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    So replacing CMT is now IMT.

    I am not sure whether to be annoyed or not. I dont mind the overall yeas being shorter, if we are just supposed to act up in CT3 as the med reg, but what is this new dual training in acute internal medicine about?

    Say if I wanted to do cardiology, would I go into ST4 and carry on as normal training as a cardiologist, or would I now be forced to do one year of acute gen med rota stuff?


    The information online about life after IMT isn't helpful at all - and to be honest I dont want to apply to it, if it means that now speciality consultants will have to do the acute general medical take.
    Its a bit ridiculous that our hands are tied and theres so little information.


    Thanks for any clarification!
    • #1
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    My understanding was that the extra year of general medicine was gained by doing the third year of IMT rather than any extra training during the registrar years (but because the overall length of training will remain the same, there will be a year less of specialty training).

    A lot of medical specialties already involve dual accreditation and consultants from those specialties already do the acute medical take. Cardiology isn't one of them at the moment, but I am guessing that will change!
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    Cardiology is already part of the acute medical take.

    That's why it is under the group 1 specialties in the new IMT programme.

    I can't help but be cynical, and suspect that the primary benefit of this change is service provision.

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    I think its a horrible idea based on flawed logic.

    As far as I can tell the main reason its been changed is because CTs were saying they didn't feel ready to be the med reg. Well duh - CMT is absolutely awful - no different to F2 whatsoever, except busier - and being the med reg is a scary thing. Its good they want to improve it, and to be fair they are talking about having more e.g. clinic time, a more robust ARCP etc.

    But I am so glad I am missing this:
    1) Lets start with the obvious - the extra year. No one joints CMT/IMT to be a gen med SHO. People join to become medical specialists, and an extra year of rotating around as an anonymous med SHO... that's a huge blow to every trainee in the country.
    Two years of restructured, actually existent training would be entirely adequate. What happened to acting up during CT2?
    2) I assume it will be paid at CT level and not ST3 level too?
    3) Ultimately we're meant to be training as specialist consultants right? Easy to forget at times. Perhaps less so in some specialities where much of the consultant job is gen med anyway, but things like Dermatology? Oncology? Neurology? They now need to achieve all the same specialist knowledge in a year less?! What provision is there to achieve that?!
    4) Based on current I have zero faith they can deliver what they promise in terms of e.g. clinics. We have to absolutely fight tooth and nail for current requirements, with many resorting to coming in on annual leave. The departments just do not give a **** - we probably aren't going to end up doing their speciality, after all.
    When we do get allocated "clinics", they can be a joke e.g. supervising exercise ECG testing, or writing discharge letters for people having elective endoscopies (two real examples). And lets not get started on procedural sign offs.
    40% of CMTs already require extra time due to this constant battle, and I've seen multiple examples of people being signed off despite not actually meeting the minimum requirements. What incentives for trusts are going to make IMT any different, exactly?

    This is just going to be a year more of the same, and because of that we're going to have even more dissatisfied trainees and ultimately worse consultants.
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    @nexttime I'm not in front of a computer now so I'll expand on my answer later, but there are several advantages to IMT (and a lot of disadvantages).

    I'll list the advantages for now:
    (1) compulsory elderly care and ITU rotations (I didn't do either, personally)
    (2) one more year to pass MRCP if required
    (3) forcing all CMTs doing group 1 specialties to be a med reg for a year will relieve the existing med regs. They will be paid ST3 wages (the pay circular clearly stated the wages for CT1 and CT2, the psych and ACCS CT3s are paid ST3 wages as far as I know)

    I'll come back with the downsides in the bit. The most obvious being neurology will be forced to do gen med on calls! (I've escaped though, personally)
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    (Original post by ecolier)
    (1) compulsory elderly care and ITU rotations (I didn't do either, personally)
    Not sure on the benefit of ITU tbh? Unless its just following the on call bleep around. Potentially procedures too, although using ITU patients as your allocated practice dummies seems a little perverse!

    Compulsory COE is good but I don't think it goes far enough - I don't see how you can be the med reg without having done e.g. cardiology, or gastro. Why was COE picked?

