A BGS resource on the Geriatric Medicine Curriculum update from August 2022 and its impact and implications for trainees and trainers.
Geriatric Medicine StRs, and Internal Medicine Trainees and Foundation Year doctors are faced with queries and challenges around exams, training and progression, which could be causing considerable anxiety.
The BGS Trainees' Council committee and VP of Education, Professor Mike Vassallo along with Dr Susan Pound, Dr Rebecca Winter, Dr Victoria O'Brien and Dr Sarah True have compiled these FAQs to help provide some clarity on what you can do, and what is being done to minimise the disruption to progression.
You can reach the Trainees' council committee via trainees@bgs.org.uk or you can email Geraint Collingridge, as the BGS secretariat representative for the Councils' committee on g.collingridge@bgs.org.uk, with further questions or resources to share.
All doctors in training (StRs, clinical fellows, IMT, Foundation year doctors and medical students who are members of the BGS are in the Trainees' Council.
Curriculum Webinar
The recording of the live webinar broadcast on 25 February 2022
Introduction from Dr Susan Pound
A summary of the key differences in the curriculum, why it's changed and what will be similar
An example of an educational supervisor meeting
Questions from the audience
New Curriculum Key Differences Extended
Dr Susan Pound and Dr Rebecca Winter review the key differences and similarities in the new Curriculum
Extended Educational Supervisor Case Study
Dr Iain Wilkinson and Dr Rebecca Winter role-play an educational supervisor meeting under the new curriculum structure
Dr Iain Wilkinson and Dr Rebecca Winter role-play an educational supervisor meeting under the new curriculum structure
Stroke Training
Trainees and Trainers session - Stroke Training
Curriculum update-rationale, new training programme, and rationale including impact on enhancing stroke workforce
Anthony Pereira, Consultant neurologist and stroke physician at St George’s Hospital
Life as a stroke SpR
Dr Weiran Liu, Stroke SpR at Addenbrookes, currently doing his sub-specialty year
Transition to stroke consultant and how to get the best out of your stroke training
Dr Jatinder Minhas, Consultant Stroke Physician and Associate Professor at Leicester
Discussion
1. Why is there a new curriculum?
How will the new curriculum affect trainees and what are the big differences?
The new curriculum will affect all trainees who are not in ST7 when the transition begins in August 2022.
The big difference for trainees will be how the new curriculum moves away from the “tick-box” approach associated with the current competency-based curricula to the holistic assessment of high level learning outcomes. There are some changes in the way trainees are assessed and these are detailed further in section 3.
To find out more please watch the BGS webinar “New Curriculum Key Differences Extended” at https://www.bgs.org.uk/CurriculumFAQs.
Why do we need a new curriculum and why do we need to switch as existing trainees?
With the change in structure of physician training, including the introduction of internal medicine training, the length of time in higher specialty training has changed and this provided the ideal opportunity to revise the curriculum. The old curriculum was devised in 2010 and the shape of geriatric medicine has changed hugely in that time. By taking this opportunity to modernise our curriculum it better represents the exciting new facets of geriatric medicine which has developed since the last curriculum.
There is also a drive from the GMC for all physicians to be competent in generic capabilities.
Whilst we understand the change in physician training structure does not directly impact existing trainees we feel the new curriculum also reflects the increasing complexity of our patients and will better prepare all of our trainees for qualification as consultant geriatricians.
What is better about the new curriculum compared to the old?
The new curriculum has been designed to focus on trainee’s competencies rather than tick boxing off certain criteria and as such has a reduced administrative burden for trainees. It focuses on the current needs of services and patients. It’s been developed with a lot of input from trainers and trainees, and we believe it is a positive step towards ensuring trainees have the tools to be the consultants of the future.
2. Transition to the new curriculum: Who and when?
When will the new curriculum go live?
August 2022.
Who will need to transition to the new curriculum?
All trainees who are not ST7 in August 2022 will be required to transition to the new curriculum.
Will trainees who are less than full time and in their final year (ST7) be required to change curricula if completing their final year of training will take more than one calendar year?
If you are ST7 in August 2022 but work less than full time you will not have to change to the new curriculum. However, you may be offered a choice and could consider transferring to the new curriculum if you feel it would benefit your training. You should discuss this with your TPD.
Will those who are ST7 in August 2022 but take time out of training (eg parental leave) still need to transition to the new curriculum?
In these circumstances you do not have to transfer to the new curriculum but you may be offered the choice. Discuss this with your educational supervisor as it may be the new curriculum is beneficial to your training and you will be on the same curriculum as your peers on your return to training.
