
Information is available from the JRCPTB website giving detailed guidance on the Acute Medicine ARCP assessment blueprints and curriculum.
The Acute Medicine Curriculum is changing the 2009 Curriculum can be found here
Here is the link to the new Acute Medicine Curriculum that is expected to be ratified for 2022
Acute Medicine Trainees do not go to every Hospital in the East of England Deanery, we have rotations for Acute Medicine Trainees at the following hospitals.
| Hospital | Location |
| Norfolk & Norwich University Hospital | Norwich |
| Addenbrooke’s Hospital | Cambridge |
| Basildon Hospital | Basildon |
| Queen Elizabeth Hospital | King's Lynn |
| James Paget Hospital | Great Yarmouth |
| Ipswich Hospital | Ipswich |
| Peterborough Hospital | Peterborough |
| Hinchingbrooke Hospital | Huntingdon |
| Lister Hospital | Stevenage |
| Broomfield (Mid–Essex) Hospital | Chelmsford |
The East of England is a large geographical area with three hubs in Norwich, Cambridge and Basildon. Please note that applications are to the East of England Deanery as a whole. Hospital's have been grouped to reduce commuting and to give an understanding on where people will be rotating through their training.
Each Trainee will rotate through either Cambridge, Norwich or Basildon for at least one year of their training. This may mean that you may be allocated to any of the hospitals listed above for at least 1 year of the program.
Acute Medicine is a 4 year training program with a dual CCT in General Internal Medicine (GIM). East of England Acute Medicine Training Program is committed to reducing commuting times and supporting trainees requests on where they want to work. Hospital's have been grouped to reduce commuting and to give an understanding on where people will be rotating through their training.
Training placements are currently planned with an understanding where people will be 2-3 years in advance but with flexibility if people's personal situations change. Trainee preference and involvement is included in hospital allocations.
Trainees will spend 1-2 years in each hospital placement. With one specialty placement each year of a 4-6 month rotation block, through Cardiology, Elderly Care, ITU & Respiratory the rest of the time being based in the Acute Medicine Department.
Out of Program and Less than Full Time applications are encouraged and supported by the training program for trainee personal development with 6 months notice.
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| Centre Cluster Acute Med Placements | |||||
| Cardiology | 1 | Stevenage | |||
| Elderly Care | 2 | Huntingdon | Peterborough | ||
| ITU | 2 | Stevenage | Cambridge | ||
| Respiratory | 4 | Cambridge | Stevenage | Huntingdon | Peterbourgh |
| South Cluster Acute Med Placements | ||||
| Cardiology | 2 | Basildon | Ipswich | |
| Elderly Care | 3 | Ipswich | Basildon | Chelmsford |
| ITU | 2 | Ipswich | Chelmsford | |
| Respiratory | 3 | Basildon | Ipswich | Chelmsford |
| North Cluster Acute Med Placements | ||||
| Cardiology | 3 | NNUH | King's Lynn | Great Yarmouth |
| Elderly Care | 1 | King's Lynn | ||
| ITU | 3 | King's Lynn | NNUH | Great Yarmouth |
| Respiratory | 4 | NNUH | Great Yarmouth | |
Norfolk and Norwich University Hospitals NHS Foundation Trust
- Acute Medical Unit / General Medicine (4 posts)
- Cardiology Unit (1 posts)
Addenbrooke’s (Cambridge University) Hospital NHS Foundation Trust
- Respiratory / General Medicine (1 post)
- Acute Medical Unit / General Medicine (3 post)
- Critical Care Unit (2 posts)
- Acute Medicine Unit / General Medicine (1 post)
- Cardiology / General Medicine (1 post)
- Respiratory / General Medicine (1 post)
Queen Elizabeth Hospital, Kings Lynn
- Cardiology / GIM (1 post)
- Elderly Care Medicine, Stroke / GIM (1 post)
- Acute Medicine Unit (MAU) / GIM (1 post)
- Short stay ward, ITU / GIM (1 post)
James Paget Hospital, Great Yarmouth
- Acute Medical Unit (2 posts)
- Cardiology / General Medicine (1 post)
- Acute Medical Unit (optional Medicine for the Elderly, Respiratory, Endocrinology) (3 posts)
- Acute Medical Unit / Renal Medicine (1 post)
- Acute Medical Unit (1 post)
- Endocrine / General Medicine (1 post)
- Respiratory (1 post)
- Elderly Care (1 post)
- Elderly Care / General Medicine (1 post)
- Cardiology (1 post)
- Acute Medicine Unit (2 posts)
- Critical Care Unit (1 post)
Broomfield (Mid-Essex) Hospital, Chelmsford
- Acute Medicine Unit / General Medicine (1 post)
- Respiratory / General Medicine (1 post)
- Critical Care Unit (1 post)
Welcome all!