    (2) one more year to pass MRCP if required
    That's already an option. Its called taking a year out :p:

    (3) forcing all CMTs doing group 1 specialties to be a med reg for a year will relieve the existing med regs.
    Yeah I guess its a 'someone has to do it' kind of situation.

    I'm still really not sure how i would feel as a patient if the med reg did e.g. med onc, or haem, or GUM, as their day job though. Having people who don't do gen med routinely on the rota will surely mean the quality of med regs will slump, even despite the extra year gen med year.

    They will be paid ST3 wages (the pay circular clearly stated the wages for CT1 and CT2, the psych and ACCS CT3s are paid ST3 wages as far as I know)
    That's good.
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    (Original post by nexttime)
    Not sure on the benefit of ITU tbh? Unless its just following the on call bleep around. Potentially procedures too, although using ITU patients as your allocated practice dummies seems a little perverse!
    Exactly - I think it is mainly for procedures. It's also called "simulation-based training". I have personally found that not having done an ITU block detrimental, and most CMTs who have worked there really enjoyed it. Referrals to critical care is bread and butter of all medical doctors, I think.

    Compulsory COE is good but I don't think it goes far enough - I don't see how you can be the med reg without having done e.g. cardiology, or gastro. Why was COE picked?
    :dontknow: I suppose they think along the lines of Elderly Care = "GP of the Physicians" (whereas Cardiology = "Surgery of the Physicians" :laugh: How many times I called the cardiologists and they are scrubbed in, I cannot recall)

    That's already an option. Its called taking a year out :p:
    Well now the "year out" is the year in training!

    Yeah I guess its a 'someone has to do it' kind of situation.
    Indeed. Hopefully it will make everyone's working lives better and help get rid of "medical registrar shifts are ****" culture.


    I'm still really not sure how i would feel as a patient if the med reg did e.g. med onc, or haem, or GUM, as their day job though. Having people who don't do gen med routinely on the rota will surely mean the quality of med regs will slump, even despite the extra year gen med year.
    That may well be the case, we'll just have to see come 2021.

    That's good.
    It's not good, it's only the contract! On the old contract, even if you take the year out after CT2, or failed the year for whatever reason, you'll still get the ST3 wages. If you have to repeat for the second time, it's ST4 wages and vice versa!
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    (Original post by ecolier)
    Exactly - I think it is mainly for procedures. It's also called "simulation-based training". I have personally found that not having done an ITU block detrimental, and most CMTs who have worked there really enjoyed it. Referrals to critical care is bread and butter of all medical doctors, I think.
    In reality it'll be doing the ward rounds and the discharge summaries though right. There'll probably be more about adjusting ventilator settings than putting in central lines. Zero faith it'd be just shadowing the on call.

    :dontknow: I suppose they think along the lines of Elderly Care = "GP of the Physicians" (whereas Cardiology = "Surgery of the Physicians" :laugh: How many times I called the cardiologists and they are scrubbed in, I cannot recall)
    Yeah... overnight though you're much more likely to be dealing with a VT than rationalising someone's meds and assessing the care needs of the elderly though! Not that it isn't useful - just not sure why its been singled out!

    Indeed. Hopefully it will make everyone's working lives better and help get rid of "medical registrar shifts are ****" culture.
    If they actually put 2 med regs on in places where its clearly needed that would be a good change. Remains to be seen though - i think its much more likely just about decreasing the locum bill.

    It's not good, it's only the contract! On the old contract, even if you take the year out after CT2, or failed the year for whatever reason, you'll still get the ST3 wages. If you have to repeat for the second time, it's ST4 wages and vice versa!
    Well ok, but better than the alternative!
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    (Original post by nexttime)
    In reality it'll be doing the ward rounds and the discharge summaries though right. There'll probably be more about adjusting ventilator settings than putting in central lines. Zero faith it'd be just shadowing the on call

    Yeah... overnight though you're much more likely to be dealing with a VT than rationalising someone's meds and assessing the care needs of the elderly though! Not that it isn't useful - just not sure why its been singled out!

    If they actually put 2 med regs on in places where its clearly needed that would be a good change. Remains to be seen though - i think its much more likely just about decreasing the locum bill.


