Specialty spotlight – acute internal medicine (AIM)

Dr Roger Duckitt FRCP, consultant physician in acute internal medicine at Worthing Hospital and training programme director for acute internal medicine (AIM) at Health Education Kent, Surrey and Sussex, covers what the best thing about being an acute physician is, why it is an exciting, interesting, and varied specialty, how everyone's story is different and why good communication is essential.

Introduction to acute internal medicine

AIM provides the initial assessment, investigation, diagnosis and management of patients with an acute medical illness during the first 72 hours of their hospital stay. The speciality also provides expertise in the management of medical patients who can be cared for in an ambulatory setting.

The spectrum of clinical problems is wide, so trainees become experts in acute aspects of all medical specialties, and gain excellent practical procedure skills. AIM trainees and consultants interact daily with colleagues from the emergency department, critical care and many other medical specialities.

An acute medical unit (AMU) is often busy and bustling and hosts a mixture of clinical pathologies and patients of all ages – it is often described as the acute care hub of the hospital. Teamwork, excellent communication and time management are vital for AMUs to run efficiently and effectively. AIM consultants work as part of a team with a variety of healthcare professionals in the AMU including nurses, therapists, pharmacists, and physician associates.

Why did I choose AIM and what is unique about it?

I chose AIM because it is a young and vibrant speciality where everyday is different and offers me a new challenge. I wanted my daily work to be within a clinically excellent and patient-centred multidisciplinary team.

I would recommend AIM to anyone who enjoys working as part of a team, is flexible, relishes a challenge and can offer excellent diagnostic, practical and communication skills. There are great job prospects for anyone joining this dynamic and evolving specialty.

The variety – no day in the AMU is quite the same, and the rapid turnover of patients ensures each day brings a new and exciting challenge. AIM brings all the interesting and exciting internal medicine patients together on one ward, offering physicians a variety of presentations and diagnostic challenges. There is considerable flexibility for people considering less-than-full-time working, and a real opportunity to develop services to meet patients' needs.

Dr Nerys Conway, SpR Severn deanery and training representative Society for Acute Medicine

Training and working in AIM

Five key facts about training in AIM

  1. Exposure to internal medicine: The AIM curriculum covers all aspects of internal medicine in adults. Consultants in AIM deal daily with both acute illness and exacerbations of chronic disease. In addition, most AIM trainees are encouraged to undertake dual accreditation in general internal medicine (requiring an additional year of training) which enables provision of ongoing inpatient care for medical patients beyond 72 hours, where there is a need for this.
  2. Variety of different specialties: AIM trainees spend time attached to the AMU and rotate through specialities such as intensive care, cardiology, geriatric medicine and respiratory medicine. This broadens their experience, knowledge and helps develop their practical skills.
  3. Practical skills:  AIM trainees have the ability to develop excellent practical skills while working on the AMU and as they rotate throughout training. Often patients will require a procedure such as a lumbar puncture, paracentesis or pleural aspiration within the first 24 hours of hospital admission. Trainees also have an opportunity to gain experience in ultrasound during their respiratory and cardiology rotations.
  4. Research: The AMU hosts a range of audit and quality improvement opportunities. As the speciality is evolving there is scope to develop and improve guidelines both locally and nationally. As most medical patients who are admitted to hospital pass through the AMU, there is often an opportunity to publish case reports of those more interesting and rare cases.
  5. Specialist skill: All AIM trainees are supported in developing a specialist skill. This can be practical (ultrasound, echocardiography), academic (medical education, toxicology) or may be an opportunity to gain a further CCT in another speciality such as stroke medicine. The specialist skill is often linked to out-of-programme opportunities, and can be developed as your career progresses and adapted into your future job plan.

You can find more information on the training pathway from the Joint Royal College of Physicians Training Board. Learn more about the recruitment and interview process by visiting the ST3 recruitment page.

AIM resources

RCP resources

Historical highlights from the library, archive and museum collection

Bina Sardesai was a highly-respected consultant physician in acute medicine based in Cornwall. She was a clinical director for this specialty and an MRCP examiner. Find out more about her story .

The basis of diagnosis of the acutely unwell patient still lies in the initial clinical examination. The museum collection includes a 19th-century ivory pleximeter, used to diagnose underlying lung disease. It was held to the patient’s chest and absorbed the shock of being tapped with a ‘percussor’. A range of stethoscopes illustrates how much this fundamental instrument has changed from its precursors from a basic cylinder design to the silver ‘top hat’ stethoscope – so called because it fits neatly inside a visiting physician’s top hat.

The library has a repository of all RCP publications on the specialty including: Medical masterclass: acute medicine (2008) and Acute care toolkit 7: acute oncology on the acute medical unit (2013) . Find these and more in the library catalogue.