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From 1 August 2007, all NEW trainees, Specialty Registrars in Geriatric Medicine (StRs) as opposed to old trainees (SpRs) need to follow the new curriculum and assessment methods.

Prof Allen has already outlined the main changes elsewhere in this issue. Further details of the new system for training is available as the Gold Guide. It should be noted that SpRs still follow the Orange Guide.

New Curriculum
The new specialty curriculum is not very different from the old curriculum except that there is increased flexibility for out of programme experience which can be for up to one year of a training programme for a trainee making good progress. This time can be in research, stroke or acute medicine level 3 as explained in Steve Allen’s article. Other training abroad could also be approved. No retrospective recognition of such training or research will be acceptable. Prospective approval by PMETB is required, which is obtained by application via the deanery to PMETB and simultaneously to JRCPTB. “Acting up” as consultant experience does not require approval by PMETB. Up to 3 months of “acting-up” approved by a Programme Director/RSA with a named consultant educational supervisor supporting the trainee, will count towards training. JRCPTB must be informed by notification of our specialty co-ordinator.

The training grids have been modestly updated. The curriculum is online. The Acute Medicine (up to level 2) and Generic Curricula are quite different and are to be followed by all StRs in Geriatric Medicine.

Assessment Methods
The new assessment methods are much more comprehensive and specific, as explained by Steve Allen. They include Knowledge Based Assessment (KBA), Mini-CEXs, Case-based discussions (CBDs) (roughly 25 of each to be satisfactorily completed during the 5 year training programme), Acute Care Assessment Tools (ACATs) (about 12 needed including Acute Medicine level 2), Multisource Feedbacks (MSFs) and Patient Surveys (PSs) (2 of each for a 5 year programme) as well as satisfactory completion of audit (cycles), research methodology, ideally publication, training to teach and management courses. These are to be flexibly carried out by trainees as directed by their programme directors and educational supervisors. Satisfactory completion of these workplace based and other assessments will be assessed at the Annual Review of Competence Progression (ARCP) which replaces the RITA process and operates quite differently as a process (see the Gold Guide). RITA Cs, Ds and Es are now called Outcomes 1,2 & 3. ST3s are advised to make a start on these assessments and prepare for the KBA soon. The first KBA will take place during 2008 as explained by Oliver Corrado in a previous BGS newsletter. It will be taken as 2 web-based exams (written for those trainees who can’t be exposed to computer screens for long periods), each of 100 questions. Unfortunately the Royal Colleges of Physicians have not yet validated a CBD and ACAT and PS amongst registrars but this validation will take place shortly. It is suggested that until these are ready, educational supervisors use a similar model of CBD and ACAT to that used in Core Medical Training (CMT) or, if needed, in the Foundation programme adjusting the outcomes to the level required for the StR at their current level of training. A draft version of the new assessment grid is to be available on the BGS website and should be used with the Assessments Guide but a provisional version of the grid is demonstrated in the Figure with this article. At the present this is not yet formally approved by PMETB though they were very happy with our grid when it was presented to them. The Acute Medicine level 2 assessments will also need to be completed and will be found, when approved, on the JRCPTB website but are likely to be mainly ACATs (this may modestly increase the number of ACATs required over what is currently specified in the Geriatric Medicine training grid.

Higher level Special Interest Grids
New high level training grids are available in the following subspecialties – orthogeriatrics, falls, dementia and psychogeriatric services, continence, movement disorders and intermediate with community care. These are designed for trainees (or indeed career grades) who wish to develop additional high level skills in these subspecialty areas. Completion of this additional training is voluntary and would normally take at least 6 months to complete with the bulk of this time being allocated to the training in the subspecialty. Each grid has its own assessment methods to ascertain satisfactory progress. Completion of this additional experience does not as yet result in any additional nationally recognised certification but it is anticipated that in future they will through a system to be called “credentialing” which is currently being discussed by the Royal Colleges and PMETB. These grids can be used by trainers and trainees in their current unapproved format and will be available at on the BGS website. If a trainee undertakes subspecialty training full-time the Specialist Advisory Committee (SAC) will now consider this “in programme” for up to 6 months full time training BUT this time will be deducted from the 12 months allowable overall for out of programme experience.

Do you need help with all this?
There are lots of new developments and plenty of room for confusion, particularly as the new processes bed in and are further developed and run alongside the old system for SpRs at a deanery level. Training is being provided in many deaneries on the new workplace-based assessments. If any trainee has an uncertainty about what they should be doing they should initially discuss this with their educational supervisor and programme director. For out of programme queries these should normally be directed to our specialty co-ordinator Kirstin Barnett. If educational supervisors or programme directors are uncertain as to the new systems they could also contact me through the editor.

Chris Turnbull
Secretary SAC in Geriatric Medicine

BGS Newsletter, October 2007
Issue 13 ISSN 1748-6343 13