Your first
day in your new hospitalGet in touch
with your Educational Supervisor and arrange an Introductory Appraisal
as soon as possible to discuss your training needs and opportunities.
Assuming he/she takes part in the Acute Medical Take, your Educational
supervisor will be responsible for your GIM as well as your specialty
training.
Check with wages and salaries that you are
going to be paid both the correct banding for your job and at the
correct point on the salary scale. It is the latter that trust usually
make mistakes on - so remember that your basic pay cannot fall on
becoming a registrar. The salary scales can be found in the junior
doctors' handbook (page 69) which is on the BMA website.
Don't
forget to....Contact your defence
organisation and inform them of the change in your grade. Unfortunately
the extra responsibility causes an increase in potential litigation and
a corresponding rise in premiums. You must let them know though.
The
Medical Defence Union (0800 716 376) and the Medical Protection Society
(08457 187 17) websites can be found by clicking on their names but I
believe they prefer you to call when you change grade.
Organisation
of trainingThe Joint Committee on
Higher Medical Training (JCHMT) is based at the College and is
responsible for:
- Your
Curriculum
- Approving
SpR posts (which may be inspected)
- Providing
an External Assessor to review your training at the PYA
- Deciding
the duration of your training
- Has
regional representatives for each specialty, the Regional Specialty
Advisers (RSAs)
The
Deanery- Pays
your salary (basic)
- Pays
your study leave
- Is
responsible for delivering your training. This is organised through the
Specialty Training Committee and its Chair, the Programme Director.
In
general, the Committee organises:- SpR
appointments and post rotations
- Annual
progress meetings – RITAs – where your training is
discussed and future requirements identified
- The
Penultimate Year Assessment (PYA) about 18 months before the end of
your training when your remaining training requirements are decided and
the date of completion is set.
- Regional
training events. The Deanery also organises
“generic” training events eg Management training.
The
Postgraduate
Medical Eucation and Training Board (PMETB) is the new
government body which has replaced the STAs. It has greater lay
representation, includes GP training and may undertake other roles such
as inspection which are currently performed by the Royal Colleges.
Record of
In-Training AssessmentThe annual
RITA assessment is a formal interview arranged via the Deanery to
ensure that you have achieved an acceptable standard to proceed to the
next year of training and eventually gain a Certificate of Completion
of Training (CCT) to enable you to apply for a consultant post in the
time frame set by the College. You will be assessed in both Geriatric
Medicine and GIM in the same interview, apart from the penultimate year
assessment (PYA) when GIM is assessed separately. Below is a copy of
the requirements sent to assessors for GIM prior to your RITA. You may
find it helpful so that you can meet their expectation satisfactorily.
Guidance
for GIM AssessorsThank you for
agreeing to be an assessor for GIM. Listed below are a few points for
guidance. A copy of the GIM training requirements should also be
available to you for reference.
Training
RecordPlease check that Section 5 (generic
skills) and Section 6 (GIM) of the gray folder are complete,
satisfactory and signed by the Educational Supervisor and that there is
an up-to-date signed supervisor's report (Section 8).
At
the InterviewSpRs are generally asked to give
a brief description of their timetable and experience in GIM over the
last year.
Please check that their experience meets
the following requirements:
Emergency
Medcine- Unselected
take: minimum 4 per month in Year 1, 2 per month in two of remaining
four years.
- (exceptions:
up to one year of aged-related take allowed in geriatrics; nephrology
and cardiology - one year of specialty also counts for GIM, as long as
GIM takes are minimum 4 per month in other two years)
- Evidence
of “hands on” during takes, i.e. direct supervision
of junior staff, personal mid-take round.
- Minimum
10 cases per take. Takes can be less than 24 hours.
- No
fixed service commitment while on call.
- Attendance
on Consultant-led post-take round.
- SpR
has responsibility for continuing care of at least 10 general medical
patients, including one personal ward round per week and one
Consultant-led ward round. These patients need not have been admitted
on the SpR's take.
Coronary
Care ExperienceThe organisation of
acute cardiac admissions varies between hospitals. 3 common
models are listed below together with suitable Medical SpR training
arrangements:
- Admission and
initial treatment by the on-call Medical team. Patients admitted onto
CCU are then taken over by the Cardiology team. SpRs should review
these patients on the CCU round with the Consultant Cardiologist.
- Admission
and initial treatment by the on-call Medical team. Patients taken onto
CCU continue to be managed by the admitting firm with varying input
from the Cardiologists. SpRs should liaise directly with the Cardiology
team when their patients are under Cardiological review.
