Where did the acute medical trainees go? A review of the career pathways of acute care common stem acute medical trainees in London
Editor – As the training programme directors for higher professional training in acute internal medicine (AIM) in North Central/East and South London, we read with interest the 2016 article by the office of the Head of School for Medicine for London reflecting on the perceived value of the AIM Acute Care Common Stem (ACCS) programme. Had any acute physicians been involved, the conclusions might have been different.
In our opinion, the paper takes too narrow a view of the ACCS programme. The programme is designed to produce trainees solidly grounded in acute specialties and allow them a degree of ‘wriggle room’ before committing to higher specialty training, which might – or might not – be in one of those specialties. Strengths of ACCS include breadth of training and the opportunity to change specialty with experience. Regarding AIM, it was always intended that ACCS should be the equivalent of core medical training (CMT) in terms of subsequent access to other physicianly specialties and, conversely, that CMT alumni would be eligible for specialist training posts in AIM.
The authors are an anaesthetist and three geriatricians. We think it unlikely that many AIM physicians would support their suggestion that the AIM ACCS stream be disbanded and the posts incorporated into CMT.
There have also been local difficulties in the London ACCS programme, which may make national extrapolation inappropriate. Not all first year London ACCS trainees are allocated to AIM rather than general internal medicine posts and the range of medical subspecialties available in third year is severely restricted. Furthermore, the wide geography of the London ACCS posts and lack of a dedicated training programme director for several years contribute to a lack of professional identity for the group. There appears to be little joined up thinking regarding the ACCS and AIM higher specialty training programmes, which may have contributed to the lack of progression in the manner expected.
We contend that the AIM ACCS programme offers valuable training opportunities that should be strengthened, with greater collaboration with AIM higher specialty training, rather than disbanded. Finally, we cannot ignore the wider contemporary environment which makes a career in acute specialties less attractive to many doctors.
Conflicts of interest
Both authors are members of the AIM Specialty Advisory Committee.
- © Royal College of Physicians 2017. All rights reserved.
References
- Gowland E
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