My name is Alex McFarquhar and I am one of the newest AMU registrars on the EoE training program. Starting in Feb 2021, the last year has been busy as ever, but very enjoyable. I completed my ST3 year at NNUH which has been a fantastic experience. Having done a large part of my core training at Addenbrookes and West Suffolk, the opportunity to see how another teaching hospital sets up has been great! This together with the breadth of pathology have been two extra parts of training that I didn’t realise I would experience and enjoy so much over the last year!
I have enjoyed the extra responsibility that comes with being a medical registrar. As we all know, core training/IMT is a great way gain experience and put in place building blocks that allow better practice as a middle grade. Having made the most of this training, I am now enjoying focussing in more on the areas of medicine I find most interesting; acute scenarios, stabilising unwell patients, and initial investigations and diagnoses.
In terms of portfolio, I have found the SpR portfolio much the same as core training in terms of how it works. I find that getting work place based assessment is as previously really, and comes down to sending a few more that you receive back and being polite and persistent. It is also quite useful as a middle grade as you will likely be asked to fill out assessments for more junior colleagues gaining an appreciation of what it is like to juggle multiple tasks, with this demand on top, which can only help for the future!
I used the year to gain some experience in ultrasound, which is becoming more and more a part of diagnoses on the take and in clinic (it is important you find a hospital based or remote supervisor for this and get organised with a course and become familiar with the FAMUS website also). I have also looked at a specialist skill and completed 4 months of Respiratory attachment in which I tried to focus most on what makes a good referral to the respiratory team from the take (and what makes a less good one!) and the procedures. I tried to make sure that I came to the end of the placement having developed the independence to put in a chest drain for the most worrying acute respiratory scenario requiring a chest drain out of hours- pneumothorax with haemodynamic/respiratory compromise.
I have to say that working as a middle grade has brought the need to develop a new skill set- that of trying to manage the take and make sure the AMU is a safe place for patients.
This involves not just an ability to manage individual patients, but multiple unwell patients at the same time, whilst ensuring the team is supported and functioning well. This is a skill set I continue to learn and improve, and probably will continue to improve for the rest of my career.
I have enjoyed understanding more what kind of leader am and will be, whilst constantly looking to senior colleagues for aspects of their practice which I like, and I would like to incorporate into my practice in future.
All the best with your first year of training and please reach out if I can offer any information or support!
Useful Resources Guide
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
The Acute Medicine curriculum requires that all trainees attain an additional skill or qualification in order to attain level-3 competency.
Currently seven trainees are undertaking training in Critical Care, two are doing Stroke Fellowship, two trainees have successfully completed the British School of Echocardiography qualification, and other trainees have completed Certificates and Diplomas in Education and Management. Four are undertaking significant research projects, whilst four trainees are working less than full time, either as a job share or in specific posts.
In the past trainees have been able to acquire skills in ultrasound, diagnostic upper GI endoscopy and echocardiography; however it should be noted that it is not possible for all trainees to undertake training in a practical procedure.
A list of possible specialist skills can be found on the JRCPTB website.
Specialist skills (consider applying for HEE training bursary for specialty certificate or diploma courses)
- Stroke
- Intensive Care Medicine
- Clinical skills
- Acute Oncology
- Dermatology
- Diabetes
- Infectious Diseases
- Neurology
- Obstetric Medicine
- Palliative Care Medicine
- Perioperative Medicine
- Psychiatry
- Syncope
- Echocardiography
- Ultrasound
- Management and Leadership
- Medical Education (including Simulation)
- Patient Safety / Care Quality review methodology
- Toxicology
- Research
We currently have Acute Medicine trainees with specialty interest in:
- Medical Education
- Leadership/Management
- Diabetes
- Intensive Care Medicine
- Stroke Medicine
- Palliative Care Medicine
| Specialty Skill | ||||||||
| Trust | Town/City | Leadership/Management | Medical Education | ICM | Stroke | Diabetes | Palliative Care | Ultrasound |
| Centre Cluster | ||||||||
| Addenbrooke’s Hospital | Cambridge | Yes | Yes | Yes | Yes | Yes | No | In progress |
| Lister Hospital | Stevenage | Yes | Yes | Yes | Yes | Yes | Yes | In progress |
| Peterborough Hospital | Peterborough | Yes | Yes | Yes | Yes | |||
| Hinchingbrooke Hospital | Huntingdon | Yes | Yes | Yes | Yes | Yes | Yes | In progress |
| South Cluster | ||||||||
| Basildon Hospital | Basildon | Yes | ||||||
| Broomfield (Mid–Essex) Hospital | Chelmsford | Yes | ||||||
| Ipswich Hospital | Ipswich | Yes | Yes | Yes | No | Yes | Yes | In progress |
| North Cluster | ||||||||
| Norfolk & Norwich University Hospital | Norwich | Yes | Yes | Yes | Yes | Yes | No | In progress |
| Queen Elizabeth Hospital | King's Lynn | |||||||
| James Paget Hospital | Great Yarmouth | Yes | Yes | Yes | Yes | Yes | No | Yes |
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.
