West Midlands Postgraduate School of Medicine

West Midlands Postgraduate School of Medicine

Acute Internal Medicine

Mandatory Training Requirements For AIM Trainees:

All AIM trainees must do an audit each year and complete at least 1 full audit cycle during their training programme

All trainees must meet the requisite curriculum competencies as per the ARCP decision aid

All trainees must have passed MRCP by end of ST3 (now an entry requirement)

ALS certification must be up to date throughout training

SCE in AIM completed by end of ST5

100 hours of external AIM teaching throughout programme

Attendance of 70% regional acute medicine training days

Evidence of teaching others*

*Not on 2009 curriculum but felt to be necessary local minimum standards and likely to be necessary to meet common competencies The following Trust currently provide Acute Medicine ST3+ training:

Sandwell & West Birmingham Hospitals (City Hospital and Sandwell Hospital)

Heart of England NHS Foundation Trust (Heartlands, Solihull and Good Hope)

Walsall Hospitals NHS Trust

Royal Wolverhampton Hospitals (New Cross)

Dudley Group of Hospitals (Russells Hall)

University Hospital Birmingham NHS Foundation Trust

University Hospital North Staffordshire

Univeristy Hospital Coventry & Warwickshire

Mid Staffordshire NHS Foundation Trust

Worcestershire Acute Hospitals NHS Trust

Burton Hospitals NHS Foundation Trust

South Warwickshire NHS Foundation Trust

Below is some information on the training which can be provided at some of the training units. Please note the information provided is correct as of March 2011 but may be subject to change (for example timetable information / rota information) so should be used as a guide only.

Heartlands Hospital (2 StR training Posts)

Trainer and Educational Supervisor Information

Lead Trainer / Dr Philip Dyer /
Educational Supervisors / Raj Chandrappa /
Ali Kamal /
Sumeet Chadha /
Trishna Chakravorty /
Other Trainers / Hatim Ali /
Sanjay Saraf /

Availability of Mandatory Training

Requirement / Delivery possible with additional Information where necessary
Basic level AMU work (i.e. ability to work on an AMU whoever is doing the hands on supervision) / Yes (well developed AMU)
Higher level AMU (must involve supervision via a dedicated acute physician with experience in developing and managing an AMU) / Yes (6 acute physicians, two of whom have medical management experience)
Provision of a 4 month critical care block (minimum of 80% of the working week) with ability to obtain basic level ICM competencies – NB Provided as an essential OOPE in programme anyway if required / Yes
Provision of a 4 month elderly care block exposure (minimum of 80% of the working week) – NB this does not include stroke which is viewed separately / No
Provision of a 4 month elderly care sessional exposure (minimum of 60% of the working week) – NB this does not include stroke which is viewed separately / Yes
Provision of a 4 month respiratory block (minimum of 80% of the working week) / No
Provision of sessional respiratory training (minimum of 4 sessions per week for 4 months with exposure to Asthma,COPD,Lung cancer and TB along with NIV) / Yes, definitely with opportunities for exposure to NIV, bronchoscopy, thoracoscopy along with respiratory essentials
Provision of a 4 month cardiology block (minimum of 80% of the working week) / Only if cardiology registrar post not filled
Provision of sessional cardiology training (minimum of 4 sessions per week for 4 months with exposure to heart failure, CCU and chest pain clinics) / Yes with negotiation before trainee arrives
Provision of training in ambulatory care / No at present. Ad hoc ambulatory care management but no defined unit as yet. Still in the process of development.

Availability of Mandatory Special Interest Training

All AIM trainees need to develop a single special interest over their 4-5 years of their training. The following are the current curriculum recommended special interests (NB ICM is a common SIS dealt with elsewhere on this form and needs to be to diploma or CCT level). Other potential interests may be followed but these must be approved in advance by JRCPTB.

Special Interest / Delivery possible with additional Information where necessary
Echocardiography (to cardiology curriculum standards) / No
Upper endoscopy (to JAG standards) / No
Bronchoscopy (to respiratory curriculum standards) / Possible with some negotiation
Ultrasound (to RCR standards) / Focussed ultrasound may be possible particularly pleural effusions
Medical education (to diploma / masters level) / Yes with plentiful educational opportunities and support from supervisors of which one is completing medical education courses.
Management (to diploma / masters level) / Support will be provided
Leadership (to diploma / masters level) / Support will be provided
Toxicology (to diploma / masters level) / No
Infectious diseases and tropical medicine (to diploma / masters level) / Support will be provided for OOPE
Remote and rural medicine (following a defined training pathway with appropriate competence acquisition. Such a training and assessment pathway must be approved prospectively by the JRCPTB) / No
Inpatient diabetes care (Training should follow a training and assessment pathway agreed by both endocrine & DM SAC and AIM SAC.
Trainees should be assessed in the competencies by specialists in that field.) / Yes, 3 of the consultants are Diabetologists and one is the trust lead for inpatient diabetes.
Research (Demonstrates extensive involvement in research including
the acquisition of research grants and over five research publications in peer reviewed journals during their training period) / Yes – participating in the EFIM ALCHIMIE study. Dr Dyer has research background and experience of supervising research.
Stroke Medicine (Stroke curriculum