- Separate
on-call rota for CCU admissions such that Medical SpR on-call does not
have responsibility for CCU cases. In most hospitals with this
arrangement, SpRs still have responsibility for many acute cardiac
cases outside CCU. Regular attendance on the CCU round is also
required. Whichever model is in operation, GIM training requires
exposure to unselected cardiac patients and specialist Cardiology input
on “hot” cases (usually via the CCU round). If this
is not possible during the attachment, a secondment to CCU should be
arranged (4-6 weeks). This should include at least 2 Consultant
Cardiologist-led CCU rounds and 1 Cardiology clinic/week.
Intensive
Care ExperienceSpRs should have
shared care with ITU/HDU patients admitted on their take, e.g. daily
joint round. A 6-week secondment to ITU should be organised if this is
not possible in the whole training programme.
Advanced
Life SupportThis must be up to date.
AppraisalShould
occur three times a year.
General
Educational Training- GIM
training days & Courses : Attendance at a minimum of 4 of 9
Regional days/year is an absolute requirement. SpRs should attend
sessions in a wide variety of medical specialities during their
training away from their own discipline and keep a record of their
content.For those SpRs wishing to have e-learning sessions counted in
lieu of training days, this is acceptable as long as the training is
RCP-approved (or organised by the Training Committee), they can
demonstrate that they have participated fully rather than just logged
in and that the length of the session is roughly equivalent to a
training day.
- During
SpR training, Study Leave entitlement should be used for GIM Courses
(eg RCP Regional CME day, Advanced Medicine) as well as those in the
specialty.
- Weekly
educational activity : 2-4 hours required, distributed fairly between
GIM and specialty, e.g. staff rounds and journal clubs
- Audit
: Normally organised within speciality. SpRs should have supervised
juniors for at least one audit by end of training.
- Teaching
: A wide teaching experience across disciplines is expected during
training. “Teaching the Teachers” course is
mandatory (ideally year 4/5).
- Management
training : Management training course mandatory (year 4/5).
Presentation skills/IT : SpRs should be skilled in presentation,
communication,. presentation techniques and computing skills
Penultimate
Year AssessmentThe penultimate year
assessment comes during the last 12 to 18 months of your training and
is used as a way to make sure any gaps in your training are plugged in
plenty of time so you can be awarded your CCT promptly.
What
follows is an approximate schedule for the last 18 months of your
training which a few suggestions as to how to prepare
yourself. If there is anything else you feel would be useful
to fellow trainees to share please feel free to email anything using
the address on the front page.
Penultimate
Year Schedule
18 months prior to estimated CCTCalled
to attend a PYA in both your specialty and General Internal Medicine
(this is the only time you have a separate assessment for both
specialties).
12 months prior to
estimated CCTHave attended both PYAs and
received guidance as to your educational objectives in the last
year. By this stage it is hoped that you do not have many
gaps left in your training. It is wise not to go to your PYA
saying that you are the complete trainee. Lead the discussion
yourself as to gaps in your training and hopefully leave with a set of
sensible but achievable objectives. For example a management
course, an ALS course or undertake a secondment in psychogeriatric
medicine.
9 months prior to estimated
CCTYou should receive a yellow form from the
JCHMT describing your educational requirements and clarifying your
training to date and your estimated CCT date. Do not lose
this form. It must be signed by your training committee
chairs for both your specialties once you can provide proof you have a
achieved your objectives. It will need to be signed by the
Postgraduate Dean too but this usually occurs at your final RITA.
6
months prior to estimated CCTYour final RITA
should be approaching soon. Attend with a completed yellow
form (apart from the Dean's signature) and your finished gray training
folder. Once the yellow form is signed you can submit it to
the JCHMT who will soon furnish you with a certificate of completion of
training allowing application and entry to the specialist register.
3
months prior to actual CCTYou can apply for
jobs with an interview date which falls within your last 3 months of
training. You still cannot start work as a consultant until
your CCT date however. By now the JCHMT should have forwarded
confirmation that your training is complete to PMETB. The
JCHMT will send you a form that needs completing and sending onto PMETB
along with a copy of your passport, a photograph and a cheque for
£500.
1 month prior to
actual CCTPMETB should send agreement that you
can be entered onto the specialist register and you need to send this
onto the GMC in order to obtain a substantive post.
CCT
dateYou can now start work as a consultant in
your specialty of choice. If you are without a consultant job
you can remain as a registrar for up to 6 months whilst you look for
available posts. If you have no job after that the Deanery
stop paying you and you will have to find work as a locum consultant or
equivalent.
