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.

 

Training Programme

The training programme is five years leading to the award of dual CCT in Acute Internal Medicine and General Internal Medicine. Trainees wishing to undertake single accreditation in Acute Internal Medicine will usually be able to attain the CCT within 4 years from ST3 level.

Details of essential competencies and qualifications are detailed in the person specification for Acute Medicine at ST3, 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

Hospitals in the East of England Acute Medicine Programme

 

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.

Rotation Information

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.

 

 

Trust Town/City Acute Med Posts Cardiology Elderly Care ITU Respiratory
Centre Cluster
Addenbrooke’s Hospital   Cambridge 6     Yes Yes
Lister Hospital   Stevenage 4 Yes   Yes Yes
Peterborough Hospital   Peterborough 1   Yes   Yes
Hinchingbrooke Hospital   Huntingdon 1   Yes   Yes
South Cluster
Basildon Hospital   Basildon 2 Yes Yes Yes Yes
Broomfield (Mid–Essex) Hospital   Chelmsford 2   Yes Yes Yes
Ipswich Hospital   Ipswich 3   Yes   Yes
North Cluster
Norfolk & Norwich University Hospital   Norwich 5 Yes   Yes Yes
Queen Elizabeth Hospital   King's Lynn 3 Yes Yes Yes  
James Paget Hospital   Great Yarmouth 2 Yes   Yes Yes

 

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  

 

 

 

Trust / Specialty Information

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)

Basildon Hospital

  • 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)

Ipswich Hospital

  • Acute Medical Unit (optional Medicine for the Elderly, Respiratory, Endocrinology) (3 posts)

Peterborough Hospital

  • Acute Medical Unit / Renal Medicine (1 post)

Hinchingbrooke Hospital

  • Acute Medical Unit (1 post)
  • Endocrine / General Medicine (1 post)
  • Respiratory (1 post)
  • Elderly Care (1 post)

The Lister Hospital Stevenage

  • 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)
Curriculum

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 will 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   

 

Specialty Skills / Interests

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.

We currently have Acute Medicine trainees with specialty interest in:

  • Medical Education
  • Leadership/Management
  • Diabetes
  • Intensive Care Medicine
  • Stroke Medicine
  • Palliative Care Medicine
  • Bronchoscopy
Teaching

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.

Trainees are encouraged to attend the national and international meetings of the

Trainees are also encouraged to attend:

 

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.

 

 

Attendance at General (Internal) Medicine is also required.

 

A list of training dates can be found here.

Trainee resources and ARCP preparation

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

 

 

Study Leave

    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 & Useful Links

Further Advice

 
Dr Rachel Quail

Acute Medicine Specialty Training Committee Chair 

Stevenage
Dr Chris Adcock 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.

Useful links

Saturday, 19 June, 2021
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