In our deanery we rotate in September/October so I will not be ST7 until then. Does that mean I need to transfer to the new curriculum?
Yes, you will be expected to transfer to the new curriculum in these circumstances. If you feel this would significantly impact your training please discuss directly with your TPD.
3. How does this impact my e-portfolio and ARCP?
Will there be an up-to-date decision aid to help trainees see how many assessments are required each year?
Yes, you can find the new decision aid here. There is also a table that compares the differences in assessments available as part of this resource.
Will we have to re-link all our pre-existing SLEs to the new CIPs/start again?
No. You will not be required to re-link your pre-existing SLEs from the old curriculum to the new curriculum. At your first educational supervisor meeting please encourage your supervisor to refer back to the competencies you have already achieved and these will also remain available to review in an archive version of your old e-portfolio.
What has been the purpose of all our efforts to keep the portfolio up to date so far?
The purpose of your efforts to keep the portfolio up to date so far has been to evidence and facilitate your progress to this point. This evidence will remain accessible as all of your existing portfolio will be automatically transferred, so your efforts will not go to waste and can be easily accessed anytime.
Will the old curriculum/portfolio still be accessible?
Yes, it will be available as an archive on your e-portfolio.
Can we link forms from the old curriculum to the new one?
We would discourage re-linking items between the curriculum as this could be a substantial administrative burden. Instead we would encourage you to discuss your competencies so far with your educational supervisor at your first meeting on the new curriculum so that these can be referenced in the educational supervisors report.
What are the differences in assessment requirements between the old and new curriculum?
|
Old (2010) Curriculum |
New (2022) Curriculum |
Changes |
|
|
Advanced life support |
Valid throughout |
Valid throughout |
No change |
|
Patient survey |
To be completed in ST6 year |
To be completed by ST6 |
Same requirement but more flexibility in when patient survey can be undertaken. |
|
Multi source feedback |
To be completed in ST4 and ST6 |
One per year |
Increased requirement to each year |
|
Multi Consultant Report |
4-6 per year |
4 per year |
Reduced to previous minimum standard |
|
Supervised learning events: ACAT |
1 per year (for geriatric medicine, in addition to GIM requirement) |
4 per year or 16 in total (for geriatric medicine, in addition to GIM requirement) |
Increased from 1 to 4 per year |
|
Supervised learning events: CBD and Mini-CEX |
6 CBDs and 6 mini-CEX per year |
8 per year 32 in total |
Reduced from 12 per year to 8 per year |
|
Procedural skills |
No geriatrics specific procedures |
Competent to perform independently by CCT
|
Two new competencies |
|
SCE |
Attempted in ST5/ST6 Passed in ST7 |
Attempted in ST5/ST6 Passed in ST7 |
No change |
|
Teaching observation |
One by PYA |
One per year 4 total |
Increased from 1 to 4 total |
|
Training courses |
ST4: Research ST5: Teaching ST7: Management and leadership |
Courses in 4 core skills to be completed one per year but in no specific order:
|
One additional course: good clinical practice. More flexibility in when these can be completed. |
|
Teaching attendance |
“Satisfactory” |
50 hours per year or 200 hours total |
Specific target introduced. Can be from regional teaching and relevant conferences eg BGS meetings |
|
Quality improvement |
One per year |
Evidence of participation and leadership in QI activity throughout with at least 1 specialty related QI project to be completed and assessed with QIPAT by the time of completion of specialty training |
Focus on one |
How will those who transfer across towards the end of their training achieve sign off for the research section?
The research requirement hasn’t changed. You will be able to reference your research course in the archived portfolio.
Is there a specific number of QIPS required?
At least 1 specialty related QI project should be completed and assessed with QIPAT by the time of completion of specialty training. Evidence of participation in QIP is expected throughout training this includes supervising junior trainees or participating yourself. The emphasis is on a high quality project that makes a real difference to your team or patients.
The BGS are developing a “QI hub” resource to support for QI projects. We anticipate this will be published before the new curriculum is launched and will add link to that resource here when it is available.
Is there a certain year each course needs to be completed by ie. in the old curriculum it was mandatory to do research in ST4.
There is now more flexibility in how you can approach courses, with the aim to complete competence of one generic skill per year. The order you complete these in is now optional but it may still fall in to a natural pattern, for example leadership and management in ST6 or ST7.
For those who have a mid year ARCP rather than the usual June/July how should they approach the first ARCP after the new curriculum comes in having had only a few months to meet the new requirements?
