Training and Acute Medicine' Where are we going

1
Training and Acute Medicine.Where are we going?

• Mike Jones
• Tayside University Hospitals

2
Acute Medicine?

• Unselected Medical admissions
• First forty eight hours of care
• Triage to speciality
• Liaison with Primary Care
• Promotion of intermediate care
• Promotion of ambulatory care

3
Acute Medicine

• Sub specialty status July 2003
• NOT a separate CCST. Curriculum to be read with
  that for G(I)M
• DO develop new training programmes
• IS being promoted by the colleges
• HAS a political imperative

4
BUT...

• STA approval required re -examination of length
  of training
• Other colleges disappointed the RCPs developed
  this sub -specialty without them
• Health Ministers response to Unfinished Business

5
Competencies in G(I)M

• Clinical Expertise
• Communication skills
• Leadership skills
• Education and Mentoring skills
• Maintenance of Quality standards

6
Difficulties

• Assessment by whom and how?
• For acute care scenario
• which specific skills emphasised or to be added
• Procedures and experience that are essential
• Extra specialist training
• what are the minimum competencies to deal with
  acute medicine?

7
Specific Elements

• Central line
• Airway support and augmentation
• Critical illness awareness and data integration
• Minimising distress
• Leadership role in MAU

8
Explanation of Medical Training
9
Explanation of Medical Training?

• Ultimate authority Specialist Training Authority
  (STA)
• To be replaced by Postgraduate Medical Education
  and Training Board (PMETB) October 2004
• MMC (Health Minister responses)
• Delegated responsibility to JCHMT, JCHST etc,
  SACs and Colleges

10
Colleges

• Federation of Colleges (RCP)
• Academy of Colleges (All)
• Competency Based training
• For acute medicine
• Working group AE, ITU, Anaesthesia
• Goal Critical Care Team
• Roadmap???

11
Competency Assessment

• Mini-CEX
• DOPS
• 360 assessment
• Patient survey

12
Base speciality/ qualification
GIM MRCP
Anaesthesia FRCA
Accident Emergency MRCP/FRCS
N.T.N.
GIM
GIM Specialty
Anaesthesia
AE medicine
Specialist registrar training
12 months GIM
Acquisition of qualifying competencies as per
document
Acute medicine training programme (12 months)
Completion of base speciality training programme
(variable period)
C.C.S.T. (Variable time elapsed depending upon
base specialty and training needs)
Anaesthesia/ Acute medicine
AE/ Acute medicine
Career
GIM/ Acute medicine
GIM/ Acute Medicine/ Speciality
13
Modernising Medical CareersThe Next Steps

• Foundation 1 and 2 gt JHO and SHO
• Breadth of experience?
• Medicine based programmes or multi-specialty
  prior to specialisation?
• GP involvement
• Run through training from Basic training through
  to CCT

14
MMC

• MRCP
• How important?
• When
• For all medical staff in acute medicine?
• Subsequent knowledge tests and competency
  assessment
• Where does Acute Medicine sit?

15
Now where?

• Definition of roles and blurring?
• Hospital at Night etc.
• Develop 48 hour care, intermediate care, promote
  care in the community.
• Encourage enough doctors into Acute Medicine