Ten training days are hosted by all training locations across the training year that runs August to July. They are held at: Norwich, Cambridge, Ipswich, Stevenage, Hinchingbrooke, Basildon, Kings Lynn, Chelmsford. Currently they are held virtually using MS Teams. In the future it is likely to be a mixture between in person and Virtual meetings. Attendance from all AIM higher specialty trainees in the region is expected, Trainees are expected to attend 75% of these training days. Study leave should be granted to attend.
Trainees in Acute Medicine are also expected to attend GIM Training days. Which are one a month a list of training dates can be found here. So you should expect to eat 15-20 regional trainee
Trainees are also encouraged to attend:
- Society for Acute Medicine meetings
- Regional RCP updates in Medicine
- Cambridge Medical Seminars
Co-ordination and administration of regional training days is managed by Dr Adcock and the training working group. Please email if you have any difficulties attending or suggestions or comments on training days.
Websites:
- Joint Royal College of Physicians Training Board: Acute Internal Medicine & Sub-specialty of acute medicine
- MRCP website: www.mrcpuk.org
- National Institute for Health and Care Excellence (NICE) website: www.nice.org.uk
- Royal College of Physicians: Acute Medicine
- Scottish Intercollegiate Guidelines Network (SIGN) website: www.sign.ac.uk
- Society for Acute Medicine: Document Library
Textbooks:
- Ramrahka, P.; Moore, K. & Sam, A. (2010) “Oxford Handbook of Acute Medicine” Oxford University Press: Oxford
- Roseveare, C (2009) “Acute Medicine: Clinical Cases Uncovered” Wiley-Blackwell: Chichester
- Warell, D.; Cox, T. & Firth, J. (2010) “Oxford Textbook of Medicine” Oxford University Press: Oxford
- Lane N., Powter L., Patel S. (2016) “Best of Five MCQs for the Acute Medicine SCE” Oxford University Press: Oxford
Journals:
- Acute Medicine Journal (Rila)
- Clinical Medicine Journal (Royal College of Physicians)
Documents (PDF)
- Joint Royal College of Physicians Training Board (2012) Speciality training curriculum for acute internal medicine
- MRCP SCE in Acute Medicine Blue Print
Courses/Conferences
- a. SAM conferences – spring/autumn
- b. RCP General and Acute Medicine conferences
- c. Professional Support and well-being service (PSW) offers courses like communication skills workshops, Interview courses, etc
- d. Leadership and management courses may be offered locally by the trusts.
Resources to help you prepare for the AIM SCE
The Acute Medicine SCE takes place in mid November. The general format will be familiar from MRCP written exams - 200 best of five MCQs in 6 hours, split into a morning and afternoon session of 3 hours each. You have 1 minute 45 seconds per question, with 5 minutes to review at the end of each session.
The exam is held at the Pearson Vue centre. It’s worth having a look on their website for the practicalities of taking a test there, if you haven’t before. Check the location of your Pearson Vue centre and make note of parking and whether there’s anywhere nearby to get lunch.
Acute medicine is a very broad speciality, and it is difficult to know where to focus your revision initially. This list of resources should help with that. The questions are based on the AIM curriculum (in your e-portfolio), and there is an exam blueprint available on the SAM and MRCP websites. This gives you an idea of roughly how many questions there will be on each topic.
SAM runs a revision course in September - October (free for members, £60 for non-members, based on previous years), which I would strongly recommend. It includes a 50 question mock exam with a recap session.
If you want to start your preparation earlier than that (and you probably do), the SAM revision guide listed below contains useful general advice to help you get started (which I’m not going to repeat here). There is also a nice curated list of guidelines on the SAM website, which makes a good starting point to direct your revision.
Something to be aware of is that the “correct” answer may not be from the NICE guideline if another guideline (e.g.: ESCardio) is more up-to-date. These cases tend to get highlighted in the revision course. As patronising as it may sound, remember that the information in some resources may be out of date, and check that the guideline you’re reading online is the most recent version! I found the book “Best of five MCQs for the Acute Medicine SCE” very useful in my revision, but do note it was published in 2016 (still more recent than the Oxford Handbook).