We would not envisage this being an issue as the new curriculum is more competency based and all your experience so far will be relevant and still available as evidence on e-portfolio.
Whenever you transfer to the new curriculum it will be helpful to perform a “gap analysis” or self assessment so that you understand where your gaps are so you can discuss these early with your educational supervisor. An example of an ES meeting can be found on the website here.
There is no major change in how the trainee needs to prepare for the ARCP. They still need to do an appropriate number of supervised learning events (SLEs) and workplace based assessments (WPBAs). As the ARCP approaches, trainees need to arrange to see their ES to facilitate preparation of the ES report (ESR). They will have to self-assess the level at which they feel they are operating at for each CiP.
Many trainees have had their specialty training impacted by Covid19 and are worried about meeting the new requirements, especially those later in training. Do you have any advice or suggestions on how to make up for lost time?
You will have learnt invaluable skills during the pandemic which should be reflected in your portfolio. Early identification of gaps and working with your supervisor to address these is key. For example, if you need to make up a lot of clinics. Try and find out if your deanery has any support available to enable you to make up for lost experience. Do contact the BGS education and training reps if you feel you need more signposting.
Do you anticipate CCT be reviewed more frequently? This feels particularly significant given the change in pay at ST6.
We understand that there is a change in pay associated with progression to ST6. Whilst the new curriculum is competency based rather than time based there is still a requirement to spend a designated amount of time in training. There are no plans to review CCT date any more frequently than the current protocol. If you feel you should be considered for accelerated training please discuss this with your training programme director.
Those who will only have a short time on the new curriculum will the PYA be held at the same time? Or earlier to give us more time to work towards missing areas of new curriculum?
Your curriculum will transfer in 2022 so you will have time to work towards getting everything you need by CCT. All your experience to date counts and so you will find there are only likely to be some gaps you will need to focus on. Discussing these early with your ES is key, you can find an example ES meeting here.
4. Are there also changes in the general internal medicine component of training?
How will this be embedded into our jobs? It’s difficult to see how the new requirements are going to fit into existing job plans given we already have a very busy GIM schedule.
We envisage the new curriculum fitting easily onto your job plan. It aims to develop trainees with a broad range of skills needed to be a consultant Geriatrician. There are some new things but in many cases the requirements have relaxed. There will be support from you ES/TPD and the BGS for areas you may be worried about.
For more information about how the GIM component of the curriculum will be changing please visit: https://www.jrcptb.org.uk/training-certification/shape-training-and-physician-training-model/transition-new-curricula-jrcptb
There is also a webinar run by the JRCPTB on 4th April 2022 https://www.jrcptb.org.uk/news/webinar-meeting-future-healthcare-needs-new-curricula-acute-medical-specialties-and-higher
5. What is the impact on SAS doctors?
I am an SAS doctor planning to become a consultant geriatrician through the CESR route. Will the new curriculum impact me?
Yes it will. Once the new curriculum is fully active this will be your new guide to competencies required to qualify as a consultant and includes dual accreditation, therefore you will need to meet the requirements for both geriatric medicine and general internal medicine. Once the new curriculum is fully active there will no longer be a single accreditation for geriatric medicine.
The new curriculum will become fully active when the final geriatric medicine trainee has CCT-ed under the guidance of the old (2010) curriculum. After this point you will need to meet the requirements of the new curriculum to become a consultant geriatrician through CESR.
For more information please consult the GMC updated specialty specific guidelines for CESR. https://www.gmc-uk.org/registration-and-licensing/join-the-register/registration-applications/specialty-specific-guidance-for-cesr-and-cegpr/specialty-specific-changes-for-cesr-in-geriatric-medicine
Stroke Medicine
If I did 6 months as stroke registrar in IMT3 does this count towards stroke competencies during geriatric medicine registrar training?
The competencies and experience you will gain will be relevant and are likely to be reflected in your entrustment level when in geriatric medicine training. However, you will still need to have stroke experience as a geriatric medicine trainee as well as your themed for service CIP, and 6 months of additional stroke if you wish to have dual accreditation.
What provisions have been made for CeSR route?
Trainees who are undertaking CeSR route will have a grace period on the 'old' curriculum of approximately 12 months from August 2022. After this, trainees via the CESR route will be required to demonstrate all capabilities as described in the 2022 curriculum which includes generic, specialty and clinical internal medicine CIPs. By demonstrating these capabilities a successful applicant will be awarded an additional CESR in internal medicine. Further information can be found at https://www.jrcptb.org.uk/certificate-eligibility-specialist-registration
Can rehab medicine trainees do stroke medicine if they have done IMT3
Yes.