Medicine%20Specialty%20Training%20Curriculum%20Ma
y%202007.pdf has 3 areas – acute stroke, stroke rehabilitation, and prevention of stroke – need all 3 for CCT but 2 (i.e. not rehab) enough for AIM specialist skill) / Probably with advance negotiation with stroke team

Optional specialty attachments Available as a secondment block

(8 sessions minimum) or sessional training (4 sessions minimum)

Optional Attachment / Deliverable and specify as whether as block or sessional
Stroke / Yes – sessionally
Gastroenterology / Yes – sessionally
Renal / Yes – sessionally
Infectious Diseases / Yes – sessionally
Neurology / Parkinson’s Disease clinics and TIA clinics accessible in trust.
Prior negotiations for attendance neurology clinics
Diabetes and Endocrinology / Yes – sessionally
Critical Outreach Team / Yes – sessionally
Any other training opportunities (specify) / Availability of Immunology clinics
Potential for attending Haematology clinics
Registrars will be expected to participate in regular audit, departmental meetings and clinical governance meeting. Registrar is also expected to organise, attend and deliver unit teaching to JDs and nursing staff.

Information on available 4 month block release for trainees (whether mandatory or optional)

We provide a 4-month block of ICM and thus would expect 2 trainees requiring this training who are more likely to be year 2, 3 or 4

In Year 1 we would focus on pure acute medicine with AMU exposure and short stay ward exposure which will provide GIM curriculum requirements whilst encouraging a special interest session. A 4-month sessional placement would be organised

Year 2, 3 and 4 (if in a 5 year programme) - trainees we would expect to release for a 4-month period usually ICM whilst concentrating on acute medicine for the other 8 months. One sessional placement will be arranged if required as well

For final year trainees we would concentrate on acute medicine and management skills, whilst also supporting any mandatory PYA requirements

Example Trainee Timetable with example on call rota whilst doing

“acute medicine”

2 days per week AMU
1 or 2 outpatient clinic
2 or 3 special interest session
1 audit/admin/study/research session
1:17 on call rota

Monday / Tuesday / Wednesday / Thursday / Friday / Saturday / Sunday
09.00 – 21.30 / 09.00 – 21.30 / 09.00 – 21.30 / 09.00 – 21.30 / 21.00 – 09.30 / 21.00 – 09.30 / 21.00 – 09.30
OFF / OFF / OFF / OFF / 09.00 – 21.30 / 09.00 – 21.30 / 09.00 – 21.30
21.00 – 09.30 / 21.00 – 09.30 / 21.00 – 09.30 / 21.00 – 09.30 / OFF

This rota will run on a 17 week cycle, the remaining 14 weeks being 9-5 Ward Cover

RMO2 Duties will occur outside of the On-Call Block as they do not impinge of 9-5 work.

This template allows for RMO2 shifts on Friday (9am to 9pm) and Saturday and Sunday (9-5) within the current 17 rota participants

Outpatient exposure

A trainee in AIM based in this unit can realistically expect to meet the outpatient numbers required for GIM training - i.e. in any one year seeing 90 New outpatients (which can include ambulatory care and new ward referrals) and 300 review outpatients (which can include ambulatory care and review ward referrals)

Other opportunities Available

Teaching opportunities

ALERT
IMPACT
Surviving sepsis

Worcester Hospital (2 StR Training Posts)

Trainer and Educational Supervisor Information

Lead Trainer / Dr James Young /
Educational Supervisors / Dr Miguel Marimon /
Other Trainers / Dr AmaliaSpiliopilou /

