Curriculum sign off provides assurance that you’ve had experience and training across the full range of the curriculum (and if you haven’t, to highlight that to you and us). When you link an ACAT to a few items on the curriculum (maximum of 8 links for ACATs, and 2 for CbD/CEX, mind) that is supposed to represent the fact that you’ve had experience and meaningful feedback in relation to those particular items. Your ACAT patients may have had many more pathologies or presentations than the 8 you’ve linked to, but it’s unlikely you discussed every one of those issues.
Progressively over time, you should therefore gradually build up evidence that you’ve had experience and related training across the curriculum. Some things you’ll pick up quickly if they’re common or related to your specialty – these you can self-sign off in the curriculum and have your ES counter-sign them, perhaps even within the first year of training. Others may take longer to accrue or require targeted experience or education. By PYA you should expect to have most (but not necessarily all, you’ve got time!) of your competences evidenced, signed off by you and countersigned by your educational supervisor(s). So do it in tranches across each year of GIM training, not all at once – your ES will be grateful.