Trainees may be recruited to GIM specialty training as part of dual specialty training programmes coupled with the following specialties: acute medicine, cardiology, gastroenterology, renal, respiratory, diabetes and endocrinology, geriatrics, clinical pharmacology and therapeutics, infectious diseases and rheumatology.
The JRCPTB has decided not to mandate dual training in those medical specialties which are traditionally linked to GIM. However it strongly endorses dual training and wishes to encourage as many trainees as possible to enroll and complete dual training. This is consistent with the Shape of Training recommendation that generalist training should continue up to the level of the Certificate of Specialist Training (currently CCT) and use the skills acquired to manage and care for acutely unwell patients admitted on the acute take. The JRCPTB also encourages any trainee who has embarked on a dual-CCT programme to continue to work on the acute general take until their CCT date.
Where a trainee in a dual specialty programme wishes to drop one of their specialties and pursue a single specialty training programme they must apply to their postgraduate dean for approval.
Within the London LETBs we are encouraging all trainees recruited to dual specialty training programmes incorporating GIM to successfully complete their GIM training and achieve a CCT in GIM. However it is recognised that for some trainees single accreditation in the specialty paired with GIM may be appropriate. This may include academic trainees, trainees who have done sub-specialty training, trainees who have developed highly specialised areas of practice, trainees who may already have a CCT (or equivalent) in GIM from another country and trainees who, due to health reasons, are unable to continue with a GIM commitment.
All trainees who wish to give up training in GIM should have had a detailed discussion with their educational supervisor and/or specialty training programme director as to the advantages and disadvantages of such a move. This should be documented on their eportfolio and include reasons why this is appropriate for the trainee.
If a trainee is successful in their application to drop GIM the CCT date for the single specialty training will then be reviewed at the trainee’s next ARCP (Annual Review of Competence Progression). Amendments to the CCT date will vary from trainee to trainee and depend on how much GIM training they have already done and what their remaining curriculum requirements are. Trainees may still be expected to complete GIM placements as part of their planned training rotations and contribute to acute medical on call commitments, even though they are no longer training in GIM. Their LEPs will need to ensure that trainees have the appropriate skills and competencies to do this.
If there is any disagreement between training programme directors about whether the trainee should be allowed to give up GIM, this will be referred to head/deputy head of school of medicine for guidance. If there continues to be disagreement then the trainee will be invited in for a support meeting and the matter referred to the postgraduate dean. The trainee will need to present compelling evidence to support their application to drop GIM training.