    Well ok, but better than the alternative!
    It's hard to shift the culture that CMTs are there mainly for service provisional, rather than training. They are trying but I don't see how there's a way out. :crossedf: this forced extra year of med reg will make everyone's lives better...
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    (Original post by nexttime)
    In reality it'll be doing the ward rounds and the discharge summaries though right. There'll probably be more about adjusting ventilator settings than putting in central lines. Zero faith it'd be just shadowing the on call.
    We have had CMTs in ICU in most of the units I've worked in, and they do pretty much exactly the same as the ACCS/anaesthetic SHOs, except don't have airway skills. So yes, there's quite a lot of ward rounding and discharge summaries, but that's just the nature of the job. And most ward rounds don't just involve tailing the consultant, but juniors reviewing patients themselves, coming up with problem lists and management plans which then get tweaked by the bosses - you're not just a secretary. SHOs often also get first dibs on procedures if they're keen, as jaded oldies like me really aren't excited about CVCs/art lines etc - plus we get stuck doing all the transfers which non-airway folk (and even junior anaesthetists) can't do. And in most places they're encouraged to go out and do the ward reviews themselves - supervised at first but after a while I'm very happy to send my CTs to go and see most referrals that aren't completely in extremis, and then report back to me. Very much not just shadowing the on-call.

    I think it's actually a useful skill set for most physicians to have - not just the procedural side, but actually having an awareness of what ICU can and can't fix, what a long slow respiratory wean on your crumbly COPD-er really looks like, and being able to differentiate patients on an acute take/the ward who would really benefit from early ICU intervention. It's also much more consultant-heavy than medicine, so lots more supervised practice, feedback on your reviews and plans, and usually a good bit of teaching. I'd definitely recommend it for most general/acute physicians!
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    (Original post by Helenia)
    ...It's also much more consultant-heavy than medicine, so lots more supervised practice, feedback on your reviews and plans, and usually a good bit of teaching. I'd definitely recommend it for most general/acute physicians!
    That's the general feedback I have got from CMTs who had a rotation in ICU - that it was really helpful and constructive. It's a shame that I didn't have a job in ICU, but I didn't really resent not having Elderly Care! :rofl:
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    Mere final year but...

    I just don't get the different groupings. Why is GUM a Group 1 while Immunology is Group 2? I know GUM's got some inpatient based stuffs (esp. around HIV) but surely most GUM is as outpatient as some of the Group 2 specialties...? And why should dual-training infectious disease with microbiology or virology suddenly make it a group 2...? Is there some weird element of medicine in training of these specialties that are substantially closer to "gen med" than the other...?

    (Original post by nexttime)
    3) Ultimately we're meant to be training as specialist consultants right? Easy to forget at times. Perhaps less so in some specialities where much of the consultant job is gen med anyway, but things like Dermatology? Oncology? Neurology? They now need to achieve all the same specialist knowledge in a year less?! What provision is there to achieve that?!
    Isn't derm staying the same length as before? It's 4 years now, and 4 years (as a Group 2) specialty isn't it? Thought the premise was group 2 specialties all have 4 years of ST years + 2 years of CT?
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    From an F1 that is not terribly keen on any of the medical specialties, the new structure just puts me off even more. We will need to wait and see how it is implemented but I think it might put off the people that don't really know what they want to do yet and were thinking of just doing CMT and hoping something catches their eye in the meantime. It might just end up pushing those undecided towards something with run-through training or GP.
    • #2
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    I haven't looked at it in detail.

    I think there are some positive aspects. However, overall for me I would view it as negative. I would rather get more time in specialty training, and less time in core training. Another year of general medicine is less interesting to me. I do quite like general medicine, but more specialty time makes more sense to me.
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    Reading all this makes me really happy that I've pretty much ruled out CMT as a training pathway. Especially since it looks like my year will be in one of the first years affected by the 'new system'.
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    I honestly believe it's just to stack numbers by trapping people in another year where they can be used for service provision. They're so short on the ground, and CMT is already such an obvious way to force people to do unappealing jobs as it's the only way through, I guess they figured why not stack the crap higher. I don't really see the point in a compulsory geriatrics placement. So much coming through the door is already elderly care, you're constantly being exposed to it no matter what you do.
    A compulsory ITU placement is the only thing which I think is an improvement, in that it's good to have some experience of high level care (even just covering an HDU is good experience), but the length of it that's suggested from my memory of reading the IM stuff is pretty piddly. I'm guessing because they are wondering how they are going to offer it in some places.

