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Training the new generalists

BMJ 2019; 366 doi: https://doi.org/10.1136/bmj.l5042 (Published 06 August 2019) Cite this as: BMJ 2019;366:l5042
  1. Abi Rimmer
  1. The BMJ

Training for physicians has a new name and a new focus. Abi Rimmer looks at what’s changed and why

Earlier this month the first cohort of junior doctors entered internal medical training (IMT), which replaces core medical training (CMT). Abi Rimmer spoke to Mike Jones, medical director for training and development at the Joint Royal Colleges of Physicians Training Board, about the new training scheme.

Why has IMT been introduced?

The aim of the programme is to increase the number of trainees who have generalist skills, Jones says. “The catalyst for these changes was the [2013] Shape of Training report,1 supplemented by the Future Hospital Commission report and the Francis report [on Mid Staffordshire].23 They all said that we need more doctors who were going to have generalist skills and be able to deal with the patients coming through the front door,” he explains.

How does IMT differ from CMT?

Unlike the two year CMT, IMT is a three year programme, with trainees taking on the medical registrar role in the third year. Trainees’ progress will be assessed on 14 capabilities in practice (CiPs), representing a move away from multiple competences and the “tick box” approach of the CMT curriculum, Jones says. “The other aspect of IMT is that it now has mandated components within it including geriatrics and critical care,” he says. “There is also an indicative number of patients that trainees need to see in acute care, a mandated number of outpatient clinics undertaken, and for the first time simulation training requirements are embedded in the curriculum.”

Do all trainees have to complete three years of IMT?

No, trainees who intend to enter group 2 specialties such as dermatology, clinical genetics, and medical oncology can do so after completely the first two years of IMT, as long as they have passed their Membership of the Royal College of Physicians (MRCP) exams by the time of appointment.4 The Joint Royal Colleges of Physicians Training Board also says that most non-physician specialties that currently accept CMT are likely to require only two years of IMT.

Have any specialties changed so that their trainees will now be on the medical registrar rota?

Yes. Jones says that neurology, palliative medicine, and genitourinary medicine have become group 1 specialties. This means that trainees planning to enter these specialties will need to complete all three years of IMT, increasing their length of training by a year.5

Will third year IMT trainees receive a pay increase when they become medical registrars?

Yes. Jones says that trainees will continue to progress through the training pay scales and there is an agreement that they will be on the registrar scale when undertaking the third year of IMT.

How does this affect CMT trainees completing their training next year?

Jones says that next year this cohort will have specialty training (ST3) posts they can apply to. The physicians training board is working with Health Education England on the precise number of posts that will be available and says that various factors, such as the uptake rate in previous years, will be taken into account. Posts will be available in all previously available specialties, but the competition for these specialties will be the same as in previous years. “Nobody is going to say automatically that there are going to be loads of places in cardiology, for example, because cardiology has always been competitive,” Jones says.

What if trainees want to take a year out of training after completing CMT?

They can, but they will need to complete the third year of IMT when they return if they want to enter a group 1 specialty. This can be done in the same deanery where they completed CMT.

Will overall training time increase?

Jones makes it clear that doing the third year of IMT will not increase the overall time in training. He says, “The indicative seven year training programme that used to be two years of CMT and five years of dual training with a specialty—that will now be three years of IMT and four years of specialty training. Overall training time has not changed except for the three new group 1 specialties.”

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