Availability of Mandatory Training

Requirement / Delivery possible with additional Information where necessary
Basic level AMU work (i.e. ability to work on an AMU whoever is doing the hands on supervision) / Yes well developed short stay unit and AMU
Higher level AMU (must involve supervision via a dedicated acute physician with experience in developing and managing an AMU) / Yes
acute consultant supervision daily
Provision of a 4 month critical care block (minimum of 80% of the working week) with ability to obtain basic level ICM competencies – NB Provided as an essential OOPE in programme anyway if required / Development of medical HDU in near future
Provision of a 4 month elderly care block exposure (minimum of 80% of the working week) – NB this does not include stroke which is viewed separately / Yes
Provision of a 4 month elderly care sessional exposure (minimum of 60% of the working week) – NB this does not include stroke which is viewed separately / Yes
Daily multidisciplinary older person’s ward round available under supervision of Dr Spiliopilou
Provision of a 4 month respiratory block (minimum of 80% of the working week) / No
Provision of sessional respiratory training (minimum of 4 sessions per week for 4 months with exposure to Asthma,COPD,Lung cancer and TB along with NIV) / Exposure to NIV on unit
Provision of a 4 month cardiology block (minimum of 80% of the working week) / No
Provision of sessional cardiology training (minimum of 4 sessions per week for 4 months with exposure to heart failure, CCU and chest pain clinics) / No
Provision of training in ambulatory care / Daily ambulatory care “clinics”

Availability of Mandatory Special Interest Training

Special Interest / Delivery possible with additional Information where necessary
Echocardiography (to cardiology curriculum standards) / Access to regional course available with industry support for funding
Upper endoscopy (to JAG standards) / No
Bronchoscopy (to respiratory curriculum standards) / No
Ultrasound (to RCR standards) / No
Medical education (to diploma / masters level) / In near future and support provided
Management (to diploma / masters level) / Support will be provided
Leadership (to diploma / masters level) / Support will be provided
Toxicology (to diploma / masters level) / No
Infectious diseases and tropical medicine (to diploma / masters level) / No
Remote and rural medicine (following a defined training pathway with appropriate competence acquisition. Such a training and assessment pathway must be approved prospectively by the JRCPTB) / No
Inpatient diabetes care (Training should follow a training and assessment pathway agreed by both endocrine & DM SAC and AIM SAC.
Trainees should be assessed in the competencies by specialists in that field.) / Yes one of the consultants is the trust lead for inpatient diabetes
Research (Demonstrates extensive involvement in research including
the acquisition of research grants and over five research publications in peer reviewed journals during their training period) / In development. Dr Young has research background
Stroke Medicine (Stroke curriculum

Medicine%20Specialty%20Training%20Curriculum%20Ma
y%202007.pdf has 3 areas – acute stroke, stroke rehabilitation, and prevention of stroke – need all 3 for CCT but 2 (i.e. not rehab) enough for AIM specialist skill) / Dr Spiliopilou has stroke and elderly care background

Optional specialty attachments Available as a secondment block

(8 sessions minimum) or sessional training (4 sessions minimum)

Optional Attachment / Deliverable and specify as whether as block or sessional
Stroke / No
Gastroenterology / No
Renal / No
Infectious Diseases / Yes sessionally
Neurology / No
Diabetes and Endocrinology / Yes sessionally
Critical Outreach Team / In negotiations
Any other training opportunities (specify)

University Hospital North Staffordshire

(4 StR Training Posts)

Trainer and Educational Supervisor Information

Lead Trainer / Dr Sven Lehn /
Educational Supervisors / Dr Arjun Muhammad Iqbal /
Dr Indranil Mukherjee /
Dr Mukhopadhyay /
Other Trainers / Dr Raana Haqqee /
Dr ElfaithIdris /