    As the med reg to me it makes a lot more sense to do core specialties and to make those compulsory, if you're looking to train good general medics - so everybody gets a taste of cardio/resp/gastro for instance. Right now the thing is a bit broken in that for instance, I will have managed to come all the way through without ever doing 2 out of those 3! Geriatrics is a fairly random thing to pick and actually off-putting. When I applied geriatrics and D&E (which is gen med in disugise as far as I'm concerned) went directly to the bottom of my jobs choice list, despite which I've still seen and dealt with loads and loads of geriatric patients because they are the majority in the hospital.

    One sneaky thing is that if you don't have an ST3 job by 2020 or whatever it is, even if you've already done CMT, they plan on making you do IM3. The people who are CT1 now and planning on taking a year out are basically going to be forced to either continue straight through training, or commit to doing yet another year.
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    (Original post by seaholme)
    I honestly believe it's just to stack numbers by trapping people in another year where they can be used for service provision. They're so short on the ground, and CMT is already such an obvious way to force people to do unappealing jobs as it's the only way through, I guess they figured why not stack the crap higher. I don't really see the point in a compulsory geriatrics placement. So much coming through the door is already elderly care, you're constantly being exposed to it no matter what you do.
    A compulsory ITU placement is the only thing which I think is an improvement, in that it's good to have some experience of high level care (even just covering an HDU is good experience), but the length of it that's suggested from my memory of reading the IM stuff is pretty piddly. I'm guessing because they are wondering how they are going to offer it in some places.

    As the med reg to me it makes a lot more sense to do core specialties and to make those compulsory, if you're looking to train good general medics - so everybody gets a taste of cardio/resp/gastro for instance. Right now the thing is a bit broken in that for instance, I will have managed to come all the way through without ever doing 2 out of those 3! Geriatrics is a fairly random thing to pick and actually off-putting. When I applied geriatrics and D&E (which is gen med in disugise as far as I'm concerned) went directly to the bottom of my jobs choice list, despite which I've still seen and dealt with loads and loads of geriatric patients because they are the majority in the hospital.

    One sneaky thing is that if you don't have an ST3 job by 2020 or whatever it is, even if you've already done CMT, they plan on making you do IM3. The people who are CT1 now and planning on taking a year out are basically going to be forced to either continue straight through training, or commit to doing yet another year.
    All of this, and especially about D&E.

    The change to 3 years hasn't made me reconsider medicine as a career choice, the career specialities I'm interested in are group 2.

    But who knows what last minute randomness they'll put through.

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    • #2
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    (Original post by seaholme)

    One sneaky thing is that if you don't have an ST3 job by 2020 or whatever it is, even if you've already done CMT, they plan on making you do IM3. The people who are CT1 now and planning on taking a year out are basically going to be forced to either continue straight through training, or commit to doing yet another year.
    Hmm. I'm CT1 now. I will be applying for Reg jobs in February 2020 (or whatever month applications open).

    I want to do GI, which I know is competitive. If I don't get an offer first attempt, does that mean I have to do an IMT3 year?! Yikes if so... Do you have a good link that explains this?
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    (Original post by Anonymous)
    Hmm. I'm CT1 now. I will be applying for Reg jobs in February 2020 (or whatever month applications open).

    I want to do GI, which I know is competitive. If I don't get an offer first attempt, does that mean I have to do an IMT3 year?! Yikes if so... Do you have a good link that explains this?
    Just tried to find the answer for you and it actually looks like they've changed what they were saying. I am very sure that it was 2020 previously, because I was thinking of taking 2 years out and so I'd specifically checked! Now it looks like they're saying 2022. Good news for me and for you I suppose!

    https://www.jrcptb.org.uk/training-c...urriculum-faqs
    • #2
    #2

    (Original post by seaholme)
    Just tried to find the answer for you and it actually looks like they've changed what they were saying. I am very sure that it was 2020 previously, because I was thinking of taking 2 years out and so I'd specifically checked! Now it looks like they're saying 2022. Good news for me and for you I suppose!

    https://www.jrcptb.org.uk/training-c...urriculum-faqs
    Thank-you so much for the link.
 
 
 

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