You don’t have to spend a lot of money on preparation (having paid for the exam itself). I didn’t personally use any subscription based question banks but there are a couple out there (see below). I found the SAM revision course, “Best of five MCQs for the Acute Medicine SCE”, the MRCP question bank, and guidelines available online to be sufficient.
Do spend a little time refreshing things like DVLA regulations, ethics/law and statistics - they are guaranteed to come up in at least one question (and can be easy marks for relatively little effort). I have included some relevant links below.
Good luck!
General exam information
SAM website:
https://www.acutemedicine.org.uk/specialty-certificate-examination/
MRCP website:
SAM guide to revising for the SCE (2017):
https://internalmedicineteaching.org/uploads/3/5/5/3/35535977/guide-to-revising-sce.pdf
Pearson Vue information for test-takers:
https://home.pearsonvue.com/Test-takers/Resources.aspx
Guidelines
Curated list of guidelines from SAM (last updated 31/08/2021):
https://www.acutemedicine.org.uk/wp-content/uploads/Acute-Internal-Medicine-Guidelines-For-SCE.pdf
NICE guidelines:
https://www.nice.org.uk/guidance/published?ngt=NICE%20guidelines
SIGN guidelines:
Resus Council guidelines:
https://www.resus.org.uk/library/2021-resuscitation-guidelines
ESCardio guidelines:
https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines
BTS guidelines:
https://www.brit-thoracic.org.uk/quality-improvement/guidelines/
Question banks
MRCP website (100 questions, free):
StudyPRN (576 questions, £89 for 3 month subscription):
https://www.studyprn.com/p/acute-medicine
BMJ On Examination (315+ questions, £69 for 1 month subscription):
https://www.onexamination.com/products/sce-in-acute-medicine
Books
Lane N, Powter P and Patel S. Best of five MCQs for the Acute Medicine SCE. OUP, 2016 (350+ questions, £45.99):
https://www.amazon.co.uk/Medicine-Oxford-Higher-Specialty-Training/dp/0199680264
Amrahka, P.; Moore, K. & Sam, A. Oxford Handbook of Acute Medicine. OUP, 2010 (read online or download chapters for free via link):
https://oxfordmedicine.com/view/10.1093/med/9780198797425.001.0001/med-9780198797425
Roseveare, C. Acute Medicine: Clinical Cases Uncovered” Wiley-Blackwell, 2009 (£31.25):
https://www.amazon.co.uk/Acute-Medicine-Clinical-Cases-Uncovered/dp/1405168838
Others
DVLA - assessing fitness to drive:
GMC ethical guidance:
https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors#good-medical-practice
Mental Health Act code of practice:
Mental Capacity Act code of practice:
Statistics:
https://geekymedics.com/statistics-for-medical-students/
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
Your progress will be reviewed by ePortfolio review and form R at ARCP.
ARCP's are held twice a year in February and June
Familiarise yourself with the ARCP decision aid to ensure that you understand what curriculum requirements and how many ePortfolio assessments are required by ARCP.
ARCP Decision aids can be found here
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
ARCP decision aid Acute Internal Medicine (AIM) ARCP Decision Aid – AUGUST 2017
Gold Guide Download Gold Guide 8th Edition March 2020
JRCPTB Specialty Skills 2018 and 2020
Sub-specialty Skills for the Acute Internal Medicine (AIM) Curriculum 2020
Specialist Skills for Acute Internal Medicine 2018
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
Higher Specialty Trainees receive 30 Days of Study Leave allowance a year. Schedule 10 Paragraph 15 Junior Doctors contract Version 8. This will be used for but not restricted to study (linked to a course or programme, research, teaching, taking examinations, attending conference for educational benefit, rostered training events.
Attendance at Statutary or mandatory training is not counted as study leave Schedule 10 Paragraph 31.
Trainees in the East of England may apply for study leave activity of any cost for courses that are mandated by the curriculum or those that are not, referred to as 'aspirational'. These must be in your PDP at the start of the year and be prospectively agreed with the TPD. The eligibility criteria and process must be adhered to in order for applications to be approved.
The HEEoE Study leave home page has all relevant flow charts & forms on:
For the policy document itself:
Further Advice |
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| TBC |
Acute Medicine Specialty Training Committee Chair |
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| Dr Litza Vera | Acute Medicine Training Program Director | Cambridge |
| Dr Deepika Chabbra | STC Secretary | Basildon |
| Dr Sarah Choudhury | ARCP Lead | Peterborough |
| Dr Kamal Patel | ACCS ST3 Lead | Cambridge |
| Dr Fraz Mir | Head of School of Medicine | Cambridge |
Please follow this link for the Acute (internal) Medicine 2012 GMC National Training Survey report.