An overview of internal medicine and specialty training, other opportunities you will have as a trainee, and what the RCP can do for you at this stage of your career.
How to become a physician
Internal medicine stage 1
The usual route to becoming a physician will be via application to the internal medicine stage 1 programme after the foundation programme. This is a 3-year programme, with the first 2 years focusing on developing skills, knowledge and attributes across several specialties and settings, including acute medicine, intensive care, outpatients, simulation and geriatric medicine. During this time you are expected to complete specific competencies, skills and pass the MRCP(UK) examination, to enable you to practise as a general medical registrar in the third year.
Specialty training and internal medicine stage 2
After the third year, trainees move into specialty training and internal medicine stage 2, usually over a period of 4 years. Once training is complete, you are awarded a Certificate of Completion of Training (CCT) by the General Medical Council (GMC) and can apply to become a consultant. Many specialties require Specialty Certificate Examinations (SCE) or other royal college examinations (eg RCPath) to demonstrate that you have the competence to practise in your chosen specialty. Not all specialties require further training in internal medicine (group 2 specialties), but this means that these trainees would not be able to provide general medical duties as a consultant. For those specialties, the internal medicine stage 1 training is reduced to 2 years.
Other opportunities within medical training
Alongside their clinical work, many medical trainees opt to pursue alternative career paths to complement this and to provide them with more varied jobs. Indeed, all medical registrars get at least one session per week of personal development time towards pursuing these interests. Options available include (but are not limited to) quality improvement, developing leadership skills, medical education, research or developing subspecialty interests.
Quality improvement work has taken over from audit, with a shift in focus towards creating benefits at the end of the process rather than purely studying what’s happening. All trusts now have quality improvement teams, and trainee involvement in quality improvement work is required throughout internal medicine training. Much excellent work is done by trainee physicians, often leading to direct benefits either for patient care or for staff experience. Although not all trainees get involved in large, complicated projects, most trusts are very keen for trainee help with either ongoing or new projects and often provide excellent training for this.
RCP chief registrar scheme
The RCP chief registrar scheme is designed to help senior doctors in training develop their leadership and management skills. As well as equipping them with the skills to become future leaders themselves, this provides an excellent opportunity for trusts and trainees to work together to improve their service. Many trusts in the country now have a chief registrar post, and the majority of these provide time (often 2 days a week for a minimum 12-month post) for developing leadership skills, which counts towards the curriculum requirements for training. This can be set up as an in-programme or out-of-programme experience and is open to trainees at level ST4 and above.
Out of programme
Many medical trainees go out of programme for a period of time (ranging from a few months to a few years) to pursue a number of areas such as research, working abroad, specific experience or further training. Some of this may count towards training time, although the rules around this are complicated. Trainees are supported in doing this as it’s recognised that the consultant physicians of the future will need diverse skill sets to take on the challenges of the future NHS.
Flexible Portfolio Training
In 2019 the RCP is piloting along with HEE ‘flexible portfolio training’. This is part of a response to ‘enhancing junior doctors’ working lives’ and designed to introduce a degree of flexibility to training. It gives trainees 1 day a week to work on a project in one of four areas: clinical informatics, medical education, quality improvement or research.
By engaging with project work, the trainee has the potential to meet their generic professional capabilities in a different capacity, in addition to their regular clinical work. In 2019 this is being piloted for higher specialty trainees (ST3 level) in frontline dual-accrediting physician specialties, but has the potential to be expanded to other specialties and grades in the future.
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