Availability of Mandatory Training

Requirement / Delivery possible with additional Information where necessary
Basic level AMU work (i.e. ability to work on an AMU whoever is doing the hands on supervision) / Yes, well developed AMU with integrated Medical HDU (Higher Monitoring Unit), continuous ‘shop floor’ consultant presence on AMU till 22.00 (21.00 on weekends / bank holidays)
Higher level AMU (must involve supervision via a dedicated acute physician with experience in developing and managing an AMU) / Yes (8 acute physicians, two of whom have medical management experience, one Acute Physician with full ICM accreditation)
Provision of a 4 month critical care block (minimum of 80% of the working week) with ability to obtain basic level ICM competencies – NB Provided as an essential OOPE in programme anyway if required / Yes, currently 6 month critical care blocks with 100% of this time spent on ICU including full participation in ICU on call rota. Dedicated regular sessions for airway skills provided in theatres
Provision of a 4 month elderly care block exposure (minimum of 80% of the working week) – NB this does not include stroke which is viewed separately / Yes, 6 month blocks of 100% elderly care, including frail elderly assessment unit. This placement also fulfils criteria for full time GIM placement
Provision of a 4 month elderly care sessional exposure (minimum of 60% of the working week) – NB this does not include stroke which is viewed separately / Yes , if preferred by trainee rather than block placement
Provision of a 4 month respiratory block (minimum of 80% of the working week) / Yes, 6 months blocks of 90% Respiratory Medicine based on Respiratory ward with 12 bed NIV unit. All clinics as per curriculum available inc. lung cancer and TB.
Bronchoscopy training available for select dedicated individuals.
This placement also fulfils criteria for full time GIM placement
Provision of sessional respiratory training (minimum of 4 sessions per week for 4 months with exposure to Asthma,COPD,Lung cancer and TB along with NIV) / Yes , if preferred by trainee rather than block placement or as specialty sessions during AMU based placement
Provision of a 4 month cardiology block (minimum of 80% of the working week) / No
Provision of sessional cardiology training (minimum of 4 sessions per week for 4 months with exposure to heart failure, CCU and chest pain clinics) / Yes, with weekly rapid access chest pain clinic and heart failure clinic , regular CCU ward round. The centre performs primary PCI 24/7
Provision of training in ambulatory care / No at present. Ambulatory care management takes place within a primary care led unit .

Availability of Mandatory Special Interest Training

Special Interest / Delivery possible with additional Information where necessary
Echocardiography (to cardiology curriculum standards) / Only by prior arrangement if cardiology training slot available
Upper endoscopy (to JAG standards) / No
Bronchoscopy (to respiratory curriculum standards) / Yes, for select committed individuals
Ultrasound (to RCR standards) / No, but local pleural uss / procedure course run 4 times per year – other local training opportunities still under development
Medical education (to diploma / masters level) / Yes, diploma and masters degree in Medical Education provided through Keele University. Also opportunity to apply for two 1 year teaching fellow posts (OOPE), Keele University
Management (to diploma / masters level) / Yes, diploma and masters degree available through Keele University
Leadership (to diploma / masters level) / Yes, diploma and masters degree available through Keele University
Toxicology (to diploma / masters level) / No
Infectious diseases and tropical medicine (to diploma/masters level) / Local ID team providing ample clinical experience but no diploma or degree course available
Remote and rural medicine (following a defined training pathway with appropriate competence acquisition. Such a training and assessment pathway must be approved prospectively by the JRCPTB) / No
Inpatient diabetes care (Training should follow a training and assessment pathway agreed by both endocrine & DM SAC and AIM SAC.
Trainees should be assessed in the competencies by specialists in that field.) / Yes, 3 of the consultants are diabetologists, in and outpatient experience can be offered. Full time block placement can be offered by prior arrangement
Research (Demonstrates extensive involvement in research including
the acquisition of research grants and over five research publications in peer reviewed journals during their training period) / Yes – currently participating in the multicentre PROMISE study investigating early goal directed therapy for severe sepsis in conjunction with the A+E and ICM departments.
Stroke Medicine (Stroke curriculum

Medicine%20Specialty%20Training%20Curriculum%20Ma
y%202007.pdf has 3 areas – acute stroke, stroke rehabilitation, and prevention of stroke – need all 3 for CCT but 2 (i.e. not rehab) enough for AIM specialist skill) / Yes, experience in all areas can be arranged. The centre was highly rated during a regional peer review in 2010 (West Midlands Quality Review Service for Urgent Care). The department offers 24/7 stroke thrombolysis, invasive catheter thrombolysis and is active in research in collaboration with Stafford University.

Optional specialty attachments Available as a secondment block

(8 sessions minimum) or sessional training (4 sessions minimum)

Optional Attachment / Deliverable and specify as whether as block or sessional
Stroke / Yes – sessionally
Gastroenterology / Yes – sessionally
Renal / Yes – sessionally
Infectious Diseases / Yes – sessionally
Neurology / Yes, sessionally inc. sub specialty clinics
Diabetes and Endocrinology / Yes –sessionally (or block pacement as above)
Critical Outreach Team / Yes – sessionally
Any other training opportunities (specify) / Potential for attending Immunology, Haematology and Oncology clinics. Sessions available to observe interventional radiology.
Registrars will be expected to participate in regular audit, lead morbidity and mortality meetings, and attend departmental meetings and clinical governance meetings. All registrars regularly deliver structured 5th year medical student teaching as part of the ‘Critical Care Module’ for Keele Medical